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Sasaki N, Kuroda R, Tsuno K, Kawakami N (2020). Fear, worry and workplace harassment
related to the COVID-19 epidemic among employees in Japan: prevalence and impact onmental and physical health. https://plaza.umin.ac.jp/heart/e-coco-j/01.shtml

Title: Fear, worry and workplace harassment related to the COVID-19 epidemic among
employees in Japan: prevalence and impact on mental and physical health
Short title: Workplace COVID-19 harassment and employees’ health
Authors (one academic degree)
Natsu Sasaki (MD), nasasaki-tky@umin.ac.jp
Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo,
Japan
Reiko Kuroda (MD), urk@ohs.adm.u-tokyo.ac.jp
Division for Environment, Health and Safety, the University of Tokyo, Tokyo, Japan
Kanami Tsuno (PhD), ktsuno-tky@umin.ac.jp
School of Health Innovation, Kanagawa University of Human Services, Kanagawa, Japan
Norito Kawakami* (MD), nkawakami@m.u-tokyo.ac.jp
Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo,
Japan
Corresponding author: Norito Kawakami (MD)Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo,Japan
7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, JAPANE-mail: nkawakami@m.u-tokyo.ac.jp
Telephone: +81-3-5841-3364, Fax: +81-3-5841-3392
Number of Tables: 3
Number of Figures: 0
Number of supplementary materials: 0
Conflict of Interest Disclosures: NK reports grants from Fujitsu LTD., SBAtWork Corp.,
personal fees from Occupational Health Foundation, Japan Dental Association, Sekisui
Chemicals, Junpukai Health Care Center, Osaka Chamber of Commerce and Industry, non-financial support from Japan Productivity Center, outside the submitted work.
Source(s) of support/funding: The sponsors had no role in the design and conduct of the study;
collection, management, analysis, and interpretation of the data; preparation, review, or
approval of the manuscript; and decision to submit the manuscript for publication.
Ethical issues :The research ethics committee of the Graduate School of Medicine and the Faculty of Medicine,
The University of Tokyo (No. 10856-(2))
Acknowledgements: N/A
Authors’ contributions: Dr. Sasaki and Dr. Kawakami had full access to all of the data in the
study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Sasaki, Kuroda, Tsuno, Kawakami.
Acquisition, analysis, or interpretation of data: Sasaki, Kawakami.
Drafting of the manuscript: Kawakami, Sasaki.
Critical revision of the manuscript for important intellectual content: Sasaki, Kuroda, Tsuno,
Kawakami.
Statistical analysis: Kawakami, Sasaki.
Administrative, technical, or material support: Sasaki.
Supervision: Kawakami.

Abstract
Background: The impact of fear, worry, and workplace harassment related to COVID-19 on employees’
mental has not been reported.
Methods: This was a cross-sectional study retrieving the sample from the cohort of full-time employees.
Participants (n=1,448) completed an online questionnaire on March 19-22, 2020. We explored thefrequency and examined whether fear, worry and workplace harassment related to COVID-19 had
effects on employees’ psychological distress and physical symptoms.
Results: Among 1,421 respondents, 80% had global fear or worry. One of 50 respondents (2.3%) had
experienced workplace harassment related to COVID-19. Most of the fear and worry, and some
workplace harassment were weakly but significantly associated with psychological distress and physicalsymptoms. Significant predictors of high global fear and worry about COVID-19 were being female,having at least one child, and having any chronic physical condition.
Conclusions: This study showed a high prevalence of fear, worry, and workplace harassment related to
COVID-19 in Japan.
Word count: 150 words
Keywords: COVID-19, discrimination, occupational health, SARS-CoV-2, stigma.

INTRODUCTION
The Coronavirus (COVID-19) epidemic started in Wuhan, China, in late 2019 (1) and quickly spread tomost countries in the world. While many countries took community-based measures to prevent the
epidemic, occupational safety and health are also important (2). It has been suggested that the COVID19 epidemic could increase psychological stress in the community (3-6). This stress could be due to fearof COVID-19 infection (3, 6), and also to harassment and discrimination (7, 8). However, the prevalenceof fear, worry and workplace harassment related to COVID-19, as well as their impact on employees’
mental and physical health has gone unreported. This cross-sectional study investigated the prevalenceof fear and worry and workplace harassment related to COVID-19 at the early stage of the COVID-19
outbreak (March 19-22, 2020) and their association with psychological distress and physical symptoms
among employees in Japan. While we already reported the proportion of implemented workplacemeasures (9) and their association with fear/worry related to COVID-19 and psychological distress andphysical symptoms (10) using the same dataset, we first reported the findings focusing fear and worry
and workplace harassment related to COVID-19 and their impact on mental and physical health of
employees.

METHODSThis was a cross-sectional study of participants of a previous baseline survey conducted in February
2019. Self-reported questionnaire data was collected from 4,120 full-time employees invited from morethan 500,000 pre-registered members of an Internet survey company. Following approval by the research
ethics committee of the Graduate School of Medicine and the Faculty of Medicine, The University ofTokyo (No. 10856-(2)), we conducted an online survey of the baseline respondents from 19 to 22 March
2020 (9, 10).
Using a self-report questionnaire, we assessed respondents’ sociodemographic characteristics andfear/worry about COVID-19. Global fear and worry over COVID-19 were measured by asking “Do you
feel anxiety over COVID-19?” Responses were scored along a 6-point Likert-type scale (ranging from
1 “Not at all” to 6 “Feel strongly”) that was dichotomized into high (4 or higher) and low (3 or less). An
additional 12 items asked about topic-specific fears and worries, with each item rated on a 4-point
Likert-type scale (ranging from 1 “Strongly disagree” to 4 “Strongly agree”). For the analysis, we used
only nine items: six items on fear or worry about COVID-19 infection and three items on job instability
caused by the epidemic. All items were selected based on preliminary factor analysis (Cronbach’s alphacoefficients, 0.815 and 0.718, respectively).
Workplace harassment related to COVID-19 (e.g., being the target of sarcastic comments) was
measured using five items, with each item rated “Yes” or “No.” Any workplace harassment related to
COVID-19 was defined if the respondent endorsed any of these items.
Psychological distress (lack of vigor, anger-irritability, fatigue, anxiety, depression) and physicalsymptoms in the last 30 days were evaluated using corresponding scales of the Brief Job Stress
Questionnaire (11), with higher scores indicating greater distress or more symptoms. Psychologicaldistress and physical symptoms were also assessed at baseline in 2019 and used as a control variable.

Announcement of measures taken by the company about the prevention of COVID-19 was asked
and dichotomized into “Yes” or “No.” Chronic physical conditions that might affect the severity andmortality (12-14) of COVID-19 were also asked. Information about sociodemographic and occupational
characteristics (gender, age, marital status, having at least one child, occupation, company size) was alsoelicited.
Standardized betas were calculated to evaluate the association of fears and worries and workplaceharassment with psychological distress and physical symptoms, adjusting for gender, age, marital status,
having at least one child, and occupational type (Model 1), and then for chronic physical conditions andpsychological distress or physical symptoms at baseline (Model 2) by using multiple regression analysis.
Factors associated with the global fear, worry about COVID-19 and workplace harassment wereanalyzed using the multiple logistic regression model (forced entry method). Statistical significance wasdefined as a two-sided p < 0.05. SPSS 26.0. Japanese version (IBM Corp., Armonk, NY, USA) was used.

RESULTSA total of 1,448 respondents (35.1%) completed the survey in 2020. We excluded unemployed
respondents (n = 27) so the final sample consisted of 1,421 respondents (TABLE 1). Scores of physicalsymptoms significantly but slightly decreased from baseline to the 2020 survey (p<0.001).
Approximately 80% of respondents reported strong or some global fear and worry about COVID-19(TABLE 2); 68% to 81% of respondents endorsed items of fear of infection, while 32% to 53% did
endorsed items pertaining to fear of infection and worry about job instability. The proportion of
respondents who reported any COVID-19 related workplace harassment was 2.3 %.
----------- Insert TABLE 1 and TABLE 2 here-----------

Global fear and worry about COVID-19 significantly correlated with psychological distress after
adjusting covariates (Model 2: standardized coefficient [β]=0.103, p<0.001) and with physicalsymptoms after adjusting for the baseline score of physical symptoms and chronic disease (Model 2: β=
0.091, p<0.001). Three of the six items and the sum score of fear and worry about infection significantly
and weakly correlated both with psychological distress and physical symptoms (Model 2: β=0.050 0.095); All three items and the sum score of fear and worry about job instability significantly correlatedwith psychological distress and physical symptoms (Model 2: β=0.060 - 0.118). Two of five items (i.e.,being the target of sarcastic comments, being harassed) were significantly but weakly correlated withphysical symptoms (Model 2: β=0.052, p=0.017; β=0.083, p<0.001).
Significant predictors of high global fear and worry about COVID-19 were being female (oddsratio [OR], 2.51; 95% CI, 1.87 – 3.36), having at least one child (OR, 1.47; 95% CI, 1.02 -2.11), andhaving any chronic physical condition (OR, 1.57; 95% CI 1.05 – 2.34) (TABLE 3). Having any chronic
condition was significantly associated with the workplace harassment (OR, 2.24; 95% CI 1.02 – 4.91).
----------- Insert TABLE 3 here-----------DISCUSSION
This cross-sectional study of employees of Japan showed that fear and worry related to COVID-19 was
extremely high, as reported before in the community samples (3, 6): Four out of five reported global
fear or worry, and more than two-third worried about the possibility of getting the infection. In addition,
more than 30% of respondents worried about instability of their job due to the epidemic of COVID-19.
The global fear and worry was more prevalent among females, those with having children, and thosewith chronic conditions that may affect the mortality from COVID-19. Also, the study found that a nonnegligible proportion (2.3%) of respondents experienced workplace harassment related to the COVID19. The workplace harassment was more prevalent among those with chronic physical conditions, butless among those with at least one child. Most fears of COVID-19 infection, worries about job instability
and workplace harassment were weakly but significantly associated with psychological distress or
physical symptoms. Occupational health professionals and primary care physicians need to be aware of
the widespread fear and worry, as well as workplace harassment related to COVID-19 that may affectthe mental and physical health of employees and patients. Employers should take appropriate action to
discourage workplace harassment over COVID-19.
Several limitations warrant discussion. Our study used a cross-sectional design and all
responses were self-reported. The sample was drawn from registered members of one survey company,
and the follow-up rate was low. Finally, respondents’ fear of infection, worry about employment
insecurity and workplace harassment may depend on their country, culture, and the severity of the
COVID-19 pandemic.

Word count: 1227 words.

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TABLE 1. Demographic characteristics of Japanese full-time employees and the scores of mental andphysical health in 2019 and 2020 (N = 1421).

N (%)
716 (50.4)

Mean (SD) [min - max]Male
Mean age
41.21 (10.5) [21 – 60]
Marital status
Single695 (48.9)
Married726 (51.1)
Having at least one childNone
825 (58.1)
Yes
596 (41.9)
Company size>500 employees
577 (40.6)<500 employees
844 (59.4)
Occupational typeManagers
126 (8.9)
Non-manual892 (62.8)
Manual403 (28.4)
Measures taken by the company
1135 (79.9)
for prevention of COVID-19 (any)Chronic physical conditions (any) †241 (17.0)
Mental and physical health‡
Psychological distress in 201941.23 (11.4) [18 - 72]
Psychological distress in 2020
41.16 (11.4) [18 - 72]
Physical symptoms in 201919.97 (6.5) [11 - 44]
Physical symptoms in 2020
19.22 (6.3) [11 - 44]† Chronic physical conditions included hypertension, diabetes, heart disease (e.g., angina, heart failure),
cerebrovascular disease (e.g., cerebral infarction, cerebral hemorrhage), cancer, malignant neoplasm,
respiratory disease, liver disease, kidney disease, and other self-reported chronic disease.
‡ Scale scores of the Brief Job Stress Questionnaire. Higher scores indicates greater distress or more
symptoms.
SD: standard deviation.

TABLE 2. Prevalence and associations with psychological distress and physical symptoms and fear, worry and harassment related to COVID-19 among employees inJapan (N = 1421).
Prevalence
Variables (possible range)
Fear and worry about COVID-19 infection
Global fear and worry about COVID-19 (1-6)
Fear and worry about infection (1-4)
Difficulty to obtain medical supplies and hygiene products
Lack of correct information and knowledge
Policies and responses of the national and local governments
My family may be infected
Limiting daily activities
I might be infected
Sum of the above (6-24)
Fear and worry about job instability (1-4)
Future prospects of my company
My job not going along as usual
I am afraid of losing my job
Sum of the above (3-12)
Workplace harassment related to COVID-19 to oneself
Being the target of sarcastic comments
Being harassed
Being avoided
Being accused of poor preparedness for the prevention
Being forced to self-isolate at home
Any kind of workplace harassment

Psychological distress
Model 1§

Physical symptoms

Average (SD) †Proportion, % ‡CrudeModel 2§§

Crude

Model 1§Model 2§§4.31 (1.21)

79.8

β
0.175

p
<0.001

β0.183

p<0.001

β0.103

p<0.001

β0.130

p<0.001

β0.134

p<0.001

β0.091

p<0.001

3.18 (0.81)
3.01 (0.80)
3.02 (0.83)
2.88 (0.82)
2.81 (0.80)
2.77 (0.80)
17.66 (3.51)

81.4
76.5
75.4
71.9
68.1
67.9
NA

0.118
0.168
0.179
0.117
0.158
0.146
0.205

<0.001<0.001<0.001<0.001<0.001<0.001<0.001

0.113
0.160
0.175
0.117
0.150
0.145
0.201

<0.001<0.001<0.001<0.001<0.001<0.001<0.001

0.051
0.089
0.095
0.070
0.087
0.079
0.112

0.016
<0.001<0.0010.001<0.001<0.001<0.001

0.081
0.123
0.088
0.070
0.094
0.084
0.125

0.002
<0.0010.001
0.008<0.001
0.002<0.001

0.074
0.113
0.081
0.066
0.082
0.082
0.117

0.005
<0.001
0.002
0.012<0.001
0.002<0.001

0.033
0.072
0.043
0.027
0.062
0.050
0.067

0.132
0.001
0.054
0.220
0.005
0.021
0.002

2.59 (0.94)
2.45 (0.90)
2.17 (0.91)
7.25 (2.20)

52.8
47.9
31.6
NA

0.081
0.139
0.187
0.168

0.002
<0.001<0.001<0.001

0.081
0.142
0.180
0.166

0.002
<0.001<0.001<0.001

0.063
0.082
0.109
0.105

0.003
<0.001<0.001<0.001

0.107
0.117
0.190
0.172

<0.001<0.001<0.001<0.001

0.108
0.119
0.184
0.170

<0.001<0.001<0.001<0.001

0.082
0.060
0.118
0.108

<0.0010.006<0.001<0.001

N/A
N/A
N/A
N/A
N/A
N/A

1.4
0.5
0.6
0.6
0.7
2.3

0.073
0.060
0.027
0.061
-0.012
0.046

0.006
0.024
0.308
0.021
0.663
0.084

0.076
0.060
0.029
0.063
-0.005
0.053

0.004
0.023
0.279
0.017
0.856
0.044

0.040
0.043
0.013
0.041
-0.003
0.025

0.054
0.038
0.538
0.052
0.904
0.238

0.074
0.125
0.067
0.063
-0.0020.057

0.005<0.001
0.011
0.017
0.952
0.033

0.077
0.124
0.067
0.064
0.004
0.062

0.003
<0.001
0.011
0.015
0.871
0.019

0.052
0.083
0.036
0.022
0.003
0.037

0.017
<0.001
0.097
0.324
0.879
0.088

Note: Standardized β is calculated by using regression analysis.
† The item was scored with the higher score being indicative of greater anxiety related to COVID-19.
‡ The proportion of high fear and worry related to COVID-19 is shown: “strongly,” “some,” and “a little” (vs “little,” “almost none,” and “not at all”) for the global anxiety;“strongly agree” and “some agree” (vs. “some disagree” and “strongly disagree”) for anxiety about infection and job.
§ Adjusted for sex, age, marital status, child, and occupational type.
§§ Adjusted for sex, age, marital status, child, occupational type, chronic disease, and psychological distress or physical symptoms at baseline (2019).
* p<0.05. ** p<0.01.
SD: standard deviation. N/A: not applicable.

TABLE 3. Factors associated with fear, worry and harassment related to COVID-19 among Japanese workers (N = 1421).
OR
95% CI
P value
Global fear and worry for COVID-19 (high) †Sex (male=0, female=1)
2.51
1.87 – 3.36
<0.001**Age（for 10 years）
1.03
0.87 – 1.18
0.663
Marital status (single=0, married=1)
1.12
0.79 – 1.60
0.516
Having at least one child (no=0, yes=1)
1.47
1.02 – 2.11
0.038*
Company size (>500 employees=0, <500 employees =1)
0.95
0.72 – 1.27
0.743
Occupational typeManager
1.00
Non-manual
0.72
0.42 – 1.23
0.227
Manual1.02
0.59 – 1.79
0.936
COVID-19 related announcement from company (no=0, yes=1)
1.35
0.97 – 1.88
0.080
Chronic physical conditions ‡ (1>) (no=0, yes=1)
1.57
1.05 – 2.34
0.027*
Any harassment at workplace to oneself
Sex (male=0, female=1)
0.91
0.43 – 1.94
0.808
Age (for 10 years)
1.00
0.69 – 1.45
0.998
Marital status (single=0, married=1)
1.920.82 – 4.45
0.131
Having at least one child (no=0, yes=1)
0.40
0.16 – 0.98
0.045*
Company size (>500 employees=0, <500 employees =1)
1.33
0.64 – 2.77
0.454
Occupational typeManager (reference)
1.00
Non-manual
0.66
0.22 – 2.00
0.461
Manual0.25
0.06 – 1.01
0.051
COVID-19 related announcement from company (no=0, yes=1)
1.37
0.51 – 3.69
0.536
Chronic physical conditions ‡ (1>) (no=0, yes=1)
2.24
1.02 – 4.91
0.045*† High global fear and worry for COVID-19 is defined: “strongly,” “some,” and “a little” (vs “little,” “almost none,” and “not at all”).
‡ Chronic disease included hypertension, diabetes, heart disease (e.g., angina, heart failure), cerebrovascular disease (e.g., cerebral infarction, cerebral hemorrhage), cancer,
malignant neoplasm, respiratory disease, liver disease, kidney disease, and other self-reported chronic disease.
OR: odds ratio. CI: confidence interval.