Effects of the Mental Health Supporter Training Program on mental health-related public stigma among Japanese people: A pretest/posttest study.

Aim: The Mental Health Supporter Training Program is a national project conducted in Japan. This study aimed to determine the effects on mental health-related stigma, mental health literacy, and knowledge about mental health difficulties and support techniques among program participants. Methods: The target population was local residents of a wide range of generations in Japan. Outcomes were assessed at baseline (T1), immediately postintervention (T2), and at the 6-month follow-up (T3). A mixed model for repeated-measures conditional growth model analyses were employed to examine the effects of the intervention over time (T1, T2, T3). We also calculated effect sizes using Cohen's d. Results: The program had a significantly favorable pooled effect on the Japanese version of the Reported and Intended Behaviour Scale score after adjusting for covariates (reported behavior [t = 3.20, p = 0.001]; intended behavior [t = 8.04, p < 0.001]). However, when compared at each time point, only intended behavior from T1 to T2 showed a significant difference (t = 8.37, p < 0.001). Significant pooled effects were found for mental health literacy (knowledge: t = 19.85, p < 0.001; attitude: t = 15.02, p < 0.001), knowledge of mental health (t = 28.04, p < 0.001), and psychological distress (t = -2.41, p = 0.016). Conclusion: The results suggest that the program might be effective for improving intended, but not reported, behavior in the short term and for improving mental health literacy, knowledge of mental health, and psychological distress.

Difference in the risk of discrimination on psychological distress experienced by early wave infected and late wave infected COVID-19 survivors in Japan.

The psychological distress experienced by coronavirus disease of 2019 (COVID-19) survivors after recovery from the illness is amplified by discrimination endured because of their infection status. However, the difference in the risk of facing discrimination and risk of experiencing psychological distress in the early and late waves of the COVID-19 pandemic remain unclear. This study aimed to investigate whether the risk of facing discrimination because of infection status was lower in the early or late waves and whether risk of discrimination on psychological distress was more serious in later, rather than earlier waves. We conducted two online surveys to collect data from survivors divided into two groups. The participants with scores of five or more on the Kessler Psychological Distress Scale were identified as having experienced psychological distress. The participants were identified as having experienced discrimination based on infection status if they had endured being blamed, some type of discrimination, or having themselves or their families maligned. The timing of infection was split into infected during early waves of the pandemic for 2021 participants and infected during later waves of the pandemic for 2022 participants. Modified Poisson regression analyses were performed using experiences of discrimination as criteria and timing of infection as predictors. Modified Poisson regression analyses were further performed using the presence of psychological distress as a criteria and experiences of discrimination and timing of infection as the criteria, in addition to interaction effect of these es. The data of 6010 participants who were infected in early waves and 5344 participants who were infected in later waves were analyzed. The risks of being blamed, some forms of discrimination, and participants and their families being maligned were significantly lower in the group who were infected in later waves than those infected in earlier waves. Experiences of discrimination were highly associated with psychological distress in those infected in later waves than those infected in earlier waves, while only being blamed showed a significant association. Risk of discrimination was found to be lower in those infected in later waves, whereas risk of discrimination on psychological distress was shown to be more serious in those infected in later waves. Therefore, we submit that it is more important to support COVID-19 survivors who face discrimination, than it is to attempt to decrease the current discriminatory climate caused by the COVID-19 pandemic.

Association of preexisting psychiatric disorders with post-COVID-19 prevalence: a cross-sectional study.

Evidence demonstrating the association of preexisting psychiatric disorders with post-COVID-19 is limited. We aim to investigate the association using larger sample sizes and more extended postinfection periods than previous studies. A total of 6015 (response rate = 77.5%) COVID-19 survivors were surveyed using a self-administered questionnaire from July to September 2021. Poisson regression analysis with robust error variance was performed to estimate post-COVID-19 prevalence ratios (PRs) with or without preexisting psychiatric disorders. Participants with preexisting psychiatric disorders numbered 1067 (17.7%), and with post-COVID-19 were 2149 (35.7%). Post-COVID-19 PR with preexisting psychiatric disorders was 1.09 (95% CI 1.02-1.18, p = 0.013). The interaction between preexisting psychiatric disorders and postinfection periods was significant (p for interaction < 0.001). The subgroup analysis showed that those with preexisting psychiatric disorders might be at greater prolonged risk of post-COVID-19 than those without the disorders. These findings suggested that preexisting psychiatric disorders were associated with an increased post-COVID-19 risk, and post-COVID-19 with preexisting psychiatric disorders might prolong even if time passes.

Relationship between attitudes toward COVID-19 infection, depression and anxiety: a cross-sectional survey in Japan.

BACKGROUND: Although negative attitudes are known to develop with experiences of COVID-19 infection, it remains unclear whether such attitudes contribute to depression and anxiety as sequelae of COVID-19. We aimed to investigate the relationships between attitude towards COVID-19 infection and post-COVID-19 depression and anxiety. METHODS: A cross-sectional survey of COVID-19 recovered patients was conducted from July to September 2021 in Japan. Outcome variables, depression and anxiety were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7); scores of 10 and above were identified as having symptoms of depression and anxiety, respectively. Exposure variables were whether participants were experiencing the following attitude strongly: threat to life due to COVID-19 infection, helplessness regarding COVID-19 infection, blaming a third party who did not restrain from going outside, blaming themselves for their COVID-19 infection, worry about spreading the infection to others, and self-stigma (Self-Stigma Scale-Short). Modified Poisson regression analyses were performed to analyze the findings. RESULTS: A total of 6016 responses were included in the analyses. The proportion of depression was 19.88%, and anxiety was 11.47%. The threat of life due to COVID-19 infection, helplessness regarding COVID-19 infection, blaming oneself for their COVID-19 infection, and self-stigma were significantly associated with depression and anxiety after adjusting covariates. Blaming the third party who did not restrain from going outside was associated with anxiety. There was no association between the worry about spreading infection to others and depression or anxiety. CONCLUSION: Negative attitudes, including self-stigma with the experience of COVID-19 infection, were related to depression and anxiety. Further studies confirming whether countermeasures for preventing or decreasing the negative attitude towards COVID-19 infection mitigate these symptoms are needed.

Differences in the Course of Depression and Anxiety after COVID-19 Infection between Recovered Patients with and without a Psychiatric History: A Cross-Sectional Study.

BACKGROUND: This study aimed to examine the course of depression and anxiety in COVID-19 survivors with a psychiatric history compared with those without a psychiatric history. METHODS: A web-based cross-sectional survey for COVID-19 survivors was conducted from July to September 2021. A total of 6016 COVID-19 survivors, the accuracy of whose responses was determined to be assured, were included in analyses. Exposures included psychiatric history and time since COVID-19 infection, and the main outcomes and measures included severity of depression and anxiety, as assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. RESULTS: Mean severity of PHQ-9 and GAD-7 were significantly higher in participants with a psychiatric history than in those without a psychiatric history. Two-way analysis of covariance for PHQ-9 showed a significant main effect of the presence of psychiatric history and a significant interaction effect of psychiatric history × time since infection. Two-way analysis of covariance for the GAD-7 score revealed a significant main effect of the presence of psychiatric history and time since COVID-19 infection and the interaction effect of these factors. CONCLUSIONS: The course of depression and anxiety was more severe in COVID-19 survivors with a psychiatric history than in those without a psychiatric history.

Number of long-term inpatients in Japanese psychiatric care beds: trend analysis from the patient survey and the 630 survey.

BACKGROUND: The number of psychiatric care beds and the mean length of stay in psychiatric care beds in Japan have decreased over the past 10 years. However, as has long been indicated here and elsewhere, Japan lags behind other countries in terms of deinstitutionalization. Furthermore, the population of inpatients in psychiatric care beds is aging dramatically. In addition to the diversification of mental illness, the question of what measures to implement going forward regarding current psychiatric bed resources has emerged as a new challenge. METHODS: Using data from the Patient Survey and the 630 Survey, we examined trends in the number of long-term inpatients in psychiatric care beds in Japan through 2040. Population estimation was used for estimating long-term hospital bed demand because of small fluctuations in the admission and discharge of long-term inpatients. RESULTS: In 2017, nearly one-third of all long-term hospitalized patients were aged ≥75 years, and an estimated 47% of the total are expected to die by 2040. Thus, the overall demand for long-term hospitalization is forecast to decrease sharply due to aging of currently hospitalized long-term inpatients. The number of long-term inpatients in 2017 was 167,579, and this is projected to decrease to 103,141 in 2040. CONCLUSIONS: We believe it is necessary to adopt a multifaceted approach to promote hospital discharge and transition to the community, and to address the diversification of mental illness and the issue of psychiatric care bed supply/availability, which are forecast to decrease due to the natural decrease in long-term inpatients.

Association between working hours, work engagement, and work productivity in employees: A cross-sectional study of the Japanese Study of Health, Occupation, and Psychosocial Factors Relates Equity.

OBJECTIVES: The aims of the study were to investigate the association between working hours, work engagement, and work productivity, and to examine if work engagement moderates the influence of working hours on work productivity. METHODS: We used cross-sectional data from the Japanese occupational cohort survey, which involved 2093 employees in a manufacturing industry. Working hours were self-reported by the study participants. Work productivity was assessed with absolute presenteeism based on the scale of the validated Japanese version of World Health Organization Health and Work Performance Questionnaire (WHO-HPQ). Work engagement was assessed with the Nine-item Utrecht work Engagement Scale (UWES-9). Univariate and multivariable regression analyses were conducted to examine the association of working hours and work engagement with work productivity. We also carried out stratified multivariable regression analysis separately for those with high-work engagement and those with low-work engagement. RESULTS: Working >40 to 50 hours per week and >50 hours per week were significantly positively associated with work productivity in univariate analysis. However, the significant association no longer held after adjusting for work engagement. Work engagement was positively associated with work productivity even after controlling for potential confounders. Working hours were not significantly associated with work productivity among those with high-work engagement or among those with low-work engagement. CONCLUSIONS: Working hours did not have any significant associations with work productivity when taking work engagement into account. Work engagement did not moderate the influence of working hours on work productivity, though it attenuated the relationship between working hours and work productivity.

Optimal cut-off score of the Edinburgh Postnatal Depression Scale for major depressive episode during pregnancy in Japan.

AIM: Depression during pregnancy adversely affects both mother and child. As antenatal depression is a predictor of postnatal depression, early detection might prevent postnatal depression. The Edinburgh Postnatal Depression Scale (EPDS) is frequently used during the perinatal period, but the cut-off score during pregnancy has not been verified for the Japanese population. We aimed to clarify the optimal EPDS cut-off score in mid-pregnancy in Japan. METHODS: We recruited pregnant women aged 20 years or older at 12-24 gestational weeks and those who scored ≥9 on the EPDS were invited to participate in this study. In parallel with the EPDS, the Japanese version of the Mini-International Neuropsychiatric Interview was administered to determine diagnosis of major depressive episode. We then calculated the receiver-operator curve, sensitivity and specificity, and positive and negative predictive values for the EPDS. RESULTS: All 210 participants were in the second trimester except for one (12 gestational weeks). Twenty participants were diagnosed with major depressive episode. With a cut-off score set at 13 points, the area under the curve was 0.956; sensitivity and specificity were 90.0% and 92.1% [Correction added on 10 November 2017, after first online publication: The percentage for specificity has been corrected from 79.0% to 92.1%.], respectively; and positive and negative predictive values were 54.5% and 98.9%, respectively. CONCLUSION: To our knowledge, this is the first study to clarify the optimal EPDS cut-off score in the second trimester for Japan. This finding will be helpful for appropriate screening for antenatal depression in Japan.

Hepcidin-2 in mouse urine as a candidate radiation-responsive molecule.

We used high-performance liquid chromatography to separate urine obtained from whole-body gamma-irradiated mice (4 Gy) before analyzing each fraction with matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry to identify radiation-responsive molecules. We identified two candidates: hepcidin antimicrobial peptide 2 (hepcidin-2) and peptide fragments of kidney androgen-regulated protein (KAP). We observed that peak increases of hepcidin-2 in urine were delayed in a dose-dependent manner (1 Gy and above); however, the amount of KAP peptide fragments showed no correlation with radiation dose. In addition, an increase in hepcidin-2 after exposure to relatively low radiation doses (0.25 and 0.5 Gy, respectively) was biphasic (at 8-48 h and 120-168 h, respectively, after irradiation). The increase in hepcidin-2 paralleled an increase in hepcidin-2 gene (Hamp2) mRNA levels in the liver. These results suggest that radiation exposure directly or indirectly induces urinary excretion of hepcidin-2 at least in part by the upregulation of Hamp2 mRNA in the liver.

Anemia and the risk of contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT.

PURPOSE: The purpose of this study was to assess the effect of anemia on the incidence of contrast-induced nephropathy (CIN) in patients with renal impairment undergoing MDCT. MATERIALS AND METHODS: Institutional review board approval was waived for this retrospective review of 843 patients with stable renal insufficiency (eGFR between 15 and 60 mL/min) who had undergone contrast-enhanced MDCT. Baseline hematocrit and hemoglobin values were measured. Serum creatinine (SCr) was assessed at the baseline and at 48-72 h after contrast administration. RESULTS: The overall incidence of CIN in the patient population with renal insufficiency was 6.9%. CIN developed in 7.8% (54 of 695) of anemic patients, and in 2.8% (4 of 148) of non-anemic patients (P=.027). After adjustment for confounders, low hemoglobin and low hematocrit values remained independent predictors of CIN (odds ratio 4.6, 95% CI 1.0-20.5, P=.046). CONCLUSIONS: Anemia is associated with a higher incidence of CIN in patients with renal insufficiency. Anemia is a potentially modifiable risk factor for CIN, and has an unfavorable impact on prognosis in patients with renal insufficiency undergoing contrast-enhanced MDCT.

Detection of breast cancer with a computer-aided detection applied to full-field digital mammography.

A study was conducted to evaluate the sensitivity of computer-aided detection (CAD) with full-field digital mammography in detection of breast cancer, based on mammographic appearance and histopathology. Retrospectively, CAD sensitivity was assessed in total group of 152 cases for subgroups based on breast density, mammographic presentation, lesion size, and results of histopathological examination. The overall sensitivity of CAD was 91 % (139 of 152 cases). CAD detected 100 % (47/47) of cancers manifested as microcalcifications; 98 % (62/63) of those manifested as non-calcified masses; 100 % (15/15) of those manifested as mixed masses and microcalcifications; 75 % (12/16) of those manifested as architectural distortions, and 69 % (18/26) of those manifested as focal asymmetry. CAD sensitivity was 83 % (10/12) for cancers measuring 1-10 mm, 92 % (37/40) for those measuring 11-20 mm, and 92 % (92/100) for those measuring >20 mm. There was no significant difference in CAD detection efficiency between cancers in dense breasts (88 %; 69/78) and those in non-dense breasts (95 %; 70/74). CAD showed a high sensitivity of 91 % (139/152) for the mammographic appearance of cancer and 100 % sensitivity for identifying cancers manifested as microcalcifications. Sensitivity was not influenced by breast density or lesion size. CAD should be effective for helping radiologists detect breast cancer at an earlier stage.

Contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT.

OBJECTIVES: To evaluate the safety of contrast-enhanced MDCT in patients with renal impairment. METHODS: We conducted a retrospective review of 938 patients with stable renal insufficiency (eGFR between 15 and 60 ml/min) who underwent contrast-enhanced MDCT. SCr levels were measured at baseline and 48-72 h after contrast medium administration. The incidence of contrast-induced nephropathy (CIN) in the total study population was assessed. As a control group, 1,164 separate patients with renal insufficiency who did not receive contrast medium for CT were also reviewed. RESULTS: The overall incidence of CIN in the patient population with renal insufficiency was 6.1 %; the incidence was 4.4 %, 10.5 % and 10.0 % for patients whose eGFR was 45-60, 30-45 and ≤30 ml/min, respectively (P < 0.01). In the control group, 5.8 % of patients showed an increase in the SCr level from the baseline. The increase in the SCr level showed no significant difference between the patients who received CM and those who did not (P = 0.82) CONCLUSIONS: The risk of CIN from contrast-enhanced MDCT in patients with renal insufficiency appeared to be low, and there was no significant difference in the incidence of CIN in comparison with patients who did not receive CM. KEY POINTS : • The contrast medium used for multidetector CT can induce nephropathy. • Contrast-induced nephropathy (CIN) developed in 6.1 % of patients with renal insufficiency. • However, nephropathy developed in 5.8 % of similar patients not receiving contrast medium. • Thus, the risk of CIN associated with MDCT appears to be low. • Special care should still be taken in patients with renal insufficiency.

Phenobarbital (PB)-induced changes in blood coagulationrelated parameters in pregnant rats, lactating rats and pups.

Effects of repeated administration of phenobarbital (PB) on blood coagulation-related parameters were examined in non-pregnant, pregnant and lactating rats, and also in pups born to PB-treated lactating dams. PB was orally administered at a dose level of 80 mg/kg/day to pregnant (from gestation day (GD) 13), postpartum (from postpartum day (PPD) 7) and non-pregnant rats (from 13 weeks of age) for 7 days. Blood was collected on GD20 or PPD14 to perform blood coagulation examination. Concurrently, the blood coagulation parameters were examined in the pups. Increases in liver weight and/or hepatic cytochrome P450 content were observed in the PB-treated non-pregnant, pregnant and lactating rats. Activated partial thromboplastin time (APTT) was prolonged and anti-thrombin III (ATIII) concentration was increased in the lactating rats, while there were no changes in prothrombin time (PT) or APTT in the non-pregnant and pregnant rats. Moreover, prolongation of PT and APTT and decreases in factors VII and IX activities were observed in their pups. Thus, prolongation of blood coagulation time was confirmed in both dams and their pups following PB-administration to lactating dams. Effects of vitamin K(2) (VK(2)) on PB-induced changes in blood coagulation-related parameters of both dams and their pups were examined by co-administration with PB and VK(2) to lactating dams. PT and APTT were comparable to the control and PB-induced prolongation of blood coagulation time was improved in the pups while APTT was prolonged in dams, suggesting that VK(2) was beneficial to pups but not to dams.

Changes in blood coagulation-related parameters in phenobarbital-treated rabbits.

The effects of repeated administration of phenobarbital (PB) on blood coagulation time were examined using male Japanese white SPF rabbits, which are widely used for toxicological studies. PB was administered to the rabbits by oral gavage for 2 weeks, at dose levels of 0, 12.5, 25 and 50 mg/kg/day. Blood was collected on Days 8 and 14 after each day's dosing to perform blood coagulation examination. The liver was excised, weighed and examined histopathologically. Activated partial thromboplastin time (APTT) was prolonged at dose levels of 12.5 mg/kg/day or more and Thrombotest (TBT) was prolonged at 50 mg/kg/day on Day 8. APTT was prolonged at dose levels of 12.5 mg/kg/day or more, TBT was prolonged at 25 mg/kg/day or more and factor IX activity decreased at 50 mg/kg/day on Day 14. At pathological examination, liver weight increased at dose levels of 25 mg/kg/day or more, and a ground-glass appearance of the hepatocytes was observed in the central and middle parts of lobules at 12.5 mg/kg/day or more. However, changes in factor VII or X activity or prolongation of prothrombin time (PT) were not observed. Therefore, prolongation of blood coagulation time by PB administration in rabbits was considered to be due to PB's effect on the endogenous pathway alone. Moreover, an increase in anti-thrombin III (ATIII) concentration was noted at 50 mg/kg/day; however, no change was noted at dose levels of 25 mg/kg/day or less. This suggests that the contribution of ATIII to the PB-induced prolongation of coagulation time in rabbits was small.