The background and current state of implementing a legal system for stress checks in Japan

Decreased step count prior to the first visit for MDD treatment: a retrospective, observational, longitudinal cohort study of continuously measured walking activity obtained from smartphones

Introduction

Major depressive disorder (MDD) is a common debilitating psychiatric condition and a major cause of productivity loss in workers. Using intermittent, subjective indicators, previous studies have shown that physical activity can predict lower levels of depressive symptoms. However, there is an unmet need for continuous and objective measures to identify MDD development before it results in productivity loss. The aim of this study was to elucidate the association between continuously measured walking activity and the development of MDD.

Methods

This retrospective, observational, longitudinal cohort study used health insurance claims data. Individuals aged 20-74 years were included if they had a record of MDD diagnosis and daily step count data for the 60 days before and after the first recorded MDD-related visit, which was defined as the index date. Multivariate analysis was conducted to compare 7-day moving averages of step counts on each day of the analysis period with the mean step count on the index date. Joinpoint regression analysis was used to determine when the trajectory of the moving step count average changed (inflection point).

Results

In total, 2,143 patients with a mean age of 41.2 (standard deviation [SD]: 10.6) years were included. The majority of patients were men (69.5%) and employed full-time (94.1%). Antidepressants were prescribed for 59.2% of patients. The 7-day moving average step count decreased from 6,310 (SD: 3758) at day -60 to 5,879 (SD: 3183) at the index date (first recorded MDD-related visit), and then increased to 6,062 (SD: 4029) at day +60. Compared with the index date, the 7-day moving average of step counts was significantly higher at days -60 to -1, +23 to +33, and + 42 to +60, and significantly lower at days +2 and + 3. Joinpoint regression analysis of 7-day moving average step counts from day -60 to day 0 identified an inflection point at day -14.

Conclusion

In working-age Japanese people, a formal diagnosis of MDD was preceded by a notable decline in daily step counts by approximately 2 weeks. MDD diagnosis and (presumed) treatment were followed by a gradual increase in daily step counts.

Do changes in working hours increase stress in Japanese white-collar workers?

Introduction

High stress at work is associated with negative health outcomes for workers, making stress prevention a critical challenge. Overtime work is an influential stress factor. This study, therefore, aimed to longitudinally evaluate how stress increased depending on changes in working hours among Japanese white-collar workers.

Methods

We targeted 3,874 participants who were full-time workers and were recognized as having low stress in a web-based cohort in 2018 (T1) and 2019 (T2). We performed univariate and multivariate logistic regression with the following variables: years of experience, years of education, medical background, income, and roommates.

Results

We observed a greater increase in stress among female who worked 41-50 h per week at T1 and more than 50 hours per week at T2, and those who worked more than 50 h per week at T1 and 35-40/41-50 h per week at T2, compared to those who worked 41-50 h per week both at T1 and T2, with odds ratios (ORs) and 95% confidence intervals (95% CI) of OR = 2.09, 95% CI (1.18, 3,70); OR =1.86, 95% CI (1.14, 3.03), respectively. However, no association between change in working hours and stress was found among male.

Discussion

These results show that reducing stress requires decreasing working hours as well as identifying factors that lead to high stress.