Article ID: 2022-0007-OA
This study investigated lifestyle changes and the self-reported mental health status of Japanese community residents during the COVID-19 pandemic. Differences in demography, daily lifestyle changes, and approaches to problem solving were analyzed in two age cohorts (<60 vs ≥60 years). The prevalence of moderate/increased psychological distress was 31.7%, with no significant difference between the cohorts. Compared with the pre-COVID-19 era, more than 80% of the participants stopped eating out and spent more time at home, and more than 70% used public transport less frequently. There were significant differences between the cohorts for the time spent at home, opportunities to eat meals outside of home, and shopping in stores. Participants aged under 60 years were less likely to use television and newspapers or to consult a family doctor. Those aged over 60 years were less likely to consult friends/colleagues or to use the Internet/social networking services. Identifying the risk factors for psychological distress is warranted for implementing measures to maintain and improve the physical and mental health of residents.
The number of coronavirus disease 2019 (COVID-19) cases in Japan has continued to increase since it was first reported in Japan in January 2020. In the Tokyo metropolitan area (Tokyo, Kanagawa, Saitama, Chiba), which has a population of over 36 million people,1 a cumulative total of 1849 cases of COVID-19 was confirmed as of April 6, 2020.2 Because of the increased number of cases, the Japanese government declared a state of emergency that spanned April 7 to May 25, 2020, and asked the public to refrain from going out. By early January 2021, the number of daily infections nationwide was exceeding 3000 and the cumulative total exceeded 250,000.2On January 6, 2021, a second state of emergency was declared, which spanned January 7 to February 2, 2021.
Upon the declaration of this state of emergency, community residents were asked by the prefectural governor to “stay at home” to cooperate with the prefectural government’s measures. This type of lockdown, which is unique to Japan and relies on the voluntary cooperation of the people, is defined as a “mild lockdown” and does not involve strict enforcement like the hard lockdowns that took place in Europe and the USA.3 Nevertheless, as a consequence of the state of emergency, Japanese residents experienced significant changes in their daily lives, including reduced opportunities for social interaction through community activities.
Although social distancing and staying home are effective public health measures to prevent the spread of infection by droplets or contact,4 social isolation caused by staying home should be monitored as a risk factor that affects mental health and can ultimately lead to premature death.5 It has also been noted that living a restricted daily life with anxiety or fear of infection may significantly impact physical and mental health.6 Coercive lockdowns have been confirmed to have physical and psychosocial impacts on residents.7,8,9,10 However, in Japan, where there was no forced lockdown, there is little information regarding the extent to which community residents voluntarily changed their daily lives (going out, eating out, participating in community activities, etc.) in response to the government’s requests and what problems they faced as a result. There are likely many lifestyle differences (e.g., going out daily for commuting, frequency of interaction with friends, etc.) between older and younger residents because of their different life stages. Therefore, in a mild lockdown, which involves voluntary behavioral change, and in the new normal, which is a new way of life while avoiding COVID-19 infection, there may be differences in the life changes and problems experienced by each generation. In a previous study that examined the effects of the first mild lockdown, it was reported that 36.6% of participants experienced psychological distress and that psychological distress was particularly high in the younger age group.3 Moreover, few studies have examined the changes in the lives of older and younger residents resulting from this pandemic.
Generally, there is a lack of knowledge on how the COVID-19 pandemic has changed the daily lives and community activities of residents through the widespread restriction of activities that few societies have previously experienced. In this study, we conducted a preliminary examination of the changes in daily life, the resources used to solve the problems that were faced, and the relationship between lifestyle changes and mental health among community residents. The study was based on an intergenerational comparison between older (over 60 years group) and younger (under 60 years group) residents in an effort to identify measures to support the new lifestyle and community activities of residents in their efforts to prevent COVID-19 infections. The study was conducted approximately 1 year after the first COVID-19 case was confirmed in Japan and approximately 1 month after the second mild lockdown was lifted.
A cross-sectional survey using an anonymous questionnaire was conducted in March 2021. The research explanation form and an anonymous self-administered questionnaire were sent with community circulars to 2000 households belonging to a neighborhood association in a district in Kanagawa Prefecture, Japan. Those who were most interested in community activities in each household were asked to answer the questionnaire. The participants lived within a district of a regional city with a population of approximately 400,000, including a relatively large number of farmers. The area is a 15-minute drive from the nearest train station, and 10–20 minutes from the nearest shopping center by private car or local bus service.
Ethical considerationsThis study was approved by the ethical review committee of the Graduate School of Health Management, Keio University (No. 2019-26). All participants were provided with a letter explaining the study, and those who agreed to participate and returned the questionnaire by mail were considered to have indicated consent.
Data collection Participant demographicsWe assessed the subjects’ demographic variables such as participant age (by decades: 20s, 30s, 40s, ... 100s), sex, family structure (living alone, living with family members), employment status (full time, part time, or not employed), and diseases being treated.
Participant mental healthThe Japanese version of the Kessler short screening scale for psychological distress (K6), which has been validated for Japan, was used to measure psychological distress.11,12 The original scale consists of six items concerning the frequency of psychological stress experienced in the previous 30 days and is rated on a 5-point scale from 0 (none) to 4 (all of the time); the total score ranges from 0 to 24. A higher K6 score indicates worse psychological health. A K6 score of 10 or higher is evaluated as moderate or severe psychological distress in Health Japan 21, a national health promotion program in Japan.13
Changes in daily life and community activities, problem-solving approachesParticipants were asked about the changes in their daily lives and community activities that occurred after the second mild lockdown (compared with their lives before the COVID-19 pandemic) using the following question: “compared with your daily life before the pandemic of COVID-19, how much time or opportunity did you have to participate in the following activities in your life as of March 2021?” The changes in daily life were rated for five aspects of life (e.g., spending time at home). Participants responded with “increased,” “decreased,” or “no change.” Similarly, the following five types of community activities were assessed: community festivals and recreational events, community supervision activities (e.g., confirming the safety of older people living alone or supervising children going to school), luncheons organized by neighborhood associations, litter collection and beautification activities along roads and in parks, and going to places where community residents interact (e.g., community centers). Participants were also asked to choose three out of ten problem-solving methods (e.g., gathering information from TV or radio) that they used most often. These questions were developed by referring to the survey items included in the national survey.14
Data analysisContinuous variables were described using the mean and standard deviation (SD), whereas categorical variables were described as number (n) and percentage of total. Logistic regression analysis was performed to compare participant demographic characteristics, changes in daily life and community activities, and problem-solving methods in daily life during the COVID-19 pandemic between age groups (<60 vs >60 years). Logistic regression analysis was also used to investigate the relationship between participant demographic characteristics, changes in daily life and community activities, and mental health (K6 score: <10 vs ≥10). Demographic characteristics were included as adjustment variables in these logistic regression analyses. Additionally, these relationships were examined for each age group using logistic regression analysis, with the K6 score as the dependent variable. To perform subgroup analyses by age group, P values for the interaction of input variables with age and K6 were calculated. In this logistic regression analysis, responses (e.g., increased or decreased) from less than 5% of the participants were merged into the “no change” response, and multiple imputation was performed for missing data. Statistical significance was set at P < 0.05. IBM-SPSS ver. 27.0 was used for all statistical analyses (IBM, Armonk, NY, USA).
The 669 respondents who returned the questionnaires were included in the analysis (total response rate: 33.5%). Table 1 shows the age group differences for participant characteristics and the relationships between participant characteristics and mental health (K6 score). There were more females in the under 60 years group (odds ratio [OR]: 0.32; 95% confidence interval [95% CI]: 0.23–0.45; P <0.001), and the majority of those aged over 60 years were living alone (OR: 0.19; 95% CI: 0.09–0.40; P <0.001). When compared with full-time workers, part-time workers showed no differences in age groups, whereas non-working participants were more common in the over 60 years group (OR: 9.61; 95% CI: 6.24–14.81; P <0.001). Those with diseases and undergoing treatment were also more likely to be in the over 60 years group (OR: 4.87; 95% CI: 3.48–6.81; P <0.001). While there was no significant difference in K6 scores between age groups, those with a K6 score of 10 or higher accounted for 31.7% of the participants in this study. More females than males experienced moderate to great psychological distress (OR: 1.83; 95% CI: 1.30–2.59; P <0.001), and more part-time workers had poorer mental health than full-time workers (OR: 1.76; 95% CI: 1.15–2.68; P = 0.009).
| Total ( n = 669 ) | Comparison results by age ( < 60 vs 60 ≤) | Comparison results by K6 ( < 10 vs 10 ≤) | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Under 60 | Over 60 | OR | 95% CI | P** | K6 < 10 | 10 ≤ K6 | OR | 95% CI | P** | P for Interaction (*age) | |||||
| n (%) | n | n | n | n | |||||||||||
| Demographic characteristics | |||||||||||||||
| Age: 20s (20-29) | 7 | (1.0) | 7 | ― | ― | ― | ― | ― | 5 | 2 | 0.99 | 0.98 | - 1.01 | 0.386 | ― |
| 30s (30-39) | 40 | (6.0) | 40 | ― | 28 | 12 | |||||||||
| 40s (40-49) | 125 | (18.7) | 125 | ― | 76 | 48 | |||||||||
| 50s (50-59) | 151 | (22.6) | 151 | ― | 97 | 51 | |||||||||
| 60s (60-69) | 121 | (18.1) | ― | 121 | 80 | 39 | |||||||||
| 70s (70-79) | 164 | (24.5) | ― | 164 | 111 | 41 | |||||||||
| 80s (80-89) | 48 | (7.2) | ― | 48 | 28 | 14 | |||||||||
| 90s (90-99) | 2 | (0.3) | ― | 2 | 0 | 1 | |||||||||
| Age group: under 60 | 323 | (48.3) | ― | ― | ― | ― | ― | ― | 206 | 113 | 0.85 | 0.60 | - 1.20 | 0.345 | ― |
| over 60 | 335 | (50.1) | ― | ― | 219 | 95 | |||||||||
| Sex: Male | 282 | (42.2) | 90 | 185 | 0.32 | 0.23 | -0.45 | < 0.001 | 201 | 68 | 1.83 | 1.30 | - 2.59 | < 0.001 | 0.058 |
| Female | 384 | (57.4) | 233 | 149 | 229 | 143 | |||||||||
| Family structure: live alone | 57 | (8.5) | 9 | 47 | 0.19 | 0.09 | -0.40 | < 0.001 | 44 | 10 | 1.78 | 0.94 | - 3.38 | 0.079 | 0.177 |
| live with family members | 608 | (90.9) | 312 | 287 | 384 | 202 | |||||||||
| Employment status: full-time | 224 | (33.5) | 154 | 65 | 159 | 61 | 0.017 | ||||||||
| part-time | 187 | (28.0) | 119 | 66 | 1.30 | 0.85 | -2.00 | 0.224 | 108 | 72 | 1.76 | 1.15 | - 2.68 | 0.009 | |
| not working | 245 | (36.6) | 46 | 196 | 9.61 | 6.24 | -14.81 | < 0.001 | 157 | 76 | 1.27 | 0.84 | - 1.91 | 0.262 | |
| Diseases under treatment: no | 326 | (48.7) | 222 | 100 | 4.87 | 3.48 | -6.81 | < 0.001 | 224 | 93 | 1.36 | 0.97 | - 1.90 | 0.072 | 0.732 |
| yes | 333 | (49.8) | 100 | 227 | 203 | 117 | |||||||||
| K6 Score (range: 0-24) : average | 6.91 | (5.6) | ― | ― | ― | ― | ― | ||||||||
| - K6 < 10 | 432 | (64.6) | 206 | 219 | 0.84 | 0.61 | -1.18 | 0.316 | ― | ― | ― | ― | ― | ― | |
| - 10 ≤ K6 | 212 | (31.7) | 113 | 95 | ― | ― | |||||||||
OR: odds ratio; CI: confidence interval.
After multiple imputation for missing data (age, sex, and K6 score), logistic regression analysis was performed.
** Results from a logistic regression analysis with sex, family structure, disease under treatment, and employment status as adjustment variables.
Table 2 shows the age group differences in changes of daily lifestyle and community activities and the relationship between changes in daily lifestyle and community activities and mental health. When compared with lifestyle before the COVID-19 pandemic, after the second mild lockdown, even though lockdown compliance was voluntary, more than 80% of participants refrained from eating out and spent more time at home, and more than 70% of participants were less likely to use public transport. In addition, about 30% of community members experienced a decrease in outdoor exercise opportunities. For changes in daily life activities, there was a significant difference between the age groups regarding time spent at home (OR: 0.57; 95% CI: 0.34–0.97; P = 0.039). Regarding changes in daily life and their effects on mental health, participants who increased time at home (OR: 1.81; 95% CI: 1.12–2.95; P = 0.016), decreased shopping at supermarkets and stores (OR: 1.75; 95% CI: 1.22–2.50; P = 0.002), and did less outdoor exercise (OR: 1.60; 95% CI: 1.07–2.39; P = 0.022) were significantly more likely to experience moderate or severe psychological distress than those without these characteristics. No significant differences in changes in community activities existed between age groups, but those that no longer participated in community beautification activities after the COVID-19 pandemic experienced more psychological distress than participants that did not alter their activities (OR: 1.84; 95% CI: 1.14–2.97; P = 0.013).
| Total ( n = 669 ) | Comparison results by age ( < 60 vs 60 ≤) | Comparison results by K6 ( < 10 vs 10 ≤) | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Under 60 | Over 60 | OR | 95% CI | P** | K6 < 10 | 10 ≤ K6 | OR | 95% CI | P** | P for Interaction (**age) | |||||
| n (%) | n | n | n | n | |||||||||||
| Changes of daily life | |||||||||||||||
| Spending time at home: increased | 546 | (81.6) | 281 | 255 | 0.57 | 0.34 | -0.97 | 0.039 | 341 | 185 | 1.81 | 1.12 | - 2.95 | 0.016 + | 0.027 |
| decreased | 3 | (0.4) | 1 | 2 | 3 | 0 | |||||||||
| no change | 110 | (16.4) | 40 | 69 | 82 | 26 | |||||||||
| Opportunities to out for a meal: increased | 12 | (1.8) | 4 | 7 | 7 | 4 | 0.027 | ||||||||
| decreased | 546 | (81.6) | 284 | 252 | 0.90 | 0.69 | -1.19 | 0.463 | 352 | 177 | 1.01 | 0.80 | - 1.29 | 0.910 + | |
| no change | 95 | (14.2) | 35 | 60 | 62 | 29 | |||||||||
| Opportunities to move by train, bus, or | |||||||||||||||
| other public transportation | 0.956 | ||||||||||||||
| - Increased | 2 | (0.3) | 1 | 1 | 0 | 2 | |||||||||
| - Decreased | 475 | (71.0) | 232 | 234 | 1.03 | 0.82 | -1.31 | 0.790 | 296 | 161 | 1.20 | 0.99 | - 1.47 | 0.070 + | |
| - No change | 173 | (25.9) | 89 | 82 | 127 | 44 | |||||||||
| Shopping at supermarkets and stores: increased | 66 | (9.9) | 39 | 26 | 0.64 | 0.29 | -1.38 | 0.249 | 43 | 20 | 1.58 | 0.86 | - 2.91 | 0.144 | 0.561 |
| decreased | 290 | (43.3) | 131 | 154 | 1.41 | 0.88 | -2.26 | 0.152 | 168 | 115 | 1.75 | 1.22 | - 2.50 | 0.002 | |
| no change | 295 | (44.1) | 151 | 139 | 209 | 74 | |||||||||
| Opportunities to exercise outdoors | |||||||||||||||
| (e. g., jogging): increased | 134 | (20.0) | 72 | 58 | 1.03 | 0.60 | -1.78 | 0.903 | 95 | 37 | 0.94 | 0.58 | - 1.53 | 0.814 | 0.135 |
| decreased | 210 | (31.4) | 91 | 117 | 1.52 | 0.97 | -2.37 | 0.070 | 121 | 79 | 1.60 | 1.07 | - 2.39 | 0.022 | |
| no chang | 304 | (45.4) | 160 | 140 | 205 | 91 | |||||||||
| Changes in community activities | |||||||||||||||
| Community festivals and recreational events | 0.666 | ||||||||||||||
| - No longer participate / less frequently | 454 | (67.9) | 222 | 228 | 2.09 | 0.91 | -4.81 | 0.081 | 291 | 145 | 1.70 | 0.78 | - 3.68 | 0.177 | |
| - Originally not participating | 150 | (22.4) | 76 | 69 | 1.77 | 0.68 | -4.57 | 0.236 | 96 | 52 | 1.72 | 0.74 | - 3.99 | 0.208 | |
| - No change | 49 | (7.3) | 25 | 22 | 36 | 11 | |||||||||
| Watching as community activity | 0.434 | ||||||||||||||
| - No longer participate / less frequently | 259 | (38.7) | 126 | 130 | 1.25 | 0.75 | -2.07 | 0.388 | 167 | 79 | 0.97 | 0.61 | - 1.53 | 0.877 | |
| - Originally not participating | 232 | (34.7) | 123 | 103 | 0.97 | 0.58 | -1.63 | 0.913 | 152 | 76 | 0.98 | 0.61 | - 1.55 | 0.916 | |
| - No change | 153 | (22.9) | 74 | 77 | 100 | 50 | |||||||||
| Luncheons organized | |||||||||||||||
| by neighborhood associations | 0.754 | ||||||||||||||
| - No longer participate / less frequently | 276 | (41.3) | 128 | 146 | 1.85 | 0.93 | -3.70 | 0.080 | 170 | 93 | 1.41 | 0.78 | - 2.53 | 0.252 | |
| - Originally not participating | 296 | (44.2) | 156 | 133 | 1.12 | 0.56 | -2.25 | 0.744 | 200 | 91 | 1.07 | 0.61 | - 1.89 | 0.806 | |
| - No change | 75 | (11.2) | 37 | 36 | 51 | 22 | |||||||||
| Garbage picking and beautification activities | |||||||||||||||
| on roads and parks | 0.633 | ||||||||||||||
| - No longer participate / less frequently | 411 | (61.4) | 212 | 195 | 1.01 | 0.58 | -1.76 | 0.974 | 251 | 144 | 1.84 | 1.14 | - 2.97 | 0.013 | |
| - Originally not participating | 121 | (18.1) | 65 | 51 | 0.81 | 0.40 | -1.62 | 0.548 | 84 | 36 | 1.36 | 0.76 | - 2.46 | 0.301 | |
| - No change | 113 | (16.9) | 46 | 65 | 83 | 25 | |||||||||
| Go to places where community residents interact | |||||||||||||||
| (like a community center) | 0.364 | ||||||||||||||
| - No longer participate / less frequently | 331 | (49.5) | 157 | 172 | 1.71 | 0.90 | -3.26 | 0.104 | 207 | 109 | 1.24 | 0.72 | - 2.14 | 0.433 | |
| - Originally not participating | 226 | (33.8) | 116 | 103 | 1.36 | 0.70 | -2.61 | 0.363 | 150 | 71 | 1.04 | 0.60 | - 1.81 | 0.896 | |
| - No change | 92 | (13.8) | 47 | 44 | 64 | 27 | |||||||||
OR: odds ratio; CI: confidence interval.
After multiple imputation for missing data (age, sex, and K6 score), logistic regression analysis was performed.
* Results from a logistic regression analysis with sex, family structure, disease under treatment, and employment status as adjustment variabes.
** Results from a logistic regression analysis with age, sex, family structure, disease under treatment, and employment status as adjustment variables.
+ Responses (e.g., increased or decreased) from less than 5% of the participants were merged into the "no change" response.
Table 3 shows the age group differences in relationships with demographic characteristics, changes of daily lifestyle and community activities, and mental health. In the under 60 years group, those experiencing more than moderate psychological distress were more likely to be female (OR: 2.43; 95% CI: 1.40–4.22; P = 0.002), not working (OR: 2.89; 95% CI: 1.47–5.70; P = 0.002), or with a disease under treatment (OR: 1.68; 95% CI: 1.02–2.77; P = 0.043). However, in the over 60 years group, no significant association was observed between the demographic data and K6 scores. No relationship was observed between changes in daily life and mental health in the under 60 years group. In the over 60 years group, participants who spent more time at home (OR: 2.86; 95% CI: 1.44–5.71; P = 0.003), spent less time shopping in stores (OR: 2.01; 95% CI: 1.16–3.49; P = 0.013), or had fewer opportunities to exercise outdoors (OR: 2.23; 95% CI: 1.28–3.86; P = 0.005) were significantly more likely to experience moderate or severe psychological distress than those without these characteristics. There was no relationship between changes in community activities and mental health status for each age group.
| Comparison results by K6 : K6 < 10 vs 10 ≤ K6 | ||||||||
|---|---|---|---|---|---|---|---|---|
| Result of under 60 group | Result of over 60 group | |||||||
| OR | 95% CI | P | OR | 95% CI | P | |||
| Demographic characteristics | ||||||||
| Sex: Male | 2.43 | 1.40 | -4.22 | 0.002 | 1.35 | 0.83 | -2.20 | 0.224 |
| Female | ||||||||
| Family structure: live alone | 5.16 | 0.64 | -41.57 | 0.123 | 1.64 | 0.78 | -3.45 | 0.189 |
| live with family members | ||||||||
| Employment status: full-time | ||||||||
| part-time | 1.54 | 0.93 | -2.57 | 0.095 | 1.88 | 0.89 | -3.98 | 0.096 |
| not working | 2.89 | 1.47 | -5.70 | 0.002 | 0.95 | 0.52 | -1.74 | 0.862 |
| Diseases under treatment: no | 1.68 | 1.02 | -2.77 | 0.043 | 1.46 | 0.83 | -2.56 | 0.19 |
| yes | ||||||||
| Changes of daily life ** | ||||||||
| Spending time at home: increased | 1.04 | 0.51 | -2.10 | 0.917 + | 2.86 | 1.44 | -5.71 | 0.003 + |
| no change + decreased | ||||||||
| Opportunities to out for a meal: decreased | 0.76 | 0.53 | -1.08 | 0.122 + | 1.27 | 0.90 | -1.79 | 0.178 + |
| no change + increased | ||||||||
| Opportunities to move by train, bus, or other public transportation | ||||||||
| - Decreased | 1.19 | 0.90 | -1.58 | 0.212 + | 1.26 | 0.93 | -1.70 | 0.139 + |
| - No change + increased | 1.04 | 0.51 | -2.10 | 0.917 + | 2.86 | 1.44 | -5.71 | 0.003 + |
| Shopping at supermarkets and stores: increased | 1.30 | 0.59 | -2.88 | 0.518 | 1.76 | 0.54 | -5.71 | 0.340 |
| decreased | 1.57 | 0.92 | -2.67 | 0.095 | 2.01 | 1.16 | -3.49 | 0.013 |
| no change | ||||||||
| Opportunities to exercise outdoors (e. g., jogging): increased | 0.83 | 0.45 | -1.55 | 0.560 | 1.17 | 0.56 | -2.44 | 0.679 |
| decreased | 1.12 | 0.64 | -1.95 | 0.701 | 2.23 | 1.28 | -3.86 | 0.005 |
| no change | ||||||||
| Changes in community activities** | ||||||||
| Community festivals and recreational events | ||||||||
| - No longer participate / less frequently | 2.47 | 0.84 | -7.28 | 0.100 | 1.21 | 0.45 | -3.20 | 0.708 |
| - Originally not participating | 2.68 | 0.86 | -8.29 | 0.088 | 1.15 | 0.39 | -3.40 | 0.806 |
| - No change | ||||||||
| Watching as community activity | ||||||||
| - No longer participate / less frequently | 0.79 | 0.42 | -1.48 | 0.462 | 1.15 | 0.60 | -2.24 | 0.671 |
| - Originally not participating | 0.93 | 0.50 | -1.73 | 0.816 | 1.11 | 0.58 | -2.12 | 0.744 |
| - No change | ||||||||
| Luncheons organized by neighborhood associations | ||||||||
| - No longer participate / less frequently | 1.64 | 0.73 | -3.70 | 0.236 | 1.37 | 0.58 | -3.23 | 0.477 |
| - Originally not participating | 1.09 | 0.49 | -2.42 | 0.833 | 1.15 | 0.49 | -2.67 | 0.748 |
| - No change | ||||||||
| Garbage picking and beautification activities on roads and parks | ||||||||
| - No longer participate / less frequently | 2.07 | 0.97 | -4.42 | 0.060 | 1.86 | 0.78 | -4.41 | 0.153 |
| - Originally not participating | 1.97 | 0.82 | -4.75 | 0.130 | 0.99 | 0.40 | -2.47 | 0.984 |
| - No change | ||||||||
| Go to places where community residents interact (like a community center) | ||||||||
| - No longer participate / less frequently | 1.69 | 0.79 | -3.62 | 0.174 | 0.93 | 0.45 | -1.91 | 0.846 |
| - Originally not participating | 1.45 | 0.67 | -3.16 | 0.346 | 0.72 | 0.34 | -1.55 | 0.403 |
| - No change | ||||||||
OR: odds ratio; CI: confidence interval.
In logistic regression analysis, multiple imputation was performed for missing data (age, sex, and K6 score).
** Results from a logistic regression analysis with sex, family structure, disease under treatment, and employment status as adjustment variables.
+ Responses (e.g., increased or decreased) from less than 5% of the participants were merged into the "no change" response.
Table 4 shows the age group differences for the problem-solving approaches used in daily life during the COVID-19 pandemic. Most of the participants in the under 60 years group chose to collect information from the Internet and social networking services (SNSs), such as Twitter and Facebook, whereas most of the participants in the over 60 years group collected information from television and radio. When compared with the over 60 years group, participants in the under 60 years group were less likely to use the following as information sources: television or radio (OR: 2.09; 95% CI: 1.37–3.17; P <0.001), newspapers (OR: 5.64; 95% CI: 2.98–10.69; P <0.001), public agencies (OR: 2.34; 95% CI: 1.13–4.83; P = 0.022), and family doctor (OR: 2.12; 95% CI: 1.25–3.57; P = 0.005). Participants in the over 60 years group were less likely than younger participants to consult with friends or colleagues (OR: 0.29; 95% CI: 0.18–0.48; P <0.001) or to collect information from the Internet or SNSs (OR: 0.27; 95% CI: 0.18–0.42; P <0.001).
| Total (n=669) | Comparison results by age ( < 60 vs 60 ≤) | |||||||
|---|---|---|---|---|---|---|---|---|
| Under 60 | Over 60 | OR | 95% CI | P** | ||||
| n (%) | n | n | ||||||
| Talk to family member: Yes | 325 | (48.6) | 172 | 150 | 0.97 | 0.66 | - 1.45 | 0.894 |
| No | 337 | (50.4) | 151 | 178 | ||||
| Talk to friends or co-workers/superiors in workplace: Yes | 190 | (28.4) | 151 | 37 | 0.29 | 0.18 | - 0.48 | < 0.001 |
| No | 472 | (70.6) | 172 | 291 | ||||
| Gathering information from TV or radio: Yes | 252 | (37.7) | 81 | 166 | 2.09 | 1.37 | - 3.17 | < 0.001 |
| No | 410 | (61.3) | 242 | 162 | ||||
| Gathering information from newspapers: Yes | 130 | (19.4) | 20 | 108 | 5.64 | 2.98 | - 10.69 | < 0.001 |
| No | 532 | (79.5) | 303 | 220 | ||||
| Gathering information from Internet or SNS: Yes | 277 | (41.4) | 185 | 84 | 0.27 | 0.18 | - 0.42 | < 0.001 |
| No | 385 | (57.5) | 138 | 244 | ||||
| Contacting public agencies such as the prefectural or city governments: Yes | 58 | (8.7) | 18 | 39 | 2.34 | 1.13 | - 4.83 | 0.022 |
| No | 603 | (90.1) | 304 | 289 | ||||
| Talk to family doctor or other medical personnel: Yes | 158 | (23.6) | 39 | 115 | 2.12 | 1.25 | - 3.57 | 0.005 |
| No | 503 | (75.2) | 283 | 213 | ||||
| Consult with public health center: Yes | 8 | (1.2) | 3 | 5 | 0.99 | 0.12 | - 8.14 | 0.990 |
| No | 653 | (97.6) | 319 | 323 | ||||
| No concerns or problems: Yes | 79 | (11.8) | 37 | 42 | 1.31 | 0.71 | - 2.41 | 0.395 |
| No | 582 | (87.0) | 285 | 286 | ||||
| I don’t know how to solve the problems: Yes | 89 | (13.3) | 37 | 51 | 1.05 | 0.59 | - 1.87 | 0.866 |
| No | 573 | (85.7) | 285 | 278 | ||||
OR: odds ratio; CI: confidence interval.
Participants indicated the three problem-solving methods that they used most often.
** Results from a logistic regression analysis with gender, family structure, disease under treatment, and employment status as adjustment variables.
The findings of this study showed that 31.7% of participants had a K6 score of 10 or higher (Table 1), which is defined in Health Japan 21 as psychological distress equivalent to mood and anxiety disorders.13 Among the community residents who experienced a second mild lockdown, there was an increase in the proportion of those experiencing psychological distress, contrary to the findings of the National Comprehensive Survey of Living Conditions before the COVID-19 pandemic,14 which reported that 10.3% of the population had a K6 score of 10 or higher. Psychological distress has become a popular indicator of a population’s mental health.15 Factors related to psychological distress should be thoroughly examined to identify and implement support measures to help maintain the mental health of community residents. Consideration of the needs specific to gender and age groups is also necessary, along with the need for continuous monitoring of mental health status during and after the COVID-19 pandemic.
In those aged under 60 years, changes in daily life were not significantly associated with mental health. However, in participants aged over 60 years, those that spent more time at home, spent less time in supermarkets and stores, and had fewer opportunities to exercise outdoors had significantly worse mental health scores than those without these changes. Given that the ability to adapt to changes in the environment decreases with age,16 it may become important to develop new lifestyles and health habits for living with COVID-19. Slightly less than a third (31.4%) of community members experienced fewer opportunities for outdoor exercise (Table 2). Although the under 60 years group did not show any association between K6 score and changes in outdoor exercise, those in the over 60 years group with fewer opportunities for outdoor exercise were more likely to have higher K6 scores (Table 3). In a previous study of adults in the USA,17 32.3% of the originally active population experienced decreased exercise opportunities because of the spread of COVID-19, and mental health was observed to deteriorate in respondents that could no longer maintain recommended levels of physical activity. Generally, people who engage in regular physical activity display more desirable health outcomes across various physical conditions.18 Therefore, spontaneous physical activities for community residents should be encouraged to maintain and improve their physical and mental functions. While considering the need for infection prevention, it is still important to provide opportunities for exercise, both outdoors and indoors.
While the overall responses showed an association between beautification activities and mental health (Table 2), in each age group, no specific community activities were significantly associated with mental health (Table 3). Previous studies have shown that more frequent participation in community activities is associated with better mental health,19 and that those who play some role in the activities, such as leader or supporter, have better mental health.20 Because this study asked only about the types of community activities in which participants performed on a regular basis, it is possible that the relationship between community activities and mental health requires further investigation. Future studies should evaluate characteristics related to community activities in more detail and consider the frequency of community activities and participants’ roles in these activities.
Given that the ownership rate of information and communication technology (ICT) devices and their use are higher among the younger generation,21 the under 60 years group are likely to have used the Internet and SNSs more frequently for shopping and information gathering than older participants. The information related to COVID-19 is updating at a dizzying pace every day, and the forms of social interaction are also changing with the use of ICT, such as the expanding use of online meeting services,16 whereas direct interaction in the community is restricted. Because different age groups use different information sources, information should be provided through various media channels such as the Internet, newspapers, and television. Furthermore, supporting the use of ICT by the elderly is becoming increasingly important in correcting the intergenerational digital divide. ICT can facilitate timely information gathering and non-contact social interaction as well as shape the new community communication styles required during the COVID-19 pandemic.
This study had some limitations. First, because the participants were residents of a local community, they were relatively interested in community activities, which may have created a bias in preference for community involvement. Second, the participants were from a single district in a provincial city of Kanagawa Prefecture; therefore, it may be difficult to generalize our findings to other populations. Finally, the cross-sectional nature of the study did not allow for the assessment of causal relationships among the study variables. Both the questionnaire and the mental health measures (K6 instrument) were based on self-reports, although the K6 instrument has been validated for Japan. Nonetheless, the present study is one of the few studies that has observed the current status of changes in daily life caused by the COVID-19 pandemic and has examined the relationship between mental health and lifestyle changes of community residents through an intergenerational comparison between the elderly and non-elderly in Japan.
The findings of this study revealed that there were age group differences regarding changes in daily life among community residents during the COVID-19 pandemic. In the future, it will be necessary to examine changes in the condition of community residents in relation to the infection situation, clarify the risk factors for psychological distress among community residents during a pandemic, ensure opportunities for exercise, and support social interaction using ICT. It will also be necessary to implement specific support measures to maintain and improve the physical and mental health of community residents.
The authors thank all the participants in this study.
This study was supported by the Keio SFC research project, the “Future Field Development Laboratory,” established through a cooperative agreement between Odakyu Electric Railway Company and Keio University, funded the study.
