Suzuki Kazuhiro, Mizuno Yuka, Arai Yusuke, Miyamura Keitaro, Sasayama Daimei, Washizuka Shinsuke
Department of Community Mental Health, Shinshu University School of Medicine, Matsumoto, Japan.
Department of Psychiatry, Shinshu University School of Medicine, Matsumoto, Japan.
PLoS One. 2025 Aug 8;20(8):e0329644. doi: 10.1371/journal.pone.0329644. eCollection 2025.
The COVID-19 pandemic significantly impacted psychological distress globally and led to widespread behavioral changes, including mask-wearing. Research shows that mask-wearing behavior may have psychological consequences. Infection control behaviors and psychological distress are expected to decrease as the pandemic subsides. However, the effect of these changes on patients with mental illnesses remains unclear. Hence, this study aimed to evaluate the impact of relaxed mask-wearing guidelines on psychological distress among psychiatric outpatients in Japan and its association with changes in mask-wearing behavior. It included 109 outpatients from a general hospital's psychiatric department. Psychological distress was assessed using the General Health Questionnaire-12 at two time points: before and after the guideline change. Mask-wearing behavior was recorded through self-reports. Changes in psychological distress were analyzed using the Wilcoxon signed-rank test, and the association between changes in mask-wearing behavior and psychological distress was examined using multiple regression analysis, adjusting for preceding psychological distress, age, and gender. Among the 109 participants (12 with schizophrenia, 55 with mood disorders, 34 with anxiety disorders, and 8 with other conditions), a significant reduction in psychological distress was observed after the guideline relaxation (Cohen's d = 0.344, p < 0.01). Outdoor mask-wearing decreased from 89% before the guideline change to 65% after the change. Changes in mask-wearing behavior were significantly associated with reduced psychological distress (β = 2.72, p < 0.01). Relaxed mask-wearing guidelines positively impacted psychological distress among psychiatric outpatients, with unmasking associated with improved mental health. Thus, the relaxation of public health measures can contribute to improved mental health among vulnerable populations. This study provides new insights into the psychological implications of mask-wearing policies in the post-COVID-19 society and informs strategies to support mental health in future public health crises.
新冠疫情对全球心理困扰产生了重大影响，并导致了包括戴口罩在内的广泛行为变化。研究表明，戴口罩行为可能会产生心理影响。随着疫情缓解，感染控制行为和心理困扰预计会减少。然而，这些变化对精神疾病患者的影响仍不明确。因此，本研究旨在评估放宽口罩佩戴指南对日本精神科门诊患者心理困扰的影响及其与口罩佩戴行为变化的关联。研究纳入了一家综合医院精神科的109名门诊患者。在指南变更前后两个时间点，使用一般健康问卷-12评估心理困扰。通过自我报告记录口罩佩戴行为。使用Wilcoxon符号秩检验分析心理困扰的变化，并使用多元回归分析检验口罩佩戴行为变化与心理困扰之间的关联，同时对先前的心理困扰、年龄和性别进行调整。在109名参与者中（12名精神分裂症患者、55名情绪障碍患者、34名焦虑症患者和8名其他疾病患者），指南放宽后观察到心理困扰显著降低（科恩d值 = 0.344，p < 0.01）。户外戴口罩率从指南变更前的89%降至变更后的65%。口罩佩戴行为的变化与心理困扰减轻显著相关（β = 2.72，p < 0.01）。放宽口罩佩戴指南对精神科门诊患者的心理困扰产生了积极影响，不戴口罩与心理健康改善相关。因此，公共卫生措施的放宽有助于改善弱势群体的心理健康。本研究为新冠疫情后社会口罩佩戴政策的心理影响提供了新见解，并为未来公共卫生危机中支持心理健康的策略提供了参考。
