A nationwide follow-up survey of 251 Japanese physicians revealed that while outpatient numbers in psychosomatic medicine partially recovered, patient caseloads and symptom severity across multiple clinical conditions expanded alongside persistent obstacles in telemedicine assessment during the prolonged COVID-19 pandemic. Conducted by the Japanese Society of Psychosomatic Medicine and the Japanese Society of Psychosomatic Internal Medicine, the investigation evaluated shifts in routine clinical practice and patient mental health approximately two years after the initial wave of infections in Japan.
The study was designed as a one-year follow-up to a baseline survey administered between late December 2021 and January 2022, which had identified operational difficulties in outpatient and inpatient settings, rapid adoption of remote consultations, and broad declines in patient well-being. Because international prospective observational studies had yielded conflicting findings regarding whether psychological symptoms progressively worsened or rebounded as societal restrictions shifted, researchers sought updated evidence regarding the long-term clinical realities within Japanese psychosomatic care.
The cross-sectional investigation gathered responses through an online questionnaire distributed via Google Forms between December 21, 2022, and February 14, 2023. This administration window coincided with Japan’s eighth pandemic wave, a period marked by the highest recorded daily death tolls of the crisis. Invitations were delivered to the collective rosters of the two professional societies, comprising 1,827 physicians in the Japanese Society of Psychosomatic Medicine and 985 in the Japanese Society of Psychosomatic Internal Medicine, including 585 clinicians holding dual memberships, ultimately securing 251 completed responses for an 11.3 percent response rate.
Responding clinicians represented diverse healthcare tiers, with 43 percent practicing in private clinics, 21 percent in general hospitals, 18 percent in university hospitals, and 18 percent in other hospital environments. Departmental affiliations, which permitted multiple selections, showed that 69 percent of participants worked in psychosomatic medicine, 35 percent in general internal medicine excluding psychosomatic specialties, and 27 percent in psychiatry. Additional respondents reported affiliations with general medicine, pediatrics, palliative care, obstetrics and gynecology, and other clinical areas including dermatology, rehabilitation, anesthesiology, otolaryngology, surgery, and psychosomatic dentistry.
In assessing clinical patient flow, 69 percent of respondents reported that outpatient volume had returned to pre-pandemic baselines, while 28 percent reported persistent reductions, with roughly half of that group indicating patient numbers remained below 80 percent of former levels. This distribution reflected a notable recovery compared to the initial survey, where 46 percent of clinicians had documented decreased outpatient attendance. Among the 99 clinicians who maintained inpatient services, 58 percent reported admissions had returned to pre-pandemic numbers, whereas 42 percent continued to experience depressed inpatient counts, including nearly half whose inpatient populations remained under 80 percent of pre-pandemic baselines.
Telemedicine remained operational across 62 percent of the surveyed institutions, demonstrating sustained integration after an initial adoption rate of 66 percent in the prior survey. Telephone consultations formed the vast majority of remote delivery, utilized by 55 percent of respondents, while 38 percent of facilities conducted no telemedicine consultations. Beyond infection containment, physicians identified a reduced rate of patient-initiated treatment discontinuation as the most prominent advantage of remote care. However, 87 percent of respondents identified distinct disadvantages, with 70 percent reporting substantial difficulties in evaluating clinical symptoms and administering appropriate interventions, citing equivalent diagnostic hurdles for physical and psychiatric presentations.
The survey specifically assessed psychosomatic disorders, defined as physical diseases where psychosocial factors closely influence onset and course with demonstrable organic or functional impairment, excluding somatic complaints secondary to neurosis or depression. Approximately 85 percent of respondents reported significant pandemic impacts on psychosomatic patients, with 65 percent observing an exacerbation of psychiatric symptoms, about half noting declines in quality of life, and 49 percent reporting increased patient volume, compared to 37 percent in the previous survey. Major contributors included lifestyle restrictions, societal adjustment challenges, and psychological distress, with clinicians frequently observing cardiac and chest symptoms, headaches, abdominal issues, and weight gain or obesity.
Among clinicians managing eating disorders, 40 percent reported an increase in patient caseloads, compared to 18 percent in the baseline survey, while an equivalent proportion perceived no significant pandemic impact. For clinicians who did observe pandemic-related changes in eating disorder patients, roughly 65 percent identified disruptions in binge eating patterns and compensatory behaviors. Participating physicians primarily attributed these behavioral shifts to diminished physical activity resulting from movement restrictions alongside heightened personal preoccupation with food and body weight.
Clinicians also documented substantial expansions in patient volume across other psychiatric diagnoses, with increases reported by 61 percent of providers for adjustment disorders, 52 percent for mood disorders, and 62 percent for anxiety disorders, representing consistent rises over prior survey figures. Symptom worsening was observed by 59 percent of clinicians treating adjustment disorders, 43 percent treating mood disorders, and 53 percent treating anxiety disorders, accompanied by substantial declines in overall patient quality of life. Notably, anxiety disorders generated the highest perceived impact across all surveyed conditions, with approximately 90 percent of physicians confirming noticeable effects.
Cross-survey comparisons indicated an evolution in the underlying psychosocial mechanisms affecting patient populations over the course of the crisis. In the initial survey, fear of infection had emerged as the predominant factor across all diagnostic categories; in the follow-up survey, infection fear remained the dominant driver primarily for anxiety disorders, cited by approximately one-third of providers. In contrast, for psychosomatic disorders, mood disorders, and adjustment disorders, the leading contributing factors shifted toward chronic restrictions on daily routines and social activities, employment concerns, economic instability, and difficulties adapting to changing societal demands.
The study authors highlighted several methodological limitations, including the modest 11.3 percent response rate, which limits generalization across the broader population of Japanese psychosomatic practitioners. Allowing multiple department selections also precluded comparative analysis between distinct medical specialties, while the absence of demographic data regarding physician age and years of experience may have influenced perspectives on remote practice. Furthermore, the findings relied on retrospective clinician impressions rather than objective electronic health records, and the undefined degree of individual participant overlap between the two survey waves limited formal longitudinal conclusions, prompting calls for future research using direct patient-level clinical records.
The authors contextualized observed outpatient attendance trends by comparing domestic recovery patterns with broader international observations. A systematic review assessing European mental health service use documented that after an initial decline in outpatient visits early in the pandemic, visits among working-age adults increased during 2020 relative to pre-pandemic baselines. In Japan, however, very few participating institutions noted an outright increase compared to pre-crisis levels. Although outpatient numbers improved between the two surveys, the authors suggested that Japan’s recovery took considerably longer than in European settings. This protracted recovery coincided with strict domestic quarantine measures, as individuals testing positive or identified as close contacts were required to refrain from social and occupational activities under the Infectious Diseases Control Law until its legal classification was revised in May 2023.
The investigation also expanded on the complex clinical attitudes surrounding remote practice. While 40 percent of clinicians voiced concerns regarding telemedicine in the initial survey, that proportion rose to 70 percent in the follow-up. In discussing this surge, the researchers cited literature showing that remote and in-person consultations deliver comparable diagnostic reliability for conditions like depression, attention-deficit/hyperactivity disorder, and schizophrenia, but telemedicine often proves less suitable for establishing new therapeutic relationships. As in-person visits gradually resumed, anxieties regarding newly presenting patients became more salient. Furthermore, the authors noted that healthcare providers generally prefer in-person consultations more strongly than patients do, meaning physician-only surveys might overestimate telemedicine’s disadvantages. Even so, pairing remote modalities with traditional visits could help clinics maintain continuity and buffer against steep volume losses during future epidemic surges.
A methodological distinction between the two survey waves also influenced recorded diagnostic trends. In the baseline survey, all participating clinicians answered questions across all five conditions, whereas the follow-up questionnaire restricted inquiries strictly to respondents actively treating each specific disorder. The authors explained that this targeted approach aimed to enhance diagnostic precision, though it may have inflated the reported increase in eating disorder cases due to the scarcity of specialized facilities. In contrast, between 83 percent and 92 percent of respondents regularly treated psychosomatic, adjustment, mood, and anxiety disorders, indicating that any overestimation risk for those categories remained relatively small.
The shift in underlying stressors from infection fears to chronic socioeconomic friction aligned with findings from wider cohorts. A longitudinal study across 11 European countries similarly observed that while prior psychiatric history served as the main risk factor for adjustment disorder symptoms early in the pandemic, economic strains such as reduced income became far more influential after 18 months. Likewise, surveys of Japanese university students revealed that initial anxieties centered around infection mitigation later evolved into persistent psychological distress stemming from daily restrictions. Research has further demonstrated that in-person social contact exerts a stronger positive influence on mental well-being than digital exchanges, with face-to-face interactions aiding recovery from adjustment disorder symptoms where digital interactions showed no effect.
Cultural dynamics may have sustained elevated infection anxiety among Japanese patients nearly three years after the country’s first domestic case. The researchers highlighted comparative work showing that Japanese university students exhibited greater fear of COVID-19 than Polish peers, a sentiment correlating negatively with interdependent happiness. Study governance involved institutional review board approvals from both professional societies, with consent implied by survey completion. Finally, the authors noted that raw data could not be publicly shared because participant consent for open data distribution was not obtained.
Subject of Research: Physician survey on clinical practice and patient mental health in Japanese psychosomatic medicine during the COVID-19 pandemic
Article Title: The impact of the prolonged COVID-19 pandemic on the practice of psychosomatic medicine in Japan: a nationwide physician survey
Article References: Yamanaka, Y., Yoshiuchi, K., Sudo, N., Kubo, C., Fukudo, S., Japanese Society of Psychosomatic Medicine, Kusumi, I., Kako, Y., Sato, K., Kanazawa, M., Ebana, S., Kawai, K., Takeuchi, T., Nakao, M., Hashizume, M., Maruoka, S., Kikuchi, H., Kaneko, H., Yamaguchi, C., … Matsubayashi, S. (2025). The impact of the prolonged COVID-19 pandemic on the practice of psychosomatic medicine in Japan: a nationwide physician survey. BioPsychoSocial Medicine, 19(1), Article 11. https://doi.org/10.1186/s13030-025-00333-z
Image Credits: AI Generated
DOI: 10.1186/s13030-025-00333-z
Keywords: psychosomatic medicine, COVID-19 pandemic, Japan, telemedicine, mental health, physician survey, anxiety disorders, adjustment disorders, impact, prolonged, COVID-19, pandemic
