[Study of U.S. regulations on determination of work-relatedness of mental health disturbance and cerebrovascular and cardiac diseases].

Recently, work-relatedness of mental health disturbance, cerebrovascular and ischemic heart diseases has been generously recognized in the determination of workers' compensation, in administrative or civil suits in Japan. Companies that operate overseas enterprises need to investigate legislature and court opinions in countries and regions in which they operate. In this study, we studied legislative materials concerning mental health, and cerebrovascular and cardiac diseases by reviewing official documents published on homepages provided by governmental and academic bodies in the United States. Our main findings are as follows: 1. In the United States, the state authorities have wide powers. The areas where federal employment statutes are directly applied are limited to the employment conditions of the federal government or some interstate commerce. However, almost all employers in every state are required to record and report occupational injuries and illnesses, based on which, nationwide statistics are maintained. 2. The occupational injury and illness recording criteria are clearly stated in the 2001 revision of Code of Federal Regulations(CFR). During the process of amendment, various opinions were raised concerning mental illnesses. In the final ruling, employers are required to record mental illnesses when "the employee voluntarily provides the employer with an opinion from appropriate health care providers stating that the employee has a mental illness that is work related" (29CFR1904.5(b)(2)(ix)). 3. No specific criteria were found concerning cerebrovascular and ischemic heart disorders, except for the statement that injury or illness is considered if an event or exposure in the work environment significantly aggravates a pre-existing injury or illness(29CFR1904.5(a)). 4. According to the safety and health statistics(2004), around 3,000 cases(0.3 cases per 10,000 full-time workers)of mental disorders were reported in private industry workplaces. On the other hand, less than 500 cases of cerebrovascular and ischemic heart disorders were recorded. In the U.S., where significant numbers of work related mental disorders are reported, the necessity of mental health programs in workplaces is emphasized by state governments. It seems to be necessary to take care not to perform actions which might be considered as disturbance of privacy or discrimination due to disability in carrying out management measures, reflecting peoples' attitudes and legislation concerning these items. Few cases of work related cerebrovascular or ischemic heart disorders are reported in the U.S. However, recently, a reference review was published and a conference was held on this problem. Therefore it might become topical in the near future.