Health Inequity in Pandemic Anxiety About COVID-19 Infection and Socioeconomic Consequences in Japan: A Structural Equation Modeling Approach

Overview

Journal SSM Popul Health

Date 2022 Oct 24

PMID 36276239

Authors

Kyoko Shimamoto

Eoin McElroy

Yoko Ibuka

Affiliations

Soon will be listed here.

Abstract

Background: Health inequity in relation to COVID-19 infection and socioeconomic consequences is a major global concern. Mental health issues in vulnerable populations have received special attention in research and practice during the COVID-19 pandemic. However, there is limited evidence on the nature of the anxieties experienced as a result of COVID-19, and how such concerns vary across demographic groups.

Aim: This study examines anxiety among the working population of Japan (aged 18-59), in terms of both COVID-19 infection and socioeconomic consequences, using an internationally validated tool, the Pandemic Anxiety Scale (PAS).

Methods: Data were collected using an online survey (n = 2,764). The analyses included an exploratory factor analysis (EFA), a confirmatory factor analysis (CFA), and structural equation modeling (SEM), followed by validation of the Japanese version of the PAS.

Results: A two-factor latent variable model shows the multidimensionality of anxiety in regard to the COVID-19 pandemic and the disparity across population groups in predicting the two defined anxiety dimensions. Several path coefficients showed somewhat unexpected and/or unique results from Japan compared with previous European studies. Specifically, self-reported health status was not significantly related to disease anxiety, and those who were not in paid employment reported lower consequence anxiety. The SEM results showed a greater number of significant exogenous variables for consequence anxiety compared to disease anxiety, highlighting disparities in pandemic anxiety by socioeconomic status in regard to socioeconomic consequences of the pandemic.

Conclusion: In contrast to existing European studies, evidence from the current study suggests contextual patterns of health inequity. Due to the prolonged socioeconomic consequences of the pandemic, multidisciplinary research on mental health issues and the quality of life remains an important research agenda in exploring socioeconomic measures in context, towards addressing inequity concerns.

Citing Articles

Socioeconomic disparities in risk perceptions and precautionary actions against COVID-19 among the working age population aged 18-59 in Japan: a cross-sectional study.

Shimamoto K, Ibuka Y BMJ Public Health. 2025; 2(1):e000181.

PMID: 40018181 PMC: 11812742. DOI: 10.1136/bmjph-2023-000181.

References

Tanaka T, Okamoto S . Increase in suicide following an initial decline during the COVID-19 pandemic in Japan. Nat Hum Behav. 2021; 5(2):229-238. DOI: 10.1038/s41562-020-01042-z. View

Ceylan R, Ozkan B, Mulazimogullari E . Historical evidence for economic effects of COVID-19. Eur J Health Econ. 2020; 21(6):817-823. PMC: 7270155. DOI: 10.1007/s10198-020-01206-8. View

Taylor S, Landry C, Paluszek M, Fergus T, McKay D, Asmundson G . Development and initial validation of the COVID Stress Scales. J Anxiety Disord. 2020; 72:102232. PMC: 7198206. DOI: 10.1016/j.janxdis.2020.102232. View

Holmes E, OConnor R, Perry V, Tracey I, Wessely S, Arseneault L . Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry. 2020; 7(6):547-560. PMC: 7159850. DOI: 10.1016/S2215-0366(20)30168-1. View

Williamson E, Walker A, Bhaskaran K, Bacon S, Bates C, Morton C . Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020; 584(7821):430-436. PMC: 7611074. DOI: 10.1038/s41586-020-2521-4. View

Ettman C, Cohen G, Abdalla S, Sampson L, Trinquart L, Castrucci B . Persistent depressive symptoms during COVID-19: a national, population-representative, longitudinal study of U.S. adults. Lancet Reg Health Am. 2021; 5:100091. PMC: 8488314. DOI: 10.1016/j.lana.2021.100091. View

Ding Y, Xu J, Huang S, Li P, Lu C, Xie S . Risk Perception and Depression in Public Health Crises: Evidence from the COVID-19 Crisis in China. Int J Environ Res Public Health. 2020; 17(16). PMC: 7460398. DOI: 10.3390/ijerph17165728. View

Marmot M, Friel S, Bell R, Houweling T, Taylor S . Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008; 372(9650):1661-9. DOI: 10.1016/S0140-6736(08)61690-6. View

Musche V, Kohler H, Bauerle A, Schweda A, Weismuller B, Fink M . COVID-19-Related Fear, Risk Perception, and Safety Behavior in Individuals with Diabetes. Healthcare (Basel). 2021; 9(4). PMC: 8072870. DOI: 10.3390/healthcare9040480. View

10.

Kessler R, Andrews G, Colpe L, Hiripi E, Mroczek D, Normand S . Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002; 32(6):959-76. DOI: 10.1017/s0033291702006074. View

11.

McElroy E, Patalay P, Moltrecht B, Shevlin M, Shum A, Creswell C . Demographic and health factors associated with pandemic anxiety in the context of COVID-19. Br J Health Psychol. 2020; 25(4):934-944. DOI: 10.1111/bjhp.12470. View

12.

Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P . The Lancet Commission on global mental health and sustainable development. Lancet. 2018; 392(10157):1553-1598. DOI: 10.1016/S0140-6736(18)31612-X. View

13.

Ueda M, Nordstrom R, Matsubayashi T . Suicide and mental health during the COVID-19 pandemic in Japan. J Public Health (Oxf). 2021; 44(3):541-548. PMC: 8083330. DOI: 10.1093/pubmed/fdab113. View

14.

Yoshikawa Y, Kawachi I . Association of Socioeconomic Characteristics With Disparities in COVID-19 Outcomes in Japan. JAMA Netw Open. 2021; 4(7):e2117060. PMC: 8281007. DOI: 10.1001/jamanetworkopen.2021.17060. View

15.

Akgor U, Fadiloglu E, Soyak B, Unal C, Cagan M, Temiz B . Anxiety, depression and concerns of pregnant women during the COVID-19 pandemic. Arch Gynecol Obstet. 2021; 304(1):125-130. PMC: 7802427. DOI: 10.1007/s00404-020-05944-1. View

16.

Mahamid F, Veronese G, Bdier D . Fear of coronavirus (COVID-19) and mental health outcomes in Palestine: The mediating role of social support. Curr Psychol. 2021; 42(10):8572-8581. PMC: 8527283. DOI: 10.1007/s12144-021-02395-y. View

17.

Khalatbari-Soltani S, Cumming R, Delpierre C, Kelly-Irving M . Importance of collecting data on socioeconomic determinants from the early stage of the COVID-19 outbreak onwards. J Epidemiol Community Health. 2020; 74(8):620-623. PMC: 7298202. DOI: 10.1136/jech-2020-214297. View

18.

Labrague L, De Los Santos J . Fear of COVID-19, psychological distress, work satisfaction and turnover intention among frontline nurses. J Nurs Manag. 2020; 29(3):395-403. PMC: 7537256. DOI: 10.1111/jonm.13168. View

19.

Ahorsu D, Lin C, Imani V, Saffari M, Griffiths M, Pakpour A . The Fear of COVID-19 Scale: Development and Initial Validation. Int J Ment Health Addict. 2020; 20(3):1537-1545. PMC: 7100496. DOI: 10.1007/s11469-020-00270-8. View

20.

Kohler H, Bauerle A, Schweda A, Weismuller B, Fink M, Musche V . Increased COVID-19-related fear and subjective risk perception regarding COVID-19 affects behavior in individuals with internal high-risk diseases. J Prim Care Community Health. 2021; 12:2150132721996898. PMC: 8851367. DOI: 10.1177/2150132721996898. View