Which Stress Does Influence Returning to Work in Japan, Inside or Outside the Workplace?

AbstractBackground: In this cohort study, we investigated the background factors promoting and inhibiting a return to work after long-term absence from work due to sickness among psychiatric outpatients.Methods: We surveyed 73 psychiatric outpatients who were absent from work for a long time (POAWs), and 42 POAWs who were followed up until the 2-year time point. GHQ-30, NEO-FFI, MPS, RSS and questionnaires inquir-ing about background factors, including relationships with others, were used, and the data were compared those who had returned to the work by the 2-year time point with those who had not.Results: Factors promoting a return to work were "extroversion (NEO-FFI)", "organization (MPS)", and "neuroti-cism (NEO-FFI)", whereas "concern over mistakes (MPS)" was an inhibitory factor. Period of absence from work was markedly associated with psychological stress outside the workplace, while depression, anxiety, and even psycho-logical stress inside the workplace were not.Conclusions: POAWs leftfrom work by the result of psychiatric problems like depression, anxiety and so on. These were the result of their background factors, their characteristics, and psychological stress in/outside the workplace. After two-year psychiatric treatment, their psychological stress outside the workplace remained as an essential matter. These were inescapable because they were set in private place, while stress at the workplace could be leftat the work-place.Keywords: Absence, Work, Psychology, Stress, WorkplaceIntroductionRecently, in parallel with a similar trend worldwide, deterioration of working conditions in Japan has led to an increase in the incidence of depression or maladjustment in the workplace. Psychiatric disorders are now the most common reason for long-term absence from work. After treatment, the work-related consequences for such patients, who have suffered a range of psychiatric condi-tions, vary. Some are able to return to work, some may need further long-term sick leave after tem-porary return to work, and others may end up leaving their jobs entirely. However, the factors affecting the prognosis of these psychiatric outpa-tients remain unclear.There has been some discussion with regard to which factors have the most influence on malad-justment and depression, such as psychological stress in or outside the workplace, personality traits or characteristics, and so on. In our previous study, we addressed two issues (1,2). One was whether a successful return to work was possible beyond 1 year after the start of treatment for psy-chiatric outpatients with work maladjustment who had been absent from work for more than 8 weeks due to any F3 or F4 disorders defined by the ICD-10. The other was the presence of possi-ble background factors that may have affected the patients during their absence from work. We also examined the current tendency for Japanese fe-male workers to become isolated, not only in the workplace but also at home, the significance of perfectionism among workers, and how perfec-tionism might affect male and female workers dif-ferently (2).In the present cohort study, we investigated circ-umstances in the workplace 2 years after our initial study, together with the associated background factors.Subjects and methodsWe surveyed 78 psychiatric outpatients who had been absent from work (POAWs) for less than 8 weeks and had been diagnosed as having F3 or F4 disorders defined by the ICD-10 (World Health Organization 1992) (3) at the Department of Psy-chiatry, Tokyo Jikei University School of Med-i-cine, between September 2007 and August 2009. One year later, we conducted a further cohort study of these patients to determine whether they had been able to return to work by the 2-year time point, and compared those who had (RWs) with those who had not (nRWs).The survey items included: age, gender, presence of a spouse and children, scheduled and excess working hours, Global Assessment of the Func-tioning (GAF) at the baseline, any psychological stress-related experiences within the last six months, their degree of work satisfaction, actual support from any environment, relationship with superiors, colleagues, and subordinates, and other background information. …