Loneliness and Social Isolation Factors Under the Prolonged COVID-19 Pandemic in Japan: 2-Year Longitudinal Study.

BACKGROUND: Worsening loneliness and social isolation during the COVID-19 pandemic have become serious public health concerns worldwide. Despite previous research reporting persistent loneliness and social isolation under repeated emergency declarations and prolonged pandemics, long-term studies are needed to identify the actual conditions of loneliness and social isolation, and the factors that explain them. OBJECTIVE: In this study, 3 web-based surveys were conducted at 1-year intervals during the 2 years after the first state of emergency to examine changes in loneliness and social isolation and the psychosocial factors associated with them in the Japanese population. METHODS: The first survey (phase 1, May 11-12, 2020) was conducted at the end of the first emergency declaration period, the second survey (phase 2, June 14-20, 2021) was conducted at the end of the third emergency declaration period, and the third survey (phase 3, May 13-30, 2022) was conducted when the state of emergency had not been declared but many COVID-19-positive cases occurred during this period. We collected data on 3892 inhabitants (n=1813, 46.58% women; age: mean 50.3, SD 13.4 y) living in the 4 prefectures where emergency declaration measures were applied in phases 1 and 2. A linear mixed model analysis was performed to examine the association between psychosocial variables as explanatory variables and loneliness scores as the dependent variable in each phase. RESULTS: While many psychosocial and physical variables showed improvement for the 2 years, loneliness, social isolation, and the relationship with familiar people deteriorated, and the opportunities for exercise, favorite activities, and web-based interaction with familiar people decreased. Approximately half of those experiencing social isolation in phase 1 remained isolated throughout the 2-year period, and a greater number of people developed social isolation than those who were able to resolve it. The results of the linear mixed model analysis showed that most psychosocial and physical variables were related to loneliness regardless of the phase. Regarding the variables that showed a significant interaction with the phase, increased altruistic preventive behavior and a negative outlook for the future were more strongly associated with severe loneliness in phase 3 (P=.01 to <.001), while the association between fewer social networks and stronger loneliness tended to be more pronounced in phase 2. Although the interaction was not significant, the association between reduced face-to-face interaction, poorer relationships with familiar people, and increased loneliness tended to be stronger in phase 3. CONCLUSIONS: This study found that loneliness and social isolation remained unresolved throughout the long-term COVID-19 pandemic. Additionally, in the final survey phase, these issues were influenced by a broader and more complex set of factors compared to earlier phases.

The influence of interoceptive accuracy on the verbalization of emotions.

Interoception, which pertains to the physiological state of the body, is associated with subjective emotional experiences. In particular, the accuracy of perceiving interoceptive signals (interoceptive accuracy [IAcc]) is linked to the intensity of emotional arousal, known as arousal focus (AF). IAcc is believed to influence the granularity of emotional experiences. Here, we examined the relationship between IAcc and assessment and verbalisation of one's own or others' emotions. Study I demonstrated that individuals with higher IAcc exhibited significantly greater AF when evaluating their own positive emotions. Furthermore, although no correlation between IAcc and AF was found in free descriptions of emotions, a significant positive correlation was found between IAcc and the number of emotion-related words. Study II showed that individuals with higher IAcc displayed significantly higher AF when assessing the positive emotions of characters in videos. Additionally, in free descriptions of these characters, a significant positive correlation was observed between predicted verbal IQ and the number of emotion-related words. These findings support the notion that interoception is associated with AF during assessment of one's own or others' positive emotions as well as the abundance of emotion-related words. This study demonstrates the relationship between bodily sensations and social aspects of human embodiment.

Change in Alcohol Use during the Prolonged COVID-19 Pandemic and Its Psychosocial Factors: A One-Year Longitudinal Study in Japan.

This study investigated changes in alcohol use and its related psychosocial factors during the COVID-19 pandemic in Japan. Two online surveys were completed by participants between 15 and 20 June 2021 (phase 1) and 13 and 30 May 2022 (phase 2). A total of 9614 individuals participated in both phases (46% women, mean age = 50.0 ± 13.1 years) and a repeated three-way analysis of variance and multinomial logistic regression analysis were conducted. These data analyses showed that the presence of hazardous alcohol use at phase 2 was predicted by being male and unmarried, having a higher annual household income and age, having a larger social network, and displaying fewer COVID-19 prevention behaviors at phase 1. Further, the presence of potential alcoholism at phase 2 was predicted by being male, being more anxious, having a larger social network, exercising more, showing a deterioration of economic status, having more difficulties owing to a lack of daily necessities, having less healthy eating habits, and showing fewer COVID-19 prevention behaviors at phase 1. These findings suggest that psychological problems and increased work (or academic) and economic difficulties were associated with severe alcohol problems during a later stage of the COVID-19 pandemic.

Mental health and social isolation under repeated mild lockdowns in Japan.

The influence of repeated lockdowns on mental health and social isolation is unknown. We conducted a longitudinal study of the influence of repeated mild lockdowns during two emergency declarations in Japan, in May 2020 and February 2021. The analyses included 7893 people who participated in all online surveys. During repeated mild lockdowns, mental and physical symptoms decreased overall, while loneliness increased and social networks decreased. Subgroup analyses revealed that depression and suicidal ideation did not decrease only in the younger age group (aged 18-29 years) and that younger and middle-aged people (aged 18-49 years), women, people with a history of treatment for mental illness, and people who were socially disadvantaged in terms of income had higher levels of mental and physical symptoms at all survey times. Additionally, comprehensive extraction of the interaction structure between depression, demographic attributes, and psychosocial variables indicated that loneliness and social networks were most closely associated with depression. These results indicate that repeated lockdowns have cumulative negative effects on social isolation and loneliness and that susceptible populations, such as young people and those with high levels of loneliness, require special consideration during repeated lockdown situations.

Correction: The Transition of Social Isolation and Related Psychological Factors in 2 Mild Lockdown Periods During the COVID-19 Pandemic in Japan: Longitudinal Survey Study.

[This corrects the article DOI: 10.2196/32694.].

Socio-economic and behavioral characteristics associated with COVID-19 vaccine hesitancy under a declared state of emergency in Japan.

Evidence regarding coronavirus disease 2019 vaccination indicates that some people hesitate to be vaccinated, and previous studies demonstrate the variables that influence hesitancy to vaccinate. However, they have not limited the target population to areas where infection is prominent. This study aimed to clarify the characteristics of people living in these areas who hesitate to be vaccinated and recommend effective approaches to encourage vaccination. The survey was conducted online between February 24 and March 1, 2021, during which the 2nd state of emergency was declared in Japan. The analytic sample comprised 17,582 unvaccinated individuals (mean age â€‹= â€‹48.6 â€‹± â€‹13.8, range â€‹= â€‹18-90 years). The t-test results indicate that current or past treatment for physical illness exerted a strong influence on vaccine hesitancy (ds â€‹= â€‹0.30). Similarly, multiple regression analyses revealed that understanding the importance and necessity for preventive behaviors had the greatest influence on the intention to vaccinate (ߠ​= â€‹0.48). Regarding recommendations to promote willingness to be vaccinated, our findings indicated that clear explanation of the reasons for the necessity for these behaviors and collaboration between representatives of various communities would effectively encourage vaccination.

The Transition of Social Isolation and Related Psychological Factors in 2 Mild Lockdown Periods During the COVID-19 Pandemic in Japan: Longitudinal Survey Study.

BACKGROUND: Lockdowns and stay-at-home orders announced internationally for COVID-19 have led to physical and social distancing, with reports of many individuals experiencing social isolation (SI) and loneliness. Although the emergency declaration in Japan was declared as a "mild" lockdown requested by the government without penalties for violations, the lockdown measures, including SI, had several influences on people's lives and mental health as in other countries. Furthermore, Japan declared a state of emergency multiple times; thus, it is necessary to examine the influence of the transition of SI caused by repeated emergency declarations and the deterioration of mental health associated with these changes. OBJECTIVE: This study longitudinally investigated the transition of SI and its related factors during the mild lockdown under 2 declared states of emergency in Japan and analyzed psychosocial characteristics by extracting clusters where people with specific transition patterns of SI predominated. METHODS: We collected data on 7893 inhabitants (3694 [46.8%] women, 49.6 [SD 13.7] years old) living in the 7 prefectures where the initial emergency declaration was applied. The investigations took place online in the final phase of the first and second states of emergency: phase 1 (between May 11 and 12, 2020) and phase 2 (between February 24 and 28, 2021). Nonparametric Bayesian coclustering was used to visualize the exhaustive interaction structure between the transition pattern of SI and the psychosocial variables. RESULTS: There were no improvements in social networks and loneliness between the 2 phases, although psychological distress significantly improved and depression slightly decreased. Overall, 3868 (49%) of the 7893 participants remained socially isolated through phases 1 and 2, and 947 (12%) were socially isolated in phase 2, even though they were not socially isolated in phase 1. More participants experienced persistent SI in unmarried, childless, and low-household-income groups. The persistent-SI group had fewer cohabitants than other transition pattern groups. The nonparametric Bayesian coclustering results showed that most clusters, including participants without SI throughout phases 1 and 2, had healthy behaviors, more interactions, good relationships, and less loneliness and psychological stress. Furthermore, the cluster in which relationships deteriorated in phase 1 recovered in phase 2. Comparatively, the clusters with SI throughout phases 1 and 2 were divided into clusters with increased loneliness and psychological stress; clusters were close to participants' average scores in this study. The clusters with increased loneliness and psychological stress were notable for deteriorating relationships and less online interaction. CONCLUSIONS: This study revealed the actual state of transition of SI and related psychological, social, and behavioral factors under repeated declarations of a state of emergency. These results should help construct intervention methods that fit individual characteristics of people in SI during a pandemic.

Alcohol Use and Its Related Psychosocial Effects during the Prolonged COVID-19 Pandemic in Japan: A Cross-Sectional Survey.

We conducted a large-scale survey in the Japanese population, about one year after the initial declaration of the state of emergency, to investigate alcohol use under the prolonged coronavirus disease 2019 (COVID-19) pandemic and its related psychosocial and demographic characteristics. The survey was conducted online between 15 and 20 June 2021. A total of 11,427 participants were included in the analysis (48.5% female, 48.82 ± 13.30 years, range = 20-90 years). Compared with females, males were more prevalent in the hazardous user and the potential alcoholism group and were less prevalent in the no alcohol-related problem group. However, the prevalence of potential alcoholism among the participants in our study was higher than that previously reported. This trend was particularly pronounced in women. The presence of potential alcoholism was related to a deteriorated psychological status, particularly depression and anxiety, and various difficulties in their daily lives due to the COVID-19 pandemic. In the future, intervention methods and systems should be developed to provide optimal assistance to people with psychological problems who are vulnerable to alcohol-related problems during the COVID-19 pandemic, while conducting further long-term follow-up studies.

Social isolation and its psychosocial factors in mild lockdown for the COVID-19 pandemic: a cross-sectional survey of the Japanese population.

OBJECTIVE: This study investigated the sociodemographic, behavioural and psychological characteristics of socially isolated individuals during the 'mild lockdown' period of COVID-19 in Japan. DESIGN: A cross-sectional study. SETTING: The seven prefectures where the emergency declaration was first applied in Japan. PARTICIPANTS: We collected data on 11 333 individuals (52.4% women, 46.3±14.6 years) living in the seven prefectures where the emergency declaration was first applied. The online survey was performed between 11 May and 12 May 2020, in the final phase of the state of emergency. PRIMARY OUTCOME MEASURES: Lubben Social Network Scale (LSNS-6) RESULTS: We found that male sex (95% CI 1.60 to 1.98), middle age (95% CI 1.55 to 1.93) and lower income (eg, annual household income <2.0 million: 95% CI 2.29 to 3.54) predicted social isolation; being a student was a protective factor against social isolation (95% CI 0.26 to 0.62). In the comparisons of each item of the LSNS-6 by sociodemographic characteristics, men were more likely to have fewer people to talk to about their personal problems (95% CI -0.37 to -0.28) and to seek help from (95% CI -0.39 to -0.30), and the middle-aged group had a lower social network of friends. Additionally, social isolation was associated with decreased online interaction with familiar people (95% CI -1.28 to -1.13) and decreased optimistic thinking under mild lockdown (95% CI -0.97 to -0.86). CONCLUSIONS: We identified the sociodemographic and psychological characteristics associated with social isolation under mild lockdown. These results are expected to be a useful resource for identifying which groups may require intervention to improve their social interactions in order to preserve their mental health during the pandemic.

Effects of Interoceptive Sensibility on Mental Health during the Coronavirus Disease 2019 Pandemic.

The current coronavirus disease 2019 pandemic has been reported to influence interoceptive sensibility. This study focused on adaptive and maladaptive aspects of interoceptive sensibility and examined how each aspect of interoceptive sensibility affects depression, anxiety, and somatization symptoms under the mild lockdown in Japan, which was not enforceable and a non-punitive lockdown. We used data from 10,672 participants who lived in prefectures where the emergency declaration was first applied in Japan. Interoceptive sensibility was measured by the Multidimensional Assessment of Interoceptive Awareness (MAIA). The findings show that Noticing, a subscale of the MAIA, significantly contributed to the worsening of psychological and somatic symptoms (all ps < 0.001). Conversely, Not-Distracting, Not-Worrying, Self-Regulation, and Trusting significantly contributed to the decrease of these symptoms (all ps < 0.05). The findings suggest that two aspects of interoceptive sensibility affected mental health in different ways during the mild lockdown. Mindfulness and mindfulness-based interventions would be effective in terms of enhancing adaptive aspects of interoceptive sensibility.

The Psychological Impact of 'Mild Lockdown' in Japan during the COVID-19 Pandemic: A Nationwide Survey under a Declared State of Emergency.

This study examined the psychological distress caused by non-coercive lockdown (mild lockdown) in Japan. An online survey was conducted with 11,333 people (52.4% females; mean age = 46.3 ± 14.6 years, range = 18-89 years) during the mild lockdown in the seven prefectures most affected by COVID-19 infection. Over one-third (36.6%) of participants experienced mild-to-moderate psychological distress (Kessler Psychological Distress Scale [K6] score 5-12), while 11.5% reported serious psychological distress (K6 score ≥ 13). The estimated prevalence of depression (Patient Health Questionnaire-9 score ≥ 10) was 17.9%. Regarding the distribution of K6 scores, the proportion of those with psychological distress in this study was significantly higher when compared with the previous national survey data from 2010, 2013, 2016, and 2019. Healthcare workers, those with a history of treatment for mental illness, and younger participants (aged 18-19 or 20-39 years) showed particularly high levels of psychological distress. Psychological distress severity was influenced by specific interactional structures of risk factors: high loneliness, poor interpersonal relationships, COVID-19-related sleeplessness and anxiety, deterioration of household economy, and work and academic difficulties. Even when non-coercive lockdowns are implemented, people's mental health should be considered, and policies to prevent mental health deterioration are needed. Cross-disciplinary public-private sector efforts tailored to each individual's problem structure are important to address the mental health issues arising from lockdown.

A real-time survey on the psychological impact of mild lockdown for COVID-19 in the Japanese population.

To deter the spread of the coronavirus disease 2019 (COVID-19), many countries have imposed a lockdown with restrictions. On 7 April 2020, the Japanese government declared a state of emergency over the COVID-19 outbreak. Japan was in "mild lockdown" which was not enforceable and non-punitive with the declaration. We conducted an online survey to investigate factors associated with psychological distress in the "mild lockdown" under a declared state of emergency for COVID-19. We collected data on 11,333 inhabitants (52.4% women, 46.3 ± 14.6 years) living in the seven prefectures where the declaration was first applied. The investigation dates of this study, 11 and 12 May 2020, were in the final phase of the state of emergency. The survey was conducted in real-time to minimize participants' recall bias. In addition to psychological inventories often used worldwide, the questionnaires used in this survey included lifestyle and stress management items related to COVID-19 and various socio-demographic items including occupation (e.g. healthcare worker) or income.

A case of anesthesia mumps that required postoperative re-intubation.

We encountered a 59-year-old man who first underwent left internal carotid endarterectomy for left internal carotid artery stenosis and then presented with postoperative swelling of the bilateral salivary glands. He then developed upper airway obstruction that required emergency tracheal intubation. The most likely cause was thought to be anesthesia mumps, which involves a complex interaction of multiple factors including pneumoparotitis, venous congestion, and excess saliva secretion. Many cases of salivary gland swelling recover after follow-up observation alone if there are no inflammatory findings; however, severe complications may sometimes occur. If upper airway obstruction develops as in the present case, then emergency airway management must also be considered and conscientious observation is necessary.

Low prevalence of metabolic syndrome and its components in rural Japan.

Tsunan, Niigata is a non-westernized rural Japanese town, known for heavy snowfalls and as a rice-producing area, whose inhabitants have a long life expectancy. We investigated the prevalence of obesity, metabolic syndrome (MetS) and its components in Tsunan. A total of 1,155 men and women, 40-69 years of age were recruited from participants in the 2005 public-health program in Tsunan. Obesity was defined as body-mass index (BMI) >or= 25 kg/m(2). MetS was defined as BMI >or= 25 kg/m(2) as well as at least two of the following three items: (1) high glycosylated hemoglobin (HbA1c >or= 5.5%); (2) high blood pressure (HBP: systolic blood pressure >or= 130 mmHg or diastolic blood pressure >or= 85 mmHg), and (3) low high-density lipoprotein cholesterol (HDL-C < 40 mg/dL). If an individual was diagnosed with diabetes, hypertension, or dyslipidemia, each item was recorded as a positive finding. The prevalence of MetS and its components among Tsunan inhabitants were compared to the results of the 2005 Japanese nationwide survey. The prevalence of MetS was 4.6% in males and 4.2% in females. The prevalence of obesity, high HbA1c, HBP, and low HDL-C were 22.1/22.2%, 13.4/16.4%, 46.6/40.0%, and 9.2/3.9% in males/females, respectively. All values were significantly lower than the national results, except for the rate of female obesity. The lower prevalence of MetS and its components in Tsunan may be due to the consumption of traditional Japanese food, which is still commonly eaten there, and the higher levels of regular physical activity of farmers.

Hemagglutinating virus of Japan (HVJ) envelope vector as a versatile gene delivery system.

We have developed a simple method for converting the lipid envelope of an inactivated virus to a gene transfer vector. Hemagglutinating virus of Japan (HVJ; Sendai virus) envelope vector was constructed by incorporating plasmid DNA into inactivated HVJ particles. This HVJ envelope vector introduced plasmid DNA efficiently and rapidly into various cell lines, including cancer cells and several types of primary cell culture. Efficiency of gene transfer was greatly enhanced by protamine sulfate and centrifugation. Fluorescein isothiocyanate-labeled oligodeoxynucleotides (FITC-ODN) were also delivered to cells at > 95% efficiency. When HVJ envelope vector was injected into organs directly, reporter gene expression was observed in organs including liver, brain, skin, uterus, tumor masses, lung, and eye. When HVJ envelope vector containing luciferase gene was injected into mouse tail vein, luciferase gene expression was detected primarily in spleen. FITC-ODN were also delivered to spleen cells by intravenous injection of HVJ envelope. These results suggest that HVJ envelope vector will be useful for both ex vivo and in vivo gene therapy experiments.