Yoshio Mino

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

OBJECTIVEnTo examine the prospective effects of psychosocial job characteristics evaluated with the Demand-Control-Support (DCS) and Effort-Reward Imbalance (ERI) models on insomnia.nnnMETHODSnA 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.nnnRESULTSnAmong 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.nnnCONCLUSIONSnProspective 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.

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.

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.

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

Abstractu2002 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 ≥1u2003year who could be discharged from psychiatric hospitals in Japan was estimated to be 66u2003000. 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.

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

Abstractu2002 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.

A Prospective Study on the Influences of Workplace Stress on Mental Health

A Prospective Study on the Influences of Workplace Stress on Mental Health: Akira Babazono, et al. Institute of Health Science, Kyushu University—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 AN INCREASE IN PATIENT COPAYMENTS ON MEDICAL SERVICE DEMANDS OF THE INSURED IN JAPAN

OBJECTIVESnTo examine quantitatively the effects of an increase in patient copayments from 10% to 20% on the demand for medical services in Japan.nnnMETHODSnThe subjects of the study were the employees insured by the 1,797 health insurance societies, belonging to the National Federation of Health Insurance Societies, in 1996 and 1998. Indicators of medical service demands analyzed include the inpatient, outpatient, and dental case rates, the number of serviced days per case, the medical cost per day and the medical cost per insured.nnnRESULTSnWhen the effects of an increase in patient copayments from 10% to 20% were evaluated, taking into account the average age, the average monthly salary, the total number, the gender (male-to-female) ratio and the dependent ratio of the insured, the estimated change in the case rate was -6.96% for inpatient, -4.79% for outpatient, and -5.77% for dental care. The estimated change in the number of serviced day per case was -4.66% for inpatient, -5.67% for outpatient, and -1.82% for dental care. The estimated change in the medical cost per day was -3.15% for inpatient, -13.00% for outpatient, and -11.48% for dental care. The estimated change in the medical cost per insured was -14.08% for inpatient, -21.54% for outpatient, and -18.11% for dental care.nnnCONCLUSIONSnThe increase in patient copayments from 10% to 20% enabled insurers to substantially reduce medical costs by cost shifting from the insurer to the insured, with resultant changes in the case rate and the number of service days per case.

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

INTRODUCTIONnA 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.nnnMETHODSnThis 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.nnnRESULTSnThe 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.nnnDISCUSSIONnEven 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.

Medical cost analysis of family psychoeducation for schizophrenia

Abstractu2002 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 ¥270u2003000 in the psychoeducation group and ¥470u2003000 in the control group. The mean total medical costs were ¥500u2003000 in the psychoeducation group and ¥710u2003000 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.

Seasonality of birth in patients with schizophrenia in Japan

Abstractu2002 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 88u2003788. 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.