Associations between work-related stressors and QALY in a general working population in Japan: a cross-sectional study.

OBJECTIVE: To investigate an association between quality-adjusted life years (QALY) and work-related stressors (job strain, effort/reward imbalance, and poor support from supervisor and coworkers), and estimate loss in QALY caused by these stressors. METHODS: A cross-sectional study investigated data from a third-wave survey (in December 2017) of a 2-year prospective cohort study of Japanese workers. At baseline (first-wave survey), 5000 participants were recruited from workers who registered with an internet survey company. A total of 2530 participants responded to the second-wave survey 1 year later. Participants were then further recruited to the third-wave survey. An online questionnaire collected information regarding health-related quality of life (measured by EQ-5D-5L), job strain, supervisor and coworker support (Brief Job Stress Questionnaire), effort/reward imbalance (Effort/reward Imbalance Questionnaire), and demographic variables (age, sex, education, occupation, work contract, smoking, and alcohol drinking). Multiple linear regression analysis of the QALY score calculated from responses to EQ-5D-5L was employed on standardized scores of the work-related stressors and adjusted for demographic variables (SPSS version 26). RESULTS: Data of 1986 participants were analyzed. Job strain (unstandardized coefficient, b = - 0.013, p < 0.01) and effort/reward imbalance (b = - 0.011, p < 0.01) and coworker support (b = 0017, p < 0.01) were significantly associated with QALY score in the fully adjusted model. CONCLUSION: Job strain, effort/reward imbalance, and poor coworker support may be associated with a reduced QALY score among workers. A substantial impairment in QALY associated with the work-related stressors indicates that workplace interventions targeting work-related stressors may be cost-effective.

Spouse Factors Related to the Leave Period of Employees on Temporary Leave for Depression.

In depression, the health condition of family members (particularly spouses) may influence the reinstatement process of employees on temporary leave. The length of leave from work may reflect the quality of the process leading to the stage of reinstatement, and a short period to reinstatement may increase the possibility of a smooth reinstatement. In this study we investigated the relationship between spouse factors and length of leave period. The subjects were 63 permanent employees on temporary leave for depression and their spouses. We investigated demographic characteristics, spouse factors, individual factors, household factors, and workplace factors, and extracted the factors related to the length of leave period through hierarchical multiple regression analysis. Results revealed that the Frenchay Activities Index (FAI), a spouse factor, was consistently and significantly related to the length of leave (ß = -0.37, P < 0.01). The higher the spouse FAI, the shorter the leave period of employees on temporary leave. In particular, the spouses' leisure activities were related to the leave period, whereas the effects of housework and work were unclear. The results suggest that the assessment and intervention of the spouses' activities of daily living are important in reinstatement support.

Work-Family Spillover, Job Demand, Job Control, and Workplace Social Support Affect the Mental Health of Home-Visit Nursing Staff.

The primary purpose of this study was to clarify the path by which high job demands on home-visit nursing staff affect their mental health through work-family negative spillover (WFNS, FWNS). The secondary purpose was to clarify the path by which high job control and high social support in the workplace positively affect the mental health of nursing home-visit staff through work-family positive spillover (WFPS, FWPS). A cross-sectional survey using a self-administered questionnaire was conducted on 1,022 visiting nursing staff working at 108 visiting nursing stations in Fukuoka Prefecture in February, 2019. The measurement tools comprised sociodemographic factors, the Japanese version of the Survey Work-Home Interaction - NijmeGen (SWING-J), Job Content Questionnaire (JCQ-22), the Work-Family Culture Scale, and the K6 scale. Six models were determined in an analysis of the model: (1) working time load → WFNS → FWNS → psychological distress, (2) job demands → WFNS → FWNS → psychological distress, (3) job demands → psychological distress, (4) workplace support → job control → WFPS → psychological distress, (5) workplace support → WFPS → psychological distress, and (6) workplace support → psychological distress. This study clarified that job demands and working time load may adversely affect the mental health of home-visit nursing staff through the mediation of WFNS. It was also clarified that high job control and workplace support may have a positive effect on mental health through the mediation of WFPS.

[Problems in Providing Care to Young Workers with Mental Health Disturbance - A Survey Using of the Cases of Workers Who Had Taken Sick Leave Due to Mental Health Disturbance].

In this study we discuss the measures of providing care to young workers with mental health disturbance by analyzing the cases of workers who had taken sick leave due to mental health disturbance. We analyzed 36 cases, collected from 11 occupational physicians, of workers who had taken sick leave due to mental health disturbance, and discuss measures for providing care to such young workers. We organized and classified data containing the details of the care provided to the workers and analyzed the main aspects and problems in providing it. We compared two age groups of workers: a below age 30 group, and an age 30 and above group. We observed that occupational nurses were more frequently the primary persons who dealt with workplace consultations in the below age 30 group (before sick leave: 38.9%; during sick leave: 38.9%) compared to the age 30 and above group (before sick leave: 16.7%, during sick leave: 11.1%). Most of the case providers expressed the opinion that a support system is necessary to help the workers return to work and it is an important factor in providing care to workers who have taken sick leave due to mental health disturbance. Coordination with the families of the workers was also important in the below age 30 group. It might be difficult to assign young workers to suitable workplaces or duties because of their inadequate job skills, lack of sufficient experience, and influence of personal factors on mental health. Our results suggest that it is important to provide appropriate care for young workers with mental health disturbance, such as support by occupational nurses, and to strengthen the collaboration between their families and the workplace staff.

Brief intervention in the workplace for heavy drinkers: a randomized clinical trial in Japan.

AIMS: To investigate the effectiveness of brief intervention (BI) conducted in the workplace for heavy drinkers. METHODS: A randomized controlled trial was conducted at six companies in Japan. Participants were heavy drinkers who met the inclusion criteria and were randomized into three groups: the BI group, BI with diary group and a control group. Outcomes (total drinks, binge drinking episodes and alcohol-free days) were evaluated at 3 and 12 months. RESULTS: The 304 participants recruited were allocated to the three groups and 277 participated in all follow-up evaluations. Dropout rates in the respective groups were 7.0, 14.9 and 5.5%. Some improvements were observed in all the groups. In particular, alcohol-free days in the BI group were significantly increased by 93.0% at 12 months. Total drinks at 12 months were reduced by 41 g per week in the BI group compared with the control group, although the intergroup difference was not significant. CONCLUSION: BI in the workplace is effective for increasing the number of alcohol-free days. However, the effectiveness on decreasing alcohol consumption was unclear, which could be explained by alcohol screening itself causing a reduction in drinking.

Buffering effects of job resources on the association of overtime work hours with psychological distress in Japanese white-collar workers.

PURPOSE: The purpose of the present study was to investigate the buffering effects of job resources, utilizing the job demands-control (or demand-control-support) and effort-reward imbalance models (i.e., job control, workplace social support, and extrinsic reward), on the association of overtime work hours with psychological distress in Japanese employees. METHODS: A total of 1,198 participants (valid response rate = 93.7 %) from five branches of a manufacturing company in Japan completed a self-administered questionnaire comprising the scales assessing job resources, psychological distress, and demographic characteristics. We obtained the information on working hours in the most recent month from the personnel records of the surveyed company. Multiple logistic regression analyses were conducted. In a series of analyses, interaction term of overtime work hours with each job resource was included in the model. RESULTS: Significant interaction effect of overtime work hours with job control was observed. Among the low job control group, the long overtime (80 h or more) subgroup had a significantly higher prevalence odds ratio of psychological distress compared to the short overtime (44 h or less) subgroup. No significant association of overtime work hours with psychological distress was found among the high job control group. On the other hand, there was no significant interaction effect of overtime work hours with workplace social support or extrinsic reward. CONCLUSIONS: The present findings suggest that high job control has an effect on reducing psychological distress in relation to overtime work hours in Japanese employees.

[Role of occupational physician for workers' mental health].

In this paper, I briefly review the history of occupational mental health as well as administrative trends in Japan, and summarized how occupational physicians should get involved in these activities. As for mental health in the workplace, occupational physicians are required to participate in a large number of wide-ranging activities, including the management of mental illness. On the other hand, approving the occupational physician who is in charge of mental health affairs only has some important ramifications which cannot be disregarded. Careful consideration should be given to this matter.

[Job stress and mental health at work].

In Japan, a study on mental health in workplace has expanded from tertiary to secondary and primary preventions of mental health disorders among employees. Recent movements suggest a trend of bringing numerous topics outside the industrial health, including those with perspectives from categories generally known as primordial prevention, such as enhancement of working life quality or improvement of work environment.First, according to the aforementioned trends, the present paper made an effort to organize the terms and concepts related to mental health disorders, which included the foundation for research and practice in this area as well as the outcomes of discussions on the tertiary and secondary preventions.Second, the primary models of work-related stress, along its impact on mental health, and the scales for assessing workers' mental health issues were discussed, which have been used in numerous studies since the 1990s. The introduction of those models and scales contributed immensely to the expansion of this field's research areas. However, a number of significant factors, most of which have social or cultural implications, can influence the connection between stress at workplace and health problems. Therefore, conducting large-scale study or systematic reviews targeting domestic cases exclusively is necessary to obtain evidence for establishing highly versatile measures against mental health problems in Japan.Third, in this regard, several noteworthy large-scale research projects in Japan are highlighted as a hope for encouraging such studies in this field. However, the occupational health practitioners' effort to understand the actual workplace situations where they attend to and to put the understanding into practice has been and will remain an indispensable attribute for them in the future.

[Occupational health and early detection of depression].

The Ministry of Health, Labor and Welfare is planning to conduct a stress check for employees, using the opportunity of the periodical health check. In this paper, the author summarizes some problems with the plan, and refers to the meaning of detecting mental disorders in the workplace. Just like psychiatric treatment and other mental health activities, occupational mental health should be discussed from the historical point of view, excluding shortsighted judgment and improvised measures.

[Trends of occupational mental health in Japan].

Recently, promoting measures for workers' mental health has been one of the most important and pressing issues in occupational health. In this paper, I indicate the direction which the Ministry of Health, Labour and Welfare decided on and discuss the roles of in-plant occupational health staff. In-plant occupational health staff should attach great importance to "caseness" in their mental health activities. I express my personal opinion about the division of roles and coordination between in-plant occupational health staff and outside medical specialists. I also refer to the necessity of improvements in the workplace environment.

Induction of the arginine vasopressin-enhanced green fluorescent protein fusion transgene in the rat locus coeruleus.

We examined the effects of intracerebroventricular (i.c.v.) administration of colchicine on the expression of the arginine vasopressin (AVP)-enhanced green fluorescent protein (eGFP) fusion gene in rats. In rats administered i.c.v. vehicle (control), eGFP fluorescence was observed in the supraoptic nucleus (SON), the magnocellular division of the paraventricular nucleus (PVN), the suprachiasmatic nucleus (SCN), the median eminence (ME) and the posterior pituitary. Two days after i.c.v. administration of colchicine, eGFP fluorescence was markedly increased in the SON, the magnocellular and parvocellular divisions of the PVN, the SCN, the ME and the locus coeruleus (LC). Immunohistochemical staining for eGFP confirmed the distribution of fluorescence in both groups. In the colchicines-administered groups, immunohistochemistry for tyrosine hydroxylase (TH) revealed that the eGFP fluorescence was co-localised with TH-immunoreactivity in the LC. Similarly, in situ hybridization histochemistry for eGFP mRNA revealed a significant increase in gene expression in the LC, the SON and the PVN 12-48 h after administration of colchicine. Our results indicate that the synthesis of AVP-eGFP is upregulated in noradrenergic neurones in the LC after colchicine administration. This implies that AVP and noradrenaline, originating from LC neurones, might play a role in response to chronic stress.

Effects of a mental health training program for manufacturing company managers.

We practiced interventional approaches for the promotion of occupational mental health in a manufacturing company with approximately 2,000 workers, between 2005 and 2007. We investigated the long-term effects of our mental health training program--including Active Listening (AL) training for managers--on perceived job stressors, stress reactions and social supports of workers, and mental sick leave. We conducted the mental health training program with AL training for all managers in order to improve their communication skills and support for workers. The investigation was conducted using the Brief Job Stress Questionnaire (BJSQ). In addition, we surveyed the number of workers taking sick leave due to mental problems from 2003 to 2007. Among the categories of "job stressors" in the BJSQ, the scores for "quantitative workload," "qualitative workload" and "physical demands" improved significantly after our interventional approaches. The number of workers taking sick leave had been increasing gradually from 2003 to 2005, but this decreased by approximately half in 2006 and 2007. Our mental health training programs for managers were successful in decreasing some job stressors, stress reactions, and workers' sick leave due to mental problems.

Urinary 8-hydroxydeoxyguanosine levels and psychological reactions after sleep deprivation.

The aim of this study was to investigate whether changes in urinary 8-hydroxydeoxyguanosine (8-OH-dG), an oxidative stress indicator, occur or not, and how psychological reactions change, after one night of sleep deprivation (SD) and after 7 hour recovery sleep opportunities during three recovery days. Twenty healthy subjects participated in this study. We measured their urinary 8-OH-dG levels and psychological reactions using the Profile of Mood States (POMS) for 5 days: on the baseline day, the post-vigil day, and on 3 recovery days after SD. The urinary 8-OH-dG levels and subscale scores of POMS were analyzed using repeated analysis of variance (ANOVA). In the psychological reactions, the values of Vigor on the post-vigil day and 2nd recovery day were significantly lower than on the baseline day. Fatigue and confusion on the post-vigil day were significantly higher than on the baseline day, and on the 1st and 2nd recovery days were relatively higher compared to the baseline day but returned to baseline level on the 3rd recovery day. The urinary 8-OH-dG levels did not change significantly after SD, on the post-vigil day or on the 3rd recovery days. These results suggest that the effect of one night of SD on psychological reactions continued for 2 or 3 days, and SD might not influence urinary 8-OH-dG levels despite marked changes in psychological reactions.

[The transformation of occupational mental health in Japan].

Occupational mental health has been practiced for approximately 90 years in Japan. Today, there are high expectations for psychiatrists to be aware of this topic. Some past discussions and opinions related to occupational mental health remain fully applicable today. Based on these discussions and opinions, psychiatrists concerned with occupational mental health should take a medium to long-term view of meeting the demands of the workplace. It goes without saying that cooperation between psychiatrists and occupational health staff in the practice of occupational mental health is very important, but there is also ground for controversy regarding the division of their roles. The roles that psychiatrists are demanded to fulfill in activities related to mental health differ according to factors such as the type of business, workplace size, and occupational health system in place. Psychiatrists should practices with an understanding of the perspective of occupational health.

The effect of changes in overtime work hours on depressive symptoms among Japanese white-collar workers: A 2-year follow-up study.

OBJECTIVE: The purpose of this study was to investigate the effect of changes in overtime work hours on depressive symptoms among Japanese white-collar workers. METHODS: Participant data were collected from a company's annual mental health survey in June 2013 and June 2014. The participants comprised 922 workers who responded to the survey in both the years and had records of monthly working hours in the past 2 years. We obtained information on monthly working hours from personnel records from June 2012 to May 2014. Depressive symptoms were measured by the Brief Job Stress Questionnaire. Changes in overtime work hours were measured by creating a five-category variable for each monthly average of overtime work hours in the past year: (a) stable short, (b) decreased, (c) stable medium, (d) increased, and (e) stable long groups. Analysis of covariance was conducted to estimate the degree of depressive symptoms of each group for changes in overtime work hours. RESULTS: Significant differences among the groups were observed (F = 3.67, P = 0.006). In the Bonferroni multiple comparison test, significantly lower depressive symptoms were observed in the decreased group (point estimate = 9.56) compared to the stable short (10.76), stable medium (10.71), and increased groups (10.99). There was no significant difference between the decreased group and the stable long group (10.98). CONCLUSIONS: A decrease in overtime work hours may prevent the deterioration of mental health. This knowledge could support the necessity of mental health measures through decreasing overtime work hours proposed by national policy in Japan.

Social Support During Emergency Work and Subsequent Serious Psychological Distress: A Cross-Sectional Study Among Emergency Workers who Responded to the Fukushima Daiichi Nuclear Power Plant Accident.

OBJECTIVE: To examine the association between social support for emergency workers and levels of subsequent psychological distress, focusing on workers who responded to the Fukushima Nuclear Power Plant accident. METHODS: Male emergency workers (N = 1405) completed self-administered questionnaires, measuring social support during emergency work, subsequent serious psychological stress, occupational and demographic characteristics, and some confounders. Multiple logistic regression analyses were performed. RESULTS: Supervisor support was significantly associated with lower psychological distress, particularly for workers present at the site for over 31 days. For workers present for 10 days or less, coworker support was marginally significant. CONCLUSIONS: Social support is an important resource for reducing the risk of subsequent serious psychological distress among emergency workers. The associations of social support with psychological distress can differ depending on work duration and the providers of the support.

[Use and evaluation of Action Checklist for health risk management of employees working long hours].

In Japan, the Industrial Safety and Health Law requires an employer to implement medical interviews for employees working long hours. The law stipulates the criteria of the targeted workers as those whose working time exceeds the legal limit of working hours, those with accumulated fatigue, and those who desire to receive an interview from a physician. Therefore, the employers should make an appropriate system to identify the workers who require a medical interview among employees working long hours with increasing health risks. In this study, we used "The Action Checklist for health risk management of employees working long hours (ACL)" and evaluated its efficacy. We conducted two studies: a seminar study, using ACL as an educational material in the seminar targeting occupational health professionals, and an interventional study, distributing materials with ACL in one group of small-scale enterprises and not in another group. In the seminar study, we observed a greater number of practical answers to the problems hypothetically set in the seminar among the occupational health professionals who used ACL. The results of a questionnaire given after the seminar revealed ACL was favorably accepted among 80% of all the participants in the seminar as "I have fully understood the usage of ACL" and "ACL seems to be useful in my workplace". In the interventional study, we could not see positive results from the distribution of ACL, possibly because of the low response rate, short interventional term or distribution without individual explanation. Further investigation and efforts should be considered to widely diffuse ACL with individual explanations, to prevent health disorders caused or aggravated by working long hours.

[Effectiveness of mental health training including active listening for managers].

We carried out mental health training with Active Listening for managers of A company, which was the electronics manufacturing company with 1,900 employees. The purpose of the present study was to examine the effect on managers and employees in the workplace on the training. The subjects were all persons who managed regular employees directly in A company. We performed the investigation from May 2006 to February 2007 and carried out the training from September to November in 2006. The contents of the training were from the chapter on "The education and training of managers" in the "The guideline for maintenance and promotion of mental health for workers" issued by the Ministry of Health, Labour and Welfare in Japan in 2006. We divided the contents and implemented them in two sessions. "Responding to worker consultation" was one of the contents of Active Listening. In the first session, we explained about Active Listening, and in the second session we ran a practical involving Inventive Experiential Listening. One month later, we distributed material summarizing the training to all the participants. To evaluate the effect of the training, we conducted surveys of the participants using the Active Listening Attitude Scale (ALAS), prior to and after the training, and distributed questionnaires, post-training about the contents of the training and changes of consciousness and action. Furthermore, we performed surveys pre- and post-training using the Brief Job Stress Questionnaire (BJSQ) 12 items version, distributed to all employees. We evaluated the effect of the training on 124 managers and 908 workers by the investigation. The score of each subscale was analyzed by repeated measures analysis of variance. There were no significant differences in the scores of both the "Listening attitude" and "Listening skill" subscales of ALAS between pre-training and post-training, but the mean scores post-training were higher than those pre-training on both subscales. There were significant increases post-training in "Job demands", "Worksite support by supervisor" and "Worksite support by co-worker", subscales of the BJSQ 12 items version. Particularly, the "Worksite support by supervisor" subscale increased significantly in 8 of the 47 sections in a comparison among sections. In this present study, we investigated the effectiveness of mental health training including Active Listening for managers, and suggest that to train Active Listening and use it at the worksite possibly strengthens "Worksite support by supervisor".

Effect of the National Stress Check Program on mental health among workers in Japan: A 1-year retrospective cohort study.

OBJECTIVES: This retrospective cohort study evaluated the impact of the Stress Check Program, a recently introduced national policy and program aimed at reducing psychological distress among Japanese workers. METHODS: A baseline survey was conducted from November 2015 to February 2016, the period when Japan began enforcing the Stress Check Program. A one-year follow-up survey was conducted in December 2016. In the follow-up survey, two exposure variables were collected: having taken the annual stress survey, and experiencing an improvement in the psychosocial work environment. Psychological distress was assessed using the Brief Job Stress Questionnaire (BJSQ) at baseline and 1-year follow-up. The two exposure variables were used to define four groups: "Neither", "Stress survey (SS) only", "Psychosocial work environment improvement (WI) only", and "Both". BJSQ results were analyzed using repeated measures general linear modeling (GLM). RESULTS: The study included 2,492 participants: 1,342 in the "Neither" group, 1,009 in the "SS only" group, 76 in the "WI only" group, and 65 in the "Both" group. Overall time-group interaction effects were not significant. The "Both" group showed significantly greater improvements in psychological distress than the "Neither" group (p = 0.02) at the 1-year follow-up, although the effect size was small (d = -0.14). CONCLUSIONS: Combination of the annual stress survey and improvement in psychosocial work environment may have been effective in reducing psychological distress in workers, although the effect size was small.

Association between job stressors and heavy drinking: age differences in male Japanese workers.

The objective of the present study is to investigate the association between various occupational stressors and heavy drinking among male Japanese workers in different age groups. Using the Generic Job Stress Questionnaire, 13 occupational stressors and 2 workplace support indicators were assessed. The questionnaire survey was conducted of 25,104 workers, and the present study analyzed the data from 17,501 male workers. Heavy drinking was defined as weekly alcohol consumption of >275 g, and a total of 1,131 men (6.5%) were classified as heavy drinkers. After adjusting for shift work, occupational class, marital status and smoking, heavy drinking was related to "support from supervisor" for the 18-29 and 50-72 yr-old groups. For the 30-39 yr-old group, heavy drinking was related to "intragroup conflict", "job control" and "cognitive demands." For the 40-49 yr-old group, heavy drinking was related to "physical environment", "quantitative workload" and "underutilization of abilities." The present study clarified that certain occupational stressors relate to heavy drinking, and that this association varies among different age groups.