The economic impact of loss of performance due to absenteeism and presenteeism caused by depressive symptoms and comorbid health conditions among Japanese workers

Mindful Self-Compassion Smartphone Intervention for Worker Mental Health in Japan: Protocol for a Randomized Controlled Trial

BACKGROUND

Mental health problems among workers cause enormous losses to companies in Japan. However, workers have been considered to have limited access to psychological support because of time constraints, which makes it difficult for them to engage in face-to-face psychological support interventions.

OBJECTIVE

This study aimed to present an intervention protocol that describes a randomized controlled trial to examine whether brief guided mindfulness meditation (MM) or self-compassion meditation (SCM) provided by a smartphone app is effective for mental health and work-related outcomes among workers.

METHODS

This is an open-label, 3-arm randomized controlled trial. The participants will be recruited through an open call on relevant websites with the following inclusion criteria: (1) employees who are working more than 20 hours per week, (2) between the ages of 18 and 54 years, (3) not on a leave of absence, (4) not business owners or students, and (5) not currently diagnosed with a mental disorder and have a Kessler Psychological Distress Scale-6 score below 13 points. We will include 200 participants and randomly assign them to an SCM course (n=67), an MM course (n=67), and a waitlist group (n=66). The intervention groups (SCM and MM) will be instructed to engage in daily guided self-help, self-compassion, and MMs lasting 6-12 minutes per day over 4 weeks. Primary outcomes will include psychological distress and job performance, and secondary outcomes will include somatic symptoms, cognitive flexibility, self-esteem, self-compassion, perceived stress, well-being, emotion regulation, work engagement, anger, psychological safety, and creativity. All procedures were approved by the ethics committee of the University of Tokyo (22-326). All participants will be informed of the study via the websites, and written informed consent will be collected via web-based forms.

RESULTS

The recruitment of participants began in December 2022, and the intervention began in January 2023. As of September 2023, a total of 375 participants have been enrolled. The intervention and data collection were completed in late October 2023.

CONCLUSIONS

This study will contribute to the development of effective self-care intervention content that will improve mental health, work performance, and related outcomes and promote mindful and self-compassionate attitudes when faced with distress.

TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trials Registry UMIN000049466; https://tinyurl.com/23x8m8nf.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53541.

Comparative Review of the Socioeconomic Burden of Lower Back Pain in the United States and Globally

Internationally, the United States (U.S.) cites the highest cost burden of low back pain (LBP). The cost continues to rise, faster than the rate of inflation and overall growth of health expenditures. We performed a comprehensive literature review of peer-reviewed and non- peer-reviewed literature from PubMed, Scopus, and Google Scholar for contemporary data on prevalence, cost, and projected future costs. Policymakers in the U.S. have long attempted to address the high-cost burden of LBP through limiting low-value services and early imaging. Despite these efforts, costs (~$40 billion; ~$2,000/patient/yr) continue to rise with increasing rates of unindicated imaging, high rates of surgery, and subsequent revision surgery without proper trial of non-pharmacologic measures and no corresponding reduction in LBP prevalence. Globally, the overall prevalence of LBP continues to rise largely secondary to a growing aging population. Cost containment methods should focus on careful and comprehensive clinical assessment of patients to better understand when more resource-intensive interventions are indicated.

The Impact of Exercise and Health Management on Workplace Creativity

Objectives

This study aimed to investigate Japan's service sector employees to determine whether employee creativity is associated with the provision of a fitness program (that encourages employees to perform physical exercise) or a health and productivity management (H&PM) program at the workplace.

Design

This was a cross-sectional study.

Methods

A nationwide online survey was conducted using stratified sampling. Data were obtained for respondents' demographic characteristics, subjective health, exercise frequency, and organizational wellness support. Workplace creativity, psychological safety, and leadership were evaluated using standardized scales. A binary logistic regression was performed to examine the relationship between organizational wellness support programs and workplace creativity.

Results

Respondents were 1,955 full-time employees in private-sector organizations (979 men and 976 women; mean age 40.30 ± 10.85). Workplace creativity was significantly more likely respondents whose employers provided a fitness program (adjusted OR = 1.86, 95% CI = 1.39-2.48, p<.001) or an H&PM program (adjusted OR = 2.07, 95% CI = 1.53-2.80, p<.001). Furthermore, workplace creativity was significantly more likely in employees who perceived themselves as rather healthy or healthy. Employees who exercised frequently over the past year were more likely to display creativity than those never exercised.

Conclusions

Workplace creativity was associated with good subjective health, high exercise frequency, and organizational wellness support programs offered by employers. Human resource management for employees' fitness and health is crucial for cultivating the productivity and innovation necessary for business success.

Managing office worker presenteeism by providing financial aid for acupuncture therapy: a pragmatic multicenter randomized comparative study

To evaluate whether financial aid for acupuncture therapy is beneficial for non-manufacturing job workers (office workers) who are aware of reduced job performance due to health issues (presenteeism), a four-wk pragmatic multicenter randomized controlled trial was conducted with office workers who were aware of their presenteeism. The control group only implemented the workplace-recommended presenteeism measures, whereas the intervention group received financial aid for acupuncture therapy of up to 8,000 JPY (Japanese yen) in addition to implementing the presenteeism measures recommended by each workplace. The major outcome measure was the World Health Organization Health and Work Performance Questionnaire relative presenteeism score. A total of 203 patients were assigned to the intervention (n=103) and control (n=108) groups. The intervention group underwent a median of 1.0 (interquartile range [IQR], 1.0 to 2.0) sessions of acupuncture for neck disorders (64%), back disorders (16%), and depressed mood/anxiety/irritation (5%), among others. Results showed that the intervention group had slightly better job performance than the control group (effect size [r]=0.15, p=0.03). Financial aid for acupuncture therapy may help compensate for losses incurred by enterprises in the form of 14,117 JPY per worker a month.

A non-randomized, controlled, interventional study to investigate the effects of community pharmacists' cognitive behavioral therapy-based interventions on medication adherence and relevant indicators in patients with depression

BACKGROUND

The prevalence of depression is increasing in Japan. Pharmacists play an important role in helping patients use medicines effectively. Several studies had investigated the impact of community pharmacists on patient adherence to antidepressant therapy, and their results indicated that further study was warranted.

METHODS

This study was conducted from June 2019 to May 2020 using a cluster non-randomized, open-label, parallel-group design. Four community pharmacy stores in Osaka and Hyogo Prefectures, Japan, participated in the study, and enrolled patients with unipolar depression. In the intervention group (IG), patients received cognitive behavioral therapy (CBT)-based medication support, and their medication adherence and adverse drug reactions were monitored by telephone. In the control group (CG), the pharmacists engaged in routine interactions with the study participants. Before participating in this study, the intervention-group pharmacists attended a 5-hour training session on CBT-based medication support. The primary outcome of this study was medication adherence, assessed using the Drug Attitude Inventory (DAI)-10. Secondary outcomes included the changes from baseline at 6 months in the following variables: the Patient Health Questionnaire (PHQ)-9 total score, the EQ-5D-5 L (Euro-QOL 5 dimensions 5 levels) score, patient satisfaction, and the Pharmacists' Confidence Scale about Medication Consultation for Depressive Patients (PCMCD) score.

RESULTS

Four pharmacies (two in IG and two in CG) completed the intervention period. Results were obtained from 19 patients in the IG and 12 patients in the CG. In the IG, the mean DAI-10 score increased from 4.941 at baseline to 6.105, the mean PHQ-9 score decreased from 9.263 to 8.625, and the mean patient satisfaction score increased from 39.947 to 42.211. In the CG, the mean DAI-10 score decreased from 6.333 to 4.167, the mean PHQ-9 score increased from 9.333 to 12.923, and the mean patient satisfaction score decreased from 38.929 to 38.167.

CONCLUSION

CBT-based medication support provided by community pharmacists may improve patient medication adherence to antidepressant therapy and symptoms. Such support can be expected to facilitate better treatment of depressed patients and may also allow the duration of treatment to be shortened.

TRIAL REGISTRATION

UMIN000037954, Date of first registration: 17/06/2019.

A Cross-Sectional Study of the Impact of Pain Severity on Absenteeism and Presenteeism Among Japanese Full-Time Workers

INTRODUCTION

Pain is known to have a high impact on work performance, but there are several confounding factors, such as stress and mental issues. Little is known about the impact of pain severity on work performance when adjusted for such confounding factors. The aim of this study was to identify the effect of pain severity on absence from work (absenteeism) and reduced performance (presenteeism).

METHODS

A cross-sectional study was conducted among full-time workers at an industrial manufacturing company in Japan. Participants were assessed using a self-reported questionnaire, including work performance evaluations, pain characteristics, pain-related fear, psychological distress, stress at the workplace and home, workaholism, and self-awareness. Principal component analysis was utilized to decrease the dimensions of the measures, and orthogonal rotation was performed on identified components with an eigenvalue > 1.0. Multivariable logistic regression analyses were performed to determine the association between pain severity and absenteeism and presenteeism, and were adjusted for confounding factors. We also analyzed the association between pain intensity and presenteeism using multivariable logistic regression analyses.

RESULTS

A total of 349 workers participated in the study. Six principal components were identified as confounding factors: work stress, regulation, mental instability, less support, home stress, and life dissatisfaction. Multivariable logistic regression analyses showed significant associations of moderate to severe pain with absenteeism (p = 0.02) and low and high presenteeism (p = 0.004 and 0.009, respectively), adjusted for age, sex, body mass index, short sleep, and the six principal components. Pain intensity was also significantly associated with low and high presenteeism (p = 0.002 and 0.014, respectively) in people with pain.

CONCLUSIONS

Pain severity is a risk factor for absenteeism and presenteeism, even if workers have comorbid psychological stress or mental health problems.

Presenteeism and absenteeism before and after single-level lumbar spine surgery

BACKGROUND CONTEXT

Health can impact work performance through absenteeism, time spent away from work, and presenteeism, inhibited at-work performance. Low back pain is common and costly, both in terms of direct medical expenditures and indirect reduced work performance.

PURPOSE

Surgery for lumbar spinal pathology is an important part of treatment for patients who do not respond to nonsurgical management. While the indirect costs of return to work and absenteeism among employed patients undergoing lumbar spine surgery have been studied, little work has been done to quantify presenteeism before and after lumbar spine surgery.

STUDY DESIGN/SETTING

Prospective cohort study at a single high-volume urban musculoskeletal specialty hospital.

PATIENT SAMPLE

Patients undergoing single-level lumbar spinal fusion and/or decompression surgery.

OUTCOME MEASURES

Presenteeism and absenteeism were measured using the World Health Organization's Health and Work Performance Questionnaire before surgery, as well as 6 weeks, 6 months, and 12 months after surgery.

METHODS

Average presenteeism and absenteeism were evaluated at pre-surgical baseline and each follow-up timepoint. Monthly average time lost to presenteeism and absenteeism were calculated before surgery and 12 months after surgery. Study data were collected and managed using REDCap electronic data capture tools with support from Clinical and Translational Science Center grant, UL1TR002384. One author discloses royalties, private investments, consulting fees, speaking/teaching arrangements, travel, board of directorship, and scientific advisory board membership totaling >$300,000.

RESULTS

We enrolled 134 employed surgical patients, among whom 115 (86%) responded at 6 weeks, 105 (78%) responded at 6 months, and 115 (86%) responded at 12 months. Preoperatively, mean age was 56.4 years (median 57.5), and 41.0% were women; 68 (50.7%) had only decompressions, while 66 (49.3%) had fusions. Among respondents at each time point, 98%, 92%, and 92% were still employed, among whom 76%, 96%, and 96% had resumed working, respectively (median 29 days). Average at-work performance among working patients (who responded at each pair of timepoints) moved from 75.4 to 78.7 between baseline and 6 weeks, 71.8 to 85.9 between baseline and 6 months, and 73.0 to 88.1 between baseline and 12 months. Gains were concentrated among the 52.0% of patients whose at-work performance was declining (and low) leading up to surgery. Average absenteeism was relatively unmoved between baseline and each follow-up. Before surgery, the monthly average time lost to presenteeism and absenteeism was 19.8% and 18.9%, respectively; 12 months after surgery, these numbers were 9.7% and 16.0%; changes represent a mitigated loss of 13.0 percentage points of average monthly value.

CONCLUSIONS

Presenteeism and absenteeism contributed roughly evenly to preoperative average monthly lost time. Although average changes in absenteeism and 6-week at-work performance were small, average changes in at-work performance at 6 and 12 months were significant. Cost-benefit analyses of lumbar spine surgery should therefore consider improved presenteeism, which appears to offset some of the direct and indirect costs of surgical treatment.

Identifying bereaved grievers with greatest medical or social service needs in Japan

Objective

Severe grief adversely affects the health of bereaved families, potentially burdening medical and community health services. Interventions for effective community health maintenance must identify the people likely to face severe effects of bereavement. The present study identified characteristics of mourners who experience severe grief within a year of bereavement to confirm whether this grief increased their reliance on Japanese medical and social services.

Design

We conducted a nationwide postal survey of Japanese bereaved within the previous year, to compare those reporting daily or overwhelming ‘heavy’ grief to those with less heavy grief, in terms of demographic and socioeconomic details, daily work and non-work activity, frequency of medical and social service use.

Setting/participants

In 2019, with the support of the Ministry of Education and the All Japan Funeral Co-Operation, we distributed approximately 5500 questionnaires to Japanese who had presided at funerals within the past year for anonymous return. By January of 2020, we received 1078 complete voluntary responses from bereaved Japanese.

Results

Half of the ‘heavy grief’ group (n=143) reported adverse effects on health and daily life, including needs for pharmacological, medical or welfare support. Losses of husbands or children were particularly connected to severe grief; ‘unexpected’ death from cancer caused the greatest shock. Employment (even part-time) buffered against severe grief; grief was greater for the unemployed and substantially worse for those who lost significant income at the same time as they lost loved ones.

Conclusion

These findings suggest that prior counselling should reduce the shock of bereavement and economic loss, which increases subsequent medical dependence. Medical professionals and community health workers can use the above factors to target in advance the family members in greatest danger of heavy grief, to intervene lest grief adversely affect their physical and psychological health after bereavement.

Changes in Presenteeism Six Months After Returning from Sick Leave Due to Mental Illness

This study examines how psychological distress (measured by the K10 screening test) and presenteeism (measured by the quality and quantity method) change in the six months after returning to work from having taken a sick leave because of a mental illness. In a manufacturing company with approximately 2,600 employees, 23 employees returned to work after experiencing mental illness between April 2015 and March 2016, and all 23 agreed to participate in the study. We analyzed 18 cases for which we had sufficient data. Two of the employees were absent from work in the sixth month. We performed multilevel analysis for K10 and presenteeism over time on the 16 without recurrence. A significant decreasing trend was observed for both K10 and presenteeism. Eleven of the 16 employees were consistently below the K10 cutoff value of 10 for six months, and 5 had zero presenteeism in the sixth month, whereas 6 employees showed improvement in presenteeism that stopped midway through the study. An occupational physician judged that the employees could work normally with presenteeism of zero. After returning to work, it is important to monitor not only psychiatric symptoms but also presenteeism.

Increased Work from Home and Low Back Pain among Japanese Desk Workers during the Coronavirus Disease 2019 Pandemic: A Cross-Sectional Study

To prevent the spread of coronavirus disease 2019 (COVID-19), desk workers in Japan have been encouraged to work from home. Due to rapidly increased working from home, working in environments that are not properly designed and working with poor posture can affect low back pain (LBP). This study aimed to examine the relationship between increased work from home during the COVID-19 pandemic and LBP among Japanese desk workers. Using study data from the Japan COVID-19 and Society Internet Survey 2020 conducted from August to September 2020, 4227 desk workers who did not have LBP before the COVID-19 pandemic were analyzed out of 25,482 total respondents. Odds ratios (ORs) and 95% confidence intervals (CIs) for LBP were calculated by multivariable logistic regression, adjusting for covariates such as socioeconomic factors. During the COVID-19 pandemic, 31.3% of desk workers with an increased chance of working from home, and 4.1% had LBP. Desk workers with increased working from home were more likely to have LBP (OR: 2.00 (95% CI, 1.36–2.93)). In this large-scale study, increased work from home was associated with LBP among desk workers during the COVID-19 pandemic. Therefore, preparing an appropriate work environment for desk workers working from home can improve productivity, leading to positive effects.

The Economic Burden of Lost Productivity due to Presenteeism Caused by Health Conditions Among Workers in Japan

To identify the primary health conditions that cause presenteeism, and to estimate the economic cost of lost productivity due to presenteeism in Japan.

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BACKGROUND

Absenteeism is costly, yet evidence suggests that presenteeism-illness-related reduced productivity at work-is costlier. We quantified employed patients' presenteeism and absenteeism before and after total joint arthroplasty (TJA).

METHODS

We measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization's Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.

RESULTS

In total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).

CONCLUSION

Among employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.

Mediating Roles of Cognitive Complaints on Relationships between Insomnia, State Anxiety, and Presenteeism in Japanese Adult Workers

Complaints of cognitive functions (CCFs), defined as subjective cognitive dysfunction, affect social function; additionally, for workers, this condition is an important factor in presenteeism and mediates the effect of depressive symptoms on presenteeism. This study aimed to investigate whether CCFs mediate the relationships among insomnia, state anxiety (SA), and presenteeism. Participants were 471 Japanese adult workers evaluated using the Athens Insomnia Scale, State-Trait Anxiety Inventory (Form Y), Cognitive Complaints in Bipolar Disorder Rating Assessment, and Work Limitations Questionnaire 8 to assess insomnia, SA, CCFs, and presenteeism, respectively. Path analysis was used to evaluate the correlations between variables. CCFs significantly mediated the associations among insomnia, SA, and presenteeism. To address the presenteeism associated with insomnia and SA, it may be useful to assess the mediating roles of CCFs.

Two definitions of presenteeism: sickness presenteeism and impaired work function

BACKGROUND

Two major definitions exist for presenteeism: sickness presenteeism and impaired work function. The evidence for comparing previous studies on presenteeism is insufficient because of the different definitions of presenteeism used.

AIMS

To assess the relationship between the two major definitions of presenteeism.

METHODS

This cross-sectional study analysed secondary data on 5334 respondents to an employee survey administered in a construction company in Japan. Impaired work function was measured using the Work Functioning Impairment Scale (WFun). Multiple logistic regression was performed.

RESULTS

A strong linear association was observed between the number of days of sickness presenteeism and impaired work function (all P < 0.001). In contrast, the number of days of sickness absence was only partially positively associated with impaired work function. All choices for most frequent health problem were positively associated with impaired work function, beginning with mental problems (adjusted odds ratio [OR] = 20.45, 95% confidence interval [CI]: 14.94-28.01), followed by malaise (adjusted OR = 11.91, 95% CI: 9.08-15.62) and sleeping problems (adjusted OR = 8.62, 95% CI: 6.57-11.33).

CONCLUSIONS

A strong relationship was observed between the two major definitions of presenteeism, even after adjusting for a variety of chronic health conditions. Although a consensus on the definition of presenteeism is yet to be reached, this study provides insight on comparing existing studies on presenteeism.

Unmet Needs in Japanese Patients Who Report Insufficient Efficacy with Triptans for Acute Treatment of Migraine: Retrospective Analysis of Real-World Data

INTRODUCTION

Migraine attacks notably impact people's daily lives, health-related quality of life (HRQoL), and ability to work. Triptans are widely used as acute medication for a migraine attack but are ineffective, poorly tolerated, or contraindicated in some patients. HRQoL and work productivity are therefore likely to pose particular problems for patients whose migraine attacks do not respond sufficiently to triptan acute treatment. This real-world study aimed to determine whether migraine-related HRQoL, disability, and work productivity differed between triptan insufficient responders (TIRs) and sufficient responders (TSRs) receiving this acute treatment for migraine in Japan.

METHODS

This was a retrospective analysis of 2017 Adelphi Migraine Disease Specific Programme cross-sectional survey data collected from physicians and their consulting patients with migraine in Japan. Patients had to be receiving a triptan as their sole acute prescribed medication for migraine. TIRs were defined as patients who achieved headache pain freedom within 2 h of taking triptan acute treatment in no more than three of five migraine attacks. Differences in outcomes between TIRs and TSRs were examined in adjusted analyses using a multivariable general linear model.

RESULTS

Of 200 patients receiving a triptan as their sole prescribed acute treatment for migraine, 88 (44.0%) were classed as TIRs. Migraine-Specific Quality of Life Questionnaire scores were significantly lower-indicating poorer HRQoL-among TIRs than TSRs, as were mean EuroQol 5-dimension utility and visual analog scale scores (p < 0.05 for comparisons). TIRs also reported significantly (p ≤ 0.003) greater impairment than TSRs across all Work Productivity and Activity Impairment domains, with the exception of work time missed. Migraine disability was higher among TIRs than TSRs.

CONCLUSION

Migraine attacks had a negative impact on the HRQoL, disability, and work productivity of people with migraine in Japan reporting insufficient efficacy with acute triptan treatment, highlighting the need for more effective acute treatment options.

Potential Work Time Lost Due to Sickness Absence and Presence Among Japanese Workers

OBJECTIVE

The current study aimed to quantify the overall sickness absence and sickness presence in five Japanese companies.

METHODS

Two indicators were calculated: worktime lost rates and average working days lost per employee per annum.

RESULTS

In total, 1.1% of working days per annum were lost due to sick leave. The average number of annual sick-leave days per employee was 2.58. Sickness presence accounted for a total worktime loss of 6.55% and an average of 15.36 work days lost per employee per annum. Overall, employees lost 7.65% of their total working days, or an average of 17.92 days were lost per employee per annum, due to sickness leave and sickness presence combined.

CONCLUSION

Sickness-absence rate among Japanese workers is quite lower than other countries; however, sickness presence is more critical than absenteeism, which is in line with other countries.

Social burden of people with the migraine diagnosis in Japan: evidence from a population-based cross-sectional survey

OBJECTIVES

To quantify the social burden among Japanese migraine patients in the context of currently available migraine treatments, by comparison with non-migraine controls, and comparison of migraine patients currently taking prescription medication versus not taking prescription medication.

DESIGN

Cross-sectional analysis.

SETTING

Data from the population-based online self-administered Japan National Health and Wellness Survey (NHWS) 2017.

PARTICIPANTS

Respondents to the NHWS (n=30 001) were ≥18 years. Migraine patients were respondents with self-reported experience and physician diagnosis of migraine. Non-migraine controls reported no migraine experience. Migraine patients were subgrouped into currently taking prescription medication for migraine (Rx) and currently not taking prescription medication (non-Rx).

METHODS

One-way analysis of variance tests were performed to compare health-related quality of life (HRQoL), work productivity and activity impairment and healthcare resource utilisation between migraine patients and matched non-migraine controls selected by 1:1 propensity score matching. Generalised linear models were used to compare outcomes and migraine related characteristics between Rx and non-Rx.

RESULTS

Compared with matched controls, migraine patients (n=1265) had significantly lower HRQoL in terms of lower Physical Component Summary (48.36 vs 51.29, p<0.001), Mental Component Summary (44.65 vs 48.31, p<0.001), Role/Social Component Summary (41.78 vs 46.18, p<0.001) and mean EuroQol 5-Dimension index (0.77 vs 0.86, p<0.001) scores. Migraine patients experienced significantly higher absenteeism (6.95% vs 3.07%, p<0.001), presenteeism (32.73% vs 18.94%, p<0.001), work productivity loss (34.82% vs 20.03%, p<0.001) and daily activity impairment (35.70% vs 22.04%, p<0.001) and visited healthcare professionals more often (8.38 vs 4.57, p<0.001) than controls. No significant differences in these outcomes were found when comparing Rx (n=587) and non-Rx (n=678) patients.

CONCLUSIONS

There is an unmet need for improved HRQoL and work productivity in Japanese migraine patients despite the currently available prescription medications, which are important factors to consider for future development of migraine therapies.

Presenteeism among health care workers: literature review

Presenteeism is an occupational and psychosocial phenomenon with negative impact on the work environment. In addition to causing losses in productivity losses, it also has implications for the state of health of workers. Therefore, presenteeism is likely to become a serious public health problem. The aim of the present study was to discuss the implications, means for evaluation and impact of presenteeism on the health and work of health care workers. We performed a literature search in database PubMed using keywords presenteeism, absenteeism, nurse presenteeism, physician presenteeism, sickness presenteeism, physician health organization, and working sick. We conclude that adequate assessment, raising the health managers' awareness about the risks and harms associated with this phenomenon, and developing management tools will contribute to reduce the impact of presenteeism. This seems to be the proper path to make this problem more visible and hinder its growth.

The Relationship Between Fear-avoidance Beliefs in Employees with Chronic Musculoskeletal Pain and Work Productivity: A Longitudinal Study

This study aimed to identify risk factors for chronic musculoskeletal pain (CMSP) and sought to examine the effect of fear-avoidance beliefs (FABs) on work productivity in workers with CMSP. We performed a longitudinal study using self-administered questionnaires given to employees in three different industries between April 2016 and March 2017. The questionnaire concerned background characteristics, work-related factors and musculoskeletal pain, the Work Functioning Impairment Scale (WFun), and the Japanese version of the Tampa Scale for Kinesiophobia (TSK-J). We performed logistic regression analysis to evaluate factors affecting CMSP and a multi-way analysis of variance to analyze the relationship between FABs and CMSP and the effect of FABs on the ability to function at work. Age (odds ratio [OR] = 1.02, 95% confidence interval [CI]: 1.00-1.03), mean working hours (OR = 1.18, 95% CI: 1.04-1.33), and changes in working hours (OR = 1.18, 95% CI: 1.02-1.37) were significantly associated with CMSP. Regarding FABs, we found that the stronger the FAB, the greater the WFun score, and that an increase in FABs resulted in a significant increase in WFun scores. This study demonstrated that long or increased working hours may be risk factors for CMSP, and that stronger FABs in those with CMSP are associated with decreased ability to function at work. In addition, measures to reduce FABs in workers with CMSP may be effective.

The Impact of Oral Health on Work Performance of Japanese Workers

OBJECTIVE

The aim of this study was to investigate the association between oral health and work performance measured as absenteeism and presenteeism.

METHODS

Study participants were employees (mean age: 42.7 ± 11.4 years) of 11 companies in Japan. Oral examination and self-administered questionnaires provided information on industrial category, work schedule, work performance (absenteeism and presenteeism), and smoking status.

RESULTS

The proportion of absenteeism (2.7%) or presenteeism (6.8%) of workers caused by oral health problems was low. Logistic regression analysis showed that the risk of absenteeism due to oral health problems was not significantly related to occupation or oral health status. However, the risk of presenteeism caused by oral health problems was 2.01 (95% confidence interval, 1.03 to 3.92) times higher among participants with periodontitis.

CONCLUSIONS

Periodontal disease is associated with presenteeism of workers. It is considered that the periodontal disease countermeasure in the workplace should be provided.

Factors associated with disabling low back pain among nursing personnel at a medical centre in Japan: a comparative cross-sectional survey

OBJECTIVES

Low back pain (LBP) is a common cause of disability among nursing personnel. Although many studies regarding the risk factors for LBP among nursing staff have focused on the physical load at work, multidimensional assessments of risk factors are essential to identify appropriate preventive strategies. We aimed to investigate the association of multidimensional factors (individual, physical, psychological and occupational) with disabling LBP among nursing personnel in Japan.

DESIGN

Observational study with comparative cross-sectional design.

SETTING

Data were collected using the self-administered questionnaire at a tertiary medical centre.

PARTICIPANTS

After excluding participants with missing variables, 718 nursing personnel were included in the analysis.

OUTCOME MEASURES

A self-administered questionnaire assessed individual characteristics, rotating night shift data, severity of LBP, previous episode of LBP, sleep problem, kinesiophobia (Tampa Scale for Kinesiophobia), depressive condition (K6), physical flexibility and frequency of lifting at work. A logistic regression model was used to evaluate the factors associated with disabling LBP (LBP interfering with work) among nursing personnel.

RESULTS

Of all participants, 110 (15.3%) reported having disabling LBP. The multivariable logistic regression analysis after adjustment for several confounding factors showed that kinesiophobia (highest tertile, adjusted OR (aOR): 6.13, 95% CI : 3.34 to 11.27), previous episode of LBP (aOR: 4.31, 95% CI: 1.50 to 12.41) and insomnia (aOR: 1.66, 95% CI: 1.05 to 2.62) were significantly associated with disabling LBP.

CONCLUSIONS

The present study indicated that kinesiophobia, a previous episode of LBP, and sleep problems were associated with disabling LBP among nursing personnel. In the future, workplace interventions considering assessments of these factors may reduce the incidence of disabling LBP in nursing staff, although further prospective studies are needed.

Total Health-Related Costs Due to Absenteeism, Presenteeism, and Medical and Pharmaceutical Expenses in Japanese Employers

Objective:

This study aimed to examine a detailed breakdown of costs (absenteeism, presenteeism, and medical/pharmaceutical expenses), of the employees in four pharmaceutical companies in Japan.

Methods:

This is a cross-sectional study. Absenteeism and presenteeism were measured by a self-administered questionnaire for workers, and their costs were estimated using the human capital approach. Presenteeism was evaluated by the degree affected quality and quantity of work. Medical and pharmaceutical expenses were obtained by insurance claims.

Results:

The monetary value due to absenteeism was $520 per person per year (11%), that of presenteeism was $3055 (64%), and medical/pharmaceutical expenses were $1165 (25%). Two of the highest total cost burdens from chronic illness were related to mental (behavioral) health conditions and musculoskeletal disorders.

Conclusion:

A total cost approach can help employers set priorities for occupational health, safety, and population health management initiatives.

Survey on chronic disabling low back pain among care workers at nursing care facilities: a multicenter collaborative cross-sectional study

Purpose: Care workers at nursing care facilities have a high rate of low back pain (LBP). Although increasing evidence has revealed the important role of psychosocial factors in chronic LBP, factors associated with chronic LBP interfering with work have not been fully investigated in Japanese workers at nursing care facilities. The present study aimed to determine the prevalence of chronic LBP interfering with work and related factors of chronic LBP including psychosocial factors, among workers at nursing care facilities.

Material and methods: Eligible participants in the present study were Japanese workers at 95 nursing care facilities in Ishikawa Prefecture (n=2,242). Of these, 1,345 participants completed a self-administered questionnaire that included the following items: individual characteristics, severity of LBP, sleep problem, fear-avoidance beliefs (Tampa Scale for Kinesiophobia: TSK), STarT Back Screening Tool (SBST), fatigue, somatizing tendency, and work-related stress such as job satisfaction, job demand, interpersonal stress at work, and social support. The logistic regression analysis was used to assess factors associated with chronic disabling LBP.

Results: Of participants who completed the questionnaires, 159 (11.8%) reported chronic LBP that interfered with their work. The multivariable analysis of related-factors of chronic disabling LBP found statistically significant associations with the following: high score of psychological subscale in SBST (adjusted odds ratio [aOR]: 5.83, 95% confidence interval [CI]: 3.55–9.59), high score of TSK (aOR: 1.08, 95% CI: 1.05–1.13), and high somatizing tendency (aOR: 2.07, 95% CI: 1.31–3.23).

Conclusion: Psychological factors, including fear-avoidance beliefs or somatizing tendency, showed significant association with chronic LBP that interfered with work, among workers at nursing care facilities. Our results suggest that these factors would need to be considered in addition to screening for the risk factors of LBP chronicity by SBST when evaluating workers with chronic disabling LBP.

Relationships Between Chronic Musculoskeletal Pain and Working Hours and Sleeping Hours: A Cross-sectional Study

Ten to twenty percent of the population of Japan has chronic pain. Although studies have confirmed a relationship between sleeping hours and chronic pain, it remains unclear whether there is an association between working hours and chronic pain, especially chronic musculoskeletal pain (CMP), in workers. A self-administered questionnaire that sought information regarding background characteristics and work-related factors was sent to 118 enterprises; finally, 1,747 participants were included in the analysis and were classified into CMP (n = 448) and non-CMP (n = 1299) groups. Logistic regression analysis revealed that age (odds ratio [OR] = 1.02, 95% confidence interval [CI]: 1.01-1.03), sex (reference: female, OR = 0.68, 95% CI: 0.52-0.88), working hours (OR = 1.11, 95% CI: 1.03-1.20), and sleeping hours (OR = 0.84, 95% CI: 0.75-0.95) were significantly associated with CMP. Participants were categorized into four groups according to working hours (long: ≥ 9 hours/day [long-work], short: < 9 hours/day [short-work]) and sleeping hours (long: ≥ 7 hours/day [long-sleep], short: < 7 hours/day [short-sleep]). Furthermore, logistic regression analysis showed that the CMP OR was 2.02 (95% CI: 1.46-2.78) times higher in 'long-work plus short-sleep workers' and 1.47 (95% CI: 0.94-2.30) times higher in 'long-work plus long-sleep workers' than in 'short-work plus long-sleep workers'. Thus, working hours are associated with CMP frequency, but sleeping sufficiently may prevent CMP in workers even if they work for long hours. In conclusion, adequate instructions on sleeping hours should be provided by occupational health staff, as this may be effective in preventing CMP.

Building an allostatic load index from data of occupational medical checkup examinations: a feasibility study

The allostatic load index (ALI) assesses the physiological adaption to chronic stress by cumulative changes in the circulation, respiration, inflammation, metabolic and anthropometric systems. The ALI thus can function as a risk marker for secondary prevention in occupational medicine. The aim of this study was to investigate the feasibility of creating a predictive marker by using data from an executive checkup program of an international company and to examine its relationship to work-related surrogate health parameters. Datasets from 307 examinations of 151 executives (19 males and 132 females) were available. Each participant attended at least one checkup examination between 2003 and 2015. The mean age was 43.6 (SD ±6.6, 31-64y). We developed four different ALIs with different biomarkers of the cardio-vascular, immune, metabolic and anthropometric systems. As a primary mediator, the thyroid-stimulating hormone was used as a proxy. For each ALI, the associations with the work ability index (WAI) and categories of sick leave days (SLD) were examined. Zero inflation was considered for SLD. One ALI showed a significant negative association with the WAI (B = -0.680, SE =0.266, p = .049). The results of a second ALI had a similar trend (B= -0.355, SE =0.201, p = .081). After adjustment for zero inflation two other ALIs showed a positive association with SLD. This study provides the first hints that biomarkers form a secondary prevention program are useful in calculating a meaningful ALI. Thus, the concept of allostatic load could be used in workplace health-promotion.

Anxiety and the severity of Tension-Type Headache mediate the relation between headache presenteeism and workers' productivity

The primary objective of this study was to explore the mechanisms and conditions whereby Tension-Type Headache (TTH) presenteeism relates to health-related loss of productivity as a result of both reduced physical and mental health. To this end, Structural Equation Modeling (SEM) was used to conduct a secondary data analysis of a randomized clinical trial involving 78 Tension-type Headache (TTH) patients. The results showed that TTH presenteeism did not directly relate to health-related loss of productivity, either due to physical, or mental health problems. However, through anxiety-state, TTH presenteeism decreased patients' productivity, as consequence of reduced physical and mental health. Moreover, by increasing the severity of the Tension-Type Headache, TTH presenteeism indirectly decreased patients' productivity as consequence of reduced physical health (but not mental health). Finally, our results show that such indirect effects only occur when the cause of TTH is non-mechanical (e.g., hormonal causes, etc.). Our work provides an integrative model that can inform organizational behaviorists and health professionals (e.g., physiotherapists). Implications for organizational health are discussed.

Association between presenteeism and health-related quality of life among Japanese adults with chronic lower back pain: a retrospective observational study

OBJECTIVES

This study investigated the relationship between presenteeism and health-related quality of life (HRQoL) among Japanese adults with chronic lower back pain (CLBP).

DESIGN

This was a retrospective, cross-sectional study.

SETTING

Data were collected via a self-administered online survey of the Japanese adult general population.

PARTICIPANTS

The present study used 2014 Japan National Health and Wellness Survey (NHWS) data (n=30 000). Specifically, data were included from NHWS respondents who self-reported being employed in the past week and having experienced LBP in the past month, with these symptoms lasting for at least 3 months (n=239). 84 (35.1%) participants in this study were female.

PRIMARY AND SECONDARY OUTCOME MEASURES

Presenteeism and HRQoL were measured using the Work Productivity and Activity Impairment Questionnaire-General Health (categorical (none: 0%, low: 10%-20%, high: ≥30%) and continuous) and Medical Outcomes Study 36-Item Short Form Health Survey, respectively. Covariates included patient demographics, health characteristics, pain characteristics and depression severity (Patient Health Questionnaire).

RESULTS

Presenteeism was reported by 77.4% of respondents. High (vs no) presenteeism related to more severe pain in the prior week (4.9±2.2 vs 3.6±2.1, p=0.001) and currently (5.1±2.1 vs 3.9±3.9, p=0.007), more pain sites (1.9±1.6 vs 1.1±1.4, p=0.004) and greater depression severity (7.5±6.5 vs 3.6±3.6, p<0.001). Adjusting for covariates, high (vs no) presenteeism related to lower mental and physical HRQoL. For low versus no presenteeism, significant HRQoL differences were observed in general health (43.0, 95% CI 40.3 to 45.6 vs 46.9, 95% CI 43.9 to 49.8, p=0.015).

CONCLUSIONS

Most respondents experienced presenteeism. Those with high or low presenteeism had poorer HRQoL than respondents with no presenteeism. Monitoring presenteeism rates may help identify workers with an unmet need for better CLBP-related pain management.

Objectively Measured Physical Activity and Low Back Pain in Japanese Men

BACKGROUND

There are several studies on the relationship between low back pain and physical activity. However, the results of these studies vary, and the relationship between them remains unclear. Therefore, we conducted a cross-sectional study to evaluate the association between objectively measured physical activity and low back pain in Japanese men.

METHODS

The study included 4022 Japanese men [average age: 47 (10) y]. Daily amount of moderate to vigorous physical activity and step counts were measured using an accelerometer. Low back pain, drinking and smoking, and lifestyle-related diseases were surveyed using a self-administered questionnaire. A logistic regression model was used to evaluate the relationship between physical activity and step counts with persistent low back pain after adjusting for confounders.

RESULTS

Persistent low back pain was reported in 428 participants. The multivariable-adjusted odds ratios of presenting persistent low back pain across quartiles of amount of moderate to vigorous physical activity were 1.00 (reference); 0.93 (95% confidence interval, 0.70-1.22); 0.97 (95% confidence interval, 0.74-1.28); and 0.67 (95% confidence interval, 0.50-0.90); P for linearity = .012.

CONCLUSION

We found a significant inverse relationship between objectively measured physical activity and persistent low back pain.

Work impairment, osteoarthritis, and health-related quality of life among employees in Japan

Background

Osteoarthritis (OA) is one of the most common causes of health and work impairment; however, this relationship, especially in Japan, is not well characterized. This study examined work impairment and OA in Japanese workers, specifically the relationship with health-related quality of life (HRQoL) and health status.

Methods

This retrospective, cross-sectional observational study included the data of employed adults with a self-reported OA diagnosis from the 2014 Japan National Health and Wellness Survey. Presenteeism and absenteeism were classified using the Work Productivity and Activity Impairment (WPAI) questionnaire for impairment at work in the past week. Outcome variables included health-related quality of life, which was measured with the revised Medical Outcomes Study 36-Item Short Form Survey Instrument Health Survey (SF-36v2), and depression symptom severity, which was assessed using the Patient Health Questionnaire-9 (PHQ-9).

Results

The majority (71.2%) of respondents with OA reported presenteeism, and 11.1% reported absenteeism. Presenteeism and absenteeism were both associated with younger age; a lower proportion of respondents with than without presenteeism were married or living with a partner, and a greater proportion of those with absenteeism had comorbid conditions (for all, p < 0.05). Respondents with than without presenteeism reported greater use of medications to relieve OA symptoms (37.3% versus 20.9%, p < 0.05), and those with than without absenteeism reported more frequent arthritis-related problems (p = 0.032). Among those with presenteeism, depression severity was higher (5.8 ± 6.0) than for those with no presenteeism (2.9 ± 4.3; p < 0.001). Presenteeism was associated with impairments in HRQoL on all metrics for patients with OA, with lower mental (6.4 points) and physical (4.8 points) component scores on the SF-36v2 (for all, p < 0.001).

Conclusions

Seven out of every 10 patients with OA experienced presenteeism, whereas one out of 10 reported absenteeism. OA respondents with presenteeism also showed greater medication use, lower HRQoL across both mental and physical components, and higher depression severity. Workplace interventions and effective treatment options are necessary strategies for improving the health of workers with OA in Japan.

The economic and humanistic costs of chronic lower back pain in Japan

Background

Few data are available that provide estimates of the economic impact of chronic lower back pain (CLBP) in Japan. The current study estimated the patient burden and the direct and indirect medical costs associated with CLBP in Japan using data from a large cross-sectional patient survey. CLBP was hypothesized to be associated with a considerable burden of illness and a large economic impact.

Methods

Study participants completed the Japan National Health and Wellness Survey in 2014, which included measures of health-related quality of life (HRQoL), work impairment, impairment to daily activities, and healthcare service use. Data from those reporting CLBP (N=392) were contrasted against those from matched controls without back pain, using age and sex-adjusted models.

Results

CLBP patients reported significantly lower HRQoL relative to matched controls. Age-and sex-adjusted models estimated mean annual per patient direct and indirect costs attributable to CLBP to be ¥1,820,297 ($15,239 or €12,551) and ¥1,479,899 ($12,389 or €10,203), respectively, with the majority of direct costs related to hospital expenses (¥1,584,759, which is equivalent to $13,267 and €10,927). In estimating the economic impact of CLBP on society, the CLBP respondents were estimated to include 1,508,524 individuals when extrapolated to the Japanese population (815,461 of them employed). Ultimately, this represented approximately ¥1.2 trillion ($10 billion and €8.3 billion) per year in lost productivity at the time of this study.

Conclusion

This study of patients with CLBP in Japan has shown it to be associated with a significant burden on patients and to have a considerable negative impact on the Japanese economy primarily driven by lost productivity. Further research on the effectiveness of interventions to improve the outcomes of those with CLBP is warranted.

Obesity and low back pain: a retrospective cohort study of Japanese males

[Purpose] This study evaluated whether obesity is a risk factor for low back pain, by using body fat percentage (%FAT) and body mass index (BMI) as indices of obesity among Japanese males. [Subjects and Methods] This study included 1,152 males (average age: 28.0 ± 4.6 years). BMI was calculated from subject’s height and weight, and %FAT was estimated by the thickness of two parts of skin. Low back pain, drinking and smoking were surveyed using a self-administered questionnaire, and maximal oxygen uptake was measured by a submaximal exercise test using a cycle ergometer. [Results] A significant positive dose-response relationship was shown between %FAT and persistent low back pain prevalence. Similarly, a significant positive dose-response relationship was confirmed between BMI and persistent low back pain. [Conclusion] This study suggests that both high %FAT and BMI are risk factors for persistent low back pain.

Restoring function in major depressive disorder: A systematic review

BACKGROUND

Functional impairment contributes to significant disability and economic burden in major depressive disorder (MDD). Treatment response is measured by improvement in depressive symptoms, but functional improvement often lags behind symptomatic improvement. Residual deficits are associated with relapse of depressive symptoms.

METHODS

A literature search was conducted using the following terms: "major depressive disorder," "functional impairment," "functional outcomes," "recovery of function," "treatment outcome," "outcome assessment," "social functioning," "presenteeism," "absenteeism," "psychiatric status rating scales," and "quality of life." Search limits included publication date (January 1, 1995 to August 31, 2016), English language, and human clinical trials. Controlled, acute-phase, nonrecurrent MDD treatment studies in adults were included if a functional outcome was measured at baseline and endpoint.

RESULTS

The qualitative analysis included 35 controlled studies. The Sheehan Disability Scale was the most commonly used functional assessment. Antidepressant treatments significantly improved functional outcomes. Early treatment response predicted functional improvement, while baseline disease severity did not.

LIMITATIONS

Clinical studies utilized various methodologies and assessments for functional impairment, and were not standardized or adequately powered.

CONCLUSIONS

The lack of synchronicity between symptomatic and functional improvement highlights an unmet need for MDD. Treatment guided by routine monitoring of symptoms and functionality may minimize residual functional impairments.

The relationship between occupational noise and vibration exposure and headache/eyestrain, based on the fourth Korean Working Condition Survey (KWCS)

INTRODUCTION

The individual and combined effect of occupational noise and vibration exposures, on workers' health has not been thoroughly investigated. In order to find better ways to prevent and manage workers' headache, this study aimed to investigate the effects of occupational noise and vibration exposure on headache/eyestrain.

METHODS

We used data from the fourth Korean Working Condition Survey (2014). After applying inclusion and exclusion criteria, 25,751 workers were included. Occupational noise and vibration exposure and the prevalence of headache/eyestrain were investigated by self-reported survey. Chi-square tests were used to compare differences in baseline characteristics between the group with headache/eyestrain and the group without. Odds ratios and 95% confidence intervals were estimated using a logistic regression model adjusted for several covariates. Area under the receiver operating characteristics curve (AUROC) analysis was used to evaluate the effect of occupational noise and/or vibration exposure.

RESULTS

Among the 25,751 study subjects, 4,903 had experienced headache/eyestrain in the preceding year. There were significant differences in age, education level, household income, occupational classification, shift work, occupational vibration exposure, and occupational noise exposure between the two groups (all p<0.05). The odds ratios between each exposure and headache/eyestrain increased proportionally with the level of exposure, increasing from 1.08 to 1.26 with increasing vibration exposure, and from 1.25 to 1.41 with increasing noise exposure. According to the AUROC analysis, the predictive power of each exposure was significant, and increased when the two exposures were considered in combination.

DISCUSSION

The findings of this study show that both occupational noise and vibration exposures are associated with headache/eyestrain; noise exposure more strongly so. However, when the two exposures are considered in combination, the explanatory power for headache/eyestrain is increased. Therefore, efforts aimed at reducing and managing occupational noise and vibration exposure are crucial to maintaining workers' health.

Prognostic psychosocial factors for disabling low back pain in Japanese hospital workers

Background

Although the occupational health field has identified psychosocial factors as risk factors for low back pain that causes disability, the association between disabling low back pain and psychosocial factors has not been examined adequately in Japanese hospital workers. Therefore, this study examined the association between low back pain, which interfered with work, and psychosocial factors in Japanese hospital workers.

Method

This cross-sectional study was conducted at a hospital in Japan. In total, 280 hospital workers were recruited from various occupational settings. Of these, 203 completed a self-administered questionnaire that included items concerning individual characteristics, severity of low back pain, fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), somatic symptoms (Somatic Symptom Scale-8), psychological distress (K6), workaholism, and work-related psychosocial factors (response rate: 72.5%). Logistic regression was used to explore risk factors associated with disabling low back pain.

Results

Of the 203 participants who completed questionnaires, 36 (17.7%) reported low back pain that interfered with their work. Multivariate analyses with individual factors and occupations adjusted for showed statistically significant associations between disabling low back pain and fear-avoidance beliefs (adjusted odds ratio [OR]: 2.619, 95% confidence interval [CI]: 1.003–6.538], somatic symptoms (OR: 4.034, 95% CI: 1.819–9.337), and interpersonal stress at work (OR: 2.619, 95% CI: 1.067–6.224).

Conclusions

Psychosocial factors, such as fear-avoidance beliefs, somatic symptoms, and interpersonal relationships at work, were important risk factors in low back pain that interfered with work in Japanese hospital workers. With respect to occupational health, consideration of psychosocial factors is required to reduce disability related to low back pain.

Social support and its interrelationships with demand-control model factors on presenteeism and absenteeism in Japanese civil servants

OBJECTIVES

To elucidate the impact of social support and its interrelations with other demand-control-support (DCS) model factors on presenteeism and absenteeism, and to determine which DCS factors were most influential.

METHODS

Questionnaires from 2535 local government employees were analyzed. The Brief Job Stress Questionnaire (BJSQ) was used to assess DCS factors including job demand, job control, and social support from supervisors and coworkers. The Stanford Presenteeism Scale 13-item version (SPS-13) was used to evaluate both absenteeism (absent days) and presenteeism. For the latter, the Work Impairment Score (WIS) and the Work Output Score (WOS) were also used. Possible confounder-adjusted logistic and negative binomial regression analyses were performed to obtain odds ratios (ORs) for WIS and WOS and relative risks (RRs) for absenteeism according to DCS factors.

RESULTS

Higher job control had a significantly protective effect on higher WIS in both males and females and a lower WOS in males. Based on a point estimate of an OR per 1 standard deviation change of each DCS factor, job control had the strongest effect on higher WIS in both males and females and a lower WOS in males. Higher job demand resulted in significantly higher ORs for both male and female WIS, and a lower WOS in females. Support from supervisors had a significantly protective effect on higher WIS in females and a lower WOS in males. Support from coworkers had a significantly protective effect on higher WIS in males. Higher support from coworkers had a significantly protective effect on absenteeism among both males and females, and higher job control had a significantly protective effect in females. The combination of high job strain and low support from supervisors had a significantly worsening effect, except for absenteeism in females. High job strain and low support from coworkers had a significantly worsening effect except for WOS in males.

CONCLUSIONS

The results suggest job control was the DCS factor most related to presenteeism. Higher support from supervisors and coworkers had a protective effect on presenteeism, and higher job demand had a worsening effect. Higher support from coworkers had a protective effect on absenteeism among both males and females. Interventions should focus on improving job control as a possible countermeasure to presenteeism, and encouraging support from coworkers as a possible countermeasure to absenteeism.

Absenteeism due to mental health problems and systems for return to work: an internet-based unmatched case-control study

PURPOSE

The aim of this study was to investigate the risk factors for absenteeism due to mental health problems with regard to company characteristics and systems for return to work in Japan.

METHODS

This was an Internet-based unmatched case-control study. Two hundred and fifty-eight workers who experienced over 28 days of sick leave due to mental health problems (cases) and 258 workers who have not taken sick leave (controls) were recruited. Company characteristics and the awareness and presence of systems for return to work were analysed as indicators of absenteeism.

RESULTS

A total of 501 workers were included in the analysis. Females were less likely to experience absenteeism when adjustments were made for both the awareness and presence of systems [odds ratio (OR) = 0.51 and 0.41, respectively]. Large companies showed an increased risk of having absentee workers than small companies. The awareness of a gradual resumption system and the presence of a sick pay system were related to absenteeism (OR = 2.75 and 2.40, respectively).

CONCLUSIONS

The awareness and presence of systems for return to work are related to the long-term absenteeism. The predictors of sex and company size are also related to the experience of the long-term absenteeism. To understand the effect of systems for return to work on absenteeism due to mental problems, further studies are needed.

A cross-sectional study of functional disabilities and perceived cognitive dysfunction in patients with major depressive disorder in South Korea: The PERFORM-K study

PERFORM-K was a cross-sectional observational study that investigated functional disability, productivity and quality of life in MDD outpatients in South Korea, and the associations of these with depressive symptoms, perceived cognitive dysfunction and other factors. A total of 312 outpatients who started antidepressant monotherapy underwent a single study interview. Physicians and patients assessed depression severity. Patients also assessed: perceived cognitive dysfunction, functional disability, impaired productivity and quality of life. Patients had moderate to severe depression (MADRS mean total score: 28.9±7.3), and reported marked functional disability (SDS mean total score: 16.7±8.6), impaired productivity (WPAI mean overall work productivity loss: 52.4±31.8%), perceived cognitive dysfunction (PDQ-D mean total score: 29.9±18.6) and impaired quality of life (EQ-5D mean utility index score of 0.726±0.192). Greater functional disability and impairment in daily activities were associated with more severe depression and greater perceived cognitive dysfunction. Irrespective of depression severity, patients with more severe perceived cognitive dysfunction reported worse work-related productivity outcomes (higher presenteeism and greater overall work productivity loss). PERFORM-K confirms the impact of MDD on functional status and well-being in South Korean patients, and highlights the importance of recognising cognitive dysfunction in clinical practice.

The impact of side effects from outpatient chemotherapy on presenteeism in breast cancer patients: a prospective analysis

In the field of occupational health services, productivity loss can be expressed by absenteeism (i.e., employees being absent from work and taking leave due to health problems) and presenteeism (i.e., a reduction in the ability to perform one’s tasks at work). Similar to absenteeism, it is important to assess presenteeism because it can severely reduce productivity. Despite numerous reports about the impact of disease and medical treatments on presenteeism, there is a lack of data regarding the influence of medication side effects. In this study, a prospective analysis was conducted via questionnaire survey to clarify the influence of the side effects of anticancer drugs on presenteeism in workers receiving outpatient chemotherapy for breast cancer. Between December 2012 and November 2013, the influence of side effects on the quality of life, absenteeism, and presenteeism was investigated via a questionnaire conducted before and after 1 course of chemotherapy in 19 currently employed breast cancer patients receiving outpatient chemotherapy for the first time at Gifu Municipal Hospital, Japan. The rate of absenteeism was 24.7 %, resulting in financial losses of 2002 yen/day (national statistical data) and 881 yen/day (our questionnaire data). The rate of presenteeism was 33.7 %, resulting in financial losses of 1354 yen/day (national statistical data) and 1263 yen/day (our questionnaire data). Furthermore, a significant positive correlation was observed between absenteeism and presenteeism (r = 0.687, p = 0.001), suggesting that the productivity losses associated with presenteeism due to the side effects of anticancer drugs in breast cancer patients are large and similar to that associated with absenteeism in these patients. Our results may be useful for improving the occupational health of workers receiving chemotherapy for cancer.

Work productivity loss with depression, diagnosed and undiagnosed, among workers in an Internet-based survey conducted in Japan

OBJECTIVE

The aim of this study was to investigate whether depression severity was associated with work impairments, regardless of the diagnosis.

METHODS

We conducted a cross-sectional study among 17,820 Japanese workers using an Internet-based survey. Work impairments were assessed using the Work Productivity and Activity Impairment questionnaire. Participants were grouped according to whether they had a past-year diagnosis of depression by physicians and current depression severity assessed with the Patient Health Questionnaire-9.

RESULTS

Among the undiagnosed, high severity respondents had greater overall work impairment than low severity respondents (33.3% vs 14.8%). Significant interactions between diagnosis and severity indicated greater impairments among undiagnosed than among diagnosed respondents (except on absenteeism).

CONCLUSIONS

Depression severity was associated with work productivity loss, even among the undiagnosed, suggesting a need for early detection, referral, and treatment of depression in the workplace.

Relationship between sickness presenteeism and awareness and presence or absence of systems for return to work among workers with mental health problems in Japan: an Internet-based cross-sectional study

OBJECTIVES

The objective of this study was to clarify the relationship between sickness presenteeism and the degree of awareness of company regulations regarding financial compensation for absenteeism.

METHODS

An Internet-based survey of 258 full-time workers who had more than 28 days of sickness absence due to mental health problems was conducted. Workers were categorized as having either low or high sickness presenteeism, and awareness and presence or absence of systems for return to work and duration of financial compensation were compared between groups.

RESULTS

The following factors were significantly related to high sickness presenteeism based on logistic regression analyses: working for a private company (odds ratio [OR]=2.57; 95% confidence interval [CI]=1.10-5.99); recognition of a gradual resumption system (OR=3.89, 95% CI=1.02-14.81); and awareness regarding the duration of financial compensation (OR=1.04, 95% CI=1.01-1.07).

CONCLUSIONS

No relationship was found between mental sickness presenteeism and presence or absence of systems for return to work in our multivariate analysis; however, a relationship was apparent between sickness presenteeism and characteristics of the workers' companies. These results are expected to contribute to research involving human resources and occupational health.

Associations between psychological distress and the most concerning present personal problems among working-age men in Japan

Background

Personal problems are known to influence mental health among workers. The current study investigated the most concerning present personal problems which have the greatest impact on psychological distress among working-age Japanese men, rather than issues relating to work tasks or duties.

Methods

We obtained data from the 2010 Comprehensive Survey of Living Conditions conducted by the Ministry of Health, Labour and Welfare. The original survey interviewed 289,363 households in 5,150 randomly selected municipalities of Japan, from which 228,664 households agreed to participate. We analyzed the data pertaining to men who were 20 to 59 years of age and the head of a family. The questionnaire included occupation, employment status, the most concerning present personal problems, and a measure of psychological distress (the Kessler 6 scale). Multiple logistic regression analysis was conducted to delineate the association between present personal problems and psychological distress.

Results

A total of 76,950 males were included in the analysis, 27.7% of whom reported some type of psychological distress. Statistical analysis revealed that psychological distress was associated with bullying and harassment (Odds Ratio (OR): 2.05, 95% Confidence Interval (95% CI): 1.50-2.56), divorce (OR: 1.90, 95% CI: 1.53-2.26), concerns about one’s purpose in life (OR: 1.73, 95% CI: 1.59-1.88), personal relationships with family members (OR: 1.49, 95% CI: 1.37-1.60), personal relationships with others (OR: 1.38, 95% CI: 1.29-1.48), own diseases (OR: 1.24, 95% CI: 1.15-1.33), and financial difficulties (OR: 1.16, 95% CI: 1.12-1.20); when compared with problems related to work tasks or duties.

Conclusions

Several personal factors appear to have a greater impact on the mental health of Japanese men of working age, when compared to the influence of work tasks or duties. Asking workers directly about the problems that most concern them in life might help better identify those in need psychological support. Multidisciplinary interventions to address their life concerns will likely be necessary for solving these problems and reducing psychological distress.