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1.  The relationship between suicidal ideation and symptoms of depression in Japanese workers: a cross-sectional study 
BMJ Open  2013;3(11):e003643.
The prevalence of suicidal ideation and predictors for suicidal ideation among Japanese workers is unknown, although a previous study reported a 30% prevalence rate of suicidal ideation in a psychosomatic clinical setting. Hence, we evaluated the prevalence of suicidal ideation and its relationship with depressive symptoms among Japanese workers.
For this purpose, a cross-sectional design was used. Major depressive disorder (MDD) and suicidal ideation in 1266 workers (1100 men and 166 women, aged 20–69 years) were assessed through clinical interviews conducted in accordance with the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders.
A total of 34 and 70 participants were diagnosed with suicidal ideation and MDD, respectively. Suicidal ideation was especially prevalent in 40-year-olds to 49-year-olds. Six of the eight symptoms of MDD (depressive mood, loss of interest, weight loss, psychomotor agitation, worthlessness and concentration loss) were related to suicidal ideation. Depressive mood had the strongest relationship with suicidal ideation, followed by worthlessness and concentration loss. Worthlessness had the highest area under the curve in predicting suicidal ideation, followed by concentration loss and depressive mood.
We conclude that MDD symptoms—particularly depressive mood, worthlessness and concentration loss—are potential predictors of suicidal ideation in Japanese workers.
PMCID: PMC3845061  PMID: 24293204
2.  The possible absence of a healthy-worker effect: a cross-sectional survey among educated Japanese women 
BMJ Open  2012;2(5):e000958.
Despite being highly educated in comparison with women in other member countries of the Organisation for Economic Cooperation and Development, Japanese women are expected to assume traditional gender roles, and many dedicate themselves to full-time housewifery. Women working outside the home do so under poor conditions, and their health may not be better than that of housewives. This study compared the self-rated health status and health behaviours of housewives and working women in Japan.
Cross-sectional survey.
A national university in Tokyo with 9864 alumnae.
A total 1344 women who graduated since 1985 and completed questionnaires in an anonymous mail-based survey.
Primary and secondary outcome measures
Health anxiety and satisfaction, receipt of health check-ups, eating breakfast, smoking, and sleep problems according to job status and family demands: housewives (n=247) and working women with (n=624) and without (n=436) family demands. ORs were used for risk assessment, with housewives as a reference.
After adjustment for satisfaction with present employment status and other confounding factors, working women were more likely than housewives to feel health anxiety (with family demands, OR: 1.68, 95% CI1.10 to 2.57; without family demands, OR: 3.57, 95% CI 2.19 to 4.50) and health dissatisfaction (without family demands, OR: 3.50, 95% CI 2.35 to 5.21); they were also more likely than housewives to eat an insufficient breakfast (with family demands, OR: 1.91, 95% CI 1.22 to 3.00; without family demands, OR: 4.02, 95% CI 2.47 to 6.57) and to have sleep problems (ORs: 2.08 to 4.03).
No healthy-worker effect was found among Japanese women. Housewives, at least those who are well educated, appear to have better health status and health-related behaviours than do working women with the same level of education.
PMCID: PMC3467618  PMID: 22964114
3.  The Perspective of Psychosomatic Medicine on the Effect of Religion on the Mind–Body Relationship in Japan 
Journal of Religion and Health  2012;53(1):46-55.
Shintoism, Buddhism, and Qi, which advocate the unity of mind and body, have contributed to the Japanese philosophy of life. The practice of psychosomatic medicine emphasizes the connection between mind and body and combines the psychotherapies (directed at the mind) and relaxation techniques (directed at the body), to achieve stress management. Participation in religious activities such as preaching, praying, meditating, and practicing Zen can also elicit relaxation responses. Thus, it is time for traditional religions to play an active role in helping those seeking psychological stability after the Great East Japan Earthquake and the ongoing crisis related to the nuclear accident in Fukushima, Japan, to maintain a healthy mind–body relationship.
PMCID: PMC3929030  PMID: 22434576
Buddhism; Japan; Psychosomatic medicine; Religion; Shintoism
4.  Association between Insomnia Symptoms and Hemoglobin A1c Level in Japanese Men 
PLoS ONE  2011;6(7):e21420.
The evidence for an association between insomnia symptoms and blood hemoglobin A1c (HbA1c) level has been limited and inconclusive. The aim of this study was to assess whether each symptom of initial, middle, and terminal insomnia influences HbA1c level in Japanese men.
This cross-sectional study examined 1,022 male workers aged 22–69 years with no history of diabetes at a Japanese company's annual health check-up in April 2010. High HbA1c was defined as a blood level of HbA1c ≥6.0%. Three types of insomnia symptoms (i.e., difficulty in initiating sleep, difficulty in maintaining sleep, and early morning awakening) from the previous month were assessed by 3 responses (i.e., lasting more than 2 weeks, sometimes, and seldom or never [reference group]).
The overall prevalence of high HbA1c was 5.2%. High HbA1c was positively and linearly associated with both difficulty in maintaining sleep (P for trend  = .002) and early morning awakening (P for trend  = .007). More specifically, after adjusting for potential confounding factors, high HbA1c was significantly associated with difficulty in maintaining sleep lasting more than 2 weeks (adjusted odds ratio, 6.79 [95% confidence interval, 1.86–24.85]) or sometimes (2.33 [1.19–4.55]). High HbA1c was also significantly associated with early morning awakening lasting more than 2 weeks (3.96 [1.24–12.59]).
Insomnia symptoms, particularly difficulty in maintaining sleep and early morning awakening, were found to have a close association with high HbA1c in a dose-response relationship.
PMCID: PMC3128595  PMID: 21747936
5.  Increased number of Judo therapy facilities in Japan and changes in their geographical distribution 
Judo therapy is a well established Japanese co-medical profession specializing in outpatient manual treatment of fractures and sprains. Recently, the number of judo therapists has been rapidly increasing as a result of proliferation judo therapy academies. This study examines whether such rapid increases have improved geographical distribution of judo therapy facilities in Japan.
The number of judo therapy facilities and the population in each municipality were obtained from the Web yellow pages and from Japanese census data for 2004, 2006, and 2008, respectively. Lorenz curves and Gini indices were calculated to demonstrate distributions of judo therapy facilities per 100,000 people. A bootstrapped method was used to identify statistical significances of differences in Gini indices.
In all municipalities, the mean numbers of judo therapy facilities per 100,000 people were 15.3 in 2004, 15.8 in 2006, and 17.6 in 2008. The Gini indices for judo therapy facilities nationally were 0.273 in 2004, 0.264 in 2006, and 0.264 in 2008. The numbers of judo therapy facilities increased significantly between 2006 and 2008 (p < 0.05) but the indices did not change significantly in the same period. The Gini indices for local towns and villages remained unchanged and were consistently higher (p < 0.05) than those in urban areas throughout the study periods.
Our results suggest that recent increases in the number of judo therapy facilities have not necessarily led to greater equality in their geographic distribution in terms of Gini indices.
PMCID: PMC3051884  PMID: 21352604
7.  Work-related stress and psychosomatic medicine 
This article introduces key concepts of work-related stress relevant to the clinical and research fields of psychosomatic medicine. Stress is a term used to describe the body's physiological and/or psychological reaction to circumstances that require behavioral adjustment. According to the Japanese National Survey of Health, the most frequent stressors are work-related problems, followed by health-related and then financial problems. Conceptually, work-related stress includes a variety of conditions, such as overwork, unemployment or job insecurity, and lack of work-family balance. Job stress has been linked to a range of adverse physical and mental health outcomes, such as cardiovascular disease, insomnia, depression, and anxiety. Stressful working conditions can also impact employee well-being indirectly by directly contributing to negative health behaviors or by limiting an individual's ability to make positive changes to lifestyle behaviors, such as smoking and sedentary behavior. Over the past two decades, two major job stress models have dominated the occupational health literature: the job demand-control-support model and the effort-reward imbalance model. In both models, standardized questionnaires have been developed and frequently used to assess job stress. Unemployment has also been reported to be associated with increased mortality and morbidity, such as by cardiovascular disease, stroke, and suicide. During the past two decades, a trend toward more flexible labor markets has emerged in the private and public sectors of developed countries, and temporary employment arrangements have increased. Temporary workers often complain that they are more productive but receive less compensation than permanent workers. A significant body of research reveals that temporary workers have reported chronic work-related stress for years. The Japanese government has urged all employers to implement four approaches to comprehensive mind/body health care for stress management in the workplace: focusing on individuals, utilizing supervisory lines, enlisting company health care staff, and referring to medical resources outside the company. Good communications between occupational health practitioners and physicians in charge in hospitals/clinics help employees with psychosomatic distress to return to work, and it is critical for psychosomatic practitioners and researchers to understand the basic ideas of work-related stress from the viewpoint of occupational health.
PMCID: PMC2882896  PMID: 20504368
8.  Development of a questionnaire to assess ‘Hie’ symptoms using an evidence-based analysis 
Certain symptoms and signs are culturally specific. ‘Hie’ (chill sensation) is a major symptom experienced by Japanese people; however, it is not easily understood by Westerners. Although Hie is not life-threatening, it greatly hampers the quality of life in sufferers. To develop a remedy for Hie, valid and reliable measures are required. This is the first study aimed at developing a standardized questionnaire to quantitatively measure Hie symptom.
This was a cross-sectional study. To identify question items, we conducted a literature search using published books that mention Hie and related symptoms. The first draft of the questionnaire was prepared by selecting 31 items, including three empirically used items, using the Delphi method. A total of 744 Japanese volunteers completed the draft questionnaire. Simple correlation and factor analyses were performed to select items for the final version of Hie questionnaire and for evaluating its test–retest reliability.
The following ten question items were ultimately selected: feeling a breeze, shivery feeling, tolerance, sensitivity to cold, Hie-like sensation in an airplane, dislike of air conditioning, use of gloves, use of an electric blanket, use of heavy clothing and need for heating devices. Of the ten Hie-related question items, five pertained to physical symptoms and the other five to daily behaviours. The internal consistency of the ten-item questionnaire was high, with a Cronbach’s alpha of 0.85. The test–retest reliability of the questionnaire was preserved by the paired two-tailed t test.
A new questionnaire was developed to evaluate the subjective symptom of Hie. This questionnaire demonstrated sufficient reliability and could be used as a tool to assess this symptom.
PMCID: PMC2698230  PMID: 19568894
Culture; Hie; Japan; Questionnaires; Traditional medicine
9.  A proposed approach to suicide prevention in Japan: the use of self-perceived symptoms as indicators of depression and suicidal ideation 
The incidence of suicide in Japan has increased markedly in recent years, making suicide a major social problem. Between 1997 and 2006, the annual number of suicides increased from 24,000 to 32,000; the most dramatic increase occurred in middle-aged men, the group showing the greatest increase in depression. Recent studies have shown that prevention campaigns are effective in reducing the total number of suicides in various areas of Japan, such as Akita Prefecture. Such interventions have been targeted at relatively urban populations, and national data from public health and clinical studies are still needed. The Japanese government has established the goal of reducing the annual number of suicides to 22,000 by 2010; toward this end, several programs have been proposed, including the Mental Barrier-Free Declaration, and the Guidelines for the Management of Depression by Health Care Professionals and Public Servants. However, the number of suicides has not declined over the past 10 years. Achieving the national goal during the remaining years will require extensive and consistent campaigns dealing with the issues and problems underlying suicide, as well as simple screening methods for detecting depression. These campaigns must reach those individuals whose high-risk status goes unrecognized. In this review paper, we propose a strategy for the early detection of suicide risk by screening for depression according to self-perceived symptoms. This approach was based on the symposium Approach to the Prevention of Suicide in Clinical and Occupational Medicine held at the 78th Conference of the Japanese Society of Hygiene, 2008.
PMCID: PMC2698228  PMID: 19568891
Depressive disorders; Japan; Prevention and control; Suicide
10.  Benzodiazepine prescription and length of hospital stay at a Japanese university hospital 
The relationship between bed days and benzodiazepine prescription (BDZ) in Western countries is inconclusive, and no hospital-based report has documented this phenomenon in Japan. This study was done to assess the association between bed days and BDZ in a Japanese hospital.
21,489 adult patients (55.1% men, mean age 59.9 years old) hospitalized between April, 2005 and December, 2006 were enrolled in the study. Patient age, sex, ICD-10 diagnosis, prescription profile, and days of hospital stay were assessed in 13 non-psychiatric departments using a computer ordering system. Patients prescribed a benzodiazepine during hospitalization were defined as positive.
Of the total sample, 19.9% were allocated to the benzodiazepine (+) group. Female sex and older age were significant factors associated with benzodiazepine prescription. The median number of bed days was 13, and the likelihood of BDZ significantly increased with the number of bed days, even after controlling for the effects of age, gender, and ICD-10 diagnosis. For example, when the analysis was limited to patients with 50 bed days or longer, the percentage of BDZ (32.7%) was equivalent to that of a report from France.
Irrespective of department or disease, patients prescribed benzodiazepine during their hospital stay tended to have a higher number of bed days in the hospital. The difference in the prevalence of BDZ between this study and previous Western studies might be attributed to the relatively short length of hospital stay in this study. Because BDZs are often reported to be prescribed to hospitalized patients without appropriate documentation for the indications for use, it is important to monitor the rational for prescriptions of benzodiazepine carefully, for both clinical and economical reasons.
PMCID: PMC2765986  PMID: 19818119
11.  Prospects of Psychosomatic Medicine 
PMCID: PMC2642858  PMID: 19161633
12.  Changes in body mass index by birth cohort in Japanese adults: results from the National Nutrition Survey of Japan 1956–2005 
Background The National Nutrition Survey, Japan (NNS-J) provides annual anthropometric information for a whole nation over 50 years. Based on this survey, the mean body mass index (BMI) of Japanese men and elderly women has increased in recent decades, but that of young women has decreased. We examined the effect of birth cohort on this phenomenon.
Methods We analysed data from the NNS-J for subjects aged 20–69 years. BMI during 1956–2005 and the prevalence of overweight and obesity (BMI ≥ 25 kg/m2) during 1976–2005 were estimated.
Results The BMI increased with age in every birth cohort, with similar increments, and did not peak until 60–69 years of age. However, with cross-sectional age, the BMI usually peaked before 60–69 years of age. The differences among cohorts already existed at 20–29 years of age, and slightly increased in men between 20–29 and 30–39 years of age. The BMI in all male age groups increased from the 1891–1900 through 1971–80 cohorts. However, in women, the figure increased until the 1931–40 cohorts, but later decreased. Changes in prevalence were generally consistent with changes in BMI. The recent increase (decrease in young women) in the mean BMI is attributable to birth cohort, indicating that thinner (fatter) and less recent birth cohorts have been replaced by fatter (thinner) ones.
Conclusions A cohort effect was quantitatively demonstrated based on a repeated annual survey. In Japan, the differences in BMI among cohorts were already established by young adulthood.
PMCID: PMC2639362  PMID: 18782894
Aging; body mass index; cohort effect; cross-sectional studies
13.  Clinical application of somatosensory amplification in psychosomatic medicine 
Many patients with somatoform disorders are frequently encountered in psychosomatic clinics as well as in primary care clinics. To assess such patients objectively, the concept of somatosensory amplification may be useful. Somatosensory amplification refers to the tendency to experience a somatic sensation as intense, noxious, and disturbing. It may have a role in a variety of medical conditions characterized by somatic symptoms that are disproportionate to demonstrable organ pathology. It may also explain some of the variability in somatic symptomatology found among different patients with the same serious medical disorder. It has been assessed with a self-report questionnaire, the Somatosensory Amplification Scale. This instrument was developed in a clinical setting in the U.S., and the reliability and validity of the Japanese and Turkish versions have been confirmed as well.
Many studies have attempted to clarify the specific role of somatosensory amplification as a pathogenic mechanism in somatization. It has been reported that somatosensory amplification does not correlate with heightened sensitivity to bodily sensations and that emotional reactivity exerts its influence on somatization via a negatively biased reporting style. According to our recent electroencephalographic study, somatosensory amplification appears to reflect some aspects of long-latency cognitive processing rather than short-latency interoceptive sensitivity.
The concept of somatosensory amplification can be useful as an indicator of somatization in the therapy of a broad range of disorders, from impaired self-awareness to various psychiatric disorders. It also provides useful information for choosing appropriate pharmacological or psychological therapy. While somatosensory amplification has a role in the presentation of somatic symptoms, it is closely associated with other factors, namely, anxiety, depression, and alexithymia that may also influence the same. The specific role of somatosensory amplification with regard to both neurological and psychological function should be clarified in future studies. In this paper, we will explain the concept of amplification and describe its role in psychosomatic illness.
PMCID: PMC2089063  PMID: 17925010

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