key: cord-0936496-bp0ncirl
authors: Sasaki, Natsu; Kuroda, Reiko; Tsuno, Kanami; Imamura, Kotaro; Kawakami, Norito
title: Deterioration in Mental Health Under Repeated COVID-19 Outbreaks Greatest in the Less Educated: A Cohort Study of Japanese Employees
date: 2021-01-05
journal: J Epidemiol
DOI: 10.2188/jea.je20200499
sha: 39b48aacf1af7ec3b3b4f0e87d2c729c7de75477
doc_id: 936496
cord_uid: bp0ncirl

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(N = 1,275, low [n = 607] and high education [n = 668]) ( Table 1 ). The outcome variable (ie psychological distress) was treated as missing if participants were laid off at T2 or T3 in the mixed-model analysis. The results showed that low education was associated with a significant increase in psychological distress from T1 to T3 compared to high education (adjusted estimates of fixed effect 1.26 [95% CI 0.28-2.24], P = 0.012). Details are shown in Tables 2 to 4. Our survey has several limitations. It omitted some important socioeconomic variables (eg, household income, housing tenure), and its generalizability is limited because it included only fulltime employees. However, the results suggested that psychological distress among employees with low education levels has worsened through the end of the 2 nd wave of the pandemic, supporting a previous report. 1 People with low SES, especially those with low education, maybe be at increased risk of infection and psychological stress. They have several factors that may increase their exposure to COVID-19, such as limited job opportunities, which do not allow them to work from home (eg, wholesale, transportation), 6 and limited access to reliable information about prevention. In this cohort, low education workers likely belong to smaller companies, which have been shown to implement less preventive measures for COVID-19. 7 Besides the infection, they may experience a psychological burden, such as the negative economic effects of COVID-19 control measures (ie, temporarily forced to leave employment or to reduce working hours) on the household due to their unstable work conditions, harassment related to COVID-19, and fewer social resources. In Japan, low education attainment predicts the risk of suicide. 8 To promptly reduce their psychological burden during COVID-19, it is important to close the knowledge gap in COVID-19 situations: providing trustworthy and easily understandable information about how to prevent infections, how to get financial support, and how to maintain mental health. The research company sent an e-mail to potentially eligible members based on registered information. The questionnaire was closed once the number of participants reached the target (over 4,000). (4)).

Informed consent: Online informed consent was obtained from all participants with full disclosure and explanation of this study's purpose and procedures. We explained that their participation was voluntary, and they could withdraw from the study for any reason simply by not completing the questionnaire. Role of the Funder=Sponsor: The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; or in the decision to submit the manuscript for publication. Adjusted for age, gender, and marital status. c High education was defined as ≥16 years of educational attainment (ie, university graduate or higher).

Changes in psychological distress during the COVID-19 pandemic in Japan: a longitudinal study

Changes in the number of individuals requiring hospital treatment, critically ill individuals, and newly reported cases, etc (Press Conference: The case of the coronavirus September 1, 2020; Figure 1). 2020; https:==www.mhlw.go.jp= stf=seisakunitsuite=bunya=newpage_00032

National Police Agency. The suicide situation in 2020

The deterioration of mental health among healthcare workers during the COVID-19 outbreak: a population-based cohort study of workers in Japan

Development of a short questionnaire to measure an extended set of job demands, job resources, and positive health outcomes: the new brief job stress questionnaire

Poverty, inequality, and COVID-19: the forgotten vulnerable

Workplace responses to COVID-19 and their association with company size and industry in an early stage of the epidemic in Japan

Educational levels and risk of suicide in Japan: the Japan Public Health Center study (JPHC) Cohort I

Educational Attainment and Mental Health During COVID-19 Outbreaks

The authors wish to thank the members of the Department of

Author contribution: NK was in charge of this study, supervising the process and providing his expert opinion. NS and NK organized the study design and analyzed the data. Collaborators RK, KT, and KI ensured that questions related to any part of this work's accuracy or integrity were appropriately investigated and resolved. All authors conducted the survey. NS and NK wrote the first draft of the manuscript, and all other authors critically revised it. All authors approved the final version of the manuscript.