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Heo J, Lee J, Cho H, Cho J, Kang D. Relationship between qualitative and quantitative loneliness and suicidal ideation by occupational classification in the working-age population: a nationally-representative survey. BMC Public Health 2024; 24:2708. [PMID: 39367353 PMCID: PMC11452977 DOI: 10.1186/s12889-024-20219-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 09/27/2024] [Indexed: 10/06/2024] Open
Abstract
BACKGROUND Rising digitalization and individualism in the workplace after the COVID-19 pandemic have increased loneliness and related problems in the working-age population. The potential effects of various forms of loneliness on suicidal ideation may differ depending on employment status. METHOD This is a cross-sectional study based on a national survey of mental health in the general Korean population. We classified occupations as "employed," "self-employed," or "unemployed." Loneliness was assessed using the UCLA Loneliness Scale, which measures both qualitative and quantitative aspects of loneliness. Suicidal ideation was evaluated using the Patient Health Questionnaire-9. RESULTS A total of 1770 participants aged 30-65 years (mean age: 47.7 years) were included. The mean loneliness score was 43.9 (SD = 10.4), and 28% of the participants experienced a high level of loneliness. The prevalence ratio for suicidal ideation in the group with high levels of loneliness was 3.06 (95% CI 2.57, 3.63) compared to the group with low levels of loneliness. In our subgroup analysis, we consistently observed an association between loneliness and suicidal ideation across the employed group; however, the employed was more related with qualitative loneliness, the self-employed and the unemployed were more related with quantitative loneliness. CONCLUSIONS Loneliness was associated with suicidal ideation. According to employment status, the associations were consistent, but there were interactions between type of loneliness and employment status. These findings suggest that interventions to reduce loneliness and prevent suicidal ideation should be tailored to specific employment groups, focusing on qualitative aspects for employed individuals and quantitative aspects for self-employed and unemployed individuals.
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Affiliation(s)
- Jihye Heo
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, 115 Irwon-ro, Gangnam-gu, Seoul, 06355, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
| | - Jin Lee
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, 115 Irwon-ro, Gangnam-gu, Seoul, 06355, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
| | - Hyunjin Cho
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
- International Healthcare Center, Samsung Medical Center, Seoul, South Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, 115 Irwon-ro, Gangnam-gu, Seoul, 06355, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, 115 Irwon-ro, Gangnam-gu, Seoul, 06355, Republic of Korea.
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea.
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Park K, Chang H, Hong JP, Kim MH, Park S, Jung JY, Kim D, Hahm BJ, An JH. The Effect of Time Spent on Online Gaming on Problematic Game Use in Male: Moderating Effects of Loneliness, Living Alone, and Household Size. Psychiatry Investig 2024; 21:181-190. [PMID: 38433417 PMCID: PMC10910165 DOI: 10.30773/pi.2023.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 10/25/2023] [Accepted: 12/01/2023] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the association between gaming time and problematic game use (PGU) within a large sample of Korean male gamers and to examine the potential moderating effects of loneliness, living alone, and household size. METHODS This study employed data from 743 male gamers from the National Mental Health Survey 2021, a nationally representative survey of mental illness conducted in South Korea. Self-reported data on the average gaming time per day, severity of PGU, loneliness, living alone, and household size were used. RESULTS Gaming time was positively associated with PGU and this relationship was significantly moderated by loneliness such that the positive effect of gaming time on PGU was greater when the levels of loneliness were high. The three-way interaction effect of gaming time, loneliness, and living alone was also significant, in that the moderating effect of loneliness on the relationship between gaming time and PGU was significant only in the living alone group. However, household size (i.e., number of housemates) did not moderate the interaction between gaming time and loneliness among gamers living with housemates. CONCLUSION These results suggest the importance of considering loneliness and living arrangements of male gamers, in addition to gaming time, in identifying and intervening with individuals at heightened risk of PGU.
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Affiliation(s)
- Kyeongwoo Park
- Department of Psychology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hyein Chang
- Department of Psychology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Samsung Medical Center, Seoul, Republic of Korea
| | - Myung Hyun Kim
- Department of Psychiatry, Samsung Medical Center, Seoul, Republic of Korea
| | - Sohee Park
- Department of Psychiatry, Samsung Medical Center, Seoul, Republic of Korea
| | - Jin Young Jung
- Department of Psychiatry, Samsung Medical Center, Seoul, Republic of Korea
| | - Dahae Kim
- Department of Psychiatry, Samsung Medical Center, Seoul, Republic of Korea
| | - Bong-Jin Hahm
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Hyun An
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Samsung Medical Center, Seoul, Republic of Korea
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Tesen H, Konno Y, Tateishi S, Mafune K, Tsuji M, Ando H, Nagata T, Matsugaki R, Yoshimura R, Fujino Y. A Cross-sectional Study on the Impact of Unfair Treatment Associated With COVID-19 Infection and Psychological Distress in Japanese Workers. J Occup Environ Med 2024; 66:51-55. [PMID: 37853631 DOI: 10.1097/jom.0000000000002994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Psychological distress is commonly reported sequela in COVID-19-infected people. We investigated the association between experiencing COVID-19 infection and psychological distress in Japan. METHOD A total of 14,901 persons who participated in a follow-up survey in December 2022 were included in the analysis. Odds ratios and regression coefficients were estimated by statistical analysis, with history of COVID-19 infection as the independent variable and presence of psychological distress as the dependent variable. RESULT Experiencing COVID-19 infection was associated with psychological distress. In a model adjusted for "feeling treated unfairly," the association between infection experience and a high K6 score was significantly attenuated. CONCLUSIONS The results showed that the experience of COVID-19 infection is associated with psychological distress. Moreover, most cases of psychological distress among those who experienced COVID-19 infection can be at least partly explained by a perception of unfair treatment.
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Affiliation(s)
- Hirofumi Tesen
- From the Department of Psychiatry, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan (H.T., Y.K., R.Y.); Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan (Y.K., Y.F.); Department of Occupational Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan (S.T.); Department of Mental Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan (K.M.); Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan (M.T.); Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan (H.A.); Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan (T.N.); and Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan (R.M.)
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Pezirkianidis C, Parpoula C, Athanasiades C, Flora K, Makris N, Moraitou D, Papantoniou G, Vassilopoulos S, Sini M, Stalikas A. Individual Differences on Wellbeing Indices during the COVID-19 Quarantine in Greece: A National Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7182. [PMID: 38131733 PMCID: PMC10742746 DOI: 10.3390/ijerph20247182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
The impact of COVID-19 and the associated lockdown measures on people's physical and mental wellbeing, as well as their daily lives and functioning, has been extensively studied. This study takes the approach of investigating the consequences of COVID-19 on a national scale, considering sociodemographic factors. The main objective is to make a contribution to ongoing research by specifically examining how age, gender, and marital status influence the overall impact of COVID-19 and wellbeing indicators during the second lockdown period that was implemented in response to the COVID-19 pandemic in the Greek population. The study involved a sample of 16,906 individuals of all age groups in Greece who completed an online questionnaire encompassing measurements related to personal wellbeing, the presence and search for meaning in life, positive relationships, as well as symptoms of depression, anxiety, and stress. Additionally, to gauge the levels of the perceived COVID-19-related impact, a valid and reliable scale was developed. The results reveal that a higher perception of COVID-19 consequences is positively associated with psychological symptoms and the search for meaning in life, while being negatively correlated with personal wellbeing and the sense of meaning in life. In terms of individual differences, the findings indicate that unmarried individuals, young adults, and females tend to report higher levels of psychological symptoms, a greater search for meaning in life, and a heightened perception of COVID-19-related impact. These findings are analyzed in depth, and suggestions for potential directions for future research are put forth.
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Affiliation(s)
- Christos Pezirkianidis
- Laboratory of Positive Psychology, Department of Psychology, Panteion University of Social & Political Sciences, Syggrou Ave. 136, 17671 Athens, Greece; (M.S.); (A.S.)
| | - Christina Parpoula
- Department of Psychology, Panteion University of Social & Political Sciences, Syggrou Ave. 136, 17671 Athens, Greece;
| | - Christina Athanasiades
- Department of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (C.A.); (D.M.)
| | - Katerina Flora
- Department of Psychology, University of Western Macedonia, 50100 Kozani, Greece;
| | - Nikolaos Makris
- Department of Primary Education, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Despina Moraitou
- Department of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (C.A.); (D.M.)
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center, Aristotle University of Thessaloniki, 10th km Thessaloniki-Thermi, 54124 Thessaloniki, Greece;
| | - Georgia Papantoniou
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center, Aristotle University of Thessaloniki, 10th km Thessaloniki-Thermi, 54124 Thessaloniki, Greece;
- Laboratory of Psychology, Department of Early Childhood Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Stephanos Vassilopoulos
- Department of Educational Sciences and Social Work, University of Patras, 26110 Patras, Greece;
| | - Maria Sini
- Laboratory of Positive Psychology, Department of Psychology, Panteion University of Social & Political Sciences, Syggrou Ave. 136, 17671 Athens, Greece; (M.S.); (A.S.)
| | - Anastassios Stalikas
- Laboratory of Positive Psychology, Department of Psychology, Panteion University of Social & Political Sciences, Syggrou Ave. 136, 17671 Athens, Greece; (M.S.); (A.S.)
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Fujino Y, Okawara M, Hino A, Muramatsu K, Nagata T, Ikegami K, Tateishi S, Tsuji M, Ishimaru T. Workplace infection control measures and romantic activities of workers during COVID-19 pandemic: A prospective cohort study in Japan. Front Public Health 2023; 11:1113183. [PMID: 36875420 PMCID: PMC9978820 DOI: 10.3389/fpubh.2023.1113183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/26/2023] [Indexed: 02/18/2023] Open
Abstract
Objective Due to the COVID-19 pandemic, non-married people are at high risk of loneliness. With social interactions restricted, it is important for non-married people to acquire a new romantic partner for their mental health and quality of life. We hypothesized that infection control efforts in the workplace influence people's social interactions, including romantic activities. Methods We conducted an internet-based prospective cohort study from December 2020 (baseline) to December 2021, using self-administered questionnaires. Briefly, 27,036 workers completed the questionnaires at baseline, and when followed up after 1 year, 18,560 (68.7%) participated. A total of 6,486 non-married individuals with no romantic relationship at baseline were included in the analysis. At baseline they were asked about the implementation of infection control measures in the workplace, and at follow-up they were asked about activities they performed with a view to romantic relationships during the period from baseline to follow-up. Results Compared to workers in workplaces with no infection control measures, the odds ratio (OR) associated with romance-related activities for those in workplaces with seven or more infection control measures was 1.90 (95% CI: 1.45-2.48, p < 0.001), and the OR associated with having a new romantic partner was 1.79 (95% CI: 1.20-2.66, p = 0.004). Discussion Under the COVID-19 pandemic, the implementation of infection control measures in the workplace and the expressed satisfaction with those measures promoted romantic relationships among non-married, single individuals.
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Affiliation(s)
- Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Makoto Okawara
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Ayako Hino
- Department of Mental Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Tomohisa Nagata
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Kazunori Ikegami
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Seiichiro Tateishi
- Disaster Occupational Health Center, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Mayumi Tsuji
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Tomohiro Ishimaru
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
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Ikenouchi A, Fujino Y, Matsugaki R, Mafune K, Ando H, Nagata T, Tateishi S, Yoshimura R, Tsuji M. The effects of telecommuting and family cohabiting situation on psychological distress in Japanese workers during the COVID-19 pandemic: A cross-sectional study. J Occup Health 2023; 65:e12391. [PMID: 36823751 PMCID: PMC9950352 DOI: 10.1002/1348-9585.12391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/24/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE This study aimed to determine whether telecommuting's impact on psychological distress differed depending on the status of workers' cohabiting family members during the COVID-19 pandemic. METHODS We collected data from 33 302 workers in Japan through an Internet survey, and included 27 036 valid responses in the analysis. The survey included items on family cohabitation and telecommuting status during the COVID-19 pandemic. We assessed workers' psychological distress using the Kessler 6. RESULTS The psychological distress odds ratios (ORs) were higher for participants who lived with family members requiring care (OR = 1.38, P < .001), and lower for participants living with preschool children (OR = 0.77, P < .001) or a spouse (OR = 0.80, P < .001). Furthermore, odds ratios were higher for participants who worked from home and lived with family members requiring care or preschool children (OR = 1.52, P = .002; OR = 1.28, P = .028). Stratified by the presence or absence of family members living with them, psychological distress was higher for telecommuters with family members requiring care, preschool children, or elementary school children. CONCLUSION The association between telecommuting and psychological distress varies, depending on workers' living situation with family members.
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Affiliation(s)
- Atsuko Ikenouchi
- Medical Center for DementiaHospital of the University of Occupational and Environmental Health, JapanKitakyushuJapan
- Department of Psychiatry, School of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Yoshihisa Fujino
- Department of Environmental EpidemiologyInstitute of Industrial Ecological Sciences, University of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Ryutaro Matsugaki
- Department of Preventive Medicine and Community Health, School of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Kosuke Mafune
- Department of Mental HealthInstitute of Industrial Ecological Sciences, University of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Hajime Ando
- Department of Work Systems and HealthInstitute of Industrial Ecological Sciences, University of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Tomohisa Nagata
- Department of Occupational Health Practice and ManagementInstitute of Industrial Ecological Sciences, University of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Seiichiro Tateishi
- Disaster Occupational Health CenterInstitute of Industrial Ecological Sciences, University of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Reiji Yoshimura
- Department of Psychiatry, School of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Mayumi Tsuji
- Department of Environmental Health, School of MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
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Fujino Y, Okawara M, Hino A, Muramatsu K, Nagata T, Tateishi S, Tsuji M, Ogami A, Ishimaru T. A Prospective Cohort Study of Presenteeism and Increased Risk of Divorce Among Japanese Workers. J Occup Environ Med 2022; 64:e695-e699. [PMID: 35959895 PMCID: PMC9640257 DOI: 10.1097/jom.0000000000002670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We examined the association between the presenteeism and the risk of divorce among Japanese workers during the COVID-19 pandemic. METHODS A prospective study of 27,036 individuals was conducted starting in December 2020, with 18,560 (68.7%) participating in the follow-up in December 2021. The Work Functioning Impairment Scale (WFun) was used to measure the degree of work function impairment. RESULTS Compared with the group with the lowest WFun score, the odds ratio for the group with moderate WFun was 1.16 (95% confidence interval, 0.74 to 1.82; P = 0.525), and the odds ratio for the group with the highest WFun was 1.76 (95% confidence interval, 1.18 to 2.62; P = 0.006). CONCLUSIONS This study suggests that supporting workers with presenteeism has important implications not only from the perspective of labor productivity in management but also for the individual's quality of life in terms of family relationships.
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Miyake F, Odgerel CO, Hino A, Ikegami K, Nagata T, Tateishi S, Tsuji M, Matsuda S, Ishimaru T. Job stress and loneliness among desk workers during the COVID-19 pandemic in Japan: focus on remote working. Environ Health Prev Med 2022; 27:33. [PMID: 35965100 PMCID: PMC9425057 DOI: 10.1265/ehpm.22-00107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Previous studies have reported an increase in loneliness since the outbreak of coronavirus disease 2019 (COVID-19), but there are few data on the relationship between job stress and loneliness. This study aimed to assess the relationship between job stress and loneliness among desk workers, with a focus on the impact of remote working. Methods This study was part of the Collaborative Online Research on the Novel-coronavirus and Work (CORoNaWork) project in Japan. We extracted data from 13,468 workers who indicated that they were doing desk work. Loneliness was assessed using a single question and job stress was valuated using the Job Content Questionnaire (JCQ). Multiple logistic regression was performed. Results Participants who worked remotely 4 or more days per week were marginally more likely to report feeling lonely compared with those who did not work remotely (adjusted odds ratio = 1.23, 95% CI: 0.99–5.84, P = 0.066). Remote working did not explain the interaction between JCQ scale scores and loneliness. Among remote workers, the level of support provided by co-workers and supervisors was strongly associated with feelings of loneliness as well as non-remote workers (co-worker support: AOR = 4.06, 95% CI: 2.82–5.84, P < 0.001; supervisor support: AOR = 2.49, 95% CI: 1.79–3.47, P < 0.001). Conclusions To reduce loneliness and the risk of associated mental health problems, high-frequency remote workers should interact with supervisors and co-workers using the information and communication technology developed for this purpose.
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Affiliation(s)
- Fuyu Miyake
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
| | | | - Ayako Hino
- Department of Mental Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
| | - Kazunori Ikegami
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
| | - Tomohisa Nagata
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
| | - Seiichiro Tateishi
- Disaster Occupational Health Center, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
| | - Mayumi Tsuji
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Tomohiro Ishimaru
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
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