Burnout and occupational stressors among non-medical occupational health staff.

BACKGROUND: The work required to assist individuals in improving their mental health is stressful and known to be associated with burnout. In Japanese companies, non-medical occupational health (OH) staff often take the role of maintaining and improving workers' mental health. However, few studies have examined burnout in this population. AIMS: To assess the relationship between burnout and occupational stressors among non-medical OH staff. METHODS: We conducted a cross-sectional study of OH staff who had participated in mental health seminars between 2016 and 2018. Occupational stressors were assessed using the Japanese version of the Job Content Questionnaire. Burnout was assessed using the Japanese version of the Maslach Burnout Inventory. RESULTS: We administered the survey to 230 non-medical OH staff, of which 188 completed the questionnaire. According to a hierarchical multiple linear regression analysis, high job demands were associated with greater emotional exhaustion, depersonalization and personal accomplishment. Greater job control was associated only with higher personal accomplishment. Lower job support was associated with greater emotional exhaustion and depersonalization. CONCLUSIONS: The present study found relationships between occupational stressors and burnout dimensions among OH staff. To avoid burnout among non-medical OH staff, it is important to take measures against occupational stressors, especially job demands and low levels of job support.

Plasma Nervonic Acid Is a Potential Biomarker for Major Depressive Disorder: A Pilot Study.

Background: Diagnostic biomarkers of major depressive disorder, bipolar disorder, and schizophrenia are urgently needed, because none are currently available. Methods: We performed a comprehensive metabolome analysis of plasma samples from drug-free patients with major depressive disorder (n=9), bipolar disorder (n=6), schizophrenia (n=17), and matched healthy controls (n=19) (cohort 1) using liquid chromatography time-of-flight mass spectrometry. A significant effect of diagnosis was found for 2 metabolites: nervonic acid and cortisone, with nervonic acid being the most significantly altered. The reproducibility of the results and effects of psychotropic medication on nervonic acid were verified in cohort 2, an independent sample set of medicated patients [major depressive disorder (n=45), bipolar disorder (n=71), schizophrenia (n=115)], and controls (n=90) using gas chromatography time-of-flight mass spectrometry. Results: The increased levels of nervonic acid in patients with major depressive disorder compared with controls and patients with bipolar disorder in cohort 1 were replicated in the independent sample set (cohort 2). In cohort 2, plasma nervonic acid levels were also increased in the patients with major depressive disorder compared with the patients with schizophrenia. In cohort 2, nervonic acid levels were increased in the depressive state in patients with major depressive disorder compared with the levels in the remission state in patients with major depressive disorder and the depressive state in patients with bipolar disorder. Conclusion: These results suggested that plasma nervonic acid is a good candidate biomarker for the depressive state of major depressive disorder.

Search for plasma biomarkers in drug-free patients with bipolar disorder and schizophrenia using metabolome analysis.

AIM: There is an urgent need for diagnostic biomarkers of bipolar disorder (BD) and schizophrenia (SZ); however, confounding effects of medication hamper biomarker discovery. In this study, we conducted metabolome analyses to identify novel plasma biomarkers in drug-free patients with BD and SZ. METHODS: We comprehensively analyzed plasma metabolites using capillary electrophoresis time-of-flight mass spectrometry in patients with SZ (n = 17), BD (n = 6), and major depressive disorder (n = 9) who had not received psychotropics for at least 2 weeks, and in matched healthy controls (n = 19). The results were compared with previous reports, or verified in an independent sample set using an alternative analytical approach. RESULTS: Lower creatine level and higher 2-hydroxybutyric acid level were observed in SZ than in controls (uncorrected P = 0.016 and 0.043, respectively), whereas they were unaltered in a previously reported dataset. Citrulline was nominally significantly decreased in BD compared to controls (uncorrected P = 0.043); however, this finding was not replicated in an independent sample set of medicated patients with BD. N-methyl-norsalsolinol, a metabolite of dopamine, was suggested as a candidate biomarker of BD; however, it was not detected by the other analytical method. Levels of betaine, a previously reported candidate biomarker of schizophrenia, were unchanged in the current dataset. CONCLUSION: Our preliminary findings suggest that the effect of confounding factors, such as duration of illness and medication, should be carefully controlled when searching for plasma biomarkers. Further studies are required to establish robust biomarkers for these disorders.

Aggression in Teachers is Related to Role Conflict and Role Ambiguity as Occupational Stress.

BACKGROUND: Aggression in the workplace is increasingly recognized as a serious problem, but there are few studies about worker aggression toward outsiders in the workplace. We investigated the association between aggression and occupational stress among teachers. METHODS: This was a cross-sectional study of 1583 teachers, principals, and vice-principals. Aggression was measured using the Japanese version of the Buss-Perry Aggression Questionnaire (BAQ). The survey respondents were classified into tertiles according to the BAQ score. The high BAQ group was defined as the upper tertile for the BAQ total score (BAQ total score 625). Occupational stress was measured using the Japanese version of the Generic Job Stress Questionnaire. Comparisons among the groups were performed using multiple logistic regression analysis. RESULTS: Of the 1583 respondents, 488 were included in the high BAQ group. After adjusting for demographic and occupational variables, high role conflict and role ambiguity were significantly associated with belonging to the high BAQ group. In subscales of the BAQ, high role conflict and role ambiguity related to high levels of hostility, and physical aggression. CONCLUSIONS: Occupational stress such as role conflict and role ambiguity was associated with aggression among teachers. It is necessary to reduce problems which relates to role conflict and role ambiguity for preventing teachers' aggression.

Association of worker's mental health with changes in exercise time, going-out time, and screen time (TV time, internet time, and game time) before and after the COVID-19 pandemic: A cross-sectional study.

The coronavirus disease 2019 (COVID-19) pandemic and government regulations have affected the daily lives and mental health of individuals worldwide. This study aimed to determine how much the change in time spent on exercise (exercise time), outdoor activities ("going-out" time), and screen usage (screen time) before and after the COVID-19 pandemic has affected mental health (depression, anxiety, and insomnia). In June 2021, during the third wave of the COVID-19 pandemic, a web-based, cross-sectional survey was conducted in Japan through an online research company. A total of 824 workers participated in this study. Depression, anxiety, and insomnia were assessed using the Patient Health Questionnaire-9, General Anxiety Disorder-7, and Insomnia Severity Index, respectively. The symptoms of depression were associated with age and decreased exercise time. Symptoms of anxiety were associated with not decreased going-out time. Symptoms of insomnia were associated with reduced exercise time. The results indicated that during the COVID-19 pandemic, an increase in exercise time could have prevented depression and insomnia. Similarly, a decrease in going-out time could have prevented anxiety. Furthermore, in the event of future outbreaks of unpredictable infections, such as COVID-19, decreased going out and increased exercise may help maintain mental health.

Relationships between occupational stress and depressive symptoms among prison officers in Japan.

BACKGROUND: The relationships between occupational stress and depressive symptoms in prison officers have rarely been studied in Japan. Thus, we analyzed the associations between occupational stress factors and depressive symptoms among Japanese prison officers. METHODS: This was a cross-sectional study involving 426 male prison officers (20-60-year-old). Depressive symptoms were assessed using the Zung Self-Rating Depression Scale. Using this scale and a cut-off point of 50, the subjects were divided into the "depressive group" and "non-depressive group". Occupational stress was evaluated using the Generic Job Stress Questionnaire. Comparisons among the groups were performed with multiple logistic regression analysis. RESULTS: Of the 426 subjects, 107 were included in the depressive group. After adjusting for demographic and occupational variables, higher scores for the physical environment, role ambiguity, and quantitative workload and a lower score for social support from co-workers were found to be associated with an increased odds ratio of depressive symptoms. CONCLUSIONS: The physical environment, role ambiguity, quantitative workload, and social support from coworkers are associated with depressive symptoms in Japanese prison officers. We hope that educating prison officers about the results of this study and organizational/individual-based improvement strategies will reduce their risk of depression.

Significant Weight Gain With the Administration of Lurasidone and Valproic Acid in Schizophrenia and Bipolar Disorder Patients.

Antipsychotics are frequently used to treat psychiatric disorders and have been associated with weight gain. Mental disorders are likely to reduce patients' quality of life. Unhealthy lifestyles such as reduced physical activity, sleep disturbances, and irregular diets can lead to weight gain. Herein, we report two cases of schizophrenia and bipolar disorder who had a 10-kg gain in weight in six months with the administration of lurasidone and valproic acid. Lurasidone has fewer side effects, such as weight gain and somnolence. However, concomitant use of sedating antipsychotics or mood stabilizers in the acute phase and multiple doses increase the risk of weight gain. Additionally, various factors, including psychiatric symptoms and lifestyle changes, are believed to contribute to weight gain, and a comprehensive approach should be followed.

Ten-year trends in long-term sickness absence among Japanese public servants: 2009-2018.

Sickness absences are a significant public health and economic problem worldwide. However, sickness absence diagnoses and trends have not been reported in much detail in Japan. This study was a retrospective cohort study. We examined data on certified diagnoses and the durations of sickness absence lasting over 90 days (long-term sickness absence) from 2009-2018 among city public servants in Japan. We found that 1) "Mental and behavioral disorders" (495.0-780.6 per 100,000 employees) was the most prevalent reason for long-term sickness absence, and "Mood disorders" (318.6-584.3 per 100,000 employees) was the most prevalent mental disorders diagnosis in each study year; 2) the prevalence of long-term sickness absence for mental disorders showed decreasing trends (781/100,000 in 2009 to 622/100,000 in 2018; [p=0.005, for the trend test]); 3) the trends differed by gender (p<0.05) and age (p<0.001); and 4) the duration of long-term sickness absence related to mental disorders (13.2 ± 9.0 months) was longer than long-term sickness absence resulting from all physical disorders except for diseases of the circulatory system (15.1 ± 11.6 months). Increased focus on significant depressive and neurotic disorders is needed when promoting mental health in the workplace.

Prolonged extrapyramidal symptoms induced by long-term, intermittent administration of low-dose olanzapine along with metoclopramide for emesis: A case report.

BACKGROUND: Antipsychotics with dopamine (D2) receptor antagonism can be effective for emesis in cancer patients. Extrapyramidal symptoms (EPS) induced by typical antipsychotics can be exacerbated by other D2 receptor antagonists. We describe a case of persistent EPS induced by long-term, intermittent administration of low-dose olanzapine along with metoclopramide for emesis. CASE PRESENTATION: A 59-year-old pancreatic cancer patient underwent chemotherapy for 7 months. He was referred to the psychiatry department because of restlessness and insomnia. Although he did not have obvious depressive symptoms, he was anxious about the cancer treatment. For chemotherapy-induced nausea, he had been prescribed 5 mg of olanzapine intermittently for 7 months. He had last used the drug 9 days before presenting it to us. Additionally, he received metoclopramide and palonosetron as antiemetics. We considered akathisia and cancer-related anxiety/agitation as possible causes of restlessness and insomnia, and prescribed clonazepam. However, his symptoms worsened, resulting in hospitalization. We reconsidered his symptoms as cancer-related anxiety/agitation and prescribed quetiapine. Although it was effective, he had tremors and was assessed by a neurologist. Considering the clinical manifestations of rigidity, postural reflex disorder, and a mask-like face, we suspected drug-induced parkinsonism and replaced quetiapine with biperiden on the next day, leading to his discharge after 2 weeks. He did not have symptom recurrence even after discontinuation of biperiden. CONCLUSIONS: Long-term, intermittent administration of low-dose antipsychotics with other antiemetics having D2 receptor antagonism can cause prolonged EPS. Especially in cancer patients, who often require polypharmacy, clinicians should consider exacerbated adverse effects due to drug interactions.

Intra-individual state-dependent comparison of plasma mitochondrial DNA copy number and IL-6 levels in patients with bipolar disorder.

BACKGROUND: Patients with bipolar disorder (BD) have increased plasma IL-6 levels, which are higher in depressed BD (dBD) than remitted BD (rBD). However, the mechanism that differentiates the cytokine levels between dBD and rBD is not understood. First, we determined whether brain-derived mtDNA can be detected in plasma using neuron-specific mutant Polg1 transgenic (Tg) mice. Second, we investigated whether the plasma circulating cell-free mitochondrial DNA (ccf-mtDNA) differentiate the cytokine levels between dBD and rBD. METHODS: Mouse plasma ccf-mtDNA levels were measured using real-time PCR targeting two regions of the mtDNA (CO1 and d-loop) in Tg mice and non-Tg littermates. Human plasma ccf-mtDNA levels were measured using real-time PCR targeting two regions of the mtDNA (ND1 and ND4) and IL-6 levels were evaluated in 10 patients in different states (depressed and remitted) of BD in a longitudinal manner and 10 healthy controls. RESULTS: The mouse plasma CO1/D-loop ratio was significantly lower in Tg than non-Tg mice (P = 0.0029). Human plasma ccf-mtDNA copy number, ND4/ND1 ratio, and IL-6 levels were not significantly different between dBD and rBD. Human plasma ccf-mtDNA levels showed a nominal significant correlation with delusional symptoms (P = 0.033, ρ = 0.68). LIMITATIONS: A larger sample size is required to generalize the results and to determine whether plasma ccf-mtDNA is associated with systemic inflammation. CONCLUSIONS: Tg mice revealed that brain-derived mtDNA could be present in peripheral blood. The present findings did not coincide with our hypothesis that plasma ccf-mtDNA differentiates the cytokine levels between dBD and rBD.

Relationships between Occupational Stress, Change in Work Environment during the COVID-19 Pandemic, and Depressive and Anxiety Symptoms among Non-Healthcare Workers in Japan: A Cross-Sectional Study.

This study aims to clarify the effect of occupational stress and changes in the work environment on non-healthcare workers' (HCWs) mental health during the third wave of the COVID-19 pandemic in Japan. A web-based, cross-sectional survey was conducted from 16 to 17 December 2020. Data from 807 non-HCWs were included. We evaluated occupational stress using the Generic Job Stress Questionnaire (GJSQ). Depressive and anxiety symptoms were assessed using the Japanese version of the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder 7-item scale, respectively. We collected demographic variables, work-related variables, and the variables associated with COVID-19. The adjusted odds ratios for depressive and anxiety groups were estimated using multivariate logistic regression analyses, adjusted for all the demographic variables, work-related variables, COVID-19-related variables, and the six subdivided GJSQ subscales. The results confirm a relationship between variance in workload, job future ambiguity, social support from coworkers, having contact with COVID-19 patients, and depressive and anxiety symptoms. Paying attention to job future ambiguity, the variance in workload at the workplace and individual perspectives, promoting contact and support among coworkers using online communication tools, and reducing contact with COVID-19 patients, will be useful for decreasing the depressive and anxiety symptoms among non-HCWs.

Nervonic acid level in cerebrospinal fluid is a candidate biomarker for depressive and manic symptoms: A pilot study.

OBJECTIVE: Our previous metabolomics study showed that the plasma nervonic acid levels were higher in patients with major depressive disorder (MDD) than those in healthy controls and patients with bipolar disorder (BD). To examine whether the nervonic acid levels differ in the central nervous system, we investigated the levels in the cerebrospinal fluid (CSF) of patients with MDD, BD, and healthy controls. METHODS: Nervonic acid levels in CSF were measured by gas chromatography time-of-flight mass spectrometry. The participants included 30 patients with MDD, 30 patients with BD, and 30 healthy controls. RESULTS: In contrast to our previous study, no significant differences were found in the nervonic acid level in the CSF among the patients with MDD, BD, and the healthy controls. Though no significant state-dependent changes were found among the three groups, we did observe a significant negative correlation between the nervonic acid levels and depressive symptoms in the depressive state of patients with MDD and BD (r = -0.38, p = .046). Further, a significant positive correlation was found between the nervonic acid levels and manic symptoms in the manic state of patients with BD (r = 0.79, p = .031). CONCLUSION: The nervonic acid levels in the CSF did not differ among the patients with MDD, BD, and the healthy controls; however, a significant negative correlation with depressive symptoms and a positive correlation with manic symptoms was observed. Thus, the nervonic acid levels in the CSF may be a candidate biomarker for mood symptoms.

Relationship between initial self-perceived depressive symptoms and disease severity in working patients with first-onset major depressive disorder.

The severity of major depressive disorder (MDD), which is related to the depressive symptoms, is a predictor of clinical outcomes and may be used to determine the appropriate treatment. However, there is a lack of systematic research on the relationship between early depressive symptoms and MDD severity. This study aimed to clarify the association between initial depressive symptoms and MDD severity in working patients. We assessed 118 patients aged over 20 years who visited the Neuropsychiatry Department of the Osaka City University Hospital following their first episode of MDD. Logistic regression analyses were performed to estimate the odds ratios (OR) with 95% confidence intervals (CI) for the associations between age, gender, marital status, working hours, and initial self-perceived depressive symptoms and MDD severity. Age and working hours were analyzed as continuous variables, and gender (man, woman), marital status (married, single) and severity (mild to moderate MDD, severe to very severe MDD) were analyzed as categorical variables. The most common initial self-perceived symptom was "depressed mood," followed by "fatigue or loss of energy nearly every day." The univariate analysis found no association between age, gender, marital status, or working hours and MDD severity. Initial self-perceived non-somatic symptoms were associated with increased odds of having severe MDD (odds ratio = 3.32, 95% confidence interval 1.46-7.58), and this association persisted in the adjusted model (odds ratio = 3.35, 95% confidence interval 1.47-7.60). Initial self-perceived non-somatic depressive symptoms are significantly associated with MDD severity at its first onset. Workplace support may lead to the early detection and treatment of working patients with non-somatic symptoms.

Relationship between Burnout and Mental-Illness-Related Stigma among Nonprofessional Occupational Mental Health Staff.

BACKGROUND: Stigma related to mental illness can be an obstacle affecting the quality of life of people with mental illness. Although mental illness in the workplace is a public problem globally, few studies have investigated the effect of stigma on job-related problems such as burnout. AIM: This study aimed to clarify the association between mental-illness-related stigma and burnout among nonprofessional occupational mental health staff. METHODS: In this cross-sectional study, nonprofessional occupational mental health staff's perceived mental-illness-related stigma was assessed using Link's Devaluation-Discrimination Scale, and their burnout was assessed using the Maslach Burnout Inventory. The association between stigma and burnout was analyzed by multiple linear regression analysis. RESULTS: In total, 282 participants completed the questionnaire (response rate: 91.3%). We excluded 54 nurses from the analysis to examine strictly nonprofessional occupational mental health staff. Finally, 228 eligible respondents were surveyed. Multiple linear regression analysis revealed that mental-illness-related stigma was significantly associated with a high degree of depersonalization, which was one of the burnout dimensions. However, the impact of stigma over the depersonalization domain of burnout was minor. CONCLUSION: The results suggest that higher perceived mental-illness-related stigma is associated with more severe burnout. It is important to take measures against mental-illness-related stigma to avoid burnout among occupational mental health staff.

The effect of long-term sickness absence on coworkers in the same work unit.

After workers take long-term sickness absence due to mental disorders (LTSA-MD), the occupational stress of the coworkers in the same work unit might be affected. The aims of this study were to evaluate the effect of the incident of LTSA-MD on the coworkers' occupational stress. A retrospective cohort study of 16,032 public servants was conducted. The Brief Job Stress Questionnaire (BJSQ) was used, which was administered in 2011 and 2012. To analyze the amount of change in occupational stress, the difference between the scores of the BJSQ scales in 2011 and 2012 was calculated. After adjusting for the baseline BJSQ scales, sex, age, total number of workers, and social support, analysis of covariance of the difference between the BJSQ scales' scores showed that job stressors and stress responses worsened among the coworkers after the incident of LTSA-MD. Social support did not change among the coworkers. This study indicates that an incident of LTSA-MD in the same work unit adversely affects the coworkers' occupational stress. Focusing on the coworkers' mental state after an incident of LTSA-MD in the same work unit and an early intervention strategy are needed to prevent secondary mental illness and sickness absence in the coworkers.

Gender differences in the relationships between perceived individual-level occupational stress and hazardous alcohol consumption among Japanese teachers: A cross-sectional study.

Most teachers have a high risk of work-related stress and mental disorders. Drunken driving and hazardous alcohol consumption (HAC) among teachers are social problems. Gender differences among teachers in burnout, occupational stress, self-efficacy and job satisfaction were reported. This study aimed to clarify gender differences in the relationships between perceived individual-level occupational stress and HAC among Japanese teachers. A cross-sectional study was conducted in 2013 and a total of 723 male and 476 female teachers remained after excluding non-drinkers. Perceived individual-level occupational stress was assessed using the Generic Job Stress Questionnaire. HAC was defined as ethanol consumption greater than or equal to 280 g in 1 week for male teachers, and greater than or equal to 210 g for female teachers. Multiple logistic regression analyses were conducted. HAC was identified in 16.6% of male and 12.4% of female teachers. The average ages (± standard deviation: SD) of male and female teachers were 46.9 ± 10.9 years and 39.9 ± 12.3 years, respectively. Schoolteacher was the most common position classification among male (48.7%) and female teachers (86.3%). For those with a moderate level of stress, "social support from supervisors" was associated with HAC among males (odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.23-0.8), whereas for female teachers with a high level of stress, "variance in workload" was associated with HAC (OR = 2.09, 95% CI = 1.04-4.24), using an adjusted model. This study showed that moderate social support from supervisors was negatively related to HAC among male teachers, and high variance in workload was positively related to HAC among female teachers. Gender differences need to be considered when developing HAC prevention strategies for teachers.

The relationship between circulating mitochondrial DNA and inflammatory cytokines in patients with major depression.

BACKGROUND: Although inflammatory cytokines are established biomarkers of mood disorders, their molecular mechanism is not known. We hypothesized that circulating mitochondrial DNA (mtDNA) contributes to inflammation and could be used as biomarkers. We investigated if circulating mtDNA level is associated with inflammatory cytokines and can be used as a biomarker of mood disorders. METHODS: Plasma mtDNA concentration was measured with real-time quantitative PCR targeting two regions of the mtDNA and plasma levels of four cytokines (GM-CSF, IL-2, IL-4, and IL-6) were measured with a multiplex immunoassay method in 109 patients with major depressive disorder (MDD). The most significantly correlated cytokine was verified with an enzyme-linked immunosorbent assay (ELISA). The data from 28 patients with bipolar disorder (BD), 17 patients with schizophrenia (SZ), and 29 healthy controls were compared. RESULTS: MtDNA levels showed a nominal positive correlation with GM-CSF, IL-2 and IL-4 in patients with MDD. The most significant correlation with IL-4 (ρ = 0.38, P < 0.00005) was verified with an ELISA (ρ = 0.19, P = 0.049). Unexpectedly, patients with MDD and BD showed significantly lower plasma mtDNA levels than controls. MtDNA levels were lower in the depressive state than in the euthymic state in patients with MDD. Patients with depression, bipolar disorder, and schizophrenia did not show significantly higher levels of these four cytokines than controls. LIMITATIONS: There is a possibility that the patients in this study are different from previous studies in which increased cytokine levels were reported. MtDNA levels should be measured in patients showing elevated plasma cytokine levels. A larger sample is required to generalize the results. CONCLUSIONS: The present findings coincide with our hypothesis that circulating mtDNA contributes to the inflammation in MDD. Further studies are needed to conclude whether plasma mtDNA would be a biomarker of mood disorders.

Relationships between temperaments, occupational stress, and insomnia among Japanese workers.

Insomnia among workers reduces the quality of life, contributes toward the economic burden of healthcare costs and losses in work performance. The relationship between occupational stress and insomnia has been reported in previous studies, but there has been little attention to temperament in occupational safety and health research. The aim of this study was to clarify the relationships between temperament, occupational stress, and insomnia. The subjects were 133 Japanese daytime local government employees. Temperament was assessed using the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Auto questionnaire (TEMPS-A). Occupational stress was assessed using the Generic Job Stress Questionnaire (GJSQ). Insomnia was assessed using the Athens Insomnia Scale (AIS). Stepwise multiple logistic regression analyses were conducted. In a stepwise multivariate logistic regression analysis, it was found that the higher subdivided stress group by "role conflict" (OR = 5.29, 95% CI, 1.61-17.32) and anxious temperament score (OR = 1.33; 95% CI, 1.19-1.49) was associated with the presence of insomnia using an adjusted model, whereas other factors were excluded from the model. The study limitations were the sample size and the fact that only Japanese local government employees were surveyed. This study demonstrated the relationships between workers' anxious temperament, role conflict, and insomnia. Recognizing one's own anxious temperament would lead to self-insight, and the recognition of anxious temperament and reduction of role conflict by their supervisors or coworkers would reduce the prevalence of insomnia among workers in the workplace.