Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
Clinical Research & Education Promotion Division, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
J Psychiatr Res. 2023 Mar;159:153-158. doi: 10.1016/j.jpsychires.2023.01.025. Epub 2023 Jan 19.
Previous cross-sectional studies showed that COVID-19-related discrimination against healthcare workers was linked to depression. However, no study has examined the longitudinal association that allows causal interpretations. This prospective cohort study aimed to examine whether COVID-19-related discrimination at baseline is associated with depression and suicidal ideation several months later. Data were collected from October 2020 to July 2021. Multivariable logistic regression was performed. Fixed effects models were used to control for the effect of hospitals (Level 2 variable). Adjustments also included age, sex, living alone, alcohol consumption, exercise, BMI, working hours, comorbidity, and frontline worker status (Level 1 variables). Multiple sensitivity analyses were conducted to examine if the results substantially changed and were robust to unmeasured confounding. Multiple imputation for missing data was conducted via chained equations. As the final sample, 2862 healthcare workers without depression at baseline were studied. A total of 269 individuals (9.4%) experienced COVID-19-related discrimination. Depression was suggested in 205 participants (7.2%), and suicidal ideation in 108 participants (3.8%). In the adjusted models, COVID-19-related discrimination was significantly associated with subsequent depression (OR = 2.18, 95% CI = 1.39 to 2.90) and suicidal ideation (OR = 2.07, 95% CI = 1.22 to 3.50). Multiple sensitivity analyses verified the results. COVID-19-related discrimination results in depression and suicidal ideation in healthcare workers. Interventions to prevent such discrimination against healthcare workers, e.g., anti-discrimination campaigns, are crucial during the COVID-19 pandemic.
先前的横断面研究表明，与 COVID-19 相关的对医护人员的歧视与抑郁有关。然而，尚无研究探讨允许因果推断的纵向关联。本前瞻性队列研究旨在检验基线时与 COVID-19 相关的歧视是否与数月后抑郁和自杀意念有关。数据于 2020 年 10 月至 2021 年 7 月收集。采用多变量逻辑回归进行分析。采用固定效应模型控制医院的影响（二级变量）。调整还包括年龄、性别、独居、饮酒、运动、BMI、工作时间、合并症和一线工作者状态（一级变量）。进行了多次敏感性分析，以检验结果是否发生重大变化且不受未测量混杂因素的影响。通过连锁方程对缺失数据进行多重插补。最终样本为 2862 名基线时无抑郁的医护人员。共有 269 人（9.4%）经历过与 COVID-19 相关的歧视。205 名参与者（7.2%）出现抑郁，108 名参与者（3.8%）出现自杀意念。在调整后的模型中，与 COVID-19 相关的歧视与随后的抑郁（OR=2.18，95%CI=1.39 至 2.90）和自杀意念（OR=2.07，95%CI=1.22 至 3.50）显著相关。多次敏感性分析验证了结果。与 COVID-19 相关的歧视会导致医护人员出现抑郁和自杀意念。在 COVID-19 大流行期间，预防针对医护人员的此类歧视的干预措施（例如反歧视运动）至关重要。
