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School refusal is rising globally and has reached an all-time high in Japan. It imposes critical work-family conflict on employed parents, with preliminary surveys linking it to job loss, depression, and anxiety. Despite its public health importance, work-family conflict due to school refusal has scarcely been studied in occupational health. This Opinion reviews existing research on parents of school-refusing children, discusses how occupational health professionals can support this underserved population, and outlines priorities for future research to mitigate the impacts on working-age parents’ health and employment.

Objectives The study investigated the links between workplace measures implemented in response to COVID‐19 with mental health and work performance of employees in Japan. Methods This was a cross‐sectional study of a sample from a cohort study of full‐time employees. Participants (n = 1448) completed an online self‐report questionnaire on March 19‐22, 2020. Multiple linear regression was conducted to ascertain their fear of and worry associated with COVID‐19, psychological distress, and work performance. Results The number of workplace measures correlated positively with respondents' fear of and worry associated with COVID‐19 (adjusted standardized β = 0.123, P < .001), negatively with psychological distress and positively with work performance (adjusted standardized β = −0.068, P = .032; adjusted standardized β = 0.101, P = .002; respectively). Conclusions Workplace measures may promote and maintain the mental health and work performance of employees during the COVID‐19 epidemic. The positive association between the number of measures and fear and worry about COVID‐19 may reflect increased awareness about COVID‐19 among employees resulted from taking the measures.

Objectives This study compared the longitudinal change in the mental health of healthcare and non-healthcare workers during two months of the COVID-19 outbreak in Japan. Methods Data were derived from a prospective online cohort study of 1448 full-time employees in Japan. Participants were surveyed at baseline from 19-22 March 2020 (T1) and at follow-up from 22-26 May 2020 (T2). A self-administered online questionnaire was used to assess participants' fear and worry of COVID-19, psychological distress, and physical symptoms at T1 and T2. A series of generalized linear models were created to assess changes in outcomes between healthcare and non-healthcare workers. Demographic variables (ie, sex, age, marital status, child[ren], education, and residential area) were included in the models as covariates. Results A total of 1032 participants completed the follow-up questionnaire at T2 (follow-up rate, 72.6%). After excluding unemployed respondents (N=17), the final sample comprised 1015 full-time employees (111 healthcare and 904 non-healthcare workers). After adjusting for the covariates, psychological distress (and subscales of fatigue, anxiety, and depression) as well as fear and worry of COVID-19 increased statistically significantly more among healthcare than non-healthcare workers from T1 to T2. Conclusions Psychological distress, together with fear and worry of COVID-19, increased more among healthcare compared to non-healthcare workers during the COVID-19 outbreak. The study confirmed that healthcare workers are an important target for mental healthcare during the COVID-19 outbreak.

Objectives This study aimed to compare the longitudinal change of the psychological distress of healthcare workers (HCWs) with non‐HCWs during the repeated outbreaks of the COVID‐19 in Japan. Methods The data were retrieved from the Employee Cohort Study in the Covid‐19 pandemic in Japan study. An online survey was conducted on March 2020 (T1), on May 2020 (T2), on August 2020 (T3), and on November 2020 (T4). Psychological distress was measured by the Brief Job Stress Questionnaire. A mixed‐model repeated‐measures ANOVA was conducted as an indicator of the group differences. Results A total sample of analysis was n = 996 (HCWs, n = 111; non‐HCWs, n = 885). HCWs consisted of physicians/nurses/midwives and other HCWs (eg, pharmacists, clinical laboratory technicians) in the clinical settings (n = 19; 17% and n = 61; 55%, respectively), and HCWs not working in the clinical settings (n = 31; 28%). Being HCWs were associated with a significant increase in psychological distress from T1 to T2, T3 and T4 (P = .001, P = .002, P < .001; respectively). Conclusions The mental health of HCWs deteriorated through the COVID‐19 outbreaks compared with non‐HCWs. HCWs are continuously the important targets to provide mental health support.

Objectives This study aimed to examine whether having adverse childhood experiences (ACEs) was associated with living in a deprived area in adulthood. Methods The cross-sectional study was conducted by using nation-wide data in 2022 of the Japan COVID-19 and Society Internet Survey (JACSIS). Participants were community dwelling people 18 years or older. ACEs were assessed by Japanese version of 15-items ACE measurement tool (ACE-J). Living condition was measured by Area Deprived Index (ADI) and Densely Inhabited District (DID) based on zip code. Multivariable logistic regression to analyze the associations between ADI and ACE 4 + was conducted, controlling for individual-level factors, such as age, sex, marital status, and education, as an additional analysis. Results The total of 27,916 participants were included in the analysis. The prevalence of emotional neglect, childhood poverty, and school bullying were 38.2%, 26.5%, 20.8%, respectively. 75% of the population had one or more ACE(s). The number of ACEs was associated with significantly higher risk of living in deprived area in the adulthood ( p  = 0.001). ACEs were not associated with living in density area. The association between ADI and ACEs 4 + was non-significant after controlling the individual-level factors. Conclusion People with higher number of ACEs tend to live in deprived areas in adulthood. Policy makers in highly deprived areas can apply the trauma-informed approach for the community care and support, which is critical to mitigating deficit perspectives and facilitating comprehensive support for those with ACEs.

The study aimed to examine the association of expanded adverse childhood experiences (ACEs) with psychological distress in adulthood. The data from nation-wide online cohort was used for analysis. Community dwelling adults in Japan were included. The ACEs was assessed by 15 items of ACE-J, including childhood poverty and school bullying. Severe psychological distress was determined as the score of Kessler 6 over 13. Multivariable logistic regression analysis was conducted, by using sample weighting. A total of 28,617 participants were analyzed. About 75% of Japanese people had one or more ACEs. The prevalence of those with ACEs over 4 was 14.7%. Those with ACEs over 4 showed adjusted odds ratio = 8.18 [95% CI 7.14–9.38] for severe psychological distress. The prevalence of childhood poverty was 29% for 50–64 year old participants and 40% of 65 or older participants. The impact of childhood poverty on psychological distress was less than other ACEs in these age cohorts. Bullying was experienced 21–27% in young generations, but 10% in 65 or older participants. However, the impact on psychological distress in adulthood was relatively high in all age groups. ACEs have impacted mental health for a long time. Future research and practice to reduce ACEs are encouraged.

Objectives This study aimed to examine whether a high score on the euthymia scale (ES) predicts a low incidence of depressive symptoms one year later. Methods The baseline online survey was conducted in February 2020, and a follow-up survey was done in February 2021. Japanese over 20 years old were enrolled. Respondents who answered both baseline and follow-up, and without depressive symptoms at baseline were included in the analysis. The euthymia scores at baseline was measured by the 10 items of the Japanese version of the ES. Depressive symptoms at follow-up were determined if participants showed either depressive feelings or anhedonia. The odds ratio (OR) was calculated using multivariate logistic regression analysis, adjusting for age, gender, marital status, educational attainment, and clinical visit for depressive episode before the baseline survey. Results The total of 624 participants were analyzed. A total of n = 63 (10.1%) presented depressive symptom at follow-up. A high ES score significantly predicted a lower incidence of depressive symptoms, after adjusting for covariates (aOR = 0.81 [95% confidence interval: 0.72–0.89]). Using the cutoff score retrieved from this data, a high ES score (7 or more) showed the same tendency, compared to a low ES score (< 7) (aOR = 0.46 [0.25–0.83]). Conclusions This study suggests the predictive usefulness of euthymia for subsequent depressive symptoms. Further investigation is needed by employing rigid diagnostic criteria.

Background Over the past half-century, numerous scales have been designed to quantify outcomes in people with severe mental health disorders. However, little is known about the views of people diagnosed with schizophrenia on individual outcome scales, particularly outside of European countries. Aim We conducted a qualitative study to examine the perspectives of people with schizophrenia on multiple scales in Japan. Methods Eleven participants took part in focus group interviews. Five had extensive experience as mental health peer supporters; the others had no such experience. To address potential power imbalances and facilitate dynamic discourse, participants were intentionally divided into two groups on the basis of peer support experience, and two simultaneous two-hour focus group interviews were conducted in separate rooms. The participants reviewed 12 clinical and patient-reported outcome measures and discussed their views on each measure. Interview data for each group were combined prior to analysis and qualitatively analyzed by four researchers using a thematic analysis approach. Results The average age of the participants was 42.7 years (SD = 8.3), and six were male. On average, the participants had been living with schizophrenia for 22.2 years (SD = 11.1). After analyzing the interview data, the following five themes were identified, each containing two to seven subthemes: 1) validity and format of the scale construct, 2) factors affecting the accuracy of responses, 3) plain language and familiar words in Japanese culture, 4) psychological impact on the respondents, and 5) containing important items in everyday life. Conclusion The participants provided both favorable and unfavorable feedback on each scale. When implementing research utilizing clinical outcome scales and patient-reported outcome measures, researchers should exercise caution considering the potential emotional impact on respondents. Furthermore, scale development should take into account the cultural background and psychological burden experienced by the respondents.

Enhancing the well-being of mentally healthy workers (i.e., those with lower psychological distress) is important to prevent mental health conditions, aligning with the trend of occupational positive psychology. No intervention study has investigated the effect of digital health intervention on well-being among workers with low levels of psychological distress in micro- and small-sized enterprises (MSEs). This secondary analysis examined the effectiveness of a fully automated text-based stress management program, “WellBe-LINE,” using the LINE app to improve the well-being of employees with low levels of psychological distress in MSEs. It used data from a previous randomized controlled trial (RCT) study. The previous RCT recruited adult Japanese full-time employees at an enterprise with fewer than 50 employees from registered members of a web survey company. From the RCT, only participants with low psychological distress (Kessler 6 score under 4) were employed for the present analyses. Participants in an intervention group received text messages once per week for 8 weeks. Well-being was assessed by the Mental Health Continuum-Short Form (MHC-SF) at baseline, post (2-month), and follow-up (6-month) surveys. A mixed model for repeated measures conditional growth model analysis was conducted using a group*time interaction as an intervention effect. 638 (62.5%) participants with low psychological distress were included in this secondary analysis from the 1,021 total participants. The intervention group showed a significant intervention effect post survey on improving well-being (Cohen’s d = 0.19 [95%CI 0.03–0.35], p  = 0.016) and social well-being at both the post and follow-up survey with a small effect size (Cohen’s d = 0.26 [95%CI: 0.10–0.42], d = 0.17 [0.002–0.34]; respectively). No effect was observed on emotional and psychological well-being. This study suggested that fully automated universal mental health interventions with low intensity may benefit the healthy population. Further research is needed, focusing on the development and evaluation of programs aimed at promoting well-being and positive mental health among mentally healthy workers as part of primary mental health prevention. Trial registration : The study protocol was registered in the UMIN clinical trial registration before starting recruitments: UMIN000050624 (registration date: March 18, 2023) https://center6.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000057552 .