Sekentei

We used the Sekentei Scale [22, 34], which consists of 12 items, including “I tend to adjust my actions according to the behaviors of people around me”, “I am rather unconcerned about gossip and the way I appear to others (reverse item)”, “I avoid behavior that people laugh at”, and “I would definitely return the favor if I were cared for by or received a gift from others”. The validity and reliability of the scale have been confirmed [22]. Participants responded to 12 items on a 5-point Likert scale (“1 = strongly disagree”, “2 = disagree”, “3 = neither”, “4 = agree”, or “5 = strongly agree”). The scale scores ranged from 12 to 60, where higher scores indicate a greater sense of sekentei. Cronbach’s alpha in this study was 0.61.

Information on age, sex, and residential area (“downtown area” or “mountainside area”) were obtained from the residential registry. The questionnaire included items measuring years of residence in the area, marital status (“married” or “not married”), current working status (“working” or “not working”), years of education (“≤ 9 years” or “≥ 10 years”), and subjective financial stability (“1 = poor”, “2 = somewhat poor”, “3 = normal”, “4 = somewhat affluent”, or “5 = affluent”). We calculated body mass index from actual measurements of height and weight (kg/m²), and divided the participants into three categories: “underweight” (< 18.5 kg/m²), “normal weight” (18.5–24.9 kg/m²), and “overweight” (≥ 25.0 kg/m²). A doctor or registered nurse conducted a medical interview to collect information on comorbidity, with a focus on the following six diagnosed diseases: cancer, hypertension, cardiovascular disease, cerebrovascular disease, dyslipidemia, and diabetes mellitus. We categorized the participants into groups based on the number of comorbid diseases: “0”, “1” and “≥ 2.”