How do social networks, perception of social isolation, and loneliness affect depressive symptoms among Japanese adults?

OBJECTIVE: This study aims to elucidate the complex relationship among social isolation, loneliness, and perception of social isolation and its influence on depressive symptoms by evaluating a hypothetical model. This understanding is essential for the formulation of effective intervention strategies. METHODS: We conducted an online survey on Japanese adults (N = 3,315) and used the six-item Lubben Social Network Scale to assess the size of their social networks. We employed a single question to gauge their perception of social isolation. Loneliness was assessed using the three-item UCLA Loneliness Scale, and depressive symptoms were examined using the Patient Health Questionnaire-9. Structural equation modeling was employed to test the hypothesized model. RESULTS: The final model demonstrated satisfactory fit with data (χ2 (1) = 3.73; not significant; RMSEA = 0.03; CFI = 1.00; TLI = 1.00). The size of social network demonstrated a weak negative path to loneliness and depressive symptoms (ß = -.13 to -.04). Notably, a strong positive association existed between perception of social isolation and loneliness (ß = .66) and depressive symptoms (ß = .27). Additionally, a significant positive relationship was found between loneliness and depressive symptoms (ß = .40). Mediation analysis indicated that perception of social isolation and loneliness significantly intensified the relationships between social networks and depressive symptoms. CONCLUSIONS: Results indicate that interventions of psychological approaches, such as cognitive-behavioral therapy, are effective in reducing the perception of social isolation and loneliness, which may lead to the prevention of depressive symptoms. Future longitudinal studies are expected to refine and strengthen the proposed model.

Impact of loneliness on suicidal ideation during the COVID-19 pandemic: findings from a cross-sectional online survey in Japan.

OBJECTIVES: We aim to reveal how loneliness relates to suicidal ideation following the onset of the COVID-19 pandemic. DESIGN: Cross-sectional online survey. SETTING: Community cohort study in Japan. PARTICIPANTS: The second wave of a large web-based survey, Japan COVID-19 and Society Internet Survey, was conducted in February 2021, and we analysed the data of 6436 men and 5380 women who were aged 20-59 years. MAIN OUTCOME MEASURES: The prevalence ratios (PRs) of suicidal ideation due to loneliness, depression, social isolation and decline in income during the pandemic and other sociodemographic and economic information were adjusted in the analysis. STATISTICAL METHODS: Estimations were conducted by separating a male and female sample. The survey weight (inverse probability weighting) was applied for analyses, and a Poisson regression model was used with all the potential confounders adjected. RESULTS: Overall, 15.1% of male and 16.3% of female participants were found to have had suicidal ideation during the COVID-19 pandemic. Among them, 23% of male and 20% of female participants experienced suicidal ideation for the first time. The results of the Poisson regression suggested that those who were feeling lonely had higher PRs for suicidal ideation (4.83 for men (95% CI, 3.87 to 6.16) and 6.19 for women (95% CI, 4.77 to 8.45)). The relationship between loneliness and suicidal ideation remained robust even after adjusting for depression, although there were declines in PRs. Additionally, the results showed that those who were lonely, and continued to feel lonely during the pandemic, had the highest PRs of suicidal ideation. CONCLUSION: Loneliness had both direct and indirect effects on suicidal ideation mediated through depression. Those who felt lonelier during the pandemic had the highest risk of suicidal ideation. It is necessary to adopt national measures focused on providing psychological support to people who feel lonely to prevent them from taking their own lives.

Association of fear of COVID-19 and resilience with psychological distress among health care workers in hospitals responding to COVID-19: analysis of a cross-sectional study.

Background: It remains unclear how fear of COVID-19 and resilience are related to psychological distress based on occupations among healthcare workers (HCWs) in hospitals treating patients with COVID-19. We conducted a survey on the mental health of HCWs during the COVID-19 pandemic to determine the relationship between factors such as fear of COVID-19 and resilience as well as mental distress in each occupation of HCWs. Methods: We conducted a web-based survey among HCWs at seven hospitals treating COVID-19 patients in Japan from December 24, 2020 to March 31, 2021. A total of 634 participants were analyzed, and information regarding their socio-demographic characteristics and employment status was collected. Several psychometric measures were used, including the Kessler's Psychological Distress Scale (K6), the fear of COVID-19 Scale (FCV-19S), and the Resilience Scale (RS14). Factors related to psychological distress were identified by logistic regression analysis. The association between job title and psychological scales was examined by one-way ANOVA, and t-tests were conducted to examine the association between the FCV-19S and hospital initiatives. Results: It was found that nurses and clerical workers were associated with psychological distress without considering FCV-19S or RS14; in a model that included FCV-19S, FCV-19S was associated with psychological distress, but job title was not; when RS14 was considered, resilience was protective. In terms of occupation, FCV-19S was lower among physicians and higher among nurses and clerical workers, while RS14 was higher among physicians and lower among other occupations. Having access to in-hospital consultation regarding infection control as well as to psychological and emotional support was associated with lower FCV-19S. Conclusion: Based on our findings, we can conclude that the level of mental distress differed by occupation and the differences in the fear of COVID-19 and resilience were important factors. In order to provide mental healthcare for HCWs during a pandemic, it is important to create consultation services that enable employees to discuss their concerns. In addition, it is important to take steps to strengthen the resilience of HCWs in preparation for future disasters.

Association between behavioural and psychological symptoms of dementia and residence status in patients with Alzheimer's disease.

BACKGROUND: Examining the relationship between the behavioural and psychological symptoms of dementia (BPSD) and residence status is crucial to improving BPSD and reducing the burden on caregivers. However, studies on how BPSD differ between individuals living at home and those in institutional settings are lacking. We conducted a questionnaire survey among healthcare providers (HCPs) involved in dementia care and nursing to clarify the characteristics of BPSD by residence status in patients with Alzheimer's disease (AD) living at home or in facilities. METHODS: We sent questionnaires to HCPs and asked them to answer questions on up to five cases that needed treatment for BPSD and who received long-term care insurance services from 1 April 2016 to 31 March 2017. Responses were received for 371 cases, of which 130 diagnosed with AD were analyzed. The patients were divided into two groups: patients with AD living at home (home care group) and patients with AD living in facilities (facility care group). A Chi-square test was used to identify differences between the two groups. A binomial logistic regression analysis was also conducted to clarify the association between residence status and BPSD. RESULTS: Of the 130 patients, 72 lived at home (home care group) and 58 resided in facilities (facility care group). None of the background factors was significantly different between the two groups. The Chi-square test indicated that sleep disturbance was significantly more common in the facility care group (60.3% in the facility care group vs. 33.3% in the home care group, P = 0.003), while the logistic regression analysis indicated that sleep disturbance was significantly associated with residence status (odds ratio: 2.529, P = 0.038). CONCLUSIONS: Sleep disturbances were more frequently observed among patients with AD living in institutions than among those living in their homes.

Factors associated with short and long sleep duration in older adults: Analysis of a national survey in Japan.

AIM: This study aimed to clarify the association between sleep duration and various physical and psychosocial factors among older Japanese adults. METHODS: Data from 295 367 households were obtained from the 2013 Comprehensive Survey of Living Conditions in Japan, a self-administered questionnaire survey. We restricted our analyses to 115 205 participants who responded to all the items required for this study. Multinomial logistic regression models examined the association between sleep duration and various factors. RESULTS: Overall, 26.0% of the participants slept for <6 h, 56.0% slept for 6-8 h, and 18.0% slept for ≥8 h. Poor subjective health and mental health increased the risk of both short (poor subjective health: odds ratio [OR] 1.22, 95% confidence interval [CI] 1.17-1.27; severe mental distress: OR 2.21, 95% CI 2.04-2.40) and long (poor subjective health: OR 1.19, 95% CI 1.13-1.24; severe mental distress: OR 1.25, 95% CI 1.13-1.38) sleep duration. Many subjective symptoms, including chest, respiratory, musculoskeletal and urogenital symptoms, were associated with short sleep duration. However, only memory loss was associated with long sleep duration (OR 1.23, 95% CI 1.16-1.31). CONCLUSIONS: We need to be aware that older people with short sleep duration may have various physical symptoms. Moreover, as physical and mental problems, cognitive decline and unhealthy lifestyles are associated with long sleep duration, we also need to pay attention to the living conditions of those who complain of long sleep duration. The limitations of this study were that the variables were self-reported and sleep duration was not evaluated objectively. Geriatr Gerontol Int 2022; 22: 660-666.

Mental Health of Caregivers Working in Nursing Homes during the COVID-19 Pandemic.

INTRODUCTION: There have been numerous reports of cluster outbreaks of coronavirus disease 2019 (COVID-19) in hospitals and nursing homes. Healthcare workers fighting COVID-19 experience mental health issues. Caregivers in nursing homes experienced increased psychological distress and concern about deterioration of their mental health. We conducted a large-scale web-based survey exploring mental health among caregivers working in nursing homes during the COVID-19 pandemic with the aim of identifying their support needs. METHODS: Survey participants were caregivers working at 284 nursing homes in Ibaraki prefecture, Japan. The survey period was from September 2020 to March 2021. Participants responded to a questionnaire covering gender, age, occupation, infections at facilities, infection protection, changes in nursing home users, cooperation with other medical institutions, and prejudice/discrimination. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate participants' depression and anxiety. RESULTS: In total, 676 participants completed the survey; 350 (52.5%) were with anxiety symptoms and 378 (56.7%) were with depressive symptoms (scores exceeding the HADS cut-off points). The risk for anxiety was associated with being care worker or social worker. The risk of anxiety or depression was high when family caregivers' mental state changed. DISCUSSION/CONCLUSION: This study found that caregivers working in nursing homes were exposed to high levels of stress during the COVID-19 pandemic and were at high risk for developing depression and anxiety.

Proposed Cut-Off Score for the Japanese Version of the Fear of Coronavirus Disease 2019 Scale (FCV-19S): Evidence from a Large-Scale National Survey in Japan.

The Fear of coronavirus disease 2019 (COVID-19) Scale (FCV-19S) is a seven-item self-administered psychological scale for measuring the fear of this disease. The scale has been widely adapted and validated worldwide. This study aimed to propose a cut-off score for the validated Japanese version of the FCV-19S. We conducted a nationwide online survey and included 26,286 respondents in the analysis. Respondents answered questions on their sociodemographic characteristics, and using the FCV-19S and six-item Kessler Psychological Distress Scale, we measured psychological distress and assessed whether the fear of COVID-19 interfered with their daily lives. A total score of ≥21 points was considered adequate to identify those with psychological distress or difficulties in daily living because of the fear of COVID-19. This cut-off score will contribute to mental health assessment during the COVID-19 pandemic.

Association between depressive state and behavioral changes induced by the state of emergency for Coronavirus disease 2019: Evidence from university students in Japan.

Coronavirus disease 2019 (Covid-19) has caused numerous problems worldwide since 2020. The pandemic and subsequent quarantine policies have resulted in numerous psychological problems among students. The quarantine policy forced students to change their behavior and refrain from going out. To date, the relationship between behavioral and psychological changes following the implementation of the quarantine policy has not been investigated. We conducted a web-based survey to investigate the change in time spent out of the house between before and after the implementation of the quarantine policy and how this related to changes in depression. We collected data from 12,088 students, which included the Patients Health Questionnaire-9, frequency of going out, and demographics. We divided subjects into three categories based on the frequency of going out before and after the policy was put in place. Results showed that students who frequently went out before the pandemic and strictly followed the government policy were significantly more depressed than those who did not frequently go out. In contrast, students who had always been reluctant to go out did not have a tendency for depression to worsen. Our findings indicate that behavioral modification leads to depression in those who previously had active social lives.

Demographics Associated With Stress, Severe Mental Distress, and Anxiety Symptoms During the COVID-19 Pandemic in Japan: Nationwide Cross-sectional Web-Based Survey.

BACKGROUND: With the spread of COVID-19, the deterioration of public mental health has become a major global and social problem. OBJECTIVE: The purpose of this study was to elucidate the relationship between the 3 mental health problems associated with COVID-19, that is, perceived stress, severe mental distress, and anxiety symptoms, and the various demographic factors, including occupation. METHODS: A nationwide web-based questionnaire survey was conducted in Japan from August 4 to 31, 2020. In addition to sociodemographic data, the degrees of perceived stress, severe mental distress, and anxiety symptoms associated with COVID-19 were measured. After performing a descriptive statistical analysis, factors related to stress, severe mental distress, and anxiety symptoms were analyzed using logistic regression analysis. RESULTS: A total of 8203 respondents submitted survey responses, among whom 34.9% (2861/8203) felt intense stress associated with COVID-19, 17.1% (1403/8203) were depressed, and 13.5% (1110/8203) had severe anxiety symptoms. The logistic regression analysis showed that each of the 3 mental health problems were prevalent in females, nonbinary gender, people in their 50s, 60s and older, respondents who visited psychiatrists, and those currently in psychiatric care. Severe mental distress and anxiety symptoms were associated with the number of effective lifestyle coping strategies during the lockdown period. Severe mental distress was only prevalent in teenagers and respondents in their 20s, as students tended to develop stress and severe mental distress. With regard to occupation, working in nursing care and welfare, education and research, and medical and health sectors was associated with stress; however, working in these occupations was not associated with severe mental distress and anxiety symptoms. Unemployment was associated with severe mental distress and anxiety symptoms. All 3 mental health problems were prevalent in part-time workers and those working in entertainment and arts sectors. CONCLUSIONS: Gender, age, occupation, history of psychiatric visits, and stress coping mechanisms were associated with mental health during the COVID-19 pandemic, but their associations with stress, severe mental distress, and anxiety symptoms differed. In addition, the actual state of mental health varied according to the respondents' occupation. It is necessary to consider the impact of the COVID-19 pandemic on mental health not only at the individual level but also at the occupational level.

Confirming validity of The Fear of COVID-19 Scale in Japanese with a nationwide large-scale sample.

Assessing fear and anxiety regarding COVID-19 viral infection is essential for investigating mental health during this epidemic. We have developed and validated a Japanese-language version of The Fear of COVID-19 Scale (FCV-19S) based on a large, nationwide residential sample (n = 6,750) recruited through news and social media responding to an online version of the questionnaire. Data was collected from August 4-25, 2020. Results correlated with K6, GAD-7 and IES-R psychological scales, and T-tests and analysis of variance identified associated factors. All indices indicated the two-factor model emotional fear reactions and symptomatic expressions of fear a better fit for our data than a single-factor model in Confirmatory Factor Analysis (χ2 = 164.16, p<0.001, CFI 0.991, TLI = 0.985, RMSEA = 0.043). Socio-demographic factors identified as disaster vulnerabilities such as female sex, sexual minority, elderly, unemployment, and present psychiatric history associated with higher scores. However, respondent or family member experience of infection risk, or work/school interference from confinement, had greatest impact. Results suggest necessity of mental health support during this pandemic similar to other disasters.

Mental health of gatekeepers may influence their own attitudes toward suicide: A questionnaire survey from a suicide-prevention gatekeeper training program.

AIMS: We aimed to investigate the association between general mental health and attitudes toward suicide of participants in suicide-prevention gatekeeper training programs. METHODS: We conducted a number of half day training seminars within a suicide prevention program addressing gatekeepers. Participants filled in two questionnaires, one measuring general health (General Health Questionnaire, GHQ-12), and one measuring attitudes towards suicide (ATTS). RESULTS: The total sample size of participants was 230, of whom 115 completed questionnaires. There were no significant differences in demographic backgrounds between the good mental health (GHQ-12 ≤ 4) and the poor mental health (GHQ-12 ≥ 5) groups. The poor mental health group was more likely to think that people have the right to commit suicide. CONCLUSION: There was a difference in attitudes toward suicide between the good mental health and the poor mental health groups, indicating that attention should be paid to participants' mental health when conducting suicide-prevention gatekeeper training.

Factors associated with high-risk drinking in older adults: Evidence from a national survey in Japan.

AIM: This study aimed to clarify the association between high-risk drinking and health outcomes (e.g. physical and psychosocial factors, including help-seeking behavior) among older Japanese adults. METHODS: Data were obtained from the 2013 Comprehensive Survey of Living Conditions in Japan, which surveyed 295 367 households. We restricted analyses to 55 147 current drinkers. Multinomial logistic regression models were used to examine associations between alcohol consumption and various factors. RESULTS: Overall, 35.3% of participants were in the low-risk group, 13.1% were in the at-risk group and 1.0% were in the high-risk group. Those in the at-risk and high-risk groups were more likely to be younger, male, employed and tobacco users. They were also more likely to report sleeping ≥9 h per night, and they were more likely to report unhealthy eating habits. Being in the high-risk drinking group was significantly associated with being divorced (OR 1.51, 95% CI 1.11-2.05) and having poor mental health (OR 1.57, 95% CI 1.13-1.68). The high-risk drinking group was more likely to include those who endorsed experiencing challenges without seeking aid (OR 1.87, 95% CI 1.39-2.53) or felt no need to seek aid (OR 1.39, 95% CI 1.15-1.68). CONCLUSIONS: Being at high-risk for drinking is associated with poorer help-seeking behavior, suggesting a need for more aggressive outreach. Geriatr Gerontol Int 2019; 19: 1260-1267.

Imaging studies of kleptomania in a middle-aged woman with obsessive-compulsive disorder: a case report.

A 57-year-old woman who had been arrested for shoplifting visited our hospital. She was diagnosed with kleptomania. She had previously been diagnosed with CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome and obsessive-compulsive disorder. Cranial magnetic resonance imaging showed mild atrophy of the bilateral dorsolateral prefrontal cortices, left hippocampus, and occipital cortex, as well as diffuse mild T2 hyperintensity in the deep and subcortical white matter, including the frontal region. During a single-photon emission computed tomography scan, significant hyperperfusion was observed in the right ventral striatum, including the nucleus accumbens, ventral thalamus, and right ventrolateral prefrontal areas. Patchy hypoperfusion was found in the bilateral posterior cingulate, parietal, and occipital regions. The patient's neurocognitive function was normal, except for slight impairment of her executive function. Her symptoms and neuroimaging findings were not suggestive of a specific neurocognitive disorder. Hyperactivity of the right ventral striatum may contribute to both obsessive-compulsive disorder and kleptomania. Although frontotemporal lobar degeneration is a major neurocognitive disorder related to illegal behaviours, CREST syndrome-induced white matter microstructural damage in the orbitofrontal lobe could have caused our patient's kleptomania.