Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan.
Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.
J Affect Disord. 2021 May 15;287:89-95. doi: 10.1016/j.jad.2021.03.028. Epub 2021 Mar 15.
Recent studies indicate an urgent need to take action against mental health issues during the COVID-19 pandemic. However, the association between larger-scale environmental factors such as living conditions and mental health problems during the pandemic is currently unknown.
A nationwide, cross-sectional internet survey was conducted in Japan between August and September 2020 to examine the association between urbanization level and neighborhood deprivation as living conditions and COVID-19 case numbers by prefecture. Prevalence ratios (PRs) for severe psychological distress, suicidal ideation, and new-onset suicidal ideation during the pandemic were adjusted for potential confounders.
Among 24,819 responses analyzed, the prevalence of mental health problems was 9.2% for severe psychological distress and 3.6% for new-onset suicidal ideation. PRs for severe psychological distress were significantly associated with higher urbanization level (highest PR = 1.30, 95% CI = 1.08-1.56). PRs for new-onset suicidal ideation were significantly associated with higher urbanization level (highest PR = 1.83, 95% CI = 1.37-2.45) and greater neighborhood deprivation (highest PR = 1.35, 95% CI = 1.06-1.72). Severe psychological distress and new-onset suicidal ideation were significantly more prevalent when there was higher urbanization plus lower neighborhood deprivation (PR = 1.34 [1.15-1.56], and 1.57 [1.22-2.03], respectively).
These findings suggest that it is not the number of COVID-19 cases by residence area but higher urbanization level and greater neighborhood deprivation (lower neighborhood-level socioeconomic status) that are associated with severe psychological distress and new-onset suicidal ideation during the pandemic. These findings differ in part from evidence obtained before the pandemic.
最近的研究表明，在 COVID-19 大流行期间，迫切需要采取行动解决心理健康问题。然而，目前尚不清楚居住条件等较大规模环境因素与大流行期间心理健康问题之间的关联。
2020 年 8 月至 9 月，在日本全国范围内进行了一项横断面互联网调查，以检查城市化水平和邻里剥夺（居住条件）与按县划分的 COVID-19 病例数之间的关系。在调整了潜在混杂因素后，调整了大流行期间严重心理困扰、自杀意念和新出现自杀意念的患病率比值（PR）。
在分析的 24819 个答复中，心理健康问题的患病率为严重心理困扰 9.2%，新出现自杀意念 3.6%。严重心理困扰的 PR 与较高的城市化水平显著相关（最高 PR=1.30，95%CI=1.08-1.56）。新出现自杀意念的 PR 与较高的城市化水平（最高 PR=1.83，95%CI=1.37-2.45）和更大的邻里剥夺（最高 PR=1.35，95%CI=1.06-1.72）显著相关。当城市化程度较高且邻里剥夺程度较低时（PR=1.34 [1.15-1.56] 和 1.57 [1.22-2.03]），严重心理困扰和新出现自杀意念的患病率显著更高。
这些发现表明，与大流行期间严重心理困扰和新出现自杀意念相关的是更高的城市化水平和更大的邻里剥夺（邻里层面较低的社会经济地位），而不是居住地区的 COVID-19 病例数。这些发现与大流行前获得的证据部分不同。
