Seishin Shinkeigaku Zasshi. 2010;112(10):1037-47.
The number of persons in Japan visiting a medical institution for depression in 2009 exceeded one million, a fact that is attracting particular attention in the context of the more than 30000 completed suicides that take place in Japan every year. There has never been a time when it was more urgent to address issues related to healthcare for depression. While it is true that the consultation rate for mood disorders has been increasing annually, it is not known whether this reflects an actual increase in the incidence of mood disorders, or whether it is simply due to an increase in the number of people seeking treatment. An epidemiologic survey of this shift has not been conducted, and therefore accurate figures are not available, but a 2002 epidemiologic survey indicated that 74% of people experiencing a major depressive episode did not consult a physician. In order to promote "entry to treatment" for depression-i.e., early diagnosis and early treatment-it is necessary to enhance access to healthcare for those who have not consulted a physician. At the same time, if the number of people seeking to consult a physician for depression increases from where it currently stands, psychiatrists alone will not be able to handle the load. Cooperation with primary care physicians and treatment by psychologists will become inevitable. This article discusses what information psychiatrists should provide when seeking the cooperation of primary care physicians, and also looks at recent research trends related to objective indicators, with a focus on NIRS, which are expected to be great aids to diagnosis. Concerning "exit from depression," or the reintegration of patients into society, major corporations have traditionally been encouraged to establish schemes that are primarily supportive in nature, but over the past 10 years the Ministry of Health, Labour and Welfare has also been promoting other measures. One product of these efforts is the "2004 Manual on Workplace Reentry Support for Workers Returning from Leave Due to Mental Health Issues," which was issued in 2004. This manual was revised and improved in 2009, and highlights the significant issue of employees who have taken long leaves of absence, or who have left their jobs due to depression, not being accommodated upon their return to work. This paper therefore also introduces a number of recent systems that support workplace reentry.
2009年，日本前往医疗机构就诊抑郁症的人数超过了100万。在日本每年有超过3万例自杀事件发生的背景下，这一事实尤其引人关注。解决抑郁症医疗相关问题从未像现在这样紧迫。诚然，情绪障碍的咨询率一直在逐年上升，但尚不清楚这是反映了情绪障碍发病率的实际上升，还是仅仅因为寻求治疗的人数增加。尚未对这种变化进行流行病学调查，因此没有准确的数据，但2002年的一项流行病学调查表明，74%经历过重度抑郁发作的人没有咨询过医生。为了促进抑郁症的“就医治疗”，即早期诊断和早期治疗，有必要增加未咨询过医生的人获得医疗服务的机会。与此同时，如果寻求咨询抑郁症医生的人数从目前的水平增加，仅靠精神科医生将无法应对工作量。与初级保健医生的合作以及心理学家的治疗将变得不可避免。本文讨论了精神科医生在寻求初级保健医生合作时应提供哪些信息，还探讨了与客观指标相关的近期研究趋势，重点是近红外光谱（NIRS），预计它将对诊断有很大帮助。关于“摆脱抑郁症”，即患者重新融入社会，传统上鼓励大公司建立主要是支持性的计划，但在过去10年里，厚生劳动省也一直在推动其他措施。这些努力的一个成果是2004年发布的《2004年因心理健康问题请假后重返工作岗位的员工工作场所重返支持手册》。该手册在2009年进行了修订和完善，突出了长期休假或因抑郁症离职的员工重返工作岗位时得不到妥善安置这一重大问题。因此，本文还介绍了一些近期支持重返工作岗位的系统。
