COVID-19-related anxiety and sense of coherence associated with psychological distress among rural residents in Japan during the pandemic late phase.

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has imposed significant psychological stress worldwide. Although many studies have examined the mental health impacts during the pandemic's early phase, evidence from the late phase remains limited. This study investigated the associations between COVID-19-related anxiety and sense of coherence (SOC) with psychological distress among rural residents during the pandemic late phase in Japan.

METHODS

This community-based cross-sectional study was conducted from July 2022 to March 2023, the late phase of the COVID-19 pandemic. The participants were residents of rural communities in the Shimane Prefecture, Japan. They were recruited through a health check-up program arranged by a cooperative organization for farmers. Psychological distress was assessed using the Kessler 6-item Psychological Distress Scale (K6); COVID-19-related anxiety and SOC were assessed using self-administered questionnaires. Multivariable logistic regression analyses were performed to examine the associations between pandemic-related anxiety, SOC, and psychological distress after adjusting for age, sex, subjective health status, and communicative health literacy.

RESULTS

Of the 1,310 individuals who underwent health checkups, 743 agreed to participate in the study, and 664 who completed all questionnaires were included in the final analyses. Psychological distress (K6 ≥ 5) was observed in 29.2% of participants and was more prevalent among younger adults. Fear of infection (OR = 1.32, 95% confidence interval [CI]: 1.05-1.68), stress related to mask wearing (OR = 1.35, 95% CI: 1.10-1.68), and concern about reduced income (OR = 1.32, 95% CI: 1.08-1.61) were associated with higher odds of psychological distress. Higher SOC was inversely associated with psychological distress.

CONCLUSIONS

During the late phase of the COVID-19 pandemic, several COVID-19-related anxiety factors, particularly fear of infection, stress related to mask wearing, and concern about reduced income, were associated with psychological distress among rural residents. Higher SOC was associated with lower psychological distress, suggesting that strengthening individual and community resilience may be important for mitigating the mental health impact of prolonged pandemic conditions in rural settings.