Obstructive sleep apnea (OSA) and depression may coexist in the same patient. In addition to the usual symptoms associated with OSA such as poor concentration, fatigue, excessive daytime sleepiness (EDS) and reduced　cognitive function, OSA can also cause depressive disorders. In a large−scale study of 18,980 representative adults from five　European countries, Ohayon et al. reported that 17.6% had both OSA and DSM−IV symptoms. Two randomly selected　long−term large−scale studies reported that the adjusted odds ratio of onset of depression in OSA patients was 1.8 times　(Peppard et al.) and 2.18 times (Chen et al.). If there is a strong relationship between them, the reduction of depressive　symptoms by CPAP therapy would be expected. In our hospital, 20 patients undergoing treatment for depression in　combination with OSA were followed up after OSA treatment. 14 of the 20 underwent CPAP therapy, and of 12 who　continued, 7 were able to reduce or stop their central nervous system medicines. Even with CPAP, OSA patients who exhibit excessive daytime sleepiness should consider the possible existence of depression. Likewise, patients with depression, who do not respond to treatment, should consider the possibility of OSA. The symptoms of OSA and depression can overlap in patients and have detrimental effects on each other.

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Obstructive sleep apnea (OSA) is the important risk factor of various diseases including hypertension, diabetes, and the cardiovascular diseases. Also, OSA induces sleepiness, malaise in the daytime and cause a concentration　decrease and exacerbation of the work efficiency. And OSA leads to increase of the traffic accident risk and results in economic loss. As for the appropriate continuous positive airway pressure (CPAP) therapy, treatment continuation and improvement of the adherence are important to lead to improvement of the disease and the reduction in traffic accident rate.

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In children, sleep disordered breathing (SDB) causes impairment in growth, cognitive function, attention and school performance. Definition, diagnostic criteria and treatment of pediatric SDB are not established, although the concepts of SDB spectrum or upper airway syndrome (UARS) may help us understand it. The prevalence of SDB in children is reported to be about 5%. Pediatric SDB is caused by combined multiple factors, such as upper airway (UAW) narrowing factors, UAW muscle tone factors. Obesity and adenotonsillar hypertrophy are important risk factor for pediatric SDB. Some studies suggest that obesity is more influential in older children, while adenotonsillar hypertrophy is relatively more important in younger children. Clinically, SDB leads to various symptoms in nighttime (e.g. snoring, apnea), those in daytime (e.g. rhinorrhea, sleepiness and inattention), and other future consequences (e.g. poor growth, poor school performance and cardiovascular diseases). Currently, there are several treatments for SDB available. We should aware that children who have daytime symptoms in school are possible SDB patients and that they should be appropriately screened for diagnosis and treatment.

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The manual for the Japanese Stress Check Program recommends the use of the Brief Job Stress Questionnaire (BJSQ) from among the program's instruments and proposes criteria for defining high−stress employees. We conducted an online survey to administer the BJSQ with a psychological distress scale (K6) to randomly selected employees (n=1,650) to examine the screening performance of the BJSQ. Our findings indicated that less than half of theidentified high−stress employees warrant consideration for secondary screening for psychological distress as defined by a K6 score ≥13. The positive likelihood ratio was estimated as 6. We then sought to estimate the risk of stress−associated long−term sickness absence as defined in the program manual. We followed 7356 male and 7362 female employees of a financial service company who completed the BJSQ for 1 year and identified employees with sickness absence of 1 month or longer. After adjustment for confounders, hazard ratios for incident−related sickness absence in high−stress employees were 6.6 for men and 2.8 for women. The corresponding population−attributable risks for high stress were 24% and 21%, respectively. The estimated prevalence of severe mental disorder at the workplace is low, and the effectiveness of secondary prevention is limited. The BJSQ criteria should be considered as an indicator mainly for primary prevention.

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The stress check program, which became effective in 2015, consists of a stress check (a questionnaire survey), face-to-face guidance provided by a physician for workers under high stress conditions, and improvement of the　work environment based on the results of the stress check. The main aim of the program is primary prevention of mental　health disorders in employees, but secondary prevention of disorders should also be taken into consideration in the faceto-　face guidance. In the face-to-face guidance, the following must be conducted for each applicant: confirmation of job　stressors, stress conditions and other conditions, assessment of the relevance of work to the stress condition and the presence or absence of a depressive state, guidance for self-care, encouragement of medical consultation, and appropriate measures for the workers (as necessary). Some appropriate ways and means should be devised to conduct the guidance effectively within a limited time. Periodic health examinations, health education, workshop inspections, and management education for supervisors should be connected with the face-to-face guidance for the primary and secondary prevention of mental disorders.

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I will discuss the following regarding the statutory “Stress−Check” system, started in 2016, from my experiences of being involved as an occupational physician and practitioner at several small and medium−sized businesslocations. 1. Companies have to decide on many points actively in implementing this system. 2. Proceed with implementation cooperatively with the appropriate practitioners after carefully taking into account the implementation capacity of the companies. 3. To smoothly implement and effectively utilize this system, add another examination method to standard stress−check questionnaire. 4. Arrange the implementation devices in accordance with the circumstances of the workplace. 5. Utilize existing occupational health systems in the workplace for interviews. 6. As the topic of the interview is mainly occupation−related mental health in each workplace and most medical consultation contents can be dealt with in primary care, a physician familiar with the workplace is preferable for the interviewing physician. 7. Utilize the group analysis as basic information for promoting mental health policies in the workplace through group work, etc. 8. This system not only provides an opportunity for workers to face their own stress status, but for examining/promulgating the occupational health systems in the workplace, and for consultation for employees regarding mental health.

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The Japanese government has launched a new occupational health policy called the Stress Check Program. In the program, employers are obligated to analyze the Stress Check data in relevant groups and to utilize the data to improve the psychosocial work environment. This article discuss about how to utilize Stress Check Program to achieve healthy workplaces. I first introduced the concept and procedures of work environment improvement in the program and, then, moved to critical review of them. Finally, I illustrated a strategic use of Stress Check Program to achieve really healthy workplaces.

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The “Change Agenda” is a rule that psycho−behavioral problems can be solved if private events are controlled. It is considered a maintaining factor of experiential avoidance that is defined as an attempt to avoid private events. However, no tool has been developed to measure the Change Agenda. Therefore, this study aimed to develop a measurement of the conviction degree in the Change Agenda (CAQ−believability) and the behavior according to it (CAQ− avoidance), and investigate its reliability and validity. The structural validities of CAQ−believability and CAQ−avoidance were generally sufficient. Cronbach’s α was sufficiently high and good test–retest reliability was observed. With regard to convergent validity, CAQ−believability and CAQ−avoidance generally exhibited hypothesized correlation patterns. Moreover, between the clinical and the student samples examined in this study, scores of CAQ−believability and CAQ−avoidance were higher in the clinical sample than in the student sample. These results indicate that the reliability and validity of CAQ were generally acceptable. In the field of psychological treatment, expanding behavioral repertoire and improving the quality of life are the most important goal; the CAQ can be used as a tool to achieve this goal.

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