Association between living with others and depressive symptoms in Japanese hospital workers during the COVID-19 pandemic.

Abstract

This Letter presents the findings of a cross-sectional study on the association between living with others and depressive symptoms among 1228 workers, aged 21–73 years, from a large hospital and its affiliated institute in Tokyo, 66.8% of whom had engaged in some sort of COVID-19-related work. The Introduction, Methods, Results, Discussion, and Tables are presented as an online supplement (Appendix S1). The COVID-19 pandemic is having a particularly significant psychological impact on health-care workers, with 25% reported to be depressed during the pandemic.1 Health-care workers are not only at higher risk of exposure to SARS-CoV-2 and increased workloads,2 but also social isolation and rejection due to the high probability that they will come into contact with potentially infectious COVID-19 patients.3 Social support has been recognized as a protective factor for mental health among health-care workers during the COVID-19 pandemic.4 However, social restrictions lead to reduced access to support from family and friends, and degrade social support systems, which can cause loneliness and depressed mood.5 In particular, individuals who live alone may be at high risk of adverse psychological conditions when they miss out on opportunities for emotional exchange and social support with cohabitants. These findings indicate the need to explore the relation between living alone and depressive symptoms during pandemic-related restrictions. While accumulating evidence suggests that living alone exacerbates depressive symptoms,6 research on this issue among health-care workers during the COVID-19 pandemic is scarce. To our knowledge, only one recent study in China has investigated the relation between living alone and depression symptoms in medical staff during the COVID-19 pandemic.7 The aim of this study was to examine the cross-sectional association of living with others with depressive symptoms among staff members at the National Center for Global Health and Medicine (NCGM) in Tokyo, Japan, a leading institute in the response to COVID-19 in Japan. Data for the present study were derived from the NCGM Clinical Epidemiology Study on SARS-CoV-2 Antibody, an ongoing clinical epidemiological study conducted among workers at NCGM. The first wave of the survey, conducted in July 2020, mainly targeted those who had engaged in COVID-19-related work or had worked in a department with high risk of SARS-CoV-2 infection. Of 1579 eligible participants, 1228 employees participated in the survey. Depressive symptoms were assessed using a two-question case-finding instrument for depression.8 Living status was categorized into living ‘alone,’ ‘with one person,’ ‘with two people,’ ‘with three people,’ or ‘with four people or more.’ To examine the cross-sectional association between living with others and depressive symptoms, we performed multiple logistic regression analysis and calculated the odds ratios (OR) and 95% confidence intervals of depressive symptoms for living with others, using those who lived alone as the reference group. Variables adjusted in the multivariate model were age, sex, occupation, working hours, degree of possible exposure to SARS-CoV-2, leisure-time physical activity, smoking status, alcohol consumption, sleep duration, body mass index, comorbidity of chronic disorders, and dietary factors. Details of variables used in this analysis are described in Appendix S2. Of 1228 participants, 268 participants (21.8%) were identified as having depressive symptoms. The OR of depressive symptoms tended to decrease with increasing number of cohabitants. To our knowledge, this is one of only a few studies to have investigated the association between living with others and depressive symptoms in hospital workers during the COVID-19 pandemic. Our findings agree with those of a meta-analysis of observational studies among the elderly, which indicated that older people living alone have a higher risk of depression than those living with others.6 In a cross-sectional study conducted in China during the COVID-19 pandemic, medical staff living alone reported significantly higher depressive symptoms than those living with others.7 We confirmed that living with others is associated with the mental health of hospital workers during the COVID-19 pandemic, even after adjustment for sleep and mood-related dietary factors. The present study is limited due to its cross-sectional design and lack of detailed information on family members/cohabitants. Further studies are required to address these issues. This work was supported by the NCGM COVID-19 Gift Fund and the Japan Health Research Promotion Bureau Research Fund (2020-B-09). The authors declare no conflicts of interest. Appendix S1. Introduction, Methods, Results, Discussion, and Tables. Appendix S2. Details of variables used in this analysis. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.