職場のストレス対策の取り組みとその有効性(シンポジウム:職場のメンタルヘルス最前線,2008年,第49回日本心身医学会総会(札幌))  [in Japanese] Effectiveness of Occupational Mental Health Measures on Health Outcome of Workers(Symposium/The Latest Frontiers of Occupational Mental Health)  [in Japanese]

職場のメンタルヘルス対策の有効性を調べるために,1次予防(疾病の発生予防),2次予防(早期発見・早期対処),3次予防(疾病管理,復職支援)のアプローチ事例を対象として比較検討を行った.1次予防に関しては,2004年にメンタルヘルス改善意識調査票(MIRROR)を開発し,2005年度に15事業場9,800名を対象として,職場環境改善のための介入的アプローチを行い,2006年度に効果評価を行った.改善が行われた部署では,ストレスの軽減がみられた.費用便益の評価では,6社中4社で疾病休業は減少していたが,今回用いた計算法では2社のみが黒字であった.また,継続的な管理職研修を含めた総合的対策により,休職事例数が半減した.2次,3予防に関しては,3事業場の相談事例162名および臨床事例113例に対する比較調査を行った.事業場の事例に関しては55.6%,臨床事例に対しては20.4%に対して職場調整を行ったが,前者のほうが有意に有効事例が多かった.転帰に関しては,事業場事例のほうが治癒率は有意に高かった.

Purpose: Mental health at work has become a very important issue in Japan. The purpose of this study is to investigate the effectiveness of primary prevention (prevention of mental disorders and stress management in workplaces), secondary prevention (early detection and treatment) and tertiary prevention (support for workers with mental problems and rehabilitation). Method and results : In primary prevention, we developed a check list named MIRROR (Mental Health Improvement & Reinforcement/Research of Recognition) in 2004 and conducted interventional approaches for improvement of working conditions after we evaluated needs for improvement and job stress of 9.800 workers in 15 companies using this check list and Brief Job Stress Questionnaire (BJSQ) in 2005, then evaluated effects of the approaches on job stress and cost-benefit analysis. Job stress was reduced in the worksites when improvement of working conditions was successfully carried out. On cost-benefit analysis, 4 of 6 companies showed a decrease of total absent days due to mental problems, however only 2 companies showed benefit according to the method for analysis adopted in this study. In the other manufacturing company, we conducted mental health education and practice of active listening in order to improve of communication and reinforcement of supervisor support for 4 years. A marked reduction of workers with sick leaves for more than 1month due to mental problems was observed 2 years later of these approaches. In secondary and tertiary preventions, subjects were 162 consultation cases with mental problems visited health care center in 3 companies and 113 outpatients visited the mental health centers in a general hospitals. We compared the diagnosis, job stress, effectiveness of treatment and final outcome of both cases. Depressive cases (43.4%) were significantly much more in outpatient cases compared to consultation cases (25.3%). An arrangement of job stressors was done for 55.6% of consultation cases and effective in 90.0% of those, for 20% of outpatient cases and effective in 65.2% of those. Finery, 79.9% of 162 consultation cases were completely cure, 10.5% continued medical treatment, 1.9% steel on sick leave, 4.9% moved to other companies, 27.4% of 113 outpatients cases were cure, 31.0% continued, 19.5 % dropped out, 3.5% in sick leave, 17.5 % moved and 22.1% changed hospitals. Conclusion: 1) Interventional approaches such as improvement of working condition based on stress survey or educational approaches for supervisors seem to be effective for health outcome of workers, if it has done properly. 2) It seemed that final health outcome was better in consultation cases comparing to outpatient cases, because early detection & early treatment and arrangement for job stressors were easier in consultation groups in the companies.