Moral Decision-Making, Stress, and Social Cognition in Frontline Workers vs. Population Groups During the COVID-19 Pandemic: An Explorative Study

Ethical challenges during critical phases of the COVID-19 pandemic: An interpretive synthesis

BACKGROUND

During the most critical phases of COVID-19 pandemic, dramatic situations were experienced in hospitals and care centers that nurses could hardly verbalize. Especially relevant were deep challenges related to terminal illness, situations of extreme sacrifice, as well as reflections on protective measures mixed with beliefs. We intend to analyze which problems had the greatest impact on professionals.

AIM

The aim is to explore the ultimate basis for action when making decisions and the orientation of their behavior in the face of moral conflicts.

METHOD

The methodological strategy is an interpretive synthesis. Narrative review of academic articles that analyzed ethical dilemmas during the pandemic was carried out by searching five databases (Pubmed, Scopus, Psycinfo, CINHAL, and WOS) between January 2020 and December 2022. Finally, 43 articles were selected.

ETHICAL CONSIDERATIONS

Ethical requirements were respected in all study phases.

RESULTS

The reading and review of the 43 articles initiated the first phase of inductive coding which resulted in 14 initial sub-themes. Based on this structure, a second phase of coding was carried out, giving rise to six categories or emerging themes. To facilitate the process of identifying the central category, the authors agreed to carry out a phase of synthesis, grouping the six themes into three meta-themes: the identification and acceptance of human vulnerability; the discovery of positive paradigms in traumatic situations in society; the prevalence of the common good over the particular interest, as the core structure of any society.

CONCLUSION

The study has shown the need to consider healthcare benevolence as a new dimension of health care upon global vulnerability. Responsibility is required to ensure the well-being of a global society, prioritizing the common good over particular interests and building solutions on solid moral structures. A new ethical landscape is essential, starting with a humanistic curricular training of all healthcare professionals.

Healthcare Providers' Adherence to COVID-19 Prevention and Control Practices in Health Records and Information Management, Ghana

Background

The impact of contracting coronavirus on healthcare providers (HCPs) affects their ability to combat the infection. The virus can be transmitted through droplets from sneezing, coughing, and yelling, making it essential for HCPs to plan ahead when dealing with patients with respiratory symptoms. The need to assess healthcare providers' perceived adherence to COVID-19 Prevention and Control Practices (PCP) in Health Records and Information Management is vital for optimizing healthcare operations and ensuring the safety of both patients and providers. This study assesses healthcare providers' perceived adherence to COVID-19 PCP in Health Records and Information Management. Subjects and Method. A cross-sectional survey was conducted to collect data from 1268 HCPs working in eight randomly selected hospitals across five regions in Ghana. The survey was carried out from May 15, 2022, to August 13, 2022. Simple random sampling was used to choose these eight facilities from a total of 204 hospitals. Within each facility, HCPs from various departments were selected using simple random sampling. The EpiInfo 7 software's StatCalc tool was used to choose a total sample size of 1268 from an estimated 4482 HCP-PR from the eight hospitals. Compliance with COVID-19 PCP was assessed using a 3-point scale, ranging from one (Yes always) to three (No). Cronbach's alpha reliability coefficient was used to examine the statistical reliability of the variables in the dataset. Cronbach's alpha was 0.73 overall, suggesting strong reliability. Bartlett's test for equal variances was used for comparative analysis of health facility and overall mean COVID-19 PCP in different areas of health facilities. IBM SPSS (version 23) statistical software was used for the data analysis process.

Results

A total of 1268 HCP-PR participated in the survey, resulting in a 99.6% response rate. Findings reveal that 760 healthcare professionals who handle patients' records (HCP-PR), constituting 60%, consistently followed COVID-19 protocols in the registration and clinic preparation zones. Another 390 individuals (30.7%) adhered to these protocols occasionally, while 119 (9.4%) failed to comply. Similarly, in the filing area, 739 respondents (58.3%) consistently adhered to COVID-19 protocols, 358 (28.3%) occasionally did so, and 170 (13.4%) did not follow the protocols at all. Regarding handling health records cautiously, 540 participants (42.5%) always did, 448 (35.3%) did so sometimes, and 280 (22.2%) neglected these precautions. Additionally, 520 respondents (41.0%) consistently followed COVID-19 precautions when handling computers and other equipment, 393 (31.0%) did so occasionally, and 355 (28.0%) did not adhere to these precautions.

Conclusion

The majority of respondents showed good compliance with COVID-19 protocol in the registration and clinic preparation areas. However, in the filing area, just over four out of every seven respondents consistently adhered to COVID-19 PCP. Additionally, four out of every seven participants did not comply with COVID-19 PCP when handling patients' records. Analysis reveals diverse adherence to COVID-19 PCP, and statistical tests show variable performance, highlighting standout health facilities.

Effects of Sadness and Fear on Moral Judgments in Public Emergency Events

With the rapid development of society and the deteriorating natural environment, there has been an increase in public emergencies. This study aimed to explore how sadness and fear in the context of public emergencies influence moral judgments. This research first induced feelings of sadness and fear by using videos about public emergencies and music, and then used moral scenarios from the CNI model (C parameter: sensitivity to consequences; N parameter: sensitivity to norms; I parameter: general preference for inaction) to assess participants' moral thinking. In Study 1, participants were divided into a sadness group and a neutral group, while in Study 2, participants were divided into a fear group and a neutral group. During the experiment, participants were exposed to different videos related to public emergencies to induce the corresponding emotions, and emotional music was continuously played throughout the entire experiment. Participants were then asked to answer questions requiring moral judgments. The results showed that based on the CNI model, sadness induced in the context of public emergencies significantly increased the C parameter, without affecting the N or I parameters. Fear increased the I parameter, without affecting the C or I parameters. That is, sadness and fear induced in the context of a public emergency can influence moral judgments. Specifically, sadness increases individuals' sensitivity to consequences and fear increases the general preference for inaction in moral judgments.

Anxiety and Depression Symptoms Among Young U.S. Essential Workers During the COVID-19 Pandemic

OBJECTIVE

Emerging cross-sectional data indicate that essential workers in the COVID-19 era face increased mental health risks. This study longitudinally examined clinical symptoms of generalized anxiety disorder, depression, and posttraumatic stress disorder (PTSD) among U.S. essential workers, including health care workers and workers in indispensable occupations such as manufacturing, food industry, construction, transportation, hospitality, and emergency services, during the COVID-19 pandemic. The authors anticipated high symptom levels and greater symptom severity among women versus men and among younger adults compared with older adults. Analyses also explored the association between COVID-19 vaccination status and clinical symptoms.

METHODS

This four-wave online survey study assessed clinical symptoms in a convenience sample of 4,136 essential workers at baseline and 14, 30, and 90 days between August and December 2021. Symptoms of anxiety, depression, and PTSD were measured with the Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Primary Care PTSD Screen instruments, respectively.

RESULTS

At every time point, 74%-78% of respondents reported symptoms of anxiety and depression, which were highest among younger adults (ages 18-22 years), females, and transgender respondents. Vaccinated participants had slightly higher symptom levels than unvaccinated respondents. Rates of clinical symptoms did not change significantly over time.

CONCLUSIONS

Essential workers consistently reported symptoms of generalized anxiety, depression, or PTSD, especially younger adult, female, and transgender participants. The overwhelming and unprecedented nature of the COVID-19 pandemic underscores the need to offer mental health care to essential workers, especially those in these subgroups. Employers and administrators should support and proactively encourage employees to access care when needed.

Ethical uncertainty and COVID-19: exploring the lived experiences of senior physicians at a major medical centre

Given the wide-reaching and detrimental impact of COVID-19, its strain on healthcare resources, and the urgent need for-sometimes forced-public health interventions, thorough examination of the ethical issues brought to light by the pandemic is especially warranted. This paper aims to identify some of the complex moral dilemmas faced by senior physicians at a major medical centre in Saudi Arabia, in an effort to gain a better understanding of how they navigated ethical uncertainty during a time of crisis. This qualitative study uses a semistructured interview approach and reports the findings of 16 interviews. The study finds that participants were motivated by a profession-based moral obligation to provide care during the toughest and most uncertain times of the pandemic. Although participants described significant moral dilemmas during their practice, very few identified challenges as ethical in nature, and in turn, none sought formal ethics support. Rather, participants took on the burden of resolving ethical challenges themselves-whenever possible-rationalising oft fraught decisions by likening their experiences to wartime action or by minimising attention to the moral. In capturing these accounts, this paper ultimately contemplates what moral lessons can, and must be, learnt from this experience.

Mental Health Risk Factors Related to COVID-19 among Canadian Public Safety Professionals

Public safety personnel (PSP) are known to experience difficult and demanding occupational environments, an environment that has been complicated by the COVID-19 pandemic. Firefighters, paramedics, and public safety communicators were among the front-line workers that continued to serve the public throughout the course of the pandemic. The present study considered the potential impacts of the COVID-19 pandemic on self-reported symptoms of mental health challenges in Canadian firefighters, paramedics, and public safety communicators. Participants were firefighters (n = 123), paramedics (n = 246), and public safety communicators (n = 48), who completed an online survey, including demographics, questions related to COVID-19 exposure and worry, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Social Interaction Phobia Scale, and the Posttraumatic Stress Disorder Checklist-5. Results revealed that risk factors for increased mental health symptom reporting were paramedic occupation, self-identified female, younger in age, COVID-19 personal contact, requirement to self-isolate, and self-perception of COVID-19 contraction (without confirmation through testing). The COVID-19 pandemic should be considered a risk factor for increased mental health symptom reporting in PSP.

Adaptive response of Italian young adults with autism to the COVID-19 pandemic: A longitudinal study

The COVID-19 pandemic has represented a hazardous situation for individuals with Autism Spectrum Disorder (ASD) and their families. The difficulties, following the COVID-19-derived lockdown, have involved working from home or loss of employment, and the demands of looking after their children without the daily support of specialists. The aim of this study was to evaluate the adaptive behaviour of young adult participants with ASD after the enforcement of lockdown measures in March 2020 in a specialised centre in central Italy, by administering the Italian form of the Vineland Adaptive Behaviour Scales Second Edition (VABS-II), at baseline as well as 6 months and 1 year after the lockdown. Participants with ASD who were not able to access their normal, in-person care - they were only followed at a distance (i.e. telehealth) - declined dramatically in their adaptive behaviour during the first months after the lockdown for some VABS-II dimensions such as the socialisation and daily living domains. The effects of the lockdown on adaptive behaviour remained after 1 year. Our results emphasise the need for immediate, continuous and personal support for people with ASD during and after the restrictions caused by the COVID-19 pandemic, in order to ensure at least partial recovery of adaptive functioning.

Face masks drive increased rational decision-making

Face masks play a pivotal role in the control of respiratory diseases, such as the novel coronavirus (COVID-19). Despite their widespread use, little is known about how face masks affect human social interaction. Using unique experimental data collected early on in the pandemic, we investigate how facial occlusion by face masks alters socio-economic exchange. In a behavioral economics study (N = 481), individuals accepted more monetary offers and lower offer amounts when interacting with a masked versus unmasked opponent. Importantly, this effect was mainly driven by faces covered with surgical masks relative to bandana-type masks. In the first weeks of mask use during the COVID-19 pandemic, motive attributions further moderated this effect: Participants who believed that mask wearers were seeking to protect others showed the highest acceptance rates. Overall, we describe a new phenomenon, the face-mask effect on socio-economic exchange, and show that it is modulated by contextual factors.

Navigating Pandemic Moral Distress at Home and at Work: Frontline Workers' Experiences

Background: During the COVID-19 pandemic, frontline workers faced a series of challenges balancing family and work responsibilities. These challenges included making decisions about how to reduce COVID-19 exposure to their families while still carrying out their employment duties and caring for their children. We sought to understand how frontline workers made these decisions and how these decisions impacted their experiences.Methods: Between October 2020 and May 2021, we conducted 61 semi-structured interviews in English or Spanish, with individuals who continued to work outside of the home during the pandemic and had children living at home. Interviews were recorded, transcribed verbatim, and analyzed using abductive methods.Results: Frontline workers experienced moral distress, the inability to act in accordance with their values and obligations because of internal or external constraints. Their moral distress was a result of the tensions they felt as workers and parents, which sometimes led them to feel like they had to compromise on either or both responsibilities. Individuals felt morally conflicted because 1) their COVID-19 work exposures presented risk that often jeopardized their family's health; 2) their work hours often conflicted with their increased childcare responsibilities; and 3) they felt a duty to their colleagues, patients/customers, and communities to continue to show-up to work.Conclusions: Our findings point to a need to expand the concept of moral distress to include the perspectives of frontline workers outside of the healthcare professions and the fraught decisions that workers make outside of work that may impact their moral distress. Expanding the concept of moral distress also allows for a justice-based framing that can focus attention on the disparities inherent in much frontline work and can justify programmatic recommendations, like increasing paid childcare opportunities, to alleviate moral distress.

Destigmatising mental health treatment and increasing openness to seeking treatment: randomised controlled trial of brief video interventions

BACKGROUND

Despite an elevated risk of psychopathology stemming from COVID-19-related stress, many essential workers stigmatise and avoid psychiatric care. This randomised controlled trial was designed to compare five versions of a social-contact-based brief video intervention for essential workers, differing by protagonist gender and race/ethnicity.

AIMS

We examined intervention efficacy on treatment-related stigma ('stigma') and openness to seeking treatment ('openness'), especially among workers who had not received prior mental healthcare. We assessed effectiveness and whether viewer/protagonist demographic concordance heightened effectiveness.

METHOD

Essential workers (N = 2734) randomly viewed a control video or brief video of an actor portraying an essential worker describing hardships, COVID-related anxiety and depression, and psychotherapy benefits. Five video versions (Black/Latinx/White and male/female) followed an identical 3 min script. Half the intervention group participants rewatched their video 14 days later. Stigma and openness were assessed at baseline, post-intervention, and at 14- and 30-day follow-ups. Trial registration: NCT04964570.

RESULTS

All video intervention groups reported immediately decreased stigma (P < 0.0001; Cohen's d = 0.10) and increased openness (P < 0.0001; d = 0.23). The initial increase in openness was largely maintained in the repeated-video group at day 14 (P < 0.0001; d = 0.18), particularly among viewers without history of psychiatric treatment (P < 0.0001; d = 0.32). Increases were not sustained at follow-up. Female participants viewing a female protagonist and Black participants viewing a Black protagonist demonstrated greater openness than other demographic pairings.

CONCLUSIONS

Brief video-based interventions improved immediate stigma and openness. Greater effects among female and Black individuals viewing demographically matched protagonists emphasise the value of tailored interventions, especially for socially oppressed groups. This easily disseminated intervention may proactively increase care-seeking, encouraging treatment among workers in need. Future studies should examine intervention mechanisms and whether linking referrals to psychiatric services generates treatment-seeking.

Ethical Challenges Experienced by Healthcare Workers Delivering Clinical Care during Health Emergencies and Disasters: A Rapid Review of Qualitative Studies and Thematic Synthesis

Background: The COVID-19 pandemic has posed several ethical challenges worldwide. Understanding care providers' experiences during health emergencies is key to develop comprehensive ethical guidelines for emergency and disaster circumstances.Objectives: To identify and synthetize available empirical data on ethical challenges experienced by health care workers (HCWs) providing direct patient care in health emergencies and disaster scenarios that occurred prior to COVID-19, considering there might be a significant body of evidence yet to be reported on the current pandemic.Methods: A rapid review of qualitative studies and thematic synthesis was conducted. Medline and Embase were searched from inception to December 2020 using "public health emergency" and "ethical challenges" related keywords. Empirical studies examining ethical challenges experienced by frontline HCWs during health emergencies or disasters were included. We considered that ethical challenges were present when participants and/or authors were uncertain regarding how one should behave, or when different values or ethical principles are compromised when making decisions.Outcome: After deduplication 10,160 titles/abstracts and 224 full texts were screened. Twenty-two articles were included, which were conducted in 15 countries and explored eight health emergency or disaster events. Overall, a total of 452 HCWs participants were included. Data were organized into five major themes with subthemes: HCWs' vulnerability, Duty to care, Quality of care, Management of healthcare system, and Sociocultural factors.Conclusion: HCWs experienced a great variety of clinical ethical challenges in health emergencies and disaster scenarios. Core themes identified provide evidence-base to inform the development of more comprehensive and supportive ethical guidelines and training programmes for future events, that are grounded on actual experiences of those providing care during emergency and disasters.

Emergency methods, moral dilemma and coping styles among frontline nurses: an explorative study during the COVID-19 pandemic

Background

Coronavirus disease 2019 (COVID-19) pandemic has greatly impacted China, especially the emergency services since 2020. For many, it raises unique ethical dilemmas, including psychological, moral, social, and economic issues, especially among frontline health workers.

Methods

We explored the moral dilemmas of two groups of frontline nurses during the pandemic through online questionnaires and the Corley Moral Distress Scale. We then investigated the effect of proper anti-epidemic emergency measures on alleviating moral dilemmas and improving their coping styles by exploring questions on anti-epidemic measures implemented.

Results

The average score of all the nurses’ moral dilemmas was 131.27±14.52. They encountered many moral dilemmas during the pandemic. The frontline nurses’ scores indicated more negative coping styles in the first group before systematic preparedness measures were in place.

Conclusions

This study suggests that the “Chinese emergency methods”, a set of epidemic preparedness protocols and guidelines may affect the frontline nurses in reducing moral dilemmas and improving their coping styles.

Stress and Emotional Intelligence Shape Giving Behavior: Are There Different Effects of Social, Cognitive, and Emotional Stress?

Acute stress has been linked with prosocial behavior, yet it is entirely unexplored how different types of stressors may affect individuals’ willingness to help: This is particularly relevant while people is experiencing multiple sources of stress due to the COVID-19 pandemic. Here we explore whether different types of stress influence peoples’ giving behavior and the moderating role of emotional intelligence (EI). Undergraduate students were exposed to experimentally induced social, cognitive, or emotional stress and were asked to self-report on their willingness to help and donate to a charity raising funds for COVID-19 and flu patients. Results showed that when compared to a control condition, after being exposed to a social stress, participants were more willing to help a person in need. Our results also provide evidence that, after experiencing a social stress, participants with high (vs low) trait EI were more willing to help, and, as a result, donated more. Findings indicate that moderate levels of distress are associated with increased donations. Interestingly, when stress is not too threatening, high EI can regulate it and promote prosocial behaviors.

Meat in a Seat: A Grounded Theory Study Exploring Moral Injury in Canadian Public Safety Communicators, Firefighters, and Paramedics

The work of public safety personnel (PSP) is inherently moral; however, the ability of PSP to do what is good and right can be impeded and frustrated, leading to moral suffering. Left unresolved, moral suffering may develop into moral injury (MI) and potential psychological harm. The current study was designed to examine if MI is relevant to frontline public safety communicators, firefighters, and paramedics. Semi-structured interviews (n = 3) and focus groups (n = 3) were conducted with 19 participants (public safety communicators (n = 2); paramedics (n = 7); and firefighters (n = 10)). Interviews and focus groups were audio-recorded, transcribed, coded, and constantly compared in accordance with the grounded theory method. A conceptual theory of "frustrating moral expectations" emerged, with participants identifying three interrelated properties as being potentially morally injurious: chronic societal problems, impaired systems, and organizational quagmires. Participants navigated their moral frustrations through both integrative and disintegrative pathways, resulting in either needing to escape their moral suffering or transforming ontologically. The current study results support MI as a relevant concept for frontline PSP. Given the seriousness of PSP leaving their profession or committing suicide to escape moral suffering, the importance of the impact of MI on PSP and public safety organizations cannot be ignored or underestimated. Understanding the similarities and differences of morally injurious exposures of frontline PSP may be critical for determining mental health and resilience strategies that effectively protect PSP.

Moral Decision-Making in Healthcare and Medical Professions During the COVID-19 Pandemic

With the coronavirus disease 2019 (COVID-19) outbreak, healthcare and medical professions face challenging situations. The high number of COVID-19 infected patients, scarce resources, and being vulnerable to the infection are among the reasons that may influence clinicians’ moral decision-making. Furthermore, healthcare workers may be carriers of coronavirus, resulting in their social interactions to involve moral decision-making. This study aimed to investigate the effect of working in the frontline on psychological and cognitive factors and how these factors influence moral decision-making in clinicians during the pandemic. Further, we evaluated the impact of these factors on compliance with social distancing. Clinicians who worked in hospitals allocated to coronavirus disease patients participated in our study. We designed an online survey containing eight dilemmas to test moral decision-making in clinicians. Information on clinicians’ behavior and psychological state during the COVID-19 pandemic including the degree of respect to social distancing, sources of stress, and dead cases of COVID-19 they confronted with were collected. First, the relation between these measures and moral decision-making was assessed. Next, we used multiple regression analysis to evaluate the degree to which these factors can predict variances in morality. Based on our results, clinicians’ most important source of stress was the infection of their families. Stress, estimated chance of self-infection, job satisfaction, and age predicted utilitarian behavior among them. Moreover, age, number of death cases of COVID-19 they confronted, perceived risk of infection, and stress were positively correlated to compliance with social distancing. Our results have critical implications in implementing policies for healthcare principals.

Challenges facing essential workers: a cross-sectional survey of the subjective mental health and well-being of New Zealand healthcare and 'other' essential workers during the COVID-19 lockdown

OBJECTIVES

To compare psychological outcomes, experiences and sources of stress over the COVID-19 lockdown in New Zealand in essential workers (healthcare and 'other' essential workers) with that of workers in nonessential work roles.

DESIGN

Online cross-sectional survey.

SETTING

Conducted in New Zealand over level 4 lockdown in April/May 2020.

PARTICIPANTS

Findings from employed participants (2495) are included in this report; 381 healthcare workers, 649 'other' essential workers and 1465 nonessential workers.

PRIMARY AND SECONDARY OUTCOME MEASURES

Measures included psychological distress (Kessler Psychological Distress Scale (K10)), anxiety (Generalised Anxiety Disorder (GAD-7)), well-being (WHO-5), alcohol use, subjective experiences and sources of stress. Differences between work categories were quantified as risk ratios or χ² tests.

RESULTS

After controlling for confounders that differed between groups of essential and nonessential workers, those in healthcare and those in 'other' essential work were at 71% (95% CI 1.29 to 2.27) and 59% (95% CI 1.25 to 2.02) greater risk respectively, of moderate levels of anxiety (GAD-7 ≥10), than those in nonessential work. Those in healthcare were at 19% (95% CI 1.02 to 1.39) greater risk of poor well-being (WHO-5 <13). There was no evidence of differences across work roles in risk for psychological distress (K10 ≥12) or increased alcohol use. Healthcare and 'other' essential workers reported increased workload (p<0.001) and less uncertainty about finances and employment than those in nonessential work (p<0.001). Healthcare and nonessential workers reported decreased social contact. No difference by work category in health concerns was reported; 15% had concerns about participants' own health and 33% about other people's health.

CONCLUSIONS

During the pandemic lockdown, essential workers (those in healthcare and those providing 'other' essential work) were at increased risk of anxiety compared with those in nonessential work, with those in healthcare also being at increased risk of poor well-being. This highlights the need to recognise the challenges this vital workforce face in pandemics.

Staff Experiences at a New York City Medical Center During the Spring Peak of the Covid-19 Pandemic: A Qualitative Study

Purpose

In March-April 2020, New York City was overwhelmed by COVID-19 infections, leading to substantial disruptions in nearly all aspects of care and operations at most local hospitals. This qualitative study of a quaternary, urban oncology hospital investigated the effects of these disruptions upon a professionally diverse cohort of its employees, including physicians, nurses, respiratory therapists, pharmacists, security guards, histology technicians, and environmental services workers.

Methods

The participant pool were selected through a combination of purposive and random sampling methodology and coders performed a thematic content analysis of open-ended responses.

Results

Analysis revealed several important themes, including concerns about exposure for self and others; patient care as a source of both satisfaction and stress; psychological consequences of uncertainty and ambiguity; family as sources of both comfort and apprehension; the importance of adequate institutional communication; and support from colleagues.

Conclusion

Results and analysis provide suggestions for institutional policies and initiatives in the event of a COVID-19 surge or another public health crisis. Administrative efforts should aspire to establish, strengthen, and promote interdisciplinary and interdepartmental efforts to address, and mitigate workplace and personal stressors. through timely and transparent communications, consistent clinical guidance and information about changes in hospital policies and supplemental employee assistance.

A Model of Stress Change under the First COVID-19 Pandemic among the General Public in Japanese Major Cities and Rural Areas

Research on stress related to the COVID-19 pandemic has been dominated by the cases of healthcare workers, students, patients, and their stress during the COVID-19 pandemic. This study examined the relationship between the amount of stress change under the COVID-19 pandemic and demographic factors (age, sex, occupation, etc.) in residents of a large city and a rural area of Japan. A total of 1331 valid responses were received in June 2020 from residents of Tokyo, Osaka, and Nagano registered with a private research firm. We were able to identify 15 statistically significant variables out of 36 explanatory variables, which explained the significant increase in stress compared to the pre-pandemic period. Multiple-factor analysis showed that the relationship with people is a more significant explanatory variable for the level of increase in stress than the difference in environment between big cities (Tokyo, Osaka) and rural areas (Nagano), the type of housing, and the decrease in income compared to the pre-pandemic period.