Amagasa Takashi, Nakayama Takeo, Takahashi Yoshitomo
Mental Clinic Misato, 1-5-6 Misato, City of Misato, Saitama 341-0024, Japan.
J Occup Health. 2005 Mar;47(2):157-64. doi: 10.1539/joh.47.157.
With the rapidly increasing number of work-related suicides in Japan (Karojisatsu, in Japanese), both applications for worker's compensation insurance and civil suits are proliferating. The phenomenon of work-related suicide is examined along with the process and related factors. With informed consent from bereaved families, two certified psychiatrists independently reviewed and summarized 22 insurance and legal reports filed by psychiatrists on employee suicides that were related to heavy workloads. A clinical epidemiologist participated in discussions with psychiatrists to reach a consensus concerning the cause of the suicides. Only one case involved a female. Seventeen had experienced personnel changes, such as a promotion or transfer. Low social support was recognized in 18, high psychological demand in 18, low decision latitude in 17, and long working hours in 19 cases (more than 11 hours per day for 3 months or more, and without a day off in 9). The subjects had depressive episodes by the ICD-10 criteria and showed suicidal signs. Ten of them saw a general practitioner because of unspecified somatic complaints, but no effective measures were taken. None of them had a history of psychiatric consultation or had received mental health education dealing with job stress management. Although causality cannot be made from this case series report, we hypothesize that long working hours, heavy workloads, and low social support may cause depression, which can lead to suicide. Appropriate countermeasures are urgently needed and the present findings suggest some of them are possible.
随着日本与工作相关的自杀事件数量迅速增加（日语为“过劳自杀”），申请工伤赔偿保险和提起民事诉讼的情况都在激增。本文对与工作相关的自杀现象及其过程和相关因素进行了研究。在征得遗属同意后，两名有资质的精神科医生独立审阅并总结了精神科医生提交的22份关于与繁重工作量相关的员工自杀的保险和法律报告。一名临床流行病学家参与了与精神科医生的讨论，以就自杀原因达成共识。仅1例涉及女性。17人经历过人事变动，如升职或调动。18人社会支持度低，18人心理需求高，17人决策自由度低，19例工作时间长（连续3个月以上每天工作超过11小时，9例无休息日）。这些受试者符合国际疾病分类第10版（ICD - 10）标准的抑郁发作，并有自杀迹象。其中10人因不明躯体不适去看了全科医生，但未采取有效措施。他们均无精神科咨询史或接受过应对工作压力管理的心理健康教育。尽管本病例系列报告无法确定因果关系，但我们推测长时间工作、繁重工作量和低社会支持可能导致抑郁，进而引发自杀。迫切需要采取适当的应对措施，目前的研究结果提示了其中一些可行的措施。
