A greater number of somatic pain sites is associated with poor mental health in adolescents: a cross-sectional study.

BACKGROUND: Identifying indicators of poor mental health during adolescence is a significant public health issue. Previous studies which suggested an association between the number of somatic pains and depression have mainly focused on adults or have employed samples with a narrow age range. To date, results from previous studies have been inconsistent regarding the association between somatic pain and academic impairment. Therefore, the main aims of the present study were to 1) investigate the association between the number of somatic pain sites and poor mental health using a community sample of adolescents aged 12 to 18 years and employing a simple method of assessment, and 2) examine the association between the number of somatic pain sites and perceived academic impairment. METHODS: Data analysis was conducted using a large cross-sectional survey of adolescents in grades 7 to 12. The one-month prevalence rates for three sites of somatic pain including head, neck and shoulders, and abdomen were examined. Poor mental health was evaluated using the General Health Questionnaire, and perceived academic impairment was measured using a self-report questionnaire. RESULTS: A total of 18,104 adolescents participated in the survey. A greater number of pain sites was associated with poor mental health, and this association was consistent across age and gender. There was no difference in effect on mental health between any of the pain sites. Although there was an association between the number of somatic pain sites and perceived academic impairment, the results suggested that the association was mediated by poor mental health. CONCLUSIONS: Simple reporting methods for assessing the number of pain sites may be a feasible indicator of poor mental health in adolescents. Professionals working with adolescents should consider the possibility of poor mental health, especially when students report multiple somatic pains.

Cost-effectiveness of family psychoeducation to prevent relapse in major depression: results from a randomized controlled trial.

BACKGROUND: Family psychoeducation is a relatively simple and straightforward intervention whose prophylactic effectiveness and cost-effectiveness is well-established for schizophrenia. We have recently demonstrated its effectiveness for unipolar depression, but its cost-effectiveness has never been examined. We hereby report a cost-effectiveness analysis alongside a randomized controlled trial in order to assess its cost-effectiveness for preventing relapse/recurrence in depression. METHODS: Fifty-seven patients diagnosed with major depression and undergoing its maintenance treatment, and their primary family members were randomized to treatment as usual (TAU) only or to TAU plus family psychoeducation, which consisted of four 2-hour multiple-family sessions consisting of didactic lectures about depression (30 minutes) and group discussion and problem solving (60-90 minutes). The economic analyses were undertaken from the perspective of the National Health Insurance (NHI), assuming the most reasonable price of US$50 per psychoeducation session per patient. The main outcome measures included relapse-free days and direct costs to the NHI. RESULTS: The intervention group enjoyed 272 (SD: 7.1) relapse-free days, while the control group spent 214 (SD: 90.8) relapse-free days (Cox proportional hazard ratio=0.17, 95%CI: 0.04 to 0.75, p=0.002). Cost-effectiveness acceptability curves suggested that the family psychoeducation has 90% or more chances of being cost-effective if the decision-maker is prepared to pay US$20 for one additional relapse-free day. This cost-effectiveness finding was robust when the price for family psychoeducation ranged between 50% to 150% of the baseline scenario in sensitivity analyses. If a relapse-free day is considered to be worth $30 or more, all the pricing scenarios have a close to 100% probability of being cost-effective. CONCLUSION: Family psychoeducation is effective in the relapse prevention of depression and is highly likely to be cost-effective if a relapse-free day is valued as US$20 or more. TRIAL REGISTRATION: UMIN-CTR (UMIN000005555).

Strategies and future attempts to reduce stigmatization and increase awareness of mental health problems among young people: a narrative review of educational interventions.

There is a need to reduce stigma and increase awareness in order to prevent social exclusion of people with mental illness and to facilitate the use of mental health services in young people. The purpose of this review was to examine the effects of educational interventions to reduce stigmatization and improve awareness of mental health problems among young people. An electronic search using MEDLINE, PsycINFO and Academic Search Complete was carried out for studies that evaluated the effectiveness of educational interventions. Forty eligible studies were identified. There were three types of educational interventions (Educational condition, Video-based Contact condition and Contact condition). Eighteen of 23 studies reported significant improvements in knowledge, 27 of 34 studies yielded significant changes in attitudes towards people with mental illness. Significant effects in social distance were found in 16 of 20 studies. Two of five studies significantly improved young people's awareness of mental illness. However, six studies reported difficulties in maintaining improved knowledge, attitudes and social distance in young people. Furthermore, the majority of studies did not measure the actual behavioral change. From the comparison of the three types of educational interventions, direct contact with people with mental illness (Contact condition) seems to be key in reducing stigmatization, while the components of Education and Video-based contact conditions are still arguable. Despite the demonstration of the positive effects of each educational intervention, their long-term effects are still unclear. Further research needs to involve measuring actual behavioral change and performing a long-term follow up.

Family psychoeducation for major depression: randomised controlled trial.

BACKGROUND: The value of family psychoeducation for schizophrenia has been well established, and indications for its use have recently expanded to include bipolar affective disorder. However, no study to date has adequately examined its use in depression. AIMS: To examine family psychoeducation in the maintenance treatment of depression and to investigate the influence of the family's expressed emotion (EE) on its effectiveness. METHOD: Of 103 patients diagnosed with major depression and their primary family members, 57 pairs provided written informed consent. The pairs were randomly allocated to the intervention (n = 25) or control (n = 32). One family in the intervention group and two in the control group withdrew their consent after randomisation. The intervention group underwent four psychoeducation sessions consisting of didactic lectures about depression and group problem-solving focusing on how to cope in high-EE situations. Patients did not attend these sessions. Patients in both the intervention and control groups received treatment as usual. The families' EE levels were evaluated through Five-Minute Speech Samples. The primary outcome was relapse. RESULTS: Time to relapse was statistically significantly longer in the psychoeducation group than in the control group (Kaplan-Meier survival analysis, P = 0.002). The relapse rates up to the 9-month follow-up were 8% and 50% respectively (risk ratio 0.17, 95% CI 0.04-0.66; number needed to treat 2.4, 95% CI 1.6-4.9). In Cox proportional hazard analysis, baseline EE did not moderate the effectiveness of the intervention. CONCLUSIONS: Family psychoeducation is effective in the prevention of relapse in adult patients with major depression.

Psychosocial job characteristics and smoking cessation: a prospective cohort study using the Demand-Control-Support and Effort-Reward Imbalance job stress models.

INTRODUCTION: A prospective cohort study was conducted to examine the effects of psychosocial job characteristics on smoking cessation. Previous studies have failed to indicate consistently that psychosocial job characteristics predicted smoking cessation. Using the Demand-Control-Support (DCS) and Effort-Reward Imbalance (ERI) models simultaneously, we assessed psychosocial job characteristics more comprehensively than did previous researchers. METHODS: This study was performed using a population derived from a corporate manufacturing group in Japan. At the baseline, 579 (41%) of 1,423 middle-aged (> or = 39 years) male employees were smokers. These male smokers were considered as the study subjects and were asked to undergo a follow-up examination after 2 years. Prospective analysis of the relationship between psychosocial job characteristics at the baseline and smoking cessation at the follow-up was performed. Job strain, social support, effort-reward imbalance, and overcommitment to work were assessed as psychosocial job characteristic factors. RESULTS: The smoking cessation rate among the study subjects at the follow-up was recorded as 5% (31/579). No psychosocial job characteristic factors at the baseline were significantly related to smoking cessation at the follow-up. DISCUSSION: Even with the simultaneous use of the DCS and ERI models, we did not find positive results in terms of the prospective effects of psychosocial job characteristics on smoking cessation. Considering the results of relevant previous studies and those of the present study, we suppose that psychosocial job characteristics could have essentially little effect on smoking cessation.

Association between feasibility of discharge, clinical state, and patient attitude among inpatients with schizophrenia in Japan.

AIM: There have been some studies on the feasibility of discharging mentally ill inpatients from mental hospitals. The purpose of the present study was to investigate how a psychiatrist judges whether an inpatient can be discharged. METHODS: A survey regarding such judgments on discharge was conducted involving 549 inpatients with schizophrenia with a hospital stay of > or =1 year. Relationships between psychiatrist judgments on discharge and the Brief Psychiatric Rating Scale (BPRS), Scales for the Assessment of Negative Symptoms (SANS), Global Assessment Scale (GAS), patient attitude to discharge, and other variables were investigated. A similar analysis was conducted regarding patient attitudes toward discharge. RESULTS: After controlling for potential confounding factors using multiple logistic regression, the judgments showed significant relationships with BPRS-P, SANS, GAS, and age. Patient attitudes showed significant relationships with the length of the current hospital stay, SANS, and psychiatrists' judgments. CONCLUSION: A psychiatrist's judgment regarding discharge is a comprehensive decision that takes into account psychiatric symptoms, social functioning, and age. Such a judgment could also affect a patient's own attitude toward discharge.

Psychosocial job characteristics and insomnia: a prospective cohort study using the Demand-Control-Support (DCS) and Effort-Reward Imbalance (ERI) job stress models.

OBJECTIVE: To examine the prospective effects of psychosocial job characteristics evaluated with the Demand-Control-Support (DCS) and Effort-Reward Imbalance (ERI) models on insomnia. METHODS: A prospective cohort study with a two-year observation was performed. The subjects were 1022 middle-aged (>or= 39 years) Japanese workers. The following associations were analyzed: high job strain, low social support, effort-reward imbalance, and overcommitment to work at the baseline with self-reported persistence and future onset of insomnia. RESULTS: Among those who were insomniacs at the baseline (N=292), low social support [adjusted odds ratio (95% CI): 2.00 (1.18, 3.40)] and effort-reward imbalance [2.40 (1.13, 5.10)] at the baseline had a significant relationship to insomnia at the follow-up. Among those who were not insomniacs at the baseline (N=730), overcommitment to work [1.75 (1.16, 2.66)] and high job strain [1.72 (1.06, 2.79)] at the baseline were associated with insomnia at follow-up. CONCLUSIONS: Prospective effects of psychosocial job characteristics on insomnia differed between its persistence and future onset. Proportionate reward for work effort and sufficient support at work assist recovery from insomnia, while overcommitment to work and high job strain cause future onset of insomnia.

Residential program for long-term hospitalized persons with mental illness in Japan: Randomized controlled trial.

Research on the merits of long-term group residences is inconclusive. The purpose of the present paper was to investigate the effects of supported group residence on the symptoms, social function, quality of life, general health quality, and the medical/psychiatric cost in Japan of a large number of psychiatric beds and long average length of stay. Patients were assessed every 6 months for 2 years using Positive and Negative Syndrome Scale, Katz Adjustment Scale, World Health Organization Quality of Life (WHO-QOL) and General Health Questionnaire 12-item version. Patients discharged to the supported group residence (SGR) significantly improved with regard to positive symptoms, the level of socially expected activities and free-time activities. The QOL physical domain of the inpatients was significantly more deteriorated compared to the SGR group. The total psychiatric/medical cost of the SGR group was approximately one-third that of the inpatient group, while the cost of the SGR to treat physical comorbidity was much higher. The present findings indicate that SGR has advantages for mental and social function but not for physical health. A major limitation of the present study was the high mean age (>60 years) of the subjects who had been hospitalized for a long period (mean, 24 years).

Medical cost analysis of family psychoeducation for schizophrenia.

Family psychoeducation has been shown to prevent the relapse of schizophrenia. However, whether medical costs are reduced by this approach remains uncertain. The subjects were patients with schizophrenia who lived with high-expressed emotion (EE) families and were at high risk of relapse. A total of 30 patients whose families underwent psychoeducation and intensive family sessions or psychoeducation and subsequent support were regarded as the psychoeducation group. A high-EE group without family psychoeducation made up of 24 patients was used as a control group. The mean outpatient medical cost, duration of hospitalization, inpatient medical cost, and total medical cost during the follow-up period were compared between the psychoeducation group and the control group. The mean inpatient medical cost was 270,000 yen in the psychoeducation group and 470,000 yen in the control group. The mean total medical costs were 500,000 yen in the psychoeducation group and 710,000 yen in the control group. The cost in the psychoeducation group was significantly lower than the control group by Mann-Whitney U-test. The proportion of patients with a total medical cost greater than the median value was 23% in the psychoeducation group and 54% in the control group with a significant difference. The medical cost can be reduced in the psychoeducation group compared with the control group due to the prevention of re-hospitalization by family psychoeducation.

How many long-stay schizophrenia patients can be discharged in Japan?

The mental health-care system in Japan remains hospital-based, and has the largest number of psychiatric beds per capita in the world. However, serious discussion about deinstitutionalization has recently begun. This study attempts to determine the proportion of inpatients that would benefit from community-based programs, as judged by hospital psychiatrists, and to evaluate the need for community resources for their community placement. Inpatients with schizophrenia from 139 hospitals were randomly selected. Data on the psychiatrists' judgment of discharge and required resources for community placement were obtained for 2758 subjects. Among the subjects, 1097 (39.8%) were judged to have the possibility of being discharged using community resources (possible discharge group; PDG). Provided that the proportion of PDG was 40%, controlling for the hospital background variables, the number of schizophrenia inpatients with a hospital stay of > or = 1 year who could be discharged from psychiatric hospitals in Japan was estimated to be 66,000. For the PDG, the required community resources, including accommodation, daytime activity, and daily living support services, were calculated. The numbers of governmental targets for community resources, including community accommodation, daytime activities, and daily living support services may have been underestimated.

[Effects of an educational intervention to reduce prejudice toward the mentally disabled among high school students].

OBJECTIVE: To assess the efficacy of an educational intervention among high school students aimed at increasing correct knowledge of mental health and reducing prejudice toward the mental disabled. METHODS: A total 180 high school students (intervention group 99; control group 81) participated in the investigation. The intervention program comprised a 1 hour session about mental health and a 1 hour lesson in which 2 persons suffering from mental illness narrated their experiences. The study design was a pre and post questionnaire survey (after 1 week and after 2-3 months). RESULTS: In the intervention group, the response rates were 98.0% in the pre questionnaire survey, and 88.9% in the post questionnaire survey. In the control group, the response rates 90.1%, and 93.8%, respectively. In the intervention group, means of positive attitude scores (t-test) rose significantly from 40.6 at baseline to 51.1 after 1 week and 47.4 after 2-3 months. In the control group, mean positive attitude scores were 43.1 at baseline and 41.5 after 1 week, and 42.8 after 2 -3 months. After one week of the program, favorable attitudinal changes were observed in the intervention group. However, after 2-3 months, favorable answers were reduced. In contrast, no significant change was observed in the control group. CONCLUSION: An educational program can produce favorable attitudinal changes regarding the mental disabled. On the other hand, the results suggest that it is difficult to maintain favorable attitudinal changes with this program over time.

[Factors affecting WHOQOL-26 in community-dwelling patients with schizophrenia].

OBJECTIVE: Schizophrenic patients' quality of life (QOL) has become increasingly important due to shift of mental health care from hospitals to communities. This paper describes a longitudinal study conducted to clarify relationships among the QOL, self-esteem, depressive mood, and uncooperativeness of schizophrenic patients identified in the authors' previous crosssectional study. METHODS: Subjects were 61 schizophrenic patients attending day care at mental hospitals. They were assessed initially, and again after a 12-month follow-up. The assessment was carried out using the Rosenberg Self-Esteem Scale, WHOQOL-26 Scale, and the Brief Psychiatric Rating Scale, and included personal characteristics. Covariance structure analysis (Synchronous Effects Model) was conducted to clarify the relationships between self-esteem and the WHOQOL-26 Scale, and between psychiatric states (depressive mood and uncooperativeness) and self-esteem, while controlling for subjects' individual characteristics and use of antipsychotics as confounding factors. RESULTS: The results indicated that self-esteem had a significantly positive effect on the WHOQOL-26 Scale while depressive mood and uncooperativeness were without significant effects. CONCLUSIONS: The results provide evidence that the enhancement and maintenance of self-esteem may be an effective method of improving WHOQOL-26 in schizophrenic patients.

Can stress management at the workplace prevent depression? A randomized controlled trial.

BACKGROUND: Stress, mental health and depression at the workplace have emerged as common and significant problems. The effectiveness of a stress-management program at the workplace was investigated. METHODS: The effectiveness of a stress-management program was examined in workers at a highly stressful workplace using a randomized controlled trial. The 58 workers in the office were randomly assigned into a stress-management group (n = 28) and a control group (n = 30). The stress-management program included lectures on the perception of stress, measures to cope with it, stress-management recording sheets, and e-mail counseling. This program was based on the cognitive behavioral approach. The stress-management program was carried out for 3 months, and perceived work-related stress and psychological symptoms were evaluated using: General Health Questionnaire (GHQ)-30, Center for Epidemiologic Study for Depression (CES-D), the Questionnaire of Work-Related Stress and the Effort-Reward Imbalance Questionnaire. Twenty-one out of the 28 in the stress-management group and all in the control group were successfully followed up. RESULTS: In the stress-management group, a significant improvement in the depressive symptoms was observed, compared with the control group in CES-D (p = 0.003 by two-tailed paired t-test, and p = 0.042 by repeated measure analysis of variance). In the multiple regression analysis, the effect of stress management on depressive symptoms at follow-up was significant (p = 0.041), controlling for potential confounding factors. However, the alleviation of perceived occupational stress was limited. CONCLUSIONS: A stress-management program based on the cognitive behavioral approach at the workplace may have potential for the prevention of depression.

Seasonality of birth in patients with schizophrenia in Japan.

Although most Western studies have found a birth excess during winter or early spring among patients with schizophrenia, this has not been found in Japanese samples. The purpose of the present paper was to investigate this finding using a large Japanese sample. Distributions of monthly birth numbers of patients with schizophrenia were compared to those of the general population. Patients were from the governmental data, numbering 88 788. A significant birth excess during winter to early spring was found in male and female subjects with schizophrenia compared to the general population. There is a significant birth excess during winter to early spring for schizophrenia in Japan. The authors consider that the discrepancy between the current study and the previous Japanese studies was caused by small sample size and selection bias in the previous Japanese studies.

A prospective study on the influences of workplace stress on mental health.

The purpose of this study was to clarify the influences of subjective stress in the workplace on mental health according to work contents in subjects without mental health problems. In a survey in fiscal 1997, 1,246 (84.6%) of all 1,363 workers of a manufacturing company in Japan, responded to a questionnaire including questions on subjective stress and GHQ60, and 1,135 workers answered all questions (effective response rate, 83.3%). In fiscal 1997, there were 705 "mentally healthy" workers with a GHQ score of 16. Of the 705 workers, 603 (85.5%) could be followed up by another survey 2 yr later (fiscal 1999). According to the contents of the work, multiple logistic regression analysis was performed using the status of mental health in fiscal 1999 as a dependent variable and subjective workplace stress, sex, age, smoking, and alcohol usage in fiscal 1997 as explanatory variables. The statistically significant items relating to problematic mental health for "factory work" were "too much competition", "feel pressed for time", and "cannot keep up with new technology" (Table 4). For "too much competition", the odds ratios (95% CI) of "always" and "sometimes" to "do not feel" were 4.04 (1.39-11.76) and 1.85 (0.92-3.70), respectively. For "feel pressed for time", the odds ratios (95% CI) of "always" and "sometimes" to "do not feel" were 2.40 (1.08-5.35) and 0.98 (0.46-2.06), respectively. For "cannot keep up with new technology", the odds ratio (95% CI) of "always" and "sometimes" to "do not feel" were 6.54 (0.37-116.36) and 2.52 (1.34-4.77), respectively. The statistically significant items relating to problematic mental health for "research and development or office work" were "too much trouble at work" and "feel pressed for time". For "too much trouble at work", the odds ratios (95% CI) of "always" and "sometimes" to "do not feel" were 3.92 (1.41-10.93) and 1.44 (0.67-3.09), respectively. For "feel pressed for time", the odds ratios (95% CI) of "always" and "sometimes" to "do not feel" were 2.69 (1.04-6.93) and 2.09 (0.94-4.67), respectively. Our study suggests that subjective stress items aggravating mental health are different among work contents. If we could identify items of workplace stress influencing mental health by work contents, we could utilize the results for a mental health promotion program.

Effects of environmental deprivation on negative symptoms of schizophrenia: a nationwide survey in Japan's psychiatric hospitals.

Research into the effects of environmental deprivation on negative symptoms of schizophrenia is limited, and few attempts have been made to differentiate secondary symptoms caused by the social environment. Japan's mental health system allows us to examine the extent to which understimulating social environments in hospitals contribute to negative symptoms of institutionalized patients while controlling for other factors. A random sample of inpatients of diagnosed with schizophrenia and hospitalized for 1 year or longer was drawn from the universe of inpatients attending a convenience sample of 20 hospitals across Japan. Data were collected for 549 study participants (a response rate of 91.5%). Measures included the Scale for the Assessment of Negative Symptoms (SANS), other clinical condition scales such as the Manchester Scale, and social condition scales including the Nurses' Opinion Scale and the Ward Restrictiveness Scale. Hierarchical regression analyses were conducted to determine the contribution of social environment to negative symptoms. Results showed significant correlations between negative symptom scales and most of the social environment scales, where social environment scales accounted for 18% of the variance in SANS scores. The study confirms the influence of understimulating social environments in psychiatric hospitals on negative symptoms.

A cross-cultural study on expressed emotion in carers of people with dementia and schizophrenia: Japan and England.

Expressed emotion (EE) research has been productive in investigating the influence of the interpersonal environment on a range of disorders. The majority of EE research on the influence of carers has been carried out in the west. This is the first EE study of the carers of people with dementia in Japan. The aim of this study was to investigate the relationships between EE status and aspect of burden through cross-cultural comparison of the two countries, Japan and England, with large cultural and linguistic differences. Comparisons were made between samples of EE of carers of dementia and schizophrenic patients. In total, data on 80 carer/relative-patient dyads were collected and examined: (1) 20 Japanese carers of people with dementia (JD), (2) 20 English carers of patients with Alzheimer's disease (ED), (3) 20 Japanese relatives of patients with schizophrenia (JS), and (4) 20 English relatives of patients with schizophrenia (ES). The Camberwell Family Interview was administered in each country to ascertain levels of EE. Large differences between Japan and England were found in the frequency of critical comments, in which ES>ED>JS>JD. EE correlated significantly with burden in the JD sample alone. With an operational cut-off of 2CC (CC, critical comments), EE correlated significantly with cognitive impairment as well as with clinical severity in the JD sample. There was a tendency for lower expression of both positive and negative emotional reactions towards family members in the Japanese sample. The results of this study indicate that EE is an appropriate measure for use with carers of sufferers of dementia and can be utilized across different cultures. However, flexibility with the cut-offs may be required in Eastern cultures. This needs to be tested on larger samples with sensitivity to illness and cross-cultural differences.

Association between psychosocial job characteristics and insomnia: an investigation using two relevant job stress models--the demand-control-support (DCS) model and the effort-reward imbalance (ERI) model.

BACKGROUND AND PURPOSE: The details of risky psychosocial job characteristics related to insomnia are unclear, although potential relationships between the two have been suggested. The study objective was to clarify these relationships by using the demand-control-support (DCS) model and the effort-reward imbalance (ERI) model. PATIENTS AND METHODS: A cross-sectional questionnaire survey was conducted with 1081 middle-aged (39 years and older) workers in a corporate group of electric products in Osaka, Japan. The study variables included insomnia symptoms (non-refreshing sleep, difficulty falling asleep, frequent sleep disruption, and early morning arousal) and psychosocial job characteristics which were evaluated using the DCS and ERI models, gender, age, disease, sleep-related factors, occupational status, and health practices. RESULTS: ERI [odds ratio (95% confidence interval): 2.27 (1.43, 3.60)], overcommitment [1.86 (1.40, 2.47)], and high job strain [1.55 (1.12, 2.15)] were independently associated with insomnia. The odds ratio of insomnia for individuals with high job strain was increased by adding ERI or overcommitment. CONCLUSIONS: The ERI and DCS models describe the adverse psychosocial job characteristics related to insomnia. Simultaneously employing these two models is more useful than employing a single model to identify workers at risk of insomnia. The conceptual framework derived from the job stress models assists in defining preventive measures for insomnia in workers.

Quality of life of schizophrenic patients living in the community: the relationships with personal characteristics, objective indicators and self-esteem.

The relationship of personal characteristics, objective indicators, and self-esteem to quality of life (QOL) was investigated cross-sectionally in 73 Japanese schizophrenic patients, and the question of how objective conditions affect subjective evaluation was evaluated. Depressive mood and uncooperativeness were negatively correlated with self-esteem, and self-esteem was positively correlated with QOL. Self-esteem was considered to directly affect QOL, and depressive mood and uncooperativeness to affect QOL via self-esteem. Findings suggest that, in order to improve the QOL of schizophrenia patients, interventions to help alleviate psychiatric symptoms (e.g. depressive mood, uncooperativeness) must be utilized. A change in Japanese society itself must occur so that the consequences of stigma may be reduced and patient coping skills improved.