In order to evaluate whether the number of patients with mental health disorders is increasing or not, the following levels of observation were used: 1. the macroscopic point of view, and 2. the viewpoints of on-site professionals. 1. The macroscopic point of view. 1) According to the patient trend surveys released by Japan's Ministry of Health, Labour, and Welfare (2004 Annual Report on Health and Welfare), the number of depression cases increased 45 times in 19 years, from fiscal 1984 to 2002. In addition, the number of suicides, allegedly related to depression, has been hovering between 30,000 and 35,000 for the past 10 years. Furthermore, the sales volume of antidepressants has been increasing. 2) According to 2008 survey, mainly of publicly held companies registered with Japan Productivity Center for Socio-economic Development, 56.1% of the companies answered, "mental disorders have increased in the past three years," Among the various age groups, the greatest number of patients with mental disorders were reportedly in their thirties of age. 2. Viewpoints of on-site professionals. A. In all four of the companies in which the author participates as a psychiatric advisor or doctor, mental disorders have been increasing. B. Two psychiatrists and three other professionals, a psychosomatic medicine doctor, an industrial physician, and a psychologist, participated in a Discussion Meeting for Depression and Depressed States. All reported that mental disorders have been increasing. According to all two levels of evidence, mental disorders are increasing.

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Purpose: Mental health at work has become a very important issue in Japan. The purpose of this study is to investigate the effectiveness of primary prevention (prevention of mental disorders and stress management in workplaces), secondary prevention (early detection and treatment) and tertiary prevention (support for workers with mental problems and rehabilitation). Method and results : In primary prevention, we developed a check list named MIRROR (Mental Health Improvement & Reinforcement/Research of Recognition) in 2004 and conducted interventional approaches for improvement of working conditions after we evaluated needs for improvement and job stress of 9.800 workers in 15 companies using this check list and Brief Job Stress Questionnaire (BJSQ) in 2005, then evaluated effects of the approaches on job stress and cost-benefit analysis. Job stress was reduced in the worksites when improvement of working conditions was successfully carried out. On cost-benefit analysis, 4 of 6 companies showed a decrease of total absent days due to mental problems, however only 2 companies showed benefit according to the method for analysis adopted in this study. In the other manufacturing company, we conducted mental health education and practice of active listening in order to improve of communication and reinforcement of supervisor support for 4 years. A marked reduction of workers with sick leaves for more than 1month due to mental problems was observed 2 years later of these approaches. In secondary and tertiary preventions, subjects were 162 consultation cases with mental problems visited health care center in 3 companies and 113 outpatients visited the mental health centers in a general hospitals. We compared the diagnosis, job stress, effectiveness of treatment and final outcome of both cases. Depressive cases (43.4%) were significantly much more in outpatient cases compared to consultation cases (25.3%). An arrangement of job stressors was done for 55.6% of consultation cases and effective in 90.0% of those, for 20% of outpatient cases and effective in 65.2% of those. Finery, 79.9% of 162 consultation cases were completely cure, 10.5% continued medical treatment, 1.9% steel on sick leave, 4.9% moved to other companies, 27.4% of 113 outpatients cases were cure, 31.0% continued, 19.5 % dropped out, 3.5% in sick leave, 17.5 % moved and 22.1% changed hospitals. Conclusion: 1) Interventional approaches such as improvement of working condition based on stress survey or educational approaches for supervisors seem to be effective for health outcome of workers, if it has done properly. 2) It seemed that final health outcome was better in consultation cases comparing to outpatient cases, because early detection & early treatment and arrangement for job stressors were easier in consultation groups in the companies.

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Objectives: With the abrupt increase of depression patients, it is strongly requested to support them returning to work smoothly. Therefore various treatment programs have begun to be practiced in some institutions in our country. However, they are not unified, and it is made through trial and error in each institution. Besides, there are few corroborative studies about the rehabilitation of the reinstatement support. We applied a reinstatement support program for patients with depression in Hokkaido University Hospital and reviewed its efficacy. Subjects: In about 2 years, 25 patients (male:female=5:1) participated in a treatment program, and 22 cases accomplished it. Mean age of participants was 40.0±7.8 years old, and mean score of 17 items Hamilton depression scale was 5.2±3.2 at pretreatment. Method: The program consists of occupational therapy (OT) and group cognitive-behavioral therapy (CBGT) for improvement of the reinstatement readiness, the evaluation of the possibility to return to work and the prevention of recurrence. It is a program treated by multidisciplinary collaboration for 12 weeks. We performed various kinds of questionnaire and examination at pre and post treatment, and investigated the change of them and clinical outcome. Results: Among 22 people who finished our program, 16 people (73%) returned to work. One person of those recurred (mean duration of follow-up period: 10.3±6.9 months). It revealed significant improvement at post treatment in symptom of depression (BDI), dysfunctional cognitive thoughts (ATQ-R, JIBT-20) and psychosocial function (SF-36v2). Also, the abnormality of the neuropsychological cognitive function was found in many patients, but most of them were improved at post treatment. Improvement was obtained in particular from Wisconsin card sorting test and Auditory verbal learning test in domain such as working memory or executive function. Discussion: It was suggested that a reinstatement support program for depression was effective for not only improvement of social outcome but also prevention of recurrence of depression, or neurocognitive rehabilitation. As for measuring a cognitive function neuropsychologically, it may be useful as a clinical tool to know readiness of the reinstatement objectively. Further study about predictors of the reinstatement outcome or way of cooperation with the job side will be necessary in the future.

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Background: The author thinks that there are following seven stages in many processes of the mental health activity: 1) prevention, 2) early detection, 3) consultation, 4) diagnoses, 5) treatment, 6) reinstatement and 7) recurrence prevention. Generally the industrial physician participates in 1) prevention, 2) early detection, 3) consultation, 6) reinstatement. As for the clinician, duties of 4) diagnoses and 5) treatment are important. Not much is done about 7) recurrence prevention. The author performs duties every day in a situation where the industrial physician and the clinician are concerned with all processes mentioned above. Results and Conclusions: When the clinician and the industrial physician cooperate, it is important for each one to accomplish his own duties. However, this cooperation is not always attained in practice. With regard to reinstatement in particular, it is often the difference in opinion between the clinician and the industrial physician which needs to be. Generally the industrial physician follows the health of the employee, but considers the productivity of the business establishment. Reinstatement is accepted only for the employee who can offer work force more than 40 hours a week. An accurate, objective judgment is requested by the industrial physician. On the other hand, the clinician is "a defense lawyer" who protects a weak patient. Therefore even if illness does not improve good enough, the clinician consoles an invalid and tends to let him return to work. In addition, the clinician makes a diagnose of his patient and cures him. Therefore he thinks highly of himself when he lets his patient return to work. However, it is often the case that the self-confidence of the clinician is not always acceptable in his workplace. The purpose of this report is to clarify the differences in viewpoint between clinician and industrial physician, and to discuss the importance of their cooperation and its related problems. The author also introduced their opinions about reinstatement in particular.

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Social Anxiety Disorder (SAD) is known as the most common type of Anxiety Disorder. Cognitive and cognitive behavioral models of SAD have proposed that negative interpretation of social situations maintain SAD symptoms. Related to negative interpretations, the Cost/Probability bias is considered to be a maintaining factor of SAD symptoms. In this study the Social Cost/Probability scale (SCOP) was developed and the effects of the Cost/Probability bias on social anxiety were investigated. Undergraduate students (n=362) completed a set of questionnaires: the SCOP; the Short Fear of Negative Evaluation scale (SFNE); the Social Interaction Anxiety Scale (SIAS); the Social Phobia Scale (SPS); and the Self-Rated Depression Scale (SDS). Exploratory factor analysis revealed that the SCOP consisted of two factors that were named: "Communication" and "General social situation." The Cronbach's α coefficient of each factor indicated that the SCOP had a high internal consistency. Correlation analysis between each scale revealed that each factor of the SCOP was associated with the SFNE, the SIAS, the SPS, and the SDS. The results of cluster analysis indicated that each factor of Cost/Probability bias was composed three clusters: High Cost cluster, High Probability cluster, and Low Cost/Probability cluster. The one-way ANOVA by clusters indicated that the High Cost cluster had higher scores on the SFNE, the SIAS, the SPS, and the SDS. These results indicated that the SCOP had sufficient validity and reliability as a psychological measure of the Cost/Probability bias of SAD. Furthermore, the results also indicated that High Cost. bias had a strong effect on SAD symptoms and depression. Based on these findings, it is suggested that cognitive therapy based on Cost bias would be effective in improving SAD symptoms.

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Objectives (backgrounds): In Kyusyu, Japan, there is a 112-year old Japanese male, the world oldest man who is receiving no special care. In order to investigate psycho-somatic medical features of this rare case, we did research on him. Method and subject: We approached him for information of his life history, present lifestyle, physical and psychiatric or cognitional conditions. Results and Conclusions: In younger days, he lived, studied and worked in Honshu (the mainland of Japan). After coming back home, he worked hard as a farmer. He neither drinks nor smokes and gets along well with family, especially with his caregiver. Those results might have led him to these precious healthy conditions.

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