Stress of Kindergarten teachers: How we tried to detect and to reduce it by using a small and wearable ECG and acceleration measuring device?

In 2014 school year, four female teachers of Nazareth Kindergarten decided to resign (DRT) due to workplace stress caused by human relationships between themselves. Our preliminary interview investigation revealed there was a stressor (STR), a certain elder female teacher and her less polite words and attitude. Using small and wearable ECG and acceleration measuring device, we measured 24 hour's autonomic nervous system's activity (ASNA) and sleep behavior of the STR and surrounding teachers, and tried to evaluate their stress objectively and to understand the reason of STR's less polite behaviors. For comparison, we also measured female Mind-Body Medicine (MBM) patients suffering adjustment disorder and clinical depression.

Serum folate and depressive symptoms among Japanese men and women: a cross-sectional and prospective study.

Although several studies have reported an association between blood folate concentrations and depressive symptoms, few studies have prospectively examined the association. This study aimed to investigate the cross-sectional and prospective associations between serum folate concentrations and depressive symptoms among Japanese. We analysed data among 545 subjects who participated in a health survey at the time of periodic check-up in 2009 for a cross-sectional association and among 272 subjects without depressive symptoms at baseline (in 2006) who responded to both baseline (2006) and follow-up (2009) surveys for prospective association. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. In a cross-sectional analysis, serum folate concentrations were significantly associated with a decreased prevalence of depressive symptoms (CES-D scale of ≥16). Moreover, serum folate concentrations at baseline were significantly inversely associated with depressive symptoms after 3 years; the multivariate-adjusted odds ratios (95% confidence intervals) of depressive symptoms for the lowest through highest tertile categories of serum folate concentrations were 1.00 (reference), 0.66 (0.29-1.52) and 0.40 (0.16-0.99) (P for trend=0.047). Our findings suggest that a higher serum folate may be associated with decreased risk of depressive symptoms in Japanese.

Development of a work improvement checklist for occupational mental health focused on requests from workers.

OBJECTIVES: To develop tools offering definite orientation for managers and employees to support their work improvement through occupational mental health. This research was a part of the Mental Health Improvement & Reinforcement Study (MIR study), conducted from October 2004 to March 2006. METHODS: We developed a trial version named the Kaizen Check List (KCL) by referring to problem solving methods for quality management. Then we improved it for a formal version named MIR Research of Recognition (MIRROR). A feedback form named MIR Action Guidance (MIRAGe) was also developed. We analyzed data from 1,953 respondents at five manufacturing enterprises in Japan using MIRROR and the Brief Job Stress Questionnaire (BJSQ) to determine whether or not the workers requesting work improvement had more stress than other workers. RESULTS: The KCL had 47 items, which indicated desirable working conditions for mental health at work, and four answer categories. MIRROR has 45 selected items and improved answer categories. MIRAGe displays the results of MIRROR and step-by-step guidance for work improvement. Respondents with request had significantly higher scores in stressor and lower scores in buffer factors compared with respondents without request in many items of MIRROR. CONCLUSIONS: A combinational use of MIRROR and stress scales is useful for finding worksites with high risk factors for mental health and for directing focus on work improvement at these worksites according to workers' requests.

Dietary intake of folate, other B vitamins, and omega-3 polyunsaturated fatty acids in relation to depressive symptoms in Japanese adults.

OBJECTIVE: Although a favorable effect of dietary folate and omega-3 polyunsaturated fatty acids (PUFAs) on depression is suggested from epidemiologic studies in Western countries, evidence from non-Western populations is lacking. We examined cross-sectional associations between the intake of folate, other B vitamins, and omega-3 PUFAs and depressive symptoms in Japanese adults. METHODS: Subjects were 309 Japanese men and 208 Japanese women 21-67 y of age. Dietary intake was assessed with a validated, brief, self-administered diet history questionnaire. Depressive symptoms were defined as present when subjects had a Center for Epidemiologic Studies Depression scale score > or =16. Adjustment was made for age, body mass index, work place, marital status, occupational physical activity, leisure-time physical activity, current smoking, current alcohol drinking, and job stress score. RESULTS: The prevalences of depressive symptoms were 36% for men and 37% for women. Folate intake showed a statistically significant, inverse, and linear association with depressive symptoms in men but not in women. The multivariate odds ratios (95% confidence intervals) for depressive symptoms for men in the first, second, third, and fourth quartiles of folate intake were 1.00 (reference), 0.78 (0.38-1.63), 0.57 (0.27-1.18), and 0.50 (0.23-1.06), respectively (P for trend = 0.045). No statistically significant linear association was observed for the intake of riboflavin, pyridoxine, cobalamin, total omega-3 PUFAs, alpha-linolenic acid, eicosapentaenoic acid, or docosahexaenoic acid in either sex. CONCLUSION: Higher dietary intake of folate was associated with a lower prevalence of depressive symptoms in Japanese men but not women.

Effect of the physical activities in leisure time and commuting to work on mental health.

Although some evidence suggests that exercise may improve mental health status, information regarding the intensity and duration of exercise is incomplete. The purpose of this study was to elucidate the association between physical activities in both leisure time and commuting to work and mental health. A questionnaire survey was conducted at three municipal offices in Japan. A total of 670 men and women completed the questionnaire. Mental health status was assessed by the 28-item General Health Questionnaire (GHQ). Respondents were asked about weekly hours of leisure-time exercise for four levels of exercise, and the volume of exercise was assessed using a metabolic equivalent task index. Information about commuting to work on foot or by bicycle was also obtained. The mean GHQ scores were calculated according to physical activity levels using analysis of covariance with adjustment of potential confounders including job stress. In men, the GHQ score decreased steadily with increasing levels of leisure-time exercise, and an inverse association was evident even for mild intensity exercise. Moreover, the GHQ score decreased according to increasing duration of time on commuting to work by either walking or cycling in men, but not in women. These relations did not materially change after adjustment for potential confounding factors. In women, there was no significant association between any of the indices of physical activity. In conclusion, leisure-time exercise and walking or cycling during commuting to work may be associated with better mental health in men.

Applying a solution-focused approach to support a worker who is under stress.

The solution-focused approach (SFA) developed by Insoo Kim Berg and Steve de Shazer at the Brief Family Therapy Center, Milwaukee, USA is classified as brief psychotherapy. We believe that SFA can give an occupational healthcare staff useful tools that will positively influence their relationships with workers, because it focuses on workers' strengths rather than their weaknesses when the staff interviews them using SFA. In this report, we explain the case of a worker who was under stress and was interviewed using SFA. Although the worker came to the interview because of his physical symptoms, he disclosed that he was under considerable stress at work and that his main concern was his relationship with his superior. One of the authors interviewed him using SFA. In the interview the worker discovered his own resources and strengths, and finally defined his goal. In the end, he discovered solutions by himself, and has been doing well in follow-up. We describe this process in detail, and discuss potential applications of SFA in occupational medicine.

A study of the effects of active listening on listening attitudes of middle managers.

The present study was conducted to clarify the direct effects of active listening (AL) training given to middle managers in a local government. Altogether, 345 middle managers participated in 13 AL training sessions over two years. We developed the Inventive Experiential Learning (IEL) method, and used it as the central training method in this study. To investigate how well the participants learned AL, we asked the middle managers to answer a shorter version of the Active Listening Attitude Scale (ALAS) consisting of two subscales-i.e. "Listening Attitude" and "Listening Skill"-before training, one month after and three months after training. Altogether, 284 middle managers answered the questionnaire three times. The scores of each subscale were analyzed by repeated measurement analysis of variance. The participants were divided into three groups using the percentile values of the original sample of ALAS, i.e. low-score group (-24%), medium-score group (25-75%) and high-score group (76%-), and the proportionate changes were examined. The results showed both the "Listening Attitude" and "Listening Skill" subscales increased significantly after training. Analysis of the percentiles showed that the proportion of the low-score group decreased and that of the high-score group increased in both subscales, from one to three months after training. These changes are considered to indicate that the participants have learned AL although they attended AL training for only one day.

Frequency of marital intercourse among patients with psychiatric and psychosomatic disorders in Japan.

This study investigated the frequency of marital intercourse in 951 patients with psychiatric and psychosomatic disorders and compared it to that in a normative sample. Only fourteen percent of the patient group had sexual intercourse more than once per week; thirty-nine percent were sexually inactive. The groups of patients with eating disorders, mood disorders, or any mental or behavioral disorders complicated by organic diseases such as cancer, ischemic heart disease, and other physical disorders had fewer mean coital frequencies than the controls, whereas the coital frequency of patients with anxiety disorders, somatoform disorders, sleep disorders, or psychosomatic disorders did not differ significantly from that of controls.

Relationship between burnout and communication skill training among Japanese hospital nurses: a pilot study.

We investigated the relationship between burnout and communication skill training among Japanese hospital nurses to improve the mental health of human service workers. The subjects were forty-five registered nurses referred to a self-expression skill intervention program by their section superiors, with each superior choosing from two to five nurses. The hospital was located in the Kyushu area and staffed by about four hundred nurses. The subjects were divided into an intervention group (19 nurses) and a reference group (26 nurses). The intervention group received the communication skill training in July and August, 2001. The communication skill training was carried out in accordance with the assertiveness training (AsT) precepts of Anne Dickson. In June, 2001, we delivered a set of questionnaires including age, gender, working years, a burnout scale, and a communication skill check-list as a baseline survey. The baseline questionnaires were returned at the end of June, 2001. In January, 2002, we delivered the same questionnaire again to the two groups and collected them at the end of the month. Excluding the only male and insufficient answers, twenty-six nurses (58%) returned complete answers in the initial and subsequent surveys. We found that the personal accomplishment and the two communication skills such as "accepting valid criticisms" and "negotiation" of the intervention group had improved significantly five months after the training as compared with that of the reference. Our results implied that communication skill training might have a favorable effect on burnout among Japanese hospital nurses.

Relationships among self-management skills, communication with superiors, and mental health of employees in a Japanese worksite.

The present study investigated relationships among self-management skills, communication with superiors, and the mental health of employees in a Japanese worksite. The subjects were manufacturing workers in a medium-sized company in Kyushu. In 1999, we mailed a self-administrated questionnaire which included questions on age, gender, job rank, communication with superiors, a General Self-Efficacy Scale, a Self-Management Skill Scale, and the Japanese version of the 12-item General Health Questionnaire (GHQ-12). Eighty percent of the subjects returned the questionnaire. Excluding senior managers and insufficient answers, the final response rate was fifty-five percent. The multiple regression analysis showed that job rank contributed significantly and positively and that age, communication with superiors, and self-management skills contributed significantly and negatively to the GHQ-12. Our results implied that self-management skills might have the potential of affecting the mental health of Japanese employees.

Relationships among self-efficacy, communication, self-management skills and mental health of employees at a Japanese workplace.

We investigated relationships among self-efficacy, self-management skills, communication with superiors and mental health of employees at a Japanese workplace. The subjects were 426 employees in a medium-sized manufacturing company in Kyushu. In 1999, with agreement of the company, we mailed a self-administrated questionnaire which included questions on age, gender, job rank, communication with superiors, a General Self-Efficacy Scale(GSES), a Self-Management Skill scale(SMS) and the Japanese version of the 12-item General Health Questionnaire(GHQ-12). Eighty percent of the subjects returned the questionnaire. Excluding senior managers and insufficient answers, the final response rate was 55 percent. By multiple regression analysis, we found that job rank contributed significantly and positively, and that age, communication with superiors and self-management skills contributed significantly and negatively to the GHQ-12. Our results implied that age, job rank, communication with superiors and self-management skills would contribute to the mental health of Japanese employees.

[Development of the Japanese version of the Rathus Assertiveness Schedule].

The present study investigated the reliability and validity of the Japanese version of the Rathus Assertiveness Schedule (RAS) preparatory to study the relationship between self-expression skills and mental health status of employees at a Japanese worksite. Assertiveness is one of self-expression skills and defined as standing up for one's own rights as well as for others. RAS that the most widely used was developed by Rathus in the U.S.A. and consists of 30 items. We developed the Japanese version of RAS (J-RAS) along with a back-translation. The subjects were 173 participants of a 2-day assertiveness training course from July to December, 2001 and 364 workers in a manufacturing company in the Kyushu area. We sent the J-RAS to the 173 participants before they commenced the course, and of them 170 participants returned sufficient answers for analysis. During the course their trainers completed the objective evaluations on assertive self-expression. We compared their answers with the trainers' evaluations by the Pearson's correlation to certify the J-RAS's validity. We also mailed the J-RAS to the manufacturing workers in June, 2001. Of them, 266 workers returned sufficient answers by the end of the month. We calculated the Cronbach's alpha coefficient by them to certify the internal consistency reliability of the J-RAS. In August, 2001, we mailed the J-RAS again to 98 workers who agreed to retake the test. We studied the Pearson's correlation between the initial answers and the following ones to certify the test-retest reliability of the J-RAS, using the 98 answers of the workers who agreed to be retested. Our results found that 19 item sets, excluding Q3--7, 9, 13, 19, 20, 25, 28, had significantly positive correlation with the objective evaluations. The sum of the 19 items of the J-RAS (19-item J-RAS) had significantly higher correlations with the objective evaluation than that of 30 items of the J-RAS (30-item J-RAS). The internal consistency reliability of the 19-item or 30-item J-RAS was high, because their Cronbach's alpha coefficient was more than 0.80. Their test-retest reliability was also high, because the Pearson's correlation coefficient between the initial test and the subsequent test was more than 0.84 (ps < 0.001). Our results implied that the validity and reliability of the J-RAS was could be considered as acceptable and that the 19-item J-RAS measured the assertiveness of Japanese people more exactly than the 30-item J-RAS.