Background: This longitudinal study aimed to examine the changes in psychological distress of the general public from the early to community-transmission phases of the COVID-19 pandemic and to investigate the factors related to these changes.

Methods: An internet-based survey of 2,400 Japanese people was conducted in two phases: early phase (baseline survey: February 25–27, 2020) and community-transmission phase (follow-up survey: April 1–6, 2020). The presence of severe psychological distress (SPD) was measured using the Kessler’s Six-scale Psychological Distress Scale. The difference of SPD percentages between the two phases was examined. Mixed-effects ordinal logistic regression analysis was performed to assess the factors associated with the change of SPD status between the two phases.

Results: Surveys for both phases had 2,078 valid respondents (49.3% men; average age, 50.3 years). In the two surveys, individuals with SPD were 9.3% and 11.3%, respectively, demonstrating a significant increase between the two phases (P = 0.005). Significantly higher likelihood to develop SPD were observed among those in lower (ie, 18,600–37,200 United States dollars [USD], odds ratio [OR] 1.95; 95% confidence interval [CI], 1.10–3.46) and the lowest income category (ie, <18,600 USD, OR 2.12; 95% CI, 1.16–3.86). Furthermore, those with respiratory diseases were more likely to develop SPD (OR 2.56; 95% CI, 1.51–4.34).

Conclusions: From the early to community-transmission phases of COVID-19, psychological distress increased among the Japanese. Recommendations include implementing mental health measures together with protective measures against COVID-19 infection, prioritizing low-income people and those with underlying diseases.