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(1.05–1.32)(0.93–1.56)(0.63–1.48)(2.03–3.30)(1.54–2.56)(1.62–3.33)(1.64–2.75)(0.96–1.78)(1.07–1.77)(0.98–0.99)CES-D scores were significantly positively correlated with age (p < 0.0001) and sex (p < 0.0001). In addi-tion, occupation was associated with CES-D score changes between 2019 and 2021 (p = 0.001). The results from binary logistic regression analyses for the score changes between 2019 and 2021 showed that female staff, younger employees, and nurses have a higher risk of depression among Japanese health workers (Table 2). This result is similar to that of previous studies overseas. Luo identified female sex, nursing, and financial poverty as risk factors for anxiety and depression among health-care workers during COVID-19.14) Xiong also found associations between psychological stress and being female, being under 40, having existing chronic mental illness, and being unemployed in a systematic review.15) The hypothalamic–pituitary–adrenal (HPA) axis was found to be sex-specific; therefore, stress responses differ between men and women.16) Neurobiological and immunological sex differences are also noted, and women are about twice as likely to be depressed as men.17)Nurses were at the forefront of COVID-19 prac-tice and had high infection and mortality rates.18-19) Approximately 10.1% of people infected with COVID-19 are health care workers, and guidance on infection control and mental care for nurses is necessary.20) Nurses, who are mostly women, may 95% CI0.007<0.001Table 2　Factors related to CES-D results as determined by logistic regression analysis.Sex female maleAge, yearsOccupation doctor resident nurse paramedics support staff clerk teaching staff researcher part-timep values with statistical significance are in bold.The Center for Epidemiologic Studies Depression Scale, CES-D.　Odds ratio1.1810.981.210.972.591.982.322.121.311.381have been more prone to depression as they work in the close proximity of patients with COVID-19. Therefore, adequate mental health care may be particularly vital for young female nurses.The COVID-19 pandemic has put all healthcare workers under a great deal of psychological stress. To prevent depression in this population, it is important to raise awareness of self-care practices that improve lifestyle habits and increase commu-nication. Younger generations of workers and specific healthcare occupations such as nurses are more vulnerable to depression at this time and require more support.The authors thank Enago (www.enago.jp) for carefully proofreading the manuscript.This study was funded by the Juntendo Mental Health Institute (2020-003).NK contributed to the conceptualization, design, and writing of this manuscript.p-value0.1560.882<0.001<0.001<0.001<0.0010.0860.01229ConclusionsAcknowledgmentsFundingAuthor contributions