Abstract

In Japan more than 30,000 people die of suicide annually, and the number has dramatically increased with the Japanese economic recession. Many employees are forced to work hard because of the ongoing business restructuring, and some workers who have committed suicide have been officially acknowledged as victims of depression caused by overwork for the recent 5 years. There is little doubt that depression is closely associated with the course of committing suicide. It is clinically important to detect depression earlier in a workplace because the natural disease course can be changed by anti-depressive regimens. It is economically important as well. Earlier detection of depression reduces the direct costs of prolonged depression, including the costs of medications, hospital cares, and community-based cares ; as well as the indirect costs, such as loss of earnings, lost productivity, and unemployment. Evidence has suggested that depressed persons are likely to complain of a variety of somatic symptoms and that the total number of somatic symptoms is a powerful predictor of functional impairment in physical, psychological, and social functioning. Although self-perception of general somatic symptoms is commonly reported in Japanese health checkups, the results have not adequately been utilized for the screening of specific medical conditions. Thus, we attempted to assess screening practices for detecting major depression in workers complaining of somatic symptoms at the health checkups. A total of I , 443 Japanese white-color employees (991 men and 452 women, mean age=34 years old) completed a medical symptom checklist (major 12 somatic symptoms) , and were then diagnosed using the structured clinical interviews of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). There were 42 cases (2.9%) with major depression in the total sample. Concerning the 902 subjects without any somatic symptoms, only one case (O.1%) was identified as having major depression. The prevalence of the disorder was positively associated (p <0.001) with the total number of somatic symptoms, and the area under the receiver operator characteristic (ROC) curve was O . 92 for men and O . 81 for women, which showed the sensitivity and specificity of the total number of somatic symptoms for detecting major depression. The reporting of any of somatic symptoms might be a practically useful predictor of major depression. Medical staff working in a workplace should be aware of the close association between somatic symptoms and depression in the screening practice and management of their workers. Within the context of a thorough evaluation of depression, the reporting of somatic symptoms may be an important signal to consider further examinations for the diagnosis of depression.