Relationship between duration of sick leave and time variation of words used in return-to-work programs for depression.

BACKGROUND: Return-to-work (RTW) programs are provided as rehabilitation for people who have taken sick leave from work because of mental health problems. However, methods to present this information to workplaces objectively remain limited. OBJECTIVE: This study aimed to conduct an exploratory investigation of the relationship between duration of sick leave and time variation of words used in RTW programs for depression from textual data collected from electronic medical records as a new evaluation indicator. METHODS: The study subjects were those who had taken sick leave because of major depressive or adjustment disorder and had participated in an RTW program. The study data comprised demographic characteristics and texts. Textual data were collected from electronic medical records and classified based on the SOAP note. Thereafter, the textual data were quantified into category scores based on a standard text analysis dictionary. A generalized linear mixed model was used for the statistical analysis, with the score for each category (emotional, social, cognitive, perceptual, biological, motivational, relativity, and informal) as the dependent variable and the duration of sick leave, time, and interaction between the duration of sick leave and time as the independent variables. The level of statistical significance was set at 0.05. RESULTS: In total, 42 participants were included in the analysis. The results revealed a significant interaction between the social (p = 0.001) and emotional (p = 0.002) categories. CONCLUSION: The findings suggest a relationship between word changes in electronic medical records and the duration of sick leave.

Relationships between Depression and Stress Factors in Housework and Paid Work among Japanese Women.

OBJECTIVE/BACKGROUND: The prevalence of depression in women is two times as much as that in men. However, the rehabilitation programme for return to work for patients with depression in Japan mainly focuses on male individuals. Japanese working women usually have the central role in housework in addition to paid work. Therefore, we hypothesized that Japanese working women with depression need a support programme for housework as well as paid work. The purpose of this study was to investigate the stress factors relevant to the existence of depression, in both paid work and housework, among working women. METHODS: This study recruited 35 women with depression and 35 women without depression. We carried out a cross-sectional investigation with two questionnaires having the same structure: The National Institute for Occupational Safety and Health (NIOSH) Generic Job Stress Questionnaire (for paid work) and the NIOSH Generic Housekeeping Labor Stress Questionnaire (for housework). We extracted the stress factors contributing to the existence of depression using logistic regression. RESULTS: Three stress factors were found--two in housework, and one in paid work. In housework, variance in workload and underutilization of abilities were associated with the presence of depression. In paid work, interpersonal conflict was an associated factor. CONCLUSION: Rehabilitation programmes involving variance in workload and under self-evaluation in housework, and interpersonal conflict in paid work must be adequately addressed to support working women with depression.

Treatment with intravenous hyperalimentation for severely anorectic patients and its outcome.

In treating patients with severe anorexia nervosa, it is important to improve their physical condition first. Patients who had lost close to 60% standard bodyweight (SBW) were candidates for inpatient treatment due to the mortality risk. With 80% SBW as the target for therapy, they were given both intravenous hyperalimentation and food by oral intake in order to improve their physical condition. In total, 51 patients were admitted. One died and four patients dropped out in the course of treatment. Forty-six patients who completed the inpatient treatment were reviewed. Although admitted with an average weight of approximately 60% SBW, they were discharged with a weight of approximately 80% SBW after approximately 60 days. An average follow up of 25.0 months was conducted, and two patients were found to have died. The mean weight, percentage resuming menstruation, and rehospitalization rate of the 44 survivors were 79% SBW, 23%, and 32%, respectively. The patients with the restricting type of anorexia had an earlier onset of the disorder and a better social outcome. Patients in whom onset occurred at a younger age had a better social outcome. After being discharged, the majority of the patients continued treatment as outpatients. Although the results were similar to those of conventional studies in terms of outcome, the shorter hospitalization was significant. Overall, in the treatment of patients with severe anorexia nervosa, it is important to begin psychotherapy while trying to improve their physical condition.

Family features in primary social withdrawal among young adults.

The problem of 'social withdrawal' among young adults is the focus of considerable attention in Japan today. Among the various manifestations of social withdrawal, a 'primary social withdrawal' group has been identified that cannot be diagnosed by the established classification of mental disorders. In an earlier report it was suggested that the onset mechanism for primary social withdrawal is not merely a problem of the withdrawn person themselves, but also includes problems of family relationships. The aim of the present study was to identify the characteristics and problems in family relationships associated with primary social withdrawal. For that purpose a survey was conducted using David H. Olson's Family Adaptability and Cohesion Evaluation Scale as well as a questionnaire that the present authors devised on family interactions and the personal situation of the withdrawn person. The results pointed to the following four characteristics of primary social withdrawal families: (i). there are definite rules within the family; (ii). the families share values and an unfounded pride; (iii). there is a lack of emotional exchange in the family, and it is difficult for members to sympathize with each other's negative feelings; and (iv). although concerned about each other, there is little verbal exchange. From these family characteristics, the onset mechanism for withdrawal is triggered by insignificant matters such as minor setbacks in the developmental issues of youth. Then, given the person's personality traits and aforementioned characteristics in family relationships, the person becomes mired in social withdrawal.

Cenesthopathy in adolescence.

Psychopathological investigation was conducted on the basis of the clinical observation of 23 subjects whose cenesthopathic symptoms began before 30 years of age. This illness is called 'adolescent cenesthopathy' based on the specificity of this mental condition to the adolescent period. Adolescent cenesthopathy is compared to schizophrenia, depersonalization, sensitive delusion of reference and other symptoms. Outstanding features of adolescent cenesthopathy are shown from the perspective of its difference from schizophrenia in terms of the specific characteristics of the symptoms in this disease.

[Psychopathological features of "primary social withdrawal"].

This article attempts to clarify the psychopathological features of "primary social withdrawal". Since the concept of "social withdrawal" in general may include various diseases, we isolated and defined "primary social withdrawal" by excluding cases that could be diagnosed by established classifications of mental disorders. First, we examined two cases of "primary social withdrawal" which could not be classified using DSM-IV. We then compared these patients' psychopathological features to those seen in apathy syndrome, taijin kyofu sho and personality disorders. Based on this comparison, we identified five pathological features of "primary social withdrawal": (1) episodes of defeat without a struggle, (2) protecting the ideal image of the expected self, (3) parents' investment in that ideal self, (4) holding an ideal self image shaped more by the desires of others than those of themselves, and (5) avoidance behavior to maintain the positive opinion of others. Finally, we discuss the socio-cultural background of social withdrawal and possible therapies.