World Mental Health Japan Survey Research Articles

Comorbidity and sociodemographic characteristics of adult autism spectrum disorder and attention deficit hyperactivity disorder: epidemiological investigation in the World Mental Health Japan 2nd Survey

Objectives: The present study aims to examine sociodemographic correlates and comorbid mental disorders among adult with autism spectrum disorders (ASD) and attention deficit hyperactivity disorders (ADHD) using the national representative data of Japan.Methods: Analysis was conducted on the cross-sectional data derived from the World Mental Health Japan Survey 2, whose participants were community residents aged 20–75 years old. Multiple logistic regression was conducted on the data of those who were assessed for adult ASD (N = 2227) and ADHD (N = 2297). The association of adult ASD/ADHD with sociodemographics, mood disorders, anxiety disorders, substance use disorders, suicide ideation, hikikomori (social withdrawal), and internet addiction was examined, adjusting for sex and age. Gender difference in the association was also assessed based on the interaction terms of sex.Results: None of the sociodemographics characteristics were significantly associated with adult ASD/ADHD. ADHD had increased risks for a variety of mental disorders, having the highest odds ratios for social phobia. However, a significant positive association was limited to social phobia and to drug abuse and dependence among those with adult ASD. Hikikomori and internet addiction were positively associated with ASD/ADHD, while suicide ideation was only associated with ADHD. Women with ADHD were more likely to have any one of mental disorders, as well as alcohol abuse and dependence, compared to men with ADHD.Conclusions: Adults with ASD/ADHD in Japan had increased mental health needs. The specific needs of women with ADHD should be also considered in future clinical work and research.

The global distribution of mental and substance use disorders: research gains and challenges.

Commentary on: Ishikawa H, Kawakami N, Kessler R (2015). Lifetime and 12-month prevalence, severity, and unmet need for treatment of common mental disorders in Japan: results from the final dataset of World Mental Health Japan Survey. Epidemiology and Psychiatric Sciences. (doi:10.1017/S2045796015000566)

Lifetime and 12-month prevalence, severity and unmet need for treatment of common mental disorders in Japan: results from the final dataset of World Mental Health Japan Survey.

The aim of this study is to estimate the lifetime and 12-month prevalence, severity and treatment of Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) mental disorders in Japan based on the final data set of the World Mental Health Japan Survey conducted in 2002-2006. Face-to-face household interviews of 4130 respondents who were randomly selected from Japanese-speaking residents aged 20 years or older were conducted from 2002 to 2006 in 11 community populations in Japan (overall response rate, 56%). The World Mental Health version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay administered psychiatric diagnostic interview, was used for diagnostic assessment. Lifetime/12-month prevalence of any DSM-IV common mental disorders in Japan was estimated to be 20.3/7.6%. Rank-order of four classes of mental disorders was anxiety disorders (8.1/4.9%), substance disorders (7.4/1.0%), mood disorders (6.5/2.3%) and impulse control disorders (2.0/0.7%). The most common individual disorders were alcohol abuse/dependence (7.3/0.9%), major depressive disorder (6.1/2.2%), specific phobia (3.4/2.3%) and generalized anxiety disorder (2.6/1.3%). While the lifetime prevalence of any mental disorder was greater for males and the middle-aged, the persistence (proportion of 12-month cases among lifetime cases) of any mental disorder was greater for females and younger respondents. Among those with any 12-month disorder, 15.3% were classified as severe, 44.1% moderate and 40.6% mild. Although a strong association between severity and service use was found, only 21.9% of respondents with any 12-month disorder sought treatment within the last 12 months; only 37.0% of severe cases received medical care. The mental health specialty sector was the most common resource used in Japan. Although the prevalence of mental disorders were quite low, mental disorders were the second most prevalent cause of severe role impairment among chronic physical and mental disorders. These results suggest lower prevalence of mental disorders in Japan than that in Western countries, although the general pattern of disorders, risk factors and unmet need for treatment were similar to those in other countries. Greater lifetime prevalence for males and greater persistence for females seems a unique feature of Japan, suggesting a cultural difference in gender-related etiology and course of disorders. The treatment rate in Japan was lower than that in most other high-income countries in WMH surveys.

Childhood adversities and adult use of potentially injurious physical discipline in Japan.

Using data derived from the World Mental Health Japan Survey (n = 1,186), this study examined the intergenerational continuity of potentially injurious physical discipline of children in a community sample from Japan with a special focus on the confounding effects of 11 other types of childhood adversities (CAs) and the intervening effects of mental disorders and socioeconomic status. Bivariate analyses revealed that having experienced physical discipline as children and five other CAs was significantly associated with the use of physical discipline as parents in the Japanese community examined. However, childhood physical discipline was the only CA that remained significant after adjusting for the other CAs. The association of childhood physical discipline with adult perpetration was independent of the respondents' mental disorders and household income. No significant gender differences were found in the associations between childhood physical discipline and adult perpetration. The current study on Japan provided empirical support consistent with results found in other countries regarding the intergenerational transmission of child physical abuse.

Barriers to mental health care in Japan: Results from the World Mental Health Japan Survey.

The reasons for accessing and maintaining access to mental health services in Japan may be different to those in other countries. Using the World Health Organization World Mental Health Japan survey data, this study investigated the prevalence of sociodemographic correlates of barriers for the use of, reasons for delayed access to, and reasons for dropping out from mental health care in a Japanese community-based sample. An interview survey was conducted with a random sample of residents living in 11 communities across Japan during the years 2002-2006. Data from 4130 participants were analyzed. The most frequently reported reason for not seeking mental health care was a low perceived need (63.9%). The most common reason for delaying access to help was the wish to handle the problem on one's own (68.8%), while the most common reason for dropping out of care was also a low perceived need (54.2%). Being a woman and of younger age were key sociodemographic barriers to the use of mental health services. Low perceived need was a major reason for not seeking, delay in using, and dropout from mental health services in Japan. In addition, low perceived need and structural barriers were more frequently reported than attitudinal barriers, with the exception of a desire to handle the problem on one's own. These findings suggest that improving therapist-patient communication and quality of mental health care, as well as mental health literacy education in the community, might improve access to care in Japan.

Association of socioeconomic status in childhood with major depression and generalized anxiety disorder: results from the World Mental Health Japan survey 2002-2006.

BackgroundLow socioeconomic status (SES) in childhood is known to be a significant risk factor for mental disorders in Western societies. The purpose of this study was to investigate whether a similar association exists in Japan.MethodsWe used data from the World Mental Health Japan Survey conducted from 2002–2006 (weighted N = 1,682). Respondents completed diagnostic interviews that assessed lifetime prevalence of major depression (MD) and generalized anxiety disorder (GAD), as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Associations between parental education (a proxy of SES in childhood) and lifetime onset of both disorders were estimated and stratified by gender using discrete-time survival analysis.ResultsAmong women, high parental education was positively associated with MD (odds ratio [OR]: 1.81, 95% confidence interval [CI]: 1.03-3.18) in comparison with low parental education, even after adjustment for age, childhood characteristics, and SES in adulthood. This same effect was not found for men. In contrast, higher parental education was associated with GAD (OR: 6.84, 95% CI: 1.62-28.94) in comparison with low parental education among men, but this association was not found among the women, in the fully adjusted model.ConclusionsIn Japan, childhood SES is likely to be positively associated with the lifetime onset of mental disorders, regardless of family history of mental disorders, childhood physical illness, or SES in adulthood. Further study is required to replicate the current findings and elucidate the mechanism of the positive association between mental disorders and childhood SES.

Trauma and posttraumatic stress disorder in Japan: Results from the World Mental Health Japan Survey

The purpose of the study was to report the prevalence of trauma exposure and PTSD, conditional risk of PTSD associated with each trauma exposure in the community population in Japan. An interview survey was conducted of a random sample of adult residents in 11 communities of Japan. Among 4134 respondents (response rate, 55%), data from those who completed the part 2 interview (n = 1682) were analyzed with a weight for this subsample. Lifetime experiences of 27 trauma events and PTSD were assessed using the WHO-Composite International Diagnostic Interview version 3.0. Sixty percent of the part 2 sample reported exposure to at least one lifetime traumatic event. Lifetime and 12-month PTSD prevalences were 1.3% and 0.7%, respectively. Percentage of all months lived with PTSD in the population was predominantly accounted for by physical/sexual assaults and having a child with serious illness, and unexpected death of loved one. Ten percent of respondents reported “private events”, for which respondents did not have to describe the content, which accounted for 19% of months with PTSD. The lower prevalence of PTSD in Japan seems attributable to lower conditional risks of PTSD following these events, as well as different distributions of the events. The greater impact of events that occurred to loved ones rather than to oneself and “private events” on PTSD in Japan warrants further research of cross-cultural assessment of trauma exposure and cultural heterogeneity in the trauma-PTSD relationship.

Social Anxiety Disorder

<div style="left: 70.8662px; top: 324.72px; font-size: 15.45px; font-family: serif; transform: scaleX(0.971046);" data-canvas-width="419.81549999999993">According to epidemiological studies, rates of social anxiety disorder</div><div style="left: 70.8662px; top: 344.72px; font-size: 15.45px; font-family: serif; transform: scaleX(1.11655);" data-canvas-width="424.26750000000004">(SAD) or social phobia range from 3% to 16% in the general</div><div style="left: 70.8662px; top: 364.72px; font-size: 15.45px; font-family: serif; transform: scaleX(0.987995);" data-canvas-width="69.1185">population.</div><div style="left: 139.985px; top: 365.947px; font-size: 9.00733px; font-family: serif; transform: scaleX(0.952064);" data-canvas-width="16.423109999999998">[1,2]</div><div style="left: 156.408px; top: 364.72px; font-size: 15.45px; font-family: serif; transform: scaleX(0.977187);" data-canvas-width="334.422">Social phobia and specific phobias have an earlier age</div>of onset than other anxiety disorders.

Association of Subjective and Objective Socioeconomic Status with Subjective Mental Health and Mental Disorders Among Japanese Men and Women

An inverse association between socioeconomic status (SES) and mental health has been previously well reported, but the evidence is limited in Asian populations. We therefore investigated the association of SES and subjective mental health and prevalence of any mental disorders in the general population of Japan. We used data from the World Mental Health Japan Survey of 1,496 randomly selected people aged 20 years and older in Japan. Information on education level and household income were used as objective SES indicators, and subjective social status (SSS) was measured by responses to a question regarding social position. We calculated odds ratios of SES indicators for poor subjective mental health and 12-month prevalence of any mental disorders. The adjusted odds ratio (OR) (95 % confidence interval (CI)) of respondents who rated themselves as lower than middle status in the country (low SSS group) for poor subjective mental health was 2.24 (95 % CI: 1.41, 3.57) with reference to those who rated themselves as higher than middle status (high SSS group). Similarly, inverse associations of education level and household income with poor subjective mental health were identified. A J-shaped association was confirmed between SSS and 12-month prevalence of any mental disorders. The adjusted OR (95 % CI) of SSS for any mental diseases was 0.53 (95 % CI: 0.32, 0.86) for the middle SSS group and 1.61 (95 % CI: 0.96, 2.72) for the low SSS group, compared with the high SSS group. Those associations were not attenuated when objective SES indicators were adjusted. We found inversely linear associations between subjective and objective SES and poor subjective mental health among Japanese men and women. SSS was not significantly associated with 12-month prevalence of any mental disorders. Substantial social inequalities in mental health were identified in Japan, which has been considered an egalitarian society with relatively few inequalities in health.

Sociodemographic determinants of attitudinal barriers in the use of mental health services in Japan: Findings from the World Mental Health Japan Survey 2002–2006

Sociodemographic correlates of Japanese attitudinal barriers to mental health services might be different from previous studies in Western countries, reflecting a different culture. We investigated sociodemographic correlates of attitudinal barriers to mental health services in a community population in Japan, based on data collected in the World Mental Health Survey Japan surveys. An interview survey was conducted of a random sample of residents living in 11 communities across Japan during 2002-2006. A total of 1359 participants were analyzed. The variables on attitudinal barriers to mental health services were measured by using the World Health Organization Composite International Diagnostic Interview 3.0. The association between these variables and sociodemographic variables were analyzed by using multiple logistic regressions. Being male was significantly associated with willingness to go for professional help and feeling comfortable to talk with a professional. Compared to the youngest group (20-34 years old), those aged from 35 to 49 years had a significantly lower prevalence of feeling embarrassed about friends knowing about their getting professional help, while the oldest group (aged over 65 years) had a significantly higher prevalence of being embarrassed. Being currently married was significantly associated with higher expectations about mental health services, but it was significantly and negatively associated with willingness to go for professional help. These results suggest that demographic patterns of attitudinal barriers to mental health services in Japan are unique, compared with previous studies in Western countries. An anti-stigma campaign may need to consider such country-specific patterns in a particular country.

Impact of mental disorders on work performance in a community sample of workers in Japan: The World Mental Health Japan Survey 2002–2005

Most studies that investigate the impact of mental disorders on work performance have been conducted in Western countries, but this study examines the impact of common mental disorders on sick leave and on-the-job work performance in a community sample of Japanese workers. Data from the World Mental Health Japan survey were analyzed. A subsample of 530 workers aged 20–60years were interviewed using the WHO Composite International Diagnostic Interview 3.0. The WHO Health and Work Performance Questionnaire, was used to assess sick days and on-the-job work performance for the previous 30days. Linear regression was used to estimate the impact of mental disorders on these indicators of work performance over 12months. Mood disorders, including major depressive disorder, and alcohol abuse/dependence were significantly associated with decreased on-the-job performance. There were no significant associations between mental disorders and sick/absent days. Consistent with previous studies, major depression has a great impact on on-the-job work performance in Japan. The lost productivity was estimated at approximately 28–30 lost days per year. A similar decrease in on-the-job work performance was found for alcohol abuse/dependence, which is stronger than that in other countries, probably attributable to greater tolerance of problematic drinking at Japanese worksites.

Utility of self-reported sleep disturbances as a marker for major depressive disorder (MDD): Findings from the World Mental Health Japan Survey 2002–2006

Although major depressive disorder (MDD) is a serious common disease, many depressive patients seek primary care with complaints of sleep disturbances that remain undiagnosed. The purpose of this study was to investigate the utility of self-reported sleep disturbances as a marker for MDD. This study investigated the association between 12-month prevalence of self-reported sleep disturbances and MDD using data from a cross-sectional survey in Japan. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the receiver operating characteristic curve (AUC) of self-reported sleep disturbances as a marker for MDD were 58.9%, 73.4%, 6.9%, 98.1%, and 0.66, respectively. Self-reported sleep disturbances showed highest utility for the youngest group. Among four types of sleep disturbances, the problem of daytime sleepiness was most useful as a marker for MDD. Combined with at least moderate role impairment, self-reported sleep disturbances became more informative with higher specificity (99.6%) and PPV (80.0%) as a marker for MDD. Self-reported sleep disturbances cannot be a marker for MDD in isolation. Comorbid role impairment increases the probability of MDD. Clinicians should be cautious in assessments of young people who have sleep disturbances. Daytime sleepiness should be included among the questions asked when inquiring about sleep disturbances.

Cost of depression among adults in Japan in 2005

Major depression is expected to become the leading contributor to disease burden worldwide by 2020. Previous studies have shown that the societal cost of depression is not less than that of other major illnesses, such as cardiovascular diseases or AIDS. Nevertheless, the cost of depression in Japan has never been examined. The goal of the present study was to estimate the total cost of depression in Japan and to clarify the characteristics of this burden. A prevalence-based approach was adopted to measure the total cost of depression. The total cost of depression was regarded as being comprised of the direct cost, morbidity cost and mortality cost. Diagnoses included in this study were depressive episodes and recurrent depressive disorder according to the ICD-10 or major depressive disorder according to the DSM-IV. Data were collected from publicly available statistics and the World Mental Health Japan Survey database. The total cost of depression among adults in Japan in 2005 was estimated to be ¥2.0 trillion. The direct cost was ¥0.18 trillion. The morbidity cost was ¥0.92 trillion, while the mortality cost was ¥0.88 trillion. The societal costs caused by depression in Japan are enormous, as in other developed countries. Low morbidity costs and extremely high mortality costs are characteristic in Japan. Effective interventions for preventing suicide could reduce the societal costs of depression.

Twelve‐month use of mental health services in four areas in Japan: Findings from the World Mental Health Japan Survey 2002–2003

The aim of the present study was to provide basic descriptive data regarding utilization of 12-month mental health services in the Japanese community population. Face-to-face household surveys were carried out in four areas (two urban cities and two rural municipalities), and a total of 1663 persons participated (overall response rate: 56.4%). For data collection, the structured psychiatric interview, World Mental Health version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI) was used, allowing DSM-IV diagnoses, severity, and service utilization. It was found that 7.3% of total respondents had received any service, either professional or non-professional, in the past 12 months, including 20.0% of those with 12-month DSM-IV disorders and 6.2% of those without. Thirty-three percent of those with any mood disorder used any service, and 26.8% of those used some type of health care. The probability of people with 13-15 years of education receiving mental health treatment was fourfold higher than those with >or=16 years of education. Gender, age, or income were not found to contribute to utilization of mental health services. The results confirm that the majority of people with a recent psychiatric disorder have not used mental health care or other support systems. The mental health care system in Japan has improved over the past decade, but not enough for people suffering from mental disturbances.

Twelve‐month prevalence, severity, and treatment of common mental disorders in communities in Japan: preliminary finding from the World Mental Health Japan Survey 2002–2003

To estimate the prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) mental disorders in community populations in Japan, face-to-face household surveys were conducted in four community populations in Japan. A total of 1663 community adults responded (overall response rate, 56%). The DSM-IV disorders, severity, and treatment were assessed with the World Mental Health version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMH-CIDI), a fully structured lay-administered psychiatric diagnostic interview. The prevalence of any WMH-CIDI/DSM-IV disorder in the prior year was 8.8%, of which 17% of cases were severe and 47% were moderate. Among specific disorders, major depression (2.9%), specific phobia (2.7%), and alcohol abuse/dependence (2.0%) were the most prevalent. Although disorder severity was correlated with probability of treatment, only 19% of the serious or moderate cases received medical treatment in the 12 months before the interview. Older and not currently married individuals had a greater risk of having more severe DSM-IV disorders if they had experienced any within the previous 12 months. Those who had completed high school or some college were more likely to seek medical treatment than those who had completed college. The study confirmed that the prevalence of DSM-IV mental disorders was equal to that observed in Asian countries but lower than that in Western countries. The percentage of those receiving medical treatment was low even for those who suffered severe or moderate disorders. Possible strategies are discussed.