Takeaki Takeuchi

Association of metabolic syndrome with depression and anxiety in Japanese men

AIM The evidence is conflicting as to whether or not metabolic syndrome (MetS) is associated with depression and anxiety. For this reason, we have investigated the association of MetS with depression and anxiety in Japanese men. METHODS MetS was defined as in the new (2006) criteria of the International Diabetes Federation (IDF), and depression and anxiety were assessed using the Profile of mood states (POMS), in 1215 male Japanese workers. The relationship between MetS and these mental conditions was assessed by logistic-regression analysis after controlling for age, gender, obesity, medical history (cardiovascular disease and diabetes), lifestyle habits (smoking, alcohol consumption, exercise and sleep) and work situation. Trend analyses for a positive association between MetS components and depression and anxiety were also performed. RESULTS A total of 148 (12.2%), 92 (7.6%) and 170 (14.0%) patients were diagnosed with MetS, depression and anxiety, respectively. MetS was significantly related to depression, and waist circumference contributed significantly to the relationship. Trend analysis of the number of positive MetS components and depression showed a positive trend that was of borderline significance (P(trend)=0.06). No relationship was found between MetS and anxiety. Trend analysis of the number of positive MetS components and anxiety failed to show a clear trend (P(trend)=0.57). CONCLUSION A positive relationship was found between MetS and depression, but not between MetS and anxiety, in male Japanese workers. The specific factors comprising MetS, such as waist circumference, may be a reflection of the depression.

Association of the metabolic syndrome with depression and anxiety in Japanese men: a 1-year cohort study.

Recent studies on the association between the metabolic syndrome (MetS) and depression have reported conflicting findings. This 1‐year cohort study aims to evaluate the association of MetS with the development of both depression and anxiety.

Associations of insomnia with job strain, control, and support among male Japanese workers

OBJECTIVE To assess the relationship between job stress and insomnia among office workers. METHODS This cross-sectional study examined 1209 male workers (mean age 43 years) at periodic health checkups in 2007. Insomnia was defined as consistently experiencing any of three sleep disorder symptoms (i.e., difficulty initiating sleep, difficulty maintaining sleep, and early-morning awakening) in a recent two-week period. Job stress indices included job demand, control, strain (job demand/control), and social support, as measured by the Job Content Questionnaire. RESULTS The prevalence of insomnia was 4.7%. After adjusting for age, perceived daily stress, sleep dissatisfaction, lifestyle factors, and physical comorbidities, the risk of insomnia increased with a higher degree of job strain (odds ratio 2.3, 95% confidence intervals 1.3-4.0) and decreased with a higher degree of job control (0.5, 0.3-0.8). The combination of high job strain with low degree of control or social support had an approximately three times higher risk of insomnia than that of low job strain with high degree of control or support. CONCLUSIONS Both job strain and job control had an independent effect on insomnia, and the association between job strain and insomnia was mediated by the buffering effects of control and support.

The suicide epidemic in Japan and strategies of depression screening for its prevention.

Introduction Suicide is among the most tragic outcomes of all mental disorders. WHO estimates that, worldwide, there are approximately one million deaths from suicide each year, and 20 times this number of people attempt suicide. Although the Japanese population leads the world in longevity, it has a high rate of suicide that is globally ranked ninth. From 1995 to 2004, the incidence of reported suicides rose dramatically from 17.5 to 25.1 per 100 000. Some studies have reported that this increase is closely related to the economic depression that occurred in Japan over the same period. While a reduction in suicide rates may depend on an economic recovery, public health practitioners must try to help potentially suicidal individuals, regardless of outside influences such as the economy. Depression plays an important role in the etiology of suicide. Over 60% of the individuals who commit suicide were identified as depressive. Reducing the number of suicide attempts requires, therefore, an initial identification of people with potential depression. When the University of Iowas psychiatric department hosted clinics on the National Depression Screening Day in the USA in 1996, 65% of the 927 participants required further evaluation, of whom 83% subsequently received treatment for depression. (1) Efforts made in the USA indicate that tactics instituted to identify depression can work well to reduce suicide rates at the national level. In 2000, the Japanese Government declared its goal to reduce the annual incidence of suicide by 30% until 2010. The National Committee published proposals for suicide prevention in 2002, emphasizing the importance of pre-intervention (assessment of factors affecting suicide), intervention (identification of high-risk persons to prevent suicide) and post-intervention (social support for bereaved family and friends). They also published two guidelines for managing depression: one for health-care professionals and one for public servants. The guidelines recommend a screening test for depression in the workplace and the community, using a method based on the full criteria of the Statistical manual of mental disorders, 4th edition, text revision (DSM-IV-TR), including eight or nine items for assessment. A simpler method is required to promote screening for depression nationwide. Fulfilment of the national goal within the next five years will require identification of target groups and extensive intervention for high-risk persons in these groups. Identification of target groups Depression is one of the most rapidly spreading mental disorders in Western countries and in Japan. According to the National Survey in Japan, the number of individuals diagnosed with depression increased from 83.1 to 340.0 per 100 000 during the period 1984-98. Although depression is generally more common in women than in men, the most dramatic increase has involved middle-aged men (40-60 years); this tendency also applies to the percentage of the population who commit suicide. In Japan, most middle-aged men function as the family breadwinner and may be too busy with work to visit a clinic, even when they feel mental distress. Because it is mandatory for all workers in Japan to undergo health check-ups every year at the expense of their employers, targeting middle-aged men in the workplace is a good strategy for identifying potentially depressive persons. Simple screening methods to detect depression The most commonly used standard for the diagnosis of major depressive disorder (MDD) is a structured interview by a specialist, such as a psychiatrist, according to the DSM-IV-TR criteria. Essential MDD symptoms are depressive mood and a loss of interest lasting at least two weeks; diagnosis also requires three additional concurrent symptoms (e.g. appetite loss, fatigue and insomnia). With the possible exceptions of psychiatrists and psychological specialists, diagnosing depression is not an easy task: interviews are somewhat complex and are time consuming. …

Clinical application of paroxetine for tapering benzodiazepine use in non‐major‐depressive outpatients visiting an internal medicine clinic

Abstract  Chronic benzodiazepine (BDZ) users often have difficulty with BDZ withdrawal. To examine clinical effects of selective serotonin reuptake inhibitor (SSRI) on tapering BDZ use in non‐depressive patients, 97 outpatients with a history of BDZ use for at least 3 months were recruited at an internal medicine clinic of a university hospital. After the 4th edition of the Diagnostic and Statistical Manual (DSM‐IV) clinical interviews for screening major depression, 66 outpatients (68%) without the DSM‐IV major depression were randomly assigned to one of three groups: SSRI‐assisted BDZ‐reduction group (10–20 mg of paroxetine, n = 22), simple BDZ‐reduction group (no paroxetine, n = 23), and reference group (no BDZ‐reduction, n = 21). A standardized 8‐week program involving gradual BDZ discontinuation was performed in the two BDZ‐reduction groups. The Hamilton Rating Scales for Depression (HAM‐D) and Anxiety (HAM‐A) and the BDZ Withdrawal Symptom Questionnaire were assessed during the intervention period. Those with major depression were excluded from the BDZ‐reduction intervention and treated with a different protocol of medication. In total, 10 (45.5%) in the SSRI‐assisted BDZ‐reduction group (n = 22) succeeded in becoming BDZ‐free after completing the program, whereas only four (17.4%) in the simple BDZ‐reduction group (n = 23) succeeded. The assistance of the SSRI significantly predicted the success of becoming BDZ‐free (P = 0.023), controlling for the effects of age, gender, period of BDZ use, and baseline HAM‐D and HAM‐A scores. The score changes on the three questionnaires were comparable (all P > 0.05) among the three groups during the intervention period. The use of SSRI may have beneficial effects on BDZ withdrawal without the worsening of mood states in cases without major depression.

Job stress and healthy behavior among male Japanese office workers.

BACKGROUND Lifestyle modification in healthy workers is challenging. We aim to investigate associations between job stress and healthy behavior change among workers. METHODS This cross-sectional study investigated 1,183 Japanese male white-collar workers in 2008 during health checkups for Metabolic Syndrome. Healthy behavior included either a calorie-focused diet or regular exercise. Job stress was measured by Job Content Questionnaire based on the job demands-control model and tension-anxiety and anger-hostility scales on the Profile of Mood States. RESULTS Healthy behaviors were confirmed in 54% of study subjects. Multivariate logistic model showed that healthy behaviors were positively associated with a higher degree of work control and negatively associated with greater work demand. Work control and support were negatively correlated with tension-anxiety and depression, whereas work demand and strain were positively correlated with these two emotion domains (all Ps < 0.0001). CONCLUSIONS It is suggested that addressing job stress is of clinical importance to promote healthy behaviors.

Smoking rates among schizophrenia patients in Japan

According to the meta-analysis performed by de Leon and Diaz, the smoking rate was higher among schizophrenia patients than in the general population with the exception of the populations of Japan and Colombia. The purpose of this study was to reexamine the association between schizophrenia and smoking among Japanese schizophrenia patients using objective measures. The sample comprised 172 schizophrenia inpatients (mean age: 54years; 55% male). Participants were asked by a psychiatrist whether they currently smoked, and their answers were confirmed by the Fagerström Test for Nicotine Dependence and a measurement of the carbon monoxide level in expired air. Data on 7496 Japanese people obtained from the national survey of health were used as the control group. Seventy schizophrenia patients (40.7%) were identified as smokers; the smoking rate was higher among men in their 50s (66.7%) and among women in their 40s (54.6%). The smoking rate was 24.2% in the control group, and multiple logistic regression analysis showed that this percentage was significantly higher in the schizophrenia than in the control group (odds ratio: 2.17), adjusting for sex and age. The association between smoking rate and schizophrenia is consistent across countries, including Japan.

Relationship between Smoking and Major Depression in a Japanese Workplace

Smoking and depression are among the most common and serious health problems in the world. More than 25% of smokers are reported to show some symptoms of depression 1) , and 70% of men and 80% of women with a history of major depression are estimated to have a smoking habit 2) . The relationship between smoking and depression has shown an association between smoking and depression, but the causal relationship is unknown. Thus in the present study we have two research tasks: one is to conduct a cross-sectional study with the database for the first year in order to clarify the prevalence of major depression in smoking status. In addition to smoking status, the Brinkman index 3) was used as a nicotine parameter to examine the causal relationship of smoking to depression. The second task is to conduct a cohort study, examining the causal relationship of major depression in the first year to smoking in the following year by assessing the risk of smoking progression or the potential for smoking cessation associated with prior depression. To investigate the causal relationship between smoking and depression in both directions, the risk for the onset or improvement of depression associated with the prior smoking status was also examined in the present study.

Association of metabolic syndrome with smoking and alcohol intake in Japanese men

INTRODUCTION There have been conflicting findings on whether metabolic syndrome (MetS) is associated with smoking and alcohol intake. This study investigated the association of MetS with smoking and alcohol intake. METHODS MetS was defined according to the International Diabetes Federation criteria, and smoking and alcohol intake were evaluated for 1,215 Japanese male workers using a questionnaire. The association of MetS with smoking and alcohol intake was assessed using logistic regression after adjusting for potential confounders. Proportional analyses for the prevalence of MetS among smoking and alcohol intake were performed as well. RESULTS Among the subjects, 148 (12%) were diagnosed with MetS, 485 (40%) were smokers, and 954 (79%) were regular alcohol users. The prevalence of MetS was the highest (19%) in smokers who did not drink, followed by smokers who also drank (13%), nonsmokers who drank (12%), and those who neither smoked nor drank (7%). Smoking itself was positively related to MetS (odds ratio [OR] = 1.4; 95% CI = 1.1-2.1) and MetS components, including larger waist circumference (OR = 1.5; 95% CI = 1.2-1.9), elevated triglyceride (OR = 1.9; 95% CI = 1.4-2.4), and reduced high-density lipoprotein cholesterol (OR = 1.7; 95% CI = 1.1-2.7). Alcohol intake was not significantly related to MetS; it was positively correlated only to higher fasting plasma glucose (OR = 1.7; 95% CI = 1.1-2.6). DISCUSSION These results suggest that cigarette smoking is an independent risk factor for MetS, but the risk does not seem to be exaggerated by alcohol intake.

Association of metabolic syndrome with atypical features of depression in Japanese people

It has been controversial whether metabolic syndrome (MetS) is associated with depression. We aimed to clarify the correlation between MetS and depression, considering atypical features of depression.