Effect of the National Stress Check Program on mental health among workers in Japan: A 1-year retrospective cohort study

Employee well-being in the digital age: Assessing the impacts of a smartphone application in the workplace

Recently, providing smartphone-based health-improving applications to employees has emerged as a promising strategy for sustaining their well-being. This study estimates the impact of the routine use of an application, introduced in 2020 by a Japanese manufacturing company, on various health-related behaviours and outcomes among employees by exploiting a distinctive large-scale longitudinal dataset and personnel records. The analysis addresses potential selection biases arising from the non-random nature of application usage by employing the instrumental variable approach. Regular application use generates significant positive impacts on health-related habits, including moderate alcohol consumption, regular breakfast intake and refraining from eating two hours before bedtime. Furthermore, regarding physical and psychological stress, noteworthy reductions in physical burden and less frequent experiences of annoyance are observed. Employees also report a lower frequency of dizziness, headaches and palpitations, albeit an increase in the frequency of strained eyes is noted. Additionally, application use is associated with lower systolic and diastolic blood pressure, as well as decreased levels of triglycerides and gamma-GTP.

Workers' experiences of improvements in the work environment and mental health problems: a web-based 1-year prospective study of Japanese employees

OBJECTIVES

This study aimed to prospectively investigate the association between work environment improvements and multiple mental health outcomes in a large sample of Japanese employees.

METHODS

A web-based longitudinal study surveyed 20 000 Japanese employees, 7970 of whom completed a follow-up after 1 year. Various types of work environment improvements experienced by workers were assessed using a 24-item checklist. Three mental health outcomes (poor mental health, presenteeism, and high psychosocial stress) were assessed and defined using standardized questionnaires.

RESULTS

Overall, as the total number of work environment improvements increased, the odds ratio for mental health outcomes in the follow-up survey decreased by several percentage points, even after adjusting for demographic and occupational factors. Analysis of the types of work environment improvements showed that mutual support improvements were particularly effective in reducing mental health issues. The subgroup analyses also showed that the effectiveness of workplace environment improvements might vary between secondary and tertiary industry workers depending on the types of improvements and mental health outcomes.

CONCLUSIONS

The study suggests that workplace improvements can significantly affect mental health. The effectiveness of these improvements may vary according to the type of intervention, industry of the targeted workers, and mental health outcomes. This study provides basic data on the effectiveness of workplace environment improvements that can be used for future intervention trials.

Occupational health and safety regulatory interventions to improve the work environment: An evidence and gap map of effectiveness studies

Background

Unsafe and unhealthy working conditions lead to injuries and financial losses across the globe, resulting in a need for research into effective work environment interventions.

Objectives

The objective of this evidence and gap map (EGM) is to provide an overview of existing systematic reviews and primary studies examining the effects of occupational health and safety regulatory interventions.

Search Methods

Relevant studies are identified through searches in published and unpublished literature performed up to January 2023.

Selection Criteria

The population for this EGM is workers above the age of 15 and their workplaces within the OECD. We include randomised controlled trials, non-randomised studies with a comparison of two or more groups of participants, and systematic reviews of effects.

Data Collection and Analysis

The map has been populated based on information about interventions and outcomes, study design, OECD country, and publication status. We have performed critical appraisal of included systematic reviews using an adjusted version of the AMSTAR-2 tool.

Main Results

The included studies for this report consist of six systematic reviews, 28 primary effect studies, and three on-going studies. The interactive map shows that the largest cluster of studies is located in the inspection activity domain, while the sickness absence outcome domain and the intervention categories for training initiatives and formulation of regulatory standards are only scarcely populated. Additionally, the AMSTAR-appraisal suggests a lack of rigorous systematic reviews and meta-analyses.

Authors’ Conclusions

More research in the form of primary studies and rigorous systematic reviews is needed to provide stakeholders with better guidance as to what constitutes the most efficient regulatory approaches to improve the work environment.

Working Conditions and Racial and Ethnic Disparities in Self-rated Health

OBJECTIVE

The aims of the study are to examine racial and ethnic differences in occupational physical demands, substantive complexity, time pressure, work hours, and establishment size and to assess whether working conditions contribute to racial and ethnic differences in self-rated health.

METHODS

We used 2017 and 2019 Panel Study of Income Dynamics data for 8439 adults. Using path models, we examined working conditions among Black, Latino, and White workers and explored whether those conditions mediated racial and ethnic differences in incident poor self-rated health.

RESULTS

Some working conditions disproportionately affected Black workers (high physical demands, low substantive complexity), Latino workers (low substantive complexity, small establishments), and White workers (time pressure). Time pressure predicted worse self-rated health; there was no evidence that the working conditions studied mediated racial/ethnic differences.

CONCLUSIONS

Working conditions vary by racial and ethnic group; some predict worse health.

Developing Action Plans Based on Machine Learning Analysis to Prevent Sick Leave in a Manufacturing Plant

OBJECTIVE

We aimed to develop action plans for employees' health promotion based on a machine learning model to predict sick leave at a Japanese manufacturing plant.

METHODS

A random forest model was developed to predict sick leave. We developed plans for workers' health promotion based on variable importance and partial dependence plots.

RESULTS

The model showed an area under the receiving operating characteristic curve of 0.882. The higher scores on the Brief Job Stress Questionnaire stress response, younger age, and certain departments were important predictors for sick leave due to mental disorders. We proposed plans to effectively use the Brief Job Stress Questionnaire and provide more support for younger workers and managers of high-risk departments.

CONCLUSIONS

We described a process of action plan development using a machine learning model, which may be beneficial for occupational health practitioners.

Suggestions for new organizational-level item pools for the national Stress Check Program from management philosophy and mission statement: A qualitative study using unsupervised learning

Objective

This study aimed to obtain suggestions for new organizational‐level item pools that companies could utilize to accomplish management philosophy and mission statements in the context of survey and work environment improvements for the national Stress Check Program.

Methods

A qualitative study was conducted using unsupervised learning. A large amount of text data related to management philosophy and mission statements were collected, that is, management messages described on the websites of all companies listed on the Tokyo Stock Exchange. For the main analysis, topic modeling was performed on the nouns from the management messages using Latent Dirichlet Allocation (LDA) to build a model consisting of 10 latent topics, each represented by a group of the 10 most frequently reoccurring nouns. Each group of nouns was qualitatively summarized based on the topic model.

Results

In total, 22 524 nouns were extracted from the management messages of 3575 companies. A topic model consisting of 10 latent topics was constructed using the LDA. The suggestion for new item pools included new technologies, business plans/strategies, company shareholders, health/happiness/wealth, profits/sales, development of society, a sustainable society, safety and security, customer/consumer satisfaction, corporate social responsibility, fairness, transparency, and human rights.

Conclusion

The suggestions for potential item pools were derived from management philosophy and mission statement that are not covered in the existing survey. The suggestions could be useful for motivating employers to implement work environment improvement. Future studies need to make definite items and investigate whether they correlate to job stressors and mental health among workers.

Sleep Satisfaction May Modify the Association between Metabolic Syndrome and BMI, Respectively, and Occupational Stress in Japanese Office Workers

The association between obesity and psychological stress is ambiguous. The aim is to investigate the association between metabolic syndrome (MetS) and body mass index (BMI), respectively, with occupational stress among Japanese office workers. The study is a secondary analysis of the intervention group from a randomized controlled trial. There are 167 participants included in the analysis. Occupational stress is self-reported using the Brief Job Stress Questionnaire (BJSQ). BMI and the classification of MetS/pre-MetS was based on the participants’ annual health check-up data. The primary exposure is divided into three groups: no MetS, pre-MetS, and MetS in accordance with Japanese guidelines. The secondary exposure, BMI, remains as a continuous variable. Multiple linear regression is implemented. Sensitivity analyses are stratified by sleep satisfaction. Pre-MetS is significantly associated with occupational stress (7.84 points; 95% CI: 0.17, 15.51). Among participants with low sleep satisfaction, pre-MetS (14.09 points; 95% CI: 1.71, 26.48), MetS (14.72 points; 95% CI: 0.93, 28.51), and BMI (2.54 points; 95% CI: 0.05, 4.99) are all significantly associated with occupational stress. No significant associations are observed in participants with high sleep satisfaction. The findings of this study indicate that sleep satisfaction may modify the association between MetS and BMI, respectively, and occupational stress.

The background and current state of implementing a legal system for stress checks in Japan

This paper discusses the development process, outline, main design points, post-enactment operation, and related research trends based on my own experiences from the formulation of the stress check system. Additionally, it surveys related literature and is the first of its kind to discuss future developments from a legal point of view. The ultimate purpose of the stress check system is to stimulate concrete measures for workplace environment improvements. However, despite frequent group analysis, effective measures for improving the environment have been limited. In this paper, based on past studies, I argue that reduced stress and other effects can be observed in workplaces in which such measures have been implemented, providing qualitative outcomes for workers. In addition, basic data can and has been accumulated for subsequent policies and measures. I conclude that realizing human and organizational individuality as well as supporting growth and environmental adaptation are key to the implementation of effective mental health measures.

The differences of the economic losses due to presenteeism and treatment costs between high-stress workers and non-high-stress workers using the stress check survey in Japan

OBJECTIVES

This study sought to examine differences in the economic losses due to presenteeism and costs of medical and dental treatment between high-stress workers and non-high-stress workers using the stress check survey.

METHODS

We conducted a cross-sectional study from April 1, 2018 to March 31, 2019 in a pharmaceutical company. High-stress workers were classified with the Brief Job Stress Questionnaire using two methods: the sum method and the score converted method. The incidence of presenteeism and its costs were determined using a questionnaire. The costs of medical and dental treatment were calculated according to claims. We compared the costs between high-stress and non-high-stress workers using Wilcoxon's rank-sum test.

RESULTS

Of 3910 workers, 6.3% were classified as high-stress using the sum method and 6.6% were classified as high-stress using the score converted method. The costs associated with presenteeism and medical treatment among high-stress workers were higher than the costs among non-high-stress workers, whereas the costs associated with dental treatment were not.

CONCLUSIONS

To motivate employers to improve stressful work environments, it is recommended that presenteeism measurement items be added to the stress check survey, and that the methods used in this study be used to calculate the loss associated with high-stress workers in Japanese companies. However, we must be careful in interpreting absolute presenteeism loss amounts because they are poorly reliable and valid.

A cross-sectional study on perceived workplace health support and health-related quality of life

OBJECTIVE

Many companies in Japan have been increasingly interested in "health and productivity management (H&PM)." In terms of H&PM, we hypothesized that companies can enhance their employees' perceived workplace health support (PWHS) by supporting workers' lively working and healthy living. This could then improve their health-related quality of life (HRQOL) by increasing PWHS. Consequently, this study explored the relationship between PWHS and HRQOL.

METHODS

In December 2020, during the COVID-19 pandemic, we conducted an Internet-based nationwide health survey of Japanese workers (CORoNaWork study). A database of 27 036 participants was created. The intensity of PWHS was measured using a four-point Likert scale. We used multilevel ordered logistic regression to analyze the relationship between PWHS intensity and the four domains of the Centers for Disease Control's HRQOL-4 (self-rated health, number of poor physical health days, number of poor mental health days, and activity limitation days during the past 30 days).

RESULTS

In the sex- and age-adjusted and multivariate models, the intensity of PWHS significantly affected self-rated health and the three domains of unhealthy days (physical, mental, and activity limitation). There was also a trend toward worse HRQOL scores as the PWHS decreased.

CONCLUSIONS

We found that the higher the PWHS of Japanese workers, the higher their self-rated health and the fewer their unhealthy days. Companies need to assess workers' PWHS and HRQOL and promote H&PM. H&PM is also necessary to maintain and promote the health of workers during the COVID-19 pandemic.

Association Between Psychological Distress and Stress-Related Symptoms and Increased Risk of Type 2 Diabetes in Male Individuals: An Observational Study

Background

This study evaluated the association between psychological distress and development of type 2 diabetes (T2D) among male individuals in the workplace.

Methods

This observational cohort study enrolled 6,326 male participants aged 18 - 65 years (mean age 47.4 ± 9.5 years, body mass index 23.4 ± 3.4 kg/m², hemoglobin A1c 5.5±0.3%), who received annual health checkups from April 2016 to March 2017. Those who had a hemoglobin A1c level ≥ 6.5%, previous history of diabetes, or used diabetes medication were excluded from the analysis. Psychological distress was measured using the Brief Job Stress Questionnaire. Multivariate Cox proportional hazard regression models were used to estimate the development of T2D in relation to psychological distress and stress-related symptoms. The calculated hazard ratio (aHR) was adjusted for age, body mass index, and hemoglobin A1c level.

Results

During a mean follow-up period of 1.9 years, the incidence rate of new-onset T2D was 2.0%. Baseline psychological parameters did not differ between participants with or without new-onset T2D. Depression was associated with an increased risk of T2D (aHR = 1.54, 95% confidence interval (CI): 1.07 - 2.22), whereas vigor, irritation, fatigue, and anxiety were not. Moreover, inability to handle work (aHR = 2.18, 95% CI: 1.14 - 4.19), sadness (aHR = 1.93, 95% CI: 1.14 - 3.26), headache (aHR = 1.98, 95% CI: 1.18 - 3.34), shoulder stiffness (aHR = 1.56, 95% CI: 1.10 - 2.23), and constipation/diarrhea (aHR = 1.71, 95% CI: 1.04 - 2.80) were associated with T2D incidence.

Conclusions

Depression and stress-related symptoms were associated with an increased risk of T2D. Industrial physicians and health care providers should evaluate these factors during health checkups to lower the T2D incidence in this population

Study of the Effects of Recognition of Stress on Symptoms and Regular Hospital Visits: An Analysis from Japanese National Statistics

Stress is a risk factor for numerous lifestyle diseases, including dental diseases. The purpose of the present study was to investigate how sensitivity to psychological stress relates to subjective symptoms and regular hospital visits using information from the large-scale database of national statistics. Anonymized data from 10,584 respondents aged 30–79 of the Japanese 2013 Comprehensive Survey of Living Conditions were analyzed. Respondents were classified by age into a middle-aged group and an elderly group, and a contingency table analysis, rank correlation analysis, and binomial logistic regression analysis were performed. Contingency table analysis confirmed that eight items were related to the presence of a recognition of stress, including the presence of subjective symptoms (p < 0.001), the presence of regular hospital visits (p < 0.001), symptoms of periodontal disease (p < 0.001), and self-rated health (p < 0.001). Responses for symptoms and diseases requiring regular hospital visits were ranked in order for a stress group and a no stress group, and it was found that other than fatigue symptoms being ranked highly in the stress group, there were no particular differences. Logistic regression analysis results showed significant odds ratios for six items including: self-rated health (3.91, 95% CI, 3.23 to 4.73), lifestyle awareness (1.96, 95% CI, 1.68 to 2.28), and symptoms of periodontal disease (1.71, 95% CI 1.19 to 2.48). The present study showed that susceptibility to psychological stress is related to awareness of subjective symptoms and to regular hospital visits due to disease, suggesting that these have direct and indirect mutual effects.

Implementation and effectiveness of the Stress Check Program, a national program to monitor and control workplace psychosocial factors in Japan: a systematic review. Translated secondary publication

Purpose

The purpose of this paper is to conduct a comprehensive review on the implementation and the effect of Japan's Stress Check Program, a national program to monitor and control workplace psychosocial factors that was initiated in December 2015.

Design/methodology/approach

We comprehensively reviewed articles published in Japanese and English, assessed the performance of the Stress Check Program and summarized future challenges. We also discussed the implications for practice.

Findings

The available literature presented a scientific basis for the efficiency and validity of predictions using the Brief Job Stress Questionnaire, which is the instrument recommended to screen workers with high stress in the program. No study has verified the effect of the program on workers' mental health by using group analysis of stress check results. There is room for improvement in tools that contribute to identifying workers with high stress and in measures for improving the work environment. The Stress Check Program contrasts with risk management of psychosocial factors at work, widely adopted in European countries as a strategy for improving workers' mental health by focussing on the psychosocial work environment.

Practical implications

Although the effectiveness of the Japanese program needs further evaluation, future developments of the program would provide insight for national policies on psychosocial risks/psychosocial stress at work.

Originality/value

This paper is the first systematic review on the implementation and effects of Japan's Stress Check Program.

Occupational stress and the risk of turnover: a large prospective cohort study of employees in Japan

Background

Although several studies have examined the association between occupational stress and turnover, these studies relied on cross-sectional designs, subjects’ self-report, healthcare workforce, or small sample sizes. This study aimed to confirm whether occupational stress increases the risk of turnover in a large-scale prospective cohort study using actual turnover data from company records.

Methods

The participants were 3892 male and 5765 female employees aged 20–49 years in a financial service company. We followed them from October 2012 until April 1, 2016 and used company records to identify employees who resigned. We identified employees with high and low stress using the Brief Job Stress Questionnaire. Hazard ratios for turnover in high-stress employees were estimated using Cox proportional hazards models, and population attributable risks were calculated separately for men and women.

Results

During 11,475,862 person-days, 122 men and 760 women resigned. After adjustment for age, length of service, job type, and position, the hazard ratios (95% confidence intervals) for turnover in high-stress employees were 2.86 (1.74–4.68) for men and 1.52 (1.29–1.78) for women. The corresponding population attributable risks for high stress were 8.2% for men and 8.3% for women. The component scores, i.e., job stressors, psychological/physical stress response, workplace social support, and job strain (the combination of high job demands and low job control) were also significantly associated with turnover (p < 0.05).

Conclusions

Occupational stress increases the risk of actual turnover. Measures to prevent occupational stress may be useful to prevent employee turnover.

Association between flourishing mental health and occupational stress among workers of Tsukuba Science City, Japan: a cross-sectional study

Background

Flourishing, defined as the coexistence of hedonic and eudaimonic well-being, is the most favorable end of the mental health spectrum. A growing body of evidence has demonstrated the association between flourishing mental health and favorable work-related outcomes. However, epidemiology of flourishing mental health is scarce in Japan. Moreover, the relationship between flourishing mental health and occupational stress has not been elaborated. Therefore, the aim of this study was to elucidate (1) the prevalence of flourishing mental health and (2) the association between flourishing mental health and occupational stress among Japanese workers.

Methods

The present survey was conducted in from February to March 2017 via an anonymous, self-administered, and web-based questionnaire among workers in Tsukuba Science City, Japan. Mental Health Continuum Short Form was used to assess flourishing mental health. We performed binomial logistic regression analyses to calculate the adjusted odds ratios (AOR) and 95% confidence intervals (CI) of occupational stress for flourishing mental health, controlling for sociodemographic factors.

Results

A total of 7012 respondents (4402 men, 2610 women) were analyzed. The overall prevalence of flourishing mental health among the respondents was 12.4%. Full-time (permanent) workers were less likely to be flourishing. Reward from work (AOR = 2.34, 95% CI = 2.04–2.68), support from colleagues and superiors (AOR = 1.67, 95% CI = 1.44–1.94), and workload (AOR = 1.19, 95% CI = 1.05–1.36) were positively associated with flourishing mental health, whereas mental workload (AOR = 0.65, 95% CI = 0.57–0.75) was inversely associated with flourishing mental health.

Conclusions

The findings of the present study shed light on the association between flourishing mental health and occupational stress.

Relationship between workplace social capital and suicidal ideation in the past year among employees in Japan: a cross-sectional study

Background

A growing body of evidence has demonstrated the associations between social capital and health. In residential or geographical areas, social capital has attracted attention for its protective effects against suicide. However, to this date, the relationship between social capital and suicidal ideation is not fully elaborated in the occupational setting. Therefore, the aim of the present study was to examine the association between workplace social capital and suicidal ideation in the past year among employees in Japan.

Methods

A cross-sectional, web-based survey was conducted in February/March 2017 via an anonymous self-administered questionnaire distributed to workers in Tsukuba Science City, Japan. Binomial logistic regressions were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for suicidal ideation in the past year, controlling for age group, marital status, educational attainment, and annual household income. The results were shown stratified by sex and occupation.

Results

In total, 7255 of 19,481 workers responded, out of which we could analyze 6325 responses (4030 men, 2295 women). The prevalence of suicidal ideation in the past year was 5.9% for men and 7.8% for women. Low workplace social capital was statistically significantly associated with suicidal ideation both for men (OR = 2.57, 95% CI = 1.72–3.83) and for women (OR = 1.75, 95% CI = 1.15–2.66), compared with high workplace social capital after controlling for socioeconomic factors.

Conclusion

Higher workplace social capital was associated with a reduced risk of suicidal ideation in the past year. Promoting workplace social capital could contribute to preventing suicide among employees in Japan.

Sociomedical problems of overwork-related deaths and disorders in Japan

Objectives

Cerebrovascular and cardiovascular diseases (CCVDs) and mental disorders, including suicide, are prevalent among overworked individuals in Japan. The 2014 legislation regarding the prevention of overwork‐related deaths and disorders has accelerated the research in this field and ultimately the implementation of preventive actions.

Methods

To understand the current problematic situations, the Research Center for Overwork‐Related Disorders of the National Institute of Occupational Safety and Health, Japan, conducted analyses of compensated claims for overwork‐related CCVDs and mental disorders that were recognized from January 2010 to March 2015.

Results

The majority of CCVD cases were the men in their 50s. Transport and postal activities was the highest risk industry. Cerebrovascular cases were higher than cardiovascular ones. Long working hours was the principal factor for CCVDs. The mental disorder cases comprised approximately 70% men and affected younger age groups (peak in the third decade) with various industries at risk. In men, there was an almost equal number of F3 (Mood [affective] disorders) and F4 (Neurotic, stress‐related, and somatoform disorders) diagnoses according to the 10th revision of the International Classification of Diseases and Related Health Problems. A larger number of women were diagnosed to have F4. The mental disorder cases were associated not only with long working hours, but also with injuries and disasters as well as interpersonal conflict at work.

Conclusions

Multiple, simultaneous actions need to be made by employees, employers, researchers, and the authorities to achieve the goal of reducing the number of workers suffering from the overwork‐related CCVDs and mental disorders.

[Return-to-work support programs for workers on sick leave: a systematic review and meta-analysis]

OBJECTIVES

We are responsible for answering the research question, "Does a return-to-work program improve the returning outcome?" This is one of the six research questions in the evidence-based "Return-to-work Guidance in Occupational Health 2017" developed by the Kanto branch of the Japanese Society of Occupational Health. This study aimed to integrate the effectiveness of the return-to-work program to improve the state of sick-listed employees suffering from cardiovascular disease, cancer, and musculoskeletal and mental health problems.

METHODS

Three different databases, PubMed, Cochrane Library, and Ichushi-Web were searched. Based on the results of a systematic review, the guidance developing group created the draft of the recommendations with evidence to decision framework and used a poll to determine the recommendations. We integrated the evidence from a systematic review and meta-analysis at the disease level. This study protocol was registered with PROSPERO (the registration number is: CRD42016048937).

RESULTS

A total of five articles on musculoskeletal diseases and six on mental health problems were retrieved. No articles in the cardiovascular and cancer areas matched the eligibility criteria. When workers suffered from musculoskeletal disorders, the rehabilitation group statistically returned to work earlier than the usual care group did [HR 1.58 (95% CI 1.26-1.97), -40.71days (95% CI -60.69--20.72) ]. In the mental health problems group, the psychological intervention program group had statistically less days of sick leaves as compared to that in the usual care group [-18.64 days (95% CI -27.98--9.30) ].

CONCLUSIONS

It might be suggested that work environment management, work management, tackling psychological problems, cognitive behavioral approach, and several meetings with supervisors and occupational health staff, in addition to a direct focus on backache contributed to the early return-to-work of workers suffering from musculoskeletal disease. Regarding mental health problems, interviews with a psychological approach and consultations with psychologists and psychiatrists might be effective in reducing the days of sick leaves. However, because these methods were investigated in Europe, we need to be careful when introducing these practises in Japan due to the differences in the occupational health support systems. Further, high quality evidence level studies are needed in Japan.