Reporting of somatic symptoms as a screening marker for detecting major depression in a population of Japanese white-collar workers

Multiple Physical Symptoms Are Useful to Identify High Risk Individuals for Burnout: A Study on Faculties and Hospital Workers in Japan

Healthcare workers have a high risk of burnout. This study aimed to investigate if the numbers of physical symptoms are associated with burnout among healthcare workers. We conducted a cross-sectional survey at a large university in Tokyo, Japan, in 2016. Participants were 1080: 525 faculties and 555 hospital workers. We investigated 16 physical symptoms perceived more than once per week and examined the association between the number of physical symptoms and Copenhagen Burnout Inventory (CBI); work-related (WBO), personal (PBO), and client-related (CBO) burnout. All CBI scores were higher among hospital workers than among faculties: WBO (43 vs. 29), PBO (50 vs. 33), CBO (33 vs. 29). Moreover, the higher the number of physical symptoms perceived, the higher the degree of burnout scores became (trend p-values < 0.001), except for CBO among faculties. Job strain (all except for CBO among hospital workers) and work–family conflict were associated with an increased risk of burnout. Being married (WBO and CBO among faculties), having a child (except for PBO and CBO among faculties), and job support (faculty and hospital workers with WBO and faculties with PBO) were associated with a decreased risk of burnout. Multiple physical symptoms might be useful for identifying high risk individuals for burnout.

Acupuncture for the Treatment of Depression and Physical Symptoms in Chronic Bipolar Disorder: A Case Report

Introduction

Bipolar disorder (BD) is typically treated by pharmacotherapy. However, pharmacotherapy alone is often not adequate to cope with the variety of symptoms associated with BD. The present case report describes the therapeutic effects of manual acupuncture on a patient with chronic BD, and multiple concurrent physical symptoms, that did not improve with standard pharmacotherapy.

Case

A 41-year-old woman with type II BD presented with depression, anxiety, and multiple physical symptoms. Her symptoms had first appeared 12 years prior, and she was diagnosed with type II BD 3 years after symptom onset. Although she received standard treatment, including medication and psychotherapy, her symptoms did not improve. Acupuncture treatment aimed at improving psychiatric and physical symptoms was performed weekly for 12 weeks. Depression and anxiety symptoms were evaluated using the Himorogi Self-Rating Depression Scale (HSDS) and Himorogi Self-Rating Anxiety Scale (HSAS) respectively. A visual analog scale (VAS) was used to evaluate physical symptoms including diarrhea, insomnia, and general malaise. Outcome measures were evaluated before each treatment.

Results

Throughout the course of the acupuncture intervention, no changes were made to the patient's psychotropic medication regimen. HSDS and HSAS scores decreased after 12 weeks of acupuncture treatment and improvements in all physical symptoms, as measured by the VAS, were observed. Furthermore, psychiatric symptoms with hypomanic or mixed features were not exacerbated.

Conclusions

In this patient, acupuncture was effective in improving psychiatric and physical symptoms of type II BD. This non-pharmacological intervention may be a viable option for the treatment of BD-associated symptoms.

Somatic symptoms and sleep quality as indicators of depression and suicide risk among Korean military conscripts

This study examined whether somatic symptoms and sleep quality can be indicators of depression and suicide risk in Korean military conscripts. In October and November of 2016, a total of 1,937 conscripts completed a survey that included the patient health questionnaire (PHQ) 9, PHQ15, the Mini International Neuropsychiatric Interview Plus suicidality module, and the Pittsburgh sleep quality index. Four groups were formed by depression and suicide risk status. Results from analyses of covariance indicated that overall, the severity of somatic symptoms and aspects of sleep quality were higher in conscripts with both depression and suicide risk, and greater associations of depression with somatic symptoms and sleep quality. The results of logistic regression analyses indicated that moderate to high levels of somatic symptoms and poorly perceived health were associated with the risk of depression and suicide, respectively. Poor sleep quality was associated with a higher risk of depression, but it was not significantly related to suicide risk after accounting for depression, which showed a greater association with suicide risk. Monitoring somatic and sleep complaints along with perceived health are needed as potential markers of depression and suicide risk among military conscripts.

Core Symptom Index (CSI): testing for bifactor model and differential item functioning

OBJECTIVES

The Core Symptom Index (CSI) is designed to measure anxiety, depression and somatization symptoms. This study examined the construct validity of CSI using confirmatory factor analysis (CFA) including a bifactor model and explored differential item functioning (DIF) of the CSI. The criterion and concurrent validity were evaluated.

METHODS

In all, 803 elderly patients, average age 69.24 years, 70% female, were assessed for depressive disorders and completed the CSI and the geriatric depression scale (GDS). A series involving CFA for ordinal scale was applied. Factor loadings and explained common variance were analyzed for general and specific factors; and Omega was calculated for model-based reliability. DIF was analyzed using the Multiple-Indicator Multiple-Cause model. Pearson's correlation, ANOVA, and ROC analysis were used for associations and to compare CSI and GDS in predicting major depressive disorders (MDD).

RESULTS

The bifactor model provided the best fit to the data. Most items loaded on general rather than specific factors. The explained common variance was acceptable, while Omega hierarchical for the subscale and explained common variance for the subscales were low. Two DIF items were identified; 'crying' for sex items and 'self-blaming' for education items. Correlation among CSI and clinical disorders and the GDS were found. AUC for the GDS was 0.83, and for the CSI was 0.81.

CONCLUSION

CSI appears sufficiently unidimensional. Its total score reflected a single general factor, permitting users to interpret the total score as a sufficient reliable measure of the general factors. CSI could serve as a screening tool for MDD.

[Frequency of physical symptoms in anxiety-depressive disorders: cross-sectional study in a population of 202 psychiatric consultants]

Introduction

les symptômes physiques associés aux troubles anxio-dépressifs ont fait l'objet de plusieurs études depuis plusieurs décennies, vu leurs fréquences et leurs conséquences. Le but de notre étude est de préciser la fréquence des principaux symptômes physiques dans les troubles anxieux: trouble panique (TP), trouble anxiété généralisée (TAG) et troubles phobiques (TPh), ainsi que dans les troubles dépressifs: épisode dépressif majeur (EDM) dans le cadre d'un trouble dépressif.

Méthodes

nous avons mené une étude transversale à visée descriptive, réalisée sur un échantillon de 202 consultants dans un service de psychiatrie.

Résultats

l'âge moyen des patients est de 42 ans (19 à 70 ans), avec une légère prédominance féminine: 118 (58%). Les troubles anxio-dépressifs constatés sont: l'EDM: 113(56%), le TP: 61 (30.2%), le TAG: 55 (27.2%) et les TPh: 30 (14.9%). La fréquence des patients présentant de 2 à 5, et plus de 5 symptômes était respectivement de 15.9% et 39.6% dans les troubles dépressifs, et de 9.5% et 62.9% dans les troubles anxieux. Les symptômes les plus rapportés sont d'ordre cardiopulmonaire (75%), général (73.8%) et neurologique (65.8%).

Conclusion

les symptômes physiques qui accompagnent les troubles anxio-dépressifs sont variables et souvent nombreux. Ils peuvent aggraver le pronostic de ces troubles psychiatriques en rendant difficile leur prise en charge. Un dépistage précoce de ces troubles, en portant une attention particulière à ces symptômes physiques, permettra de prévenir ces complications.

Variation in somatic symptoms by patient health questionnaire-9 depression scores in a representative Japanese sample

BACKGROUND

This study aims to evaluate variation in somatic symptoms by age using patient health questionnaire-9 (PHQ) depression scores, which may be helpful in identifying depression.

METHODS

The study evaluated a nationally representative cross-sectional sample of community-dwelling adults in Japan in 2013. We utilized the PHQ to identify risk for depression, with PHQ ≥ 10 defining at least moderate depression. Bivariate and factor analyses were used to capture underlying patterns in self-reported symptoms over a 30 day period; aged-stratified multivariate logistic regression was performed to further explore associations between age, symptoms, and depression.

RESULTS

Of 3753 respondents, 296 (8, 95% CI 7.0-8.8) reported a PHQ ≥ 10; 42% of these were male and mean age was 51.7 years old (SD = 18.6). Multivariate analysis showed that presence of fatigue and malaise (OR = 1.7, 95% CI 1.3-2.4) was significantly associated with PHQ ≥ 10. After stratification by age, PHQ ≥ 10 was associated with gastrointestinal complaints among 18-39 year olds (OR = 1.7, 95% CI 1.0-2.9); fatigue and malaise (OR = 1.8, 95% CI 1.1-3.1) among 40-64 year olds; and fatigue and malaise (OR = 1.8, 95% CI 1.1-3.0) as well as extremity pain (OR = 1.7, 95% CI 1.0-2.8) in over 65 year olds.

CONCLUSION

Age-related somatic symptom correlates of PHQ ≥ 10 differ across the lifespan. Predominantly gastrointestinal symptoms in younger patients, and generalized fatigue, malaise, and musculoskeletal pain in older groups were observed. In order for screening physicians to proactively identify depression, awareness of age-related somatic symptoms is warranted.

[Association between Job Stress and Number of Physical Symptoms among Female Nurses of Medical-university-affiliated Hospitals]

OBJECTIVES

To clarify the association between job stress and the number of physical symptoms among newly certified female nurses.

METHODS

In this cross-sectional self-administered survey, we investigated 313 female nurses working at three medical-university-affiliated hospitals in February 2016. We investigated working conditions including numbers of working and on-call hours, work-life balance, Job Content Questionnaire (JCQ) scores, and 16 physical symptoms perceived more often than once a week.

RESULTS

Among the 313 participants (mean age, 31.9), 57% were aged 21-29 years and 70% were single. Of the 16 physical symptoms investigated, fatigability was the most frequent complaint (66.1%), followed by lower back pain (44.7%). Univariate analysis showed that significant factors related to physical symptoms are job demands (p<0.001) and social support (p<0.001) in JCQ, binary index of supports (p<0.001), and total working hours per day (p =0.025). Multivariable-adjusted logistic regression analyses demonstrated that the likelihood of reporting a greater number (n≥3) of physical symptoms increased by 7% [95% confidence interval (CI), 2-13%] with a one-unit increase in job demand degree, and decreased by 16% (95% CI, 10-22%) in social support degree. When binary JCQ indexes were assessed, the high-support group [odds ratio (OR) 0.36; 95% CI, 0.23-0.59] was protectively associated with a greater number of physical symptoms while long working hours was significantly associated with a higher risk (OR 18%, 95% CI, 1-38%).

CONCLUSIONS

Reporting a greater number of physical symptoms may be a good indicator of job stress perceived by a nurse in a university hospital setting.

The perspective of psychosomatic medicine on the effect of religion on the mind-body relationship in Japan

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.

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

AIM

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.

METHODS

Participants were 1011 Japanese men aged 20-59 years. MetS was diagnosed according to criteria set by the International Diabetes Federation. Clinical interviews for major depressive disorder (MDD) employed the DSM-IV; MDD was classified into atypical and non-atypical types. The prevalence of MetS was compared between the groups with no MDD, atypical depression, and non-atypical depression via trend analyses. Multiple logistic regression analyses examined the association of MetS with atypical depression and the features thereof.

RESULTS

In total, 141 (14.0%) participants were diagnosed with MetS and 57 (5.6%) were diagnosed with MDD (14 had atypical and 43 had non-atypicalMDD). The prevalence of MetS was the highest in the group with atypical depression, followed by the non-atypical depression and no MDD groups, respectively, with a marginally significant trend (P = 0.07). The adjusted odds ratios of MetS associated with depression were 3.8 (95% confidence interval [CI] 1.1-13.2) for atypical depression and 1.6 (95% CI 0.7-3.6) for non-atypical depression. Among the five features of atypical depression, only hyperphagia was significantly related to MetS (odds ratio 2.7, 95% CI 1.8-4.1).

CONCLUSION

There was a positive association between MetS and atypical depression, but not between MetS and non-atypical depression. Specifically, hyperphagia seems to be an important factor affecting the correlation between MetS and atypical depression.

Associations of workplace bullying and harassment with pain

The aim of this study was to investigate associations of workplace bullying and harassment with headache, stiffness of the neck or shoulders, lumbago, and pain of two or more joints. The subjects in this cross-sectional study were recruited from workers (n = 1,913) at 35 healthcare or welfare facilities in Japan. Because of non-participation or missing data, the number of subjects included in the analysis varied (response rate ≥ 77.1%). Workplace bullying and harassment were assessed using the Negative Acts Questionnaire. Depression was assessed using the Brief Job Stress Questionnaire. The frequency of pain experienced by workers in the previous month was evaluated using a four-point scale. Many of the associations of person-related bullying, work-related bullying, and sexual harassment with headache, stiffness of the neck or shoulders, lumbago, and pain of two or more joints were positive and significant (p < 0.05). Even after adjustment for depression, some of the associations remained significant (p < 0.05). For example, changes in the prevalence ratio for headache associated with a 1-point increase in the work-related bullying score were 1.05 (95% confidence interval (CI) 1.01 to 1.09) in men and 1.03 (95% CI 1.01 to 1.05) in women after adjustment for age, marital status, employment status, work shift, and depression.

Utility of self-reported sleep disturbances as a marker for major depressive disorder (MDD): findings from the World Mental Health Japan Survey 2002-2006

Although major depressive disorder (MDD) is a serious common disease, many depressive patients seek primary care with complaints of sleep disturbances that remain undiagnosed. The purpose of this study was to investigate the utility of self-reported sleep disturbances as a marker for MDD. This study investigated the association between 12-month prevalence of self-reported sleep disturbances and MDD using data from a cross-sectional survey in Japan. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the receiver operating characteristic curve (AUC) of self-reported sleep disturbances as a marker for MDD were 58.9%, 73.4%, 6.9%, 98.1%, and 0.66, respectively. Self-reported sleep disturbances showed highest utility for the youngest group. Among four types of sleep disturbances, the problem of daytime sleepiness was most useful as a marker for MDD. Combined with at least moderate role impairment, self-reported sleep disturbances became more informative with higher specificity (99.6%) and PPV (80.0%) as a marker for MDD. Self-reported sleep disturbances cannot be a marker for MDD in isolation. Comorbid role impairment increases the probability of MDD. Clinicians should be cautious in assessments of young people who have sleep disturbances. Daytime sleepiness should be included among the questions asked when inquiring about sleep disturbances.

Unexplained somatic symptoms during major depression: prevalence and clinical impact in a national sample of Italian psychiatric outpatients

BACKGROUND

The aim of this study was to explore the prevalence and impact of unexplained somatic symptoms during major depression.

SAMPLING AND METHODS

A total of 560 consecutive outpatients with a major depressive episode according to the DSM-IV (text revision) were evaluated in 30 psychiatric facilities throughout Italy. 'Unexplained' somatic symptoms were evaluated using the 30-item Somatic Symptoms Checklist (SSCL-30). Somatic symptoms were considered explained if they were best accounted for as coming from a concomitant physical illness or side effects. Patients evaluated their own mood symptomatology using the Zung questionnaires for depression and anxiety and the Hypomania Checklist-32.

RESULTS

According to the SSCL-30, only 90 subjects (16.1%) had no unexplained somatic symptoms, while 231 (41.3%) had 1-5 unexplained symptoms and 239 (42.7%) had more than 5. Asthenia was the most commonly observed unexplained somatic symptom (53% of patients). Unexplained somatic symptoms were more common in females and among those suffering from major depression and depression not otherwise specified rather than in patients with recurrent major depression and bipolar disorders. No relationship between unexplained somatic symptoms and hypomanic features was observed.

CONCLUSIONS

The presence of a large number of unexplained somatic symptoms is associated with more severe depression and higher rates of misdiagnosis and inappropriate treatment.

An approach to symptoms at the interface of medicine and psychiatry: pain, insomnia, weight loss and anorexia, fatigue and forgetfulness, and sexual dysfunction

Primary care physicians commonly deal with patients who present with a somatic complaint for which no clear organic etiology can be found. This article discusses how a psychiatrist thinks about somatic symptoms (eg, pain, insomnia, weight loss and loss of appetite, fatigue and forgetfulness, sexual dysfunction) in a patient who might have depression. The management of a patient in whom no satisfactory medical or psychiatric diagnosis can be made is also reviewed briefly.

Circadian clocks in mood-related behaviors

The circadian clock organizes biochemical and physiological processes of an organism in a temporal fashion. This temporal organization is crucial to avoid interference of processes that have adverse effects on each other. Thus, disruption of temporal organization can lead to health problems and behavioral disorders related to mood alterations. To alleviate the consequences of a disrupted temporal organization in the body, it is of importance to understand the processes involved in the synchronization of all body clocks and their phase relationship to the environmental day/night cycle at the mechanistic level. This review will focus on internal and external factors affecting synchronization and function of the circadian system and highlight connections to mood-related behavior.

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

BACKGROUND

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.

METHODS

The cohort comprised 956 Japanese male employees of an enterprise (mean age, 42.7 years; SD, 10.2 years). MetS was diagnosed according to the International Diabetes Federation criteria. The psychological conditions of depression and anxiety were assessed in 2 successive years by using the profile of mood states (POMS) questionnaire and by conducting clinical interviews as per the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). We evaluated the temporal and dose-response relationships between MetS and the development of depression and anxiety, controlling for potential confounding factors like age and lifestyle-related factors.

RESULTS

We identified a positive relationship between MetS at baseline and new-onset depression in the subsequent year (OR 2.14, 95% CI 1.10-4.17). Of the five MetS components examined, only waist circumference was significantly related to new-onset depression (OR 2.08, 1.23-3.50). Trend analysis revealed a significant positive trend of association between the number of MetS components identified and new-onset depression (P(trend) < 0.01), but not between Mets and new-onset anxiety.

CONCLUSIONS

Our results suggest that MetS is a predictive factor for the development of depression, and that waist circumference largely contributes to the association between MetS and depression.

Benzodiazepine prescription and length of hospital stay at a Japanese university hospital

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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.

Accuracy of specific symptoms in the diagnosis of major depressive disorder in psychiatric out-patients: data from the MIDAS project

BACKGROUND

There is uncertainty about the diagnostic significance of specific symptoms of major depressive disorder (MDD). There is also interest in using one or two specific symptoms in the development of brief scales. Our aim was to elucidate the best possible specific symptoms that would assist in ruling in or ruling out a major depressive episode in a psychiatric out-patient setting.

METHOD

A total of 1523 psychiatric out-patients were evaluated in the Methods to Improve Diagnostic Assessment and Services (MIDAS) project. The accuracy and added value of specific symptoms from a comprehensive item bank were compared against the Structured Clinical Interview for DSM-IV (SCID).

RESULTS

The prevalence of depression in our sample was 54.4%. In this high prevalence setting the optimum specific symptoms for ruling in MDD were psychomotor retardation, diminished interest/pleasure and indecisiveness. The optimum specific symptoms for ruling out MDD were the absence of depressed mood, the absence of diminished drive and the absence of loss of energy. However, some discriminatory items were relatively uncommon. Correcting for frequency, the most clinically valuable rule-in items were depressed mood, diminished interest/pleasure and diminished drive. The most clinically valuable rule-out items were depressed mood, diminished interest/pleasure and poor concentration.

CONCLUSIONS

The study supports the use of the questions endorsed by the two-item Patient Health Questionnaire (PHQ-2) with the additional consideration of the item diminished drive as a rule-in test and poor concentration as a rule-out test. The accuracy of these questions may be different in primary care studies where prevalence differs and when they are combined into multi-question tests or algorithmic models.

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.

Symptomatology of depressive state in the workplace. A 20-year cohort study

Authors investigated symptomatology of depressive state among workers in a 20-year study. A cohort of 167 men of a company in Japan, aged 18-40 years old at baseline in 1985 was researched as a study sample. Depressive symptoms were assessed by the Zung's self-rating depression scale (SDS) consisting of 6 somatic- and 14 psychological-symptom items. In a logistic regression analysis, sleep disturbance and fatigue, and total somatic-symptom scores were related to both future and long-term depressive state (all P < 0.05), after adjusting age and other variables. Although many unrecognized cases of depression exist, they may report somatic symptoms as potential depressive state.

Symptoms of depression, prescription of benzodiazepines, and the risk of death in hemodialysis patients in Japan

Many hemodialysis patients in Japan have symptoms of depression, but whether those patients are treated appropriately is unknown. As part of the Dialysis Outcomes and Practice Patterns Study, data on symptoms of depression, physician-diagnosed depression, prescribed medications, and death were collected prospectively in cohorts in Japan (n=1603) and 11 other countries (n=5872). Symptoms of depression were as prevalent in Japan as elsewhere, but in Japan a much smaller percentage of patients had physician-diagnosed depression: only 2% in Japan vs 17% elsewhere. Antidepressants were much less commonly prescribed in Japan: only 1% in Japan vs 17% elsewhere for patients with many and frequent symptoms of depression, and 16% in Japan vs 34% elsewhere for patients with physician-diagnosed depression. In Japan, symptoms of depression were associated with prescription of benzodiazepines (without antidepressants), and patients with physician-diagnosed depression were twice as likely to be given benzodiazepines: 32% in Japan vs 16% elsewhere. Benzodiazepine monotherapy was associated with death (relative risk 1.56, 95% confidence interval (CI), 1.25-1.94), even after adjustments for 13 likely confounders (relative risk 1.27, 95% CI, 1.01-1.59). Hemodialysis patients in Japan with symptoms of depression are given not antidepressants but benzodiazepines, a practice associated with higher mortality.

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

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.

Gastric electrical activity and cardiovascular risk factors in relation to autonomic nervous function, hormonal responses, and health-related lifestyles in young men

BACKGROUND

Electrogastrography (EGG) is the noninvasive recording of gastric myoelectrical activity. The purpose of the present study was to assess associations of EGG with risk factors for cardiovascular disease (CVD), autonomic nervous function, hormonal responses, and health-related lifestyles.

METHODS

EGG was measured in 435 Japanese men, aged 24-39 years, who worked at the same company. In addition to anthropometric measurements and blood examinations, power spectral analysis of heart rate variability in low-frequency (LF; 0.04-0.15 Hz) and high-frequency (HF; 0.15-0.40 Hz) bands was conducted. LF/HF and HF were used as the indicators of sympathetic and parasympathetic nervous activity, respectively. Serum cortisol and catecholamine levels were measured as well.

RESULTS

In univariate analyses, the EGG frequency was associated positively with the serum high-density lipoprotein (HDL) and cholesterol level (both-P < 0.0001) and negatively with age, body mass index (BMI), serum triglyceride level, fasting blood sugar, and diastolic blood pressure (all P < 0.05). The EGG frequency tended to increase with increases in the HF band (P = 0.10) and was not significantly associated with the LF/HF ratio (P = 0.45). Neither hormonal responses nor health-related lifestyle factors such as smoking and alcohol were significant (all P > 0.05). A multivariate analysis indicated that both the HDL cholesterol level and BMI were independent predictors of EGG frequency (both P < 0.05), after adjusting for the significant effects of age, HF, and other CVD factors.

CONCLUSIONS

Slowed EGG frequency appeared to be linked with various CVD risk factors, including obesity and low HDL cholesterol levels, in young men.

Somatic symptoms for predicting depression: one-year follow-up study in annual health examinations

It has recently been noted that screening for depression can improve clinical outcomes. The purpose of the present study was to examine whether somatic symptoms reported at health examinations predicted depression in the following year. Subjects were 1066 Japanese workers (732 men, mean age 35 years) attending annual health examinations at an institute in two successive years. A self-administered questionnaire including items of 12 major somatic symptoms was given to all the subjects. Then clinical interviews of the DSM-IV were used to diagnose major depression and minor depression in both years. In addition, the 17-item Hamilton Depression Scale (HDS-17) was measured as one of the outcomes of depression in the following year. The prevalence of major (minor) depression was 3.7 (7.8)% at baseline and 3.4 (5.9)% for the following year, respectively. The following year's HDS-17 scores were higher (all P < 0.05) in those who had complained of each somatic symptom at baseline than in those who had not. Three somatic symptoms (low back pain, dizziness, and abdominal pain) at baseline were significant risk factors of major depression for the following year. Dizziness at baseline significantly predicted major and minor depression for the following year as well. Somatic symptoms may be good predictors to screen for depression at health examination.

Prediction of major depression in Japanese adults: somatic manifestation of depression in annual health examinations

BACKGROUND

The present study examined whether somatic symptoms found in annual health examinations, could be predictive of major depression in the ensuing year.

METHOD

Subjects analyzed were 1027 non-major-depressive workers (706 men, mean age 35) attending annual health examinations at a research institute. All were Japanese and found not to be suffering from major depression when interviewed, according to the semi-structured interviews of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). A self-administered questionnaire containing items relating to twelve major somatic symptoms was completed by all the subjects. The same DSM-IV interviews for the diagnosis of major depression were conducted to calculate the odds ratio of baseline variables for depressive and somatic symptoms, physical examination items, and health-related life-styles for the prediction of major depression in the ensuing year.

RESULTS

The prevalence of major depression in the ensuing year was 2.5%. For four somatic symptoms (fatigue, lower back pain, dizziness, and nausea), the prevalence was higher (all p < 0.05) in those who complained of each somatic symptom at baseline than in those who did not. Furthermore, the multiple logistic regression analysis indicated that lower back pain and dizziness at baseline were independent risk factors of major depression in the ensuing year [odds ratio (95% confidence intervals), 3.2 (1.1, 8.9) and 6.0 (1.8, 20.1), respectively].

LIMITATIONS

It is possible that somatic manifestations of depression are culturally bound phenomena and results might be generalizable only to Japanese workers.

CONCLUSION

Somatic symptoms reported at annual health examinations may be useful indicators for predicting major depression.

The importance of somatic symptoms in depression in primary care

OBJECTIVE

Patients with depression present with psychological and somatic symptoms, including general aches and pains. In primary care, somatic symptoms often dominate. A review of the literature was conducted to ascertain the importance of somatic symptoms in depression in primary care.

DATA SOURCES AND EXTRACTION

MEDLINE, EMBASE, and PsychLIT/PsychINFO databases (1985-January 2004) were searched for the terms depression, depressive, depressed AND physical, somatic, unexplained symptoms, complaints, problems; somatised, somatized symptoms; somatisation, somatization, somatoform, psychosomatic; pain; recognition, under-recognition; diagnosis, underdiagnosis; acknowledgment, under-acknowledgment; treatment, undertreatment AND primary care, ambulatory care; primary physician; office; general practice; attribution, re-attribution; and normalising, normalizing. Only English-language publications and abstracts were considered.

STUDY SELECTION

More than 80 papers related to somatic symptoms in depression were identified using the content of their titles and abstracts.

DATA SYNTHESIS

Approximately two thirds of patients with depression in primary care present with somatic symptoms. These patients are difficult to diagnose, feel an increased burden of disease, rely heavily on health care services, and are harder to treat. Patient and physician factors that prevent discussion of psychological symptoms during consultations must be overcome.

CONCLUSIONS

Educational initiatives that raise awareness of somatic symptoms in depression and help patients to re-attribute these symptoms should help to improve the recognition of depression in primary care.

Influence of overtime work, sleep duration, and perceived job characteristics on the physical and mental status of software engineers

To investigate the impact of overtime work, sleep duration, and perceived job characteristics on physical and mental status, a cross-sectional study was conducted on 377 workers (average age; 28 years old) in an information-technology (IT) company, engaged in consultation, system integration solution, and data management relevant to IT system. The psychophysical outcomes of overtime work were assessed using the Hamilton Depression Scale (HDS), Profile of Mood Status (POMS), major physical symptoms, and overtime work data for the preceding three-months. Sleep duration was directly asked by a physician. A job strain index was defined as the ratio of job-demands to job-control scores evaluated using the Job Content Questionnaire (JCQ). In a univariate analysis, overtime work was significantly related with HDS scores, POMS anger-hostility scores, and the total physical symptom count in both sexes (all p < 0.05), but not in multiple regression models, after controlling for sleep duration and the job strain index. Sleep duration was negatively related to the symptom count in men and to POMS tension-anxiety scores in women (both p < 0.05); the job strain index was positively related to POMS anger-hostility scores in both sexes and to HDS scores and POMS tension-anxiety scores in men (all p < 0.05). Although overtime work was associated with physical and mental complaints, sleep duration and the job strain index seemed to be better indicators for physical and mental distress in overloaded workers.

Relationship between major depression and high serum cholesterol in Japanese men

Although it has been argued that those with lower levels of serum cholesterol are likely to be depressive, the findings are inconsistent. The present study attempted to clarify the relationship between major depression and serum total cholesterol in a working population. Subjects were 987 Japanese men working at an institute, aged 20 to 64 years. In addition to blood examinations and physical measurements, clinical structured interviews of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were used to detect major depression. The prevalence of major depression was higher in the hypercholesterolemics (serum total cholesterol levels > or = 5.69 mmol/liter) than in the normocholesterolemics (3.10-5.69 mmol/liter) (6.1% vs 1.8%, p < 0.05). Notably, there was no case with major depression among the hypocholesterolemics (< 3.10 mmol/liter). Through a multiple regression analysis, serum total cholesterol levels were positively predicted by the following four variables: major depression, age, body mass index, and skipping breakfast (all p < 0.01). Concerning those diagnosed with major depression, serum total cholesterol levels remained higher in the following year (p < 0.05), comparing to those without such diagnosis. Therefore, depression is associated with higher serum cholesterol levels in a population of Japanese male workers. The irregularity of eating behavior may be one of the factors mediating high serum cholesterol levels and major depression.

Relationship between brachial-ankle pulse wave velocity and heart rate variability in young Japanese men

This study examined the relationship between arterial stiffness and autonomic nervous function in a young population. A cross-sectional study was conducted on 382 Japanese males, aged 24 to 39 years, who worked at the same information service company. Brachial-ankle pulse wave velocity (baPWV) was measured using an automatic waveform analyzer, and the spectral power of heart rate variability in the low frequency (LF: 0.04-0.15 Hz) and the high frequency (HF: 0.15-0.40 Hz) band was evaluated by the maximum entropy method. LF/HF and HF were used as the indicators of sympathetic and parasympathetic nervous activity, respectively. Psycho-hormonal responses were examined by the Profile of Mood State (tension-anxiety and anger-hostility scales) and Hamilton's Depression Scale with serum cortisol and catecholamine levels. In a univariate analysis, baPWV was positively associated with the following variables (all p <0.05): LF/HF, age, body mass index, systolic and diastolic blood pressures, heart rate, serum total cholesterol and triglycerides, blood glucose, and plasma cortisol and noradrenaline. Multiple regression analysis indicated that LF/HF was an independent predictor of baPWV (p <0.05), after controlling for significant effects of age, systolic blood pressure, and plasma noradrenaline levels. There was no significant effect of HF on baPWV in this multivariate analysis. Neither mood state nor health-related lifestyle factors such as smoking were significant. It was suggested that baPWV is closely associated with sympathetic nervous activity in young men.

Stress Perception and Social Indicators for Low Back, Shoulder and Joint Pains in Japan: National Surveys in 1995 and 2001

This study aims to clarify the effects of stress perception and related social indicators on three major musculoskeletal symptoms: low back, shoulder, and joint pains in a Japanese population. Twenty health-related variables (stress perception and 19 social indicators) and the three symptoms were obtained from the following Japanese national surveys: the Comprehensive Survey of Living Condition of the People on Health and Welfare, the System of Social and Demographic Statistics of Japan, and the Statistical Report on Health Administration Services. The results were compared among 46 Japanese prefectures in 1995 and 2001. By factor analysis, the 19 indicators were classified into three factors of urbanization, aging and life-regularity, and individualization. The prevalence of stress perception was significantly correlated to the 8 indicators of urbanization factor. Although simple correlation analysis revealed a significant relationship of stress perception only to shoulder pain (in both years) and low back pain (in 2001), the results of multiple regression analysis showed that stress perception and some urbanization factors were significantly associated with all the three symptoms in both years exclusive of joint pain in 1995. Taking the effects of urbanization into consideration, stress perception seems to be closely related to the complaints of musculoskeletal symptoms in Japan.