Urbanization level and neighborhood deprivation, not COVID-19 case numbers by residence area, are associated with severe psychological distress and new-onset suicidal ideation during the COVID-19 pandemic

Ryo Okubo; Takashi Yoshioka; Tomoki Nakaya; Tomoya Hanibuchi; Hiroki Okano; Satoru Ikezawa; Kanami Tsuno; Hiroshi Murayama; Takahiro Tabuchi

doi:10.1016/j.jad.2021.03.028

Urbanization level and neighborhood deprivation, not COVID-19 case numbers by residence area, are associated with severe psychological distress and new-onset suicidal ideation during the COVID-19 pandemic

J Affect Disord. 2021 May 15:287:89-95. doi: 10.1016/j.jad.2021.03.028. Epub 2021 Mar 15.

Authors

Ryo Okubo¹, Takashi Yoshioka², Tomoki Nakaya³, Tomoya Hanibuchi³, Hiroki Okano⁴, Satoru Ikezawa⁵, Kanami Tsuno⁶, Hiroshi Murayama⁷, Takahiro Tabuchi⁸

Affiliations

¹ Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan. Electronic address: ryo-okubo@ncnp.go.jp.
² Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.
³ Graduate School of Environmental Studies, Tohoku University, Sendai, Miyagi, Japan.
⁴ Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan.
⁵ Endowed Institute for Empowering Gifted Minds, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan.
⁶ School of Health Innovation, Kanagawa University of Human Services, Kanagawa, Japan.
⁷ Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
⁸ Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: COVID-19; Deprivation; Psychological distress; Suicidal ideation; Urbanization level.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Cross-Sectional Studies
Humans
Japan / epidemiology
Pandemics
Psychological Distress*
Risk Factors
SARS-CoV-2
Suicidal Ideation
Urbanization