It is known that more than 90% of the deceased who committed suicide had suffered from mental disorders at the time of their suicide. Awareness of suicide risk is necessary in treating mental disorders. Depression is thought to be deeply associated with suicidal behavior. As the state of adjustment disorder which is milder than depression is found to be diagnosed in nearly 20% of severe suicide attempters in Japan, medical staff should be alert to suicidal risk even among patients with subthreshold depression. In order to identify high-risk patients of suicide, we need to assess the intensity of suicidal ideation. When managing the high-risk patients of suicide, we need not only medical treatment but also care for sadness and hopelessness behind the suicidal ideation. Multi-disciplinary approach is important in caring for the suicidal patient.

The incidence of suicide in cancer patients may be twice as high as the rate of suicide in the general population. One study has shown that the risk of suicide in patients with cancer is highest in the first months after diagnosis, and that this risk decreases significantly over decades. Passive suicidal thoughts are fairly common in patients with cancer. The relationships among suicidal tendency and the desire for hastened death, requests for physician-assisted suicide, and/or euthanasia are complicated and poorly understood. Despite a relatively rare event, healthcare providers should be aware that having a diagnosis of cancer increases the risk for suicide. More specifically, prostate, lung, pancreatic, and head and neck cancer ; male sex ; older adult ; recent diagnosis ; and depression have all been associated with an increased incidence of suicide. The reactions of health care providers to the suicide are similar to those seen in family members, although caregivers often do not feel they have the right to express their feelings. Thomas Joiner of Florida State University put forth such a theory : the interpersonal-psychological theory of suicidal behavior. The theory states that, in order to die by suicide, an individual must develop high levels of three specific variables : a sense of thwarted belongingness, a perception of functioning as a burden on others, and the acquired capability for suicide. The first two variables, thwarted belongingness and perceived burdensomeness, comprise the desire for suicide. Again, identifying and treating distress in the cancer patients could not only decrease the risk of suicide but also improve a quality of life.

In eating disorders, there is an increased mortality in addition to diminished quality of life such as physiological and psychological burden and deteriorated social function. Suicide is one of major causes of death and the suicide rate is 1.24 and 0.30 per 1000 person-years in anorexia nervosa (AN) and bulimia nervosa (BN) respectively. Standardized mortality ratio is 31.0 and 7.5 in AN and BN respectively. Mortality rate is the fifth highest after schizophrenia, major depressive disorder, bipolar disorder and substance dependence among psychiatric disorders. Risk factors for suicide in eating disorder patients have been reported to be purging behaviors, psychiatric comorbidity and eating disorder severity, although suicide risk is still elevated in patients with less severe eating disorders. Considering that the number of nonsuicidal self-injuries is large in relation to suicide in eating disorders, we should pay attention to the possibility that we might be exhausted and underestimate suicidal risk after being exposed to repeated nonsuicidal self-injuries.

Previous suicide attempt is a potent risk factor of later suicide. Therefore, preventing repetition of suicide attempt for suicide attempters is pivotal in suicide prevention measures. Recently, ACTION-J, a randomized controlled multicenter trial of post-suicide attempt case management for the prevention of further attempts in Japan, suggested that assertive case management intervention could reduce the incidence of repetition of suicide attempt in suicide attempters. ACTION-J was conducted among 17 hospitals with both an emergency department and a psychiatric department. Nine hundred and fourteen eligible participants were randomly assigned to either the assertive case management group or the enhanced usual care group. The results of the study suggested that the assertive case management intervention was significantly effective up to the short term. The suicide prevention act published by the Cabinet Office had already mentioned about ACTION-J, and the training program of specified case managers has been developed by the ACTION-J study group. Ministry of Health, Labour and Welfare has just launched a project for suicide attempters based on ACTION-J, addressing the task of dissemination of the ACTION-J model.

The law requiring employers to offer a stress check came into force in December 2015. The author’s workplace started conducting a stress check from 2014 by using a “mental health check sheet” developed on its own. The check, which uses a questionnaire, is conducted on employees who have been in the workplace for three months or more after they moved in or joined there by limiting target types of stress to those related to work. For employees with serious worries about job, interviews by industrial doctors or health nurses are arranged. In some cases, arrangements for interviews with their superiors are made without involving the company. By using a standardized SDS to determine criteria for judgment, the questionnaire “TKK stress check list” was developed to satisfy the legal requirements and to increase accuracy of identifying highly stressed employees. The list is characterized by their questions where differences in the impact of stress, such as regarding “a lot of work to do” as “good experience for me” or “feel like running away from it,” are taken into account in devising them.

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 discusses 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 a critical review of them. Finally, I illustrated a strategic use of Stress Check Program to achieve really healthy workplaces by a case study.

Backgrounds : This study reports the results of a questionnaire survey conducted in the households consisting of inhabitants of Fukushima Prefecture who have evacuated to Saitama Prefecture or Tokyo Metropolis at one and two years after the Great East Japan Earthquake. The Great East Japan Earthquake in 2011 has been expanded to the nuclear power plant disaster. Consequently, approximately 56,920 inhabitants of Fukushima evacuated to other prefectures as of March 2013. This consequence sets the 2011 earthquake apart from previous natural disasters. Method : This survey was conducted by “Earthquake and human sciences project” of Waseda University and Shinsai Shien Network Saitama. Psychological stress of the evacuees (2,011 households in 2012 ; 1,875 households in Saitama and 2,393 households in Tokyo in 2013) were examined one year and two years after the disaster respectively. The questionnaire also contained such items as severity of housing destruction, Tsunami affection, worries about livelihood sustainability etc. In this study, psychological stress was measured using the Stress Response Scale-18 (SRS-18). Results : The results revealed that the stress reaction level of the evacuees from Fukushima Prefecture living in other prefectures is still “somewhat higher” despite two years passed since the disaster. A chi-square test was used to determine psychosocial factors influencing stress reactions. Results of the survey in 2012 revealed that anxiety about living costs or joblessness influenced stress reactions in men, whereas damaged houses, personal relationships, and compensation problems related to the nuclear power plant influenced stress reactions in women. However, according to the results of the 2013 survey, difficult economic conditions, aggravated health conditions, negative labeling as an evacuee, and dissatisfaction with relationships with family and neighbors influenced stress reactions in both men and women. Conclusion : The results revealed that the psychological stress is strongly related to several social factors ; economic conditions, health status, family and community relationships, and dwelling environments. By the comparison between first year result and second year result, the causes of stressors have been changed from the damage of earthquake disaster itself into the circumstances of shelter life over time. Therefore, the work in cooperation among medicine, clinical psychology, social welfare, and legal support is necessary in order to obtain mental health recovery.