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Purpose: Psychological violence and harassment have been reported to be associated with mental health problems and turnover intention among nurses. Cyberbullying, a hidden form of harassment using information and communication technology, is attracting attention as a factor that threatens the mental health of nurses. This study aimed to add coping characteristics, social support, and workplace social capital to psychological violence, harassment, and cyberbullying in female nurses and determine their association with depression and turnover intention., Participants and Methods: An anonymous, self-administered questionnaire survey was conducted, targeting 2,158 female nurses working in four domestic hospitals, excluding those in management positions. The analysis included 1,151 nurses who responded (valid response rate: 53.3%). Multiple regression analysis was performed with depression and turnover intention as dependent variables and psychological violence and harassment, cyberbullying, the brief scales for coping profile (BSCP) and social support scale scores, and social capital (SC) as independent variables., Results: Depression was positively correlated with psychological violence and harassment, cyberbullying, and the BSCP subscale "avoidance and suppression" and negatively correlated with the BSCP subscale "changing the point of view" and social support subscales "support from supervisors" and "support from co-workers." Turnover intention was positively correlated with psychological violence and harassment and the BSCP subscale "avoidance and suppression" and negatively correlated with the BSCP subscale "changing the point of view," social support subscale "support from supervisors," and vertical SC., Discussion and Conclusion: The results suggest that work environments should prevent psychological violence and harassment in nurses to promote a sense of security and eliminate mental health problems. Cyberbullying was inferred as a factor that could lead to mental health problems among nurses. Therefore, each nurse should raise their awareness of information literacy, besides attending more to their words and attitudes.

We developed the Interpersonal Sensitivity/Privileged Self Scale (IPS) to measure personality traits related to “modern-type depression,” and assessed its validity and reliability through three surveys completed by 804 undergraduates. Factors for validity were examined by confirmatory factor analysis. As predicted, the scale comprised two superordinate factors: interpersonal sensitivity (IS) and privileged self (PS). Criterion-related validity for the IPS scale was assessed by examining its relationship with depressive symptoms and typus melancholicus, and by comparing subscale scores regarding depression types (i.e., melancholic, atypical). All subscale scores were positively correlated with depressive symptoms. Correlations between typus melancholicus and subscales showed that the interpersonal sensitivity subscale was positively correlated with typus melancholicus, while the privileged self subscale was not correlated. An analysis of variance revealed that the “self-righteousness” score was significantly higher for the atypical depression group compared to the melancholic depression group. The test-retest correlation indicated good test-retest reliability for all subscales. Overall, the findings indicated that the IPS has high validity and reliability.

Objective　The present study aimed to explore the effects of sense of coherence (SOC) on depressive symptoms after employment in the Japan Self-Defense Force among male young adults.Methods　In April 2013, 953 new male members of the Japan Ground Self-Defense Force (JGSDF; age range: 18-24 years) participated in this study. Depressive symptoms were assessed using the 20-item version of the Center for Epidemiologic Studies Depression scale (CES-D), which defines a score of 16 or greater as indicating the presence of depressive symptoms. The SOC score was assessed using a 13-item version (SOC-13), in which a score of 59 or greater is as assigned to the high score group. A second survey was conducted two months later, in June of 2013. For the analysis, we selected participants without depressive symptoms at the baseline survey. The association between SOC scores at baseline and the onset of depressive symptoms was examined using a logistic regression analysis.Results　The final analysis was conducted on data on 389 new male members of the JGSDF. The logistic regression analysis showed a significant reduction in the onset of depressive symptoms among the group with high SOC scores (odds ratios: 0.59, 95% confidence interval=0.35-0.98) as compared with that observed in the group with low SOC scores.Conclusions　The present study clarified that SOC among male young adults has a buffering effect on the risk of developing depressive symptoms after employment in the Japan Self-Defense Force. Our results may be useful for improving the mental health of new employees.

Although research has indicated that dysfunctional attitudes (DA) and depressogenic inferential styles (DIS) lead to depression when negative life events occur, little is known about how these factors function when negative life events do not occur. This longitudinal study examined the hypotheses that DA and DIS at Time 1 would lead to positive life events at Time 2 (four weeks later) in the absence of, but not in the presence of, negative life events at Time 2. This study also examined whether the effects of DA and DIS on positive life events differ depending on initial levels of depression. Hierarchical regression analyses showed that in the prediction of positive events, interactions of DA and DIS with negative events and depression were not significant. The main effect of DA was significant and positive; the main effect of DIS was significant and negative. The results indicate that the effects of DA and DIS on positive events differ, and the effects do not depend on the frequency of negative events.

Objectives: The present study aimed to explore the structure of occupational health nurses' support for return-to-work to workers with depression., Methods: Semi-structured interviews were conducted with 10 occupational health nurses who support workers returning to work. Data were analyzed using the Modified Grounded Theory Approach., Results: The qualitatively analyzed data was grouped into 9 categories. The support for return-to-work was divided into 3 periods: (1) the first priority for recovery, (2) preparation for return-to-work, and (3) adaptation to work. There were indirect supports to workers such as "environmental arrangement for medical treatment," "connection," and "support form parties concerned about workers," and direct supports such as "readiness for medical treatment," "overcoming social and psychological problems," and "working life independence. " Direct support was facilitated by "construction of the relationship. " The occupational health nurses' philosophy was to support "profitable return-to-work for both the worker and the employer. " These processes were "support of confidence recovery process " to regain confidence lost through absence from work because of depression and to accomplish a smooth return-to-work., Discussion: There were problems in each period corresponding to the return-to-work conditions, and occupational health nurses supported the employees in overcoming each problem. Moreover, it was said that cooperation with the parties concerned in the office would greatly influence the success or failure in the return-to-work support, and it was thought that direct supports and indirect supports to employees with respect to adjustment with the parties concerned in the office were necessary., Conclusions: The structure of occupational health nurses' supports was to support the confidence recovery process of workers by indirect and direct support at each period of return-to-work.

This study aimed to investigate the relations between CERQ and depression, and anxiety and also aimed to reveal the characteristics of a Japanese sample through meta-analysis. The results showed that self-blame, acceptance, rumination, catastrophizing, and blaming others had significantly positive correlations with both depression and anxiety, whereas positive refocusing, refocus on planning, positive reappraisal, and putting into perspective had significantly negative correlations with both variables. Moreover, when comparing the correlation coefficients of the Japanese samples and the combined value, correlations between depression and positive reappraisal were significantly larger than the combined value. On the other hand, regarding the correlation coefficients of depression and putting into perspective, the combined value was larger than the value of Japanese samples. In addition, compared to the combined value, the Japanese sample's positive correlation between anxiety and rumination, and negative correlation between anxiety and positive reappraisal were larger.

Bereavement may become the most severe stressor in the lives of bereaved families, and it has a variety of influences on their psychological and physical aspects. Physical effects include worsening of physical conditions and an increase in the mortality, and psychological ones include increases in the suicide rate and morbidity of depression. Bereavement also has a social influence, such as causing changes in relationships. Therefore, it is necessary to provide bereaved families requiring support with appropriate intervention. Since bereaved families experience various types of distress, assessment of grief-related problems alone is inadequate. It is essential to assess the psychological, physical, social, and other aspects of bereaved families. Intervention can be expressed using the concept of postvention. There are various types of intervention : from care provided by non-specialists to psychiatric treatment provided by mental care specialists. Although bereavement is the strongest risk factor for depression, depressive symptoms following bereavement are often overlooked. Therefore, it is necessary to pay attention to such depression. Support is provided by not only health care professionals but also the general public in society, and it is essential to obtain knowledge of bereavement care in society. It should be noted that support not based on established knowledge may have an adverse effect on bereaved families (unhelpful support).

In Japan, cancer has been the leading cause of death since 1981 and is the most common and representative life-threatening disease. Cancer treatment has markedly progressed, and so the development of cancer is now not necessarily a death sentence. Nevertheless, approximately half of cancer patients actually die as a result of the disease even today. Cancer causes marked suffering of patients. Patients with advanced and/or terminal cancer suffer from various physical symptoms and are forced to face a continuous decline in their physical function, and previous studies reported that psychological distress is frequently observed in cancer patients, especially in advanced and/or terminally ill patients. Several types of psychological defense mechanism, especially denial, are frequently observed in these patients. There are multiple levels of denial For example, a patient with true denial denies the presence of cancer itself, although true denial is quite rare. A patient with moderate denial is likely to deny an association between distressing symptoms and disease, while one with mild denial denies the life-threatening nature of disease. Denial is a psychological defense mechanism that often helps advanced cancer patients to manage their anxiety and depression. It allows such patients to continue living while facing the painfulness of their situation. In this situation, it is important for therapists to note the patient's denial. Simply being aware of the denial can, in itself, be supportive for the patient. However, when denial does not work adaptively, such as it prohibiting adherence to necessary treatment and not being useful for ameliorating psychological distress and improving the quality of life, medical staff may consider confronting a patient with the reality of the situation carefully. This paper discusses the relevance of acknowledging denial and caring for patients with denial from the point of view of psycho-oncology.

Objectives: Mental disorders are increasing and their influence on productivity is a concern in the workplace. However, few studies have investigated depression among blue-collar and white-collar workers in the manufacturing industry. The purpose of this study was to clarify the factors associated with depressive symptoms, focusing on lifestyles and insomnia., Methods: A self-administered questionnaire survey was conducted of 1,963 workers at an annual health checkup in a manufacturing company. Of the 1,712 respondents (response rate: 87%), 1,258 male worker subjects (blue-collar 674; white-collar 584) were analyzed after excluding those with mental diseases. The questionnaire included items on basic attributes and lifestyle. The Athens Insomnia Scale (AIS) and The Center for Epidemiologic Studies for Depression Scale (CES-D) were used to evaluate insomnia and depressive symptoms., Results: The incidence of depressive symptoms with CES-D scores of ≥16 was 15.1% in both the blue-collar and the white-collar workers. Insomnia with AIS scores of ≥6 were encountered in 18.8% of the blue-collar workers and 18.3% of the white-collar workers. Multiple logistic regression analyses showed that for the blue-collar workers, depressive symptoms were associated with "AIS scores ≥6" (Odds ratio (OR): 10.93; 95% confidence interval (CI): 6.12-19.15), "not get rid of fatigue with sleep" (OR: 3.36; 95%CI: 1.85-6.09), "skip breakfast over 3 times a week" (OR: 3.10; 95%CI:1.42-6.76), "no family living together" (OR: 2.08; 95%CI: 1.05-4.12), and "commuting time" (OR: 1.01; 95%CI: 1.00-1.02). For the white-collar workers, depressive symptoms were related to "AIS scores ≥6" (OR: 14.91; 95%CI: 7.54-29.49), and "no family living together" (OR: 2.54; 95%CI: 1.27-5.09). Sleep time was not associated with depression in both blue- and white-collar workers. Depressive symptoms were found in 51.6% of the blue-collar workers with insomnia with AIS scores ≥6 and 53.8% of white-collar workers., Conclusions: Depressive symptoms were found at the same prevalence rate in both blue-collar and white-collar workers, which suggests that health measures for depression are necessary for both types of worker. Depressive symptoms were significantly associated with insomnia. Health advice focusing on insomnia as well as lifestyle may be important for workers.

In recent years, psychiatrists in Japan have increasingly participated in palliative care teams. In this study, reasons why psychiatrists face difficulties when treating dying patients and their family members are discussed and some solutions are suggested. With respect to diagnosis, psychiatrists often hesitate to follow a normal psychological process in an effort to adhere to their specialty and do not consider subjective components in a patient's statement in the objective methodology of psychiatric diagnosis. In addition, many psychiatrists are unfamiliar with denial in the terminal phase or the desire for hastened death and are puzzled by how the psychic phenomena of dying patients are indistinguishable from physical symptoms. Family members of dying patients may hesitate to seek psychological treatment because they feel guilty about receiving such care. Moreover, recent changes in the diagnostic criteria of depression due to grief may be confusing to psychiatrists. From a therapeutic perspective, difficulties in diagnoses directly lead to therapeutic predicaments, and depression in the terminal phase is difficult to treat because antidepressant medications are not effective. To overcome such difficulties, I suggest that psychiatrists should also carefully consider patients' physical symptoms, reinforce categorical diagnoses with a subjective understanding, and deepen their understanding of spiritual pains.

Psychiatry regarding pregnancy, childbirth, and child-rearing is changing rapidly. In this paper, the meaning of the paradigm shift from postnantal to perinatal depression along with the changing treatment are discussed. Since the late 20 century, several large-scale epidemiological surveys on the incidence and outcomes of postnatal depression have concluded not only that postpartum depression is likely to occur at a high frequency, such as 10-15%, but that the subsequent maternal mortality rate as the number of deaths from suicide is higher than deaths due to obstetric medical conditions. Additionally, evidence of the negative impact of a mother's depression on the physical and mental development of children has been accumulated as well. Several studies regarding depression during pregnancy, such as on the relatively high frequency of prenatal depression or negative consequence of interrupted pharmacological treatment, should also be highlighted. These movements seemed to reflect the change in special attributes of depressive disorders and bipolar disorders, in that the term perinatal onset came to be preferred instead of postnatal, used in DSM-IV. Comprehensive treatment guidelines for depression applicable for all women with the potential for pregnancy, delivery, and lactation are needed as the next step.

The aim of this study was to investigate the link between response styles and depression in university students. Ninety-two university students participated in a questionnaire survey, withi a follows-up survey administered 4 weeks later. Structural equation modeling was conducted with analysis of moment structures. The model describing the causal relation from response style to depression fit the data best. These results indicate that the likelihood of future depression is increased by negative rumination response and decreased by distraction response for mood changing.

The present study focused on the discrepancy between explicit self-esteem and implicit self-esteem, using the Name Letter Task with 86 graduate students. In line with suggestions from previous research, participants high in explicit self-esteem but low implicit self-esteem (called "defensive high self-esteem") showed higher in-group favoritism than participants who had high explicit and implicit self-esteem (called "secure high self-esteem"). Participants with defensive self-esteem reported higher levels of depression than secure self-esteem participants. These results strengthen the generalizability for the conceptualizations of "defensive" and "secure" high self-esteem. However, participants with low self-esteem did not show significant interactions with any variables.

This study examined gender differences for two measures of mental health as related to the quality of the marital relationship. Middle-aged respondents (221 female; 210 male) rated their marital satisfaction, affection, and communication. They also rated their psychological well-being and depression. The correlations between marital quality and mental health indicated that for males marital quality was more strongly associated with psychological well-being than with depression. Females showed no such difference, or their marital quality was associated with depression. This implies that for females, depression was a more sensitive measure of their mental health related to their husband-wife relationship. On the other hand, for males subjective well-being which was correlated with self-esteem was a more sensitive measure of their mental health.

While suicides in Japan decreased slightly to about 28,000 in 2012, there were still nearly 30,000 suicides, many of which suffered from mental illness, such as depression. Suicide among the working age society is reduced somewhat in the 50s, and a major issue relates to suicide prevention measures for young people less than 30-years old. Previous studies have shown that depression is closely related with the duration of sleep deprivation. Furthermore, we have shown a significant correlation with insomnia, depression, fatigue, and chronic pain, i.e., lifestyle-related diseases. We are attempting to establish a method for early detection of depression based upon an interview regarding the sleep of workers, and plan to apply this prophylaxis method to occupational health practice.

Patients who take prescription drugs are thought to feel both "anxiety" and "expectations" surrounding medication use. Anxiety is felt regarding medication effectiveness, side effects, and potential dependency, and is believed to impact medication adherence, which declines to less than 50% after six months. A good therapeutic relationship between patients and physicians, which allows discussion of such topics as side effects, or the duration of ongoing medication use, is required to relieve patient anxiety, but doctor-patient communication usually does not meet patients' expectations: A discrepancy exists between what clinicians report they communicate to patients, and patients' perceptions of what they were told. At the same time, patients also maintain positive expectations for change induced by pharmacotherapy. These expectations can be inferred to be closely related to the placebo effect, which is reported to account for 30% of overall therapeutic effect. However, at the beginning of treatment, few patients are seeking pharmacotherapy; rather, they hope to share their worries with physicians, or talk about the difficulties of their illness with therapists. Physicians must therefore work to understand patients' treatment preferences, and should make initial treatment decisions only after sharing information and thoroughly consulting with patients.

Aim: When clinicians follow today's diagnostic trend which gives priority to mood disorders, they risk overlooking mild manifestations of schizophrenia-like symptoms. This study was aimed at investigating clinical features of patients with a prolonged depressive state for years, showing minute schizophrenia-like symptoms without any full-fledged psychotic symptoms., Method: The subjects were 170 male inpatients with depression or a depressive state who were admitted to Kyorin University Hospital between April 200X and March 200X + 3. One of the reasons for their admission was to make a differential diagnosis. The diagnoses of fifteen patients (mean age at onset: 29.5 +/- 8.5 years, and mean age at their first visit to a psychiatrist: 34.3 +/- 10.0 years), who had been diagnosed with depression and treated with various kinds of antidepressants for years (mean period: 4.9 +/- 3.4 years) were changed to persistent depression with minute schizophrenia-like symptoms according to "pluridimensional assessment," which takes the following factors into consideration: a premorbid character, predicting situations or life events, clinical features, psychological tests, reactions to treatment, and the course and social outcome. The psychopathology of these fifteen patients was closely investigated., Results: The investigation revealed that: 1) All patients had a premorbid "schizoid tendency", which was defined as more than two of three character markers of "Schizothymie", described by E. Kretschmer. 2) Most of the patients clinically manifested after low-level psychosocial stress had activated hypersensitivity to the surroundings. 3) In addition to depressive symptoms delineated in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), clinical features included repeated physical complaints, which were poorly explained, suicidal behaviors without any understandable conflicts, unexpected arrogant attitudes toward medical staff and other patients, and superficial, simplistic, and monotonous speech and odd thoughts. They were regarded as minute symptoms of schizophrenia, which should not be overlooked. 4) They showed clear evidence of severe cognitive impairment in the Wechsler Adult Intelligence Scale third edition (WAIS-III) and in the Landscape Montage Technique (LMT). The results of these psychological tests, which should be assessed as reference materials in a clinical diagnosis, were low and bizarre when their premorbid social functioning was considered, which may be concordant with their latest defective social functioning. 5) Pharmacotherapy involving any kind of antidepressant had not been effective, and, in some patients switching to or adding antipsychotic drugs effectively reduced their minute schizophrenia-like symptoms, hypersensitivity, and loss of motivation. 6) Two patients committed suicide, three were demoted from regular to contractual employment, and the others are now undergoing rehabilitation together with schizophrenic patients in regional day-care and occupational therapy centers., Conclusions: Clinicians should explore the possibility that manifested mood changes conceal minute schizophrenia-like symptoms. Such patients should be pluridimensionally assessed. Therapeutic strategies for schizophrenic patients may be more appropriate for the patients investigated in this study.

This study investigated the effects of rumination (reflective pondering and brooding) on automatic thoughts (both negative and positive) and depressive symptoms. University students (N=183; 96 men) completed the Self-Rating Depression Scale (SDS), Automatic Thoughts Questionnaire-Revised (ATQ-R), and Response Style Scale (RSS). We conducted a path analysis which included gender as a factor. The results revealed that brooding was associated with negative automatic thoughts. Negative automatic thoughts contributed to the aggravation of depressive symptoms. In contrast, reflective pondering was associated with positive automatic thoughts. Positive automatic thoughts contributed to the reduction of depressive symptoms. These results indicate that rumination does not affect depressive symptoms directly. We suggest that rumination affects depressive symptoms indirectly through automatic thoughts, and that there are gender differences in the influence process.

The present study examines the relationship among inattentive, and hyperactive-impulsive behavior, aggression, and depression in elementary school and junior high school students. The participants were 3,885 children and their teachers and caregivers. Children's inattentive and hyperactive-impulsive behavior was rated by their teachers and caregivers (ADHD-RS). Children rated aggression (HAQ-C) and depression (DSRS-C) themselves. Inattentive and hyperactive-impulsive behavior rated by teachers and caregivers were positively related to aggression and depression. Inattention predicted higher levels of aggression and depression. Inattentive and hyperactive-impulsive behavior as rated by teachers was more highly related to depression than those behaviors as rated by caregivers. The relationships among inattentive, and hyperactive-impulsive behavior, aggression, and depression were almost the same for both elementary school and junior high school students. This study suggests the importance of assessing inattentive and hyperactive-impulsive behavior from multiple views to examine the relationship between inattentive and hyperactive-impulsive behavior and mental health problems.

Sleep disorders are serious issues in modern society. There has been marked scientific interest in sleep for a century, with the discoveries of the electrical activity of the brain (EEG), sleep-wake system, rapid eye movement (REM) sleep, and circadian rhythm system. Additionally, the advent of video-polysomnography in clinical research has revealed some of the consequences of disrupted sleep and sleep deprivation in psychiatric disorders. Decades of clinical research have demonstrated that sleep disorders are intimately tied to not only physical disease (e. g., lifestyle-related disease) but psychiatric illness. According to The International Classification of Sleep Disorders (2005), sleep disorders are classified into 8 major categories: 1) insomnia, 2) sleep-related breathing disorders, 3) hypersomnias of central origin, 4) circadian rhythm sleep disorders, 5) parasomnias, 6) sleep-related movement disorders, 7) isolated symptoms, and 8) other sleep disorders. Several sleep disorders, including obstructive sleep apnea syndrome, restless legs syndrome, periodic limb movement disorder, sleepwalking, REM sleep behavior disorder, and narcolepsy, may be comorbid or possibly mimic numerous psychiatric disorders, and can even occur due to psychiatric pharmacotherapy. Moreover, sleep disorders may exacerbate underlying psychiatric disorders when left untreated. Therefore, psychiatrists should pay attention to the intimate relationship between sleep disorders and psychiatric symptoms. Sleep psychiatry is an academic field focusing on interrelations between sleep medicine and psychiatry. This mini-review summarizes recent findings in sleep psychiatry. Future research on the bidirectional relation between sleep disturbance and psychiatric symptoms will shed light on the pathophysiological view of psychiatric disorders and sleep disorders.

Cognitive behavior therapy (CBT) is a structured short-term therapy designed to change the patient's negatively distorted cognition. The effectiveness of cognitive therapy/cognitive behavior therapy has been increasingly recognized not only by professionals and academics but also by the public, and in April, 2010, this therapy started to be covered by the national health insurance in Japan. In this article, the author described the high-intensity and low-intensity CBT from the practical point of view.

In Alzheimer's disease (AD) patients, depression is not rare. The prevalence of major depressive episodes has been reported to be within the range of 20-25% in AD patients, despite there being no association between the severity of AD and prevalence of comorbid depressive symptoms or diagnosed depression. Depression in AD patients is associated with greater impairment of the quality of life and an increased caregiver burden. As well as earlier placement in a nursing home, bio-psycho-social factors are also associated with the manifestation of depression in AD patients, and biological factors, such as the brain pathology, may be the main influence. Depressive mood, loss of interest, and anxiety are among the most marked symptoms of depression in AD patients. In comparison with major depressive disorder, in depression in AD, psychomotor retardation is more prominent, while, in major depressive disorder, somatic anxiety is more marked. In the treatment of depression in AD, non-pharmacological and pharmacological therapies are applied. Basically, support and encouragement are required. In addition, psychosocial interventions, such as validation, reminiscence, physical exercise, and interventions for caregivers of those with dementia have been reported to be useful. The results of RCT with antidepressants are inconsistent. As the efficacy of cholinesterase inhibitor for depression in AD has been reported, it is reasonable to initially provide treatment with cholinesterase inhibitors rather than antidepressant therapy.

Guidelines for the diagnosis of reading disorders in elementary school students were published recently in Japan. On the basis of these guidelines, we administrated reading test batteries to 43 Japanese junior high-school students from grade two. The reading test consisted of single sounds, single words, and single sentences. We evaluated the reading speed and the number of reading errors made by the test takers; their performance was compared with the normal value for elementary school students in grade six, as stated in the guidelines. The reading ability of the junior high-school students was not higher than that of the elementary school students. Seven students (16.3%) were found to have reading difficulties (RD group) and they met the criterion for diagnosis of reading disorder as per the guidelines. Three students had difficulties in reading single sounds and single words, but they faced no problems when reading single sentences. It was supposed that the strategies used by the students for reading sentences may have differed from those used for reading single sounds or single words. No significant differences were found between the RD and non-RD group students on scores of scholastic self-evaluation, self-esteem, and depressive symptoms. Therefore, reading difficulty did not directly influence the level of self-evaluation or depression.

A. T. Beck's cognitive model of depression posits that depressogenic schemata contribute to developing depression after stressful events occur. However, depressogenic schemata are considered to enhance the perception per se of the occurrence of stressful events. In particular, depressogenic schemata are considered to make objectively nonnegative (neutral) events stressful (i.e., generate subjective stress) through arbitrary inference, thereby contributing to developing depression. The purpose of this study was to test the hypothesis that interpersonal depressogenic schemata generate subjective interpersonal stress, thereby contributing to developing depressive symptoms. This study employed a cross-sectional design with college students (N=199; 152 females). The results of path analyses supported the hypothesis. Implications for A. T. Beck's model and C. Hammen's stress generation model were discussed.

This study examined the effect of humor coping with interpersonal stress on the relationship between cynical hostility, conscious defensiveness, and depression. University students (N = 375; 214 men and 161 women) participated in a questionnaire survey. The results of hierarchical multiple regression analyses by sex showed that humor coping with interpersonal stress alleviated the detrimental influence of cynical hostility on depression only for men with low conscious defensiveness. For women, humor coping with interpersonal stress played a role in alleviating depression independently of hostility and conscious defensiveness. These findings suggest that there are differences between men and women in the role of humor coping with interpersonal stress in affecting depression. Methodological limitations of the present study are discussed, along with possible improvements for future studies.

Consciousness about climacteric and menopausal symptoms in relationship to menopausal stage and mental health was investigated. Midlife women (N = 407, 40-60 years old) were asked about their menstrual status, consciousness of climacteric and menopausal symptoms, self-esteem and depression. Based on their menstrual status, 222 participants were divided into three groups (pre-menopause, peri-menopause, and post-menopause). The main results are as follows. Women who were pre-menopausal had a negative consciousness about menopause, which contributed negatively to their self-esteem. Women who were perimenopausal or post-menopausal had more symptoms, which contributed negatively to their mental health. These results indicate that middle-aged women should be provided with interventions focusing on their menopausal status.

Objective: The present study examined the buffering effect of social support in the workplace on job strain and depressive symptoms by conducting a cross-sectional survey using a self-report., Methods: The subjects were 712 employees (male, over 40 yr old) who worked at a precision machine factory. The questionnaire determined the subjects, ages, types of occupation, scores of depressive symptoms, job strain (job demand and job control), and social support (supervisor support and coworker support). Job strain and social support were evaluated by the Job Content Questionnaire (JCQ). The Center for Epidemiologic Studies Depression Scale (CES-D) score was measured and depressive symptoms were defined as a CES-D score > or = 16 point. Job strain and social support were calculated and divided into low-score groups (LG) and high-score groups (HG), respectively, by the median value. The mean values of CES-D in the LG and HG of job strain or social support were compared by the t-test. The hierarchical multiple regression was analyzed with the CES-D score as the dependent variable and by the characteristics of the participants, job strain and social support, and the cross-product interaction term of job strain and social support as independent variables. The effect of the degree of social support in the LG and HG of job strain on the CES-D score was evaluated by analysis of covariance adjusted for age., Results: The results showed that 23.2% of the workers had depressive symptoms, and that, the CES-D scores in the job demand group were significantly higher in HG than in LG. The CES-D scores in the job control, supervisor support, and coworker support groups were significantly higher in LG than in HG. The hierarchical multiple regression analysis showed that job demand, job control, supervisor support, and coworker support had significant main effects on the CES-D score. Furthermore, it was shown that there was a significant interaction in the CES-D score between job control and supervisor support, and that, the CES-D score in the supervisor support group was significantly higher in LG than that in HG only when job control was low., Conclusions: These results suggest that supervisor support may have the effect of buffering depressive symptoms related to low job control.

The clinical features, course and outcome of mood disorders in childhood and adolescence are discussed. The most specific symptoms of major depressive disorder in childhood and adolescence are irritability, social withdrawal, and comorbidity. Depression is a chronic and recurrent condition. The course of child onset depression resembles those with conduct disorder much more than those with mood disorders, without an increased risk for recurrence of depression into adult life. On the other hand, adolescent onset depression has a high risk of recurrent mood disorder into adulthood.

This report describes and compares four current concepts and definitions of atypical depression. Since its emergence, atypical depression has been considered a depressive state that can be relieved by MAO inhibitors. Davidson classified the symptomatic features of atypical depression into type A, which is predominated by anxiety symptoms, and type V, which is represented by atypical vegetative symptoms, such as hyperphagia, weight gain, oversleeping, and increased sexual drive. Features that are shared by both subtypes include: early onset, female predominance, outpatient predominance, mildness, few suicide attempts, nonbipolarity, nonendogeneity, and few psychomotor changes. Based on these features, bipolar depression can also be defined as atypical depression type V. Herein, we examine and classify four concepts of atypical depression according to the endogenous-nonendogenous (melancholic-nonmelancholic) and unipolar-bipolar dichotomies. The Columbia University group (see Quitkin, Stewart, McGrath, Klein et al.) and the New South Wales University group (see Parker) consider atypical depression to be chronic, mild, nonendogenous (nonmelancholic), unipolar depression. The former group postulates that mood reactivity is necessary, while the latter asserts the structural priority of anxiety symptoms over mood symptoms and the significance of interpersonal rejection sensitivity. For the Columbia group, the significance of mood reactivity reflects the theory that mood nonreactivity is the essential symptom of "endogenomorphic depression", which was proposed by Klein as typical depression. Thus, mood reactivity is not related to overreactivity or hyperactivity, which are often observed in atypical depressives. However, Parker postulates that psychomotor symptoms are the essential features of melancholia, which he recognizes as typical depression; therefore, the New South Wales group does not recognize the significance of mood reactivity. The New South Wales group accepts the relationship between anxiety symptoms and interpersonal rejection sensitivity, while the Columbia group does not recognize the importance of anxiety symptoms because they could not identify a relationship between such symptoms and the efficacy of MAO inhibitors. The concept of atypical depression proposed by the New South Wales group overlaps considerably with that of hysteroid dysphoria, which was proposed by Klein et al., and was the progenitor of Columbia group's concept of atypical depression. The Pittsburgh University group (see Himmelhoch, Kupfer, Thase et al.) and the soft bipolar spectrum group (see Akiskal, Perugi, Benazzi et al.) regard atypical depression as a depressive state that can be observed in bipolar disorder. The former groups takes into account reversed vegetative symptoms and lethargy as signs of bipolar disorder, while the latter recognizes that atypical depression shares features with bipolar II disorder or soft bipolar spectrum disorder. The soft bipolar spectrum group maintains their unique concept of bipolar disorder, which regards some unipolar depressions as bipolar disorder, while the Pittsburg group continues to share the conventional concept of a unipolar-bipolar dichotomy with other groups. The fundamental pattern of atypical depression is represented by chronic mild depressions, which are characterized by a younger age at onset, female predominance, interpersonal rejection sensitivity, and mood lability, which are difficult to distinguish from a characterological pathology. Patients who present with such patterns are frequently diagnosed with borderline, histrionic, or avoidant personality disorders; therefore, we must recognize the significance of atypical depression as a concept that can suggest the utility of medication for these patients. For such patients, however, various groups have proposed different kinds of definition and therapeutic guidelines that are difficult to synthesize and utilize in clinical settings. Moreover, some features of atypical depression outlined in the Columbia University criteria, such as a younger age at onset, chronicity, mildness, and female predominance, were excluded from DSM-IV. Consequently, the concept of atypical depression has become overextended and gradually lost its construct validity. Therefore, the diagnostic criteria for atypical depression should be reconsidered in reference to various definitions and concepts and refined through accumulated clinical research.

Why are patients with depression so disappointed with their psychiatric treatment? One of the causes of their disappointment is a 'bogus contract' (Smith, 2001) between patients and psychiatrists. Patients tend to idealize modern psychiatry as if it could solve many of their problems, including social ones. Psychiatrists, however, know that modern psychiatry has limited powers and that they cannot solve all problems, especially social ones. There is a huge mismatch between what psychiatrists are trained for and what they are required to do. In fact, the biological model of depression is inadequate to help depressive patients, particularly patients with psycho-social problems. It has long been believed that antidepressant medications represent the best established treatment for major depressive disorder. Recent meta-analyses (Kirsch et al., 2008; Fournier et al., 2010), however, found little evidence that anti-depressants have a specific pharmacological effect relative to a pill placebo for patients with mild or moderate symptoms. This may be owing partly to the fact that depression is associated with ineluctable life events like separation, interpersonal conflicts, unexpected adversities, etc., that are central to being human. Both patients and psychiatrists should be aware of the limitations of psychiatric treatment. A more realistic relationship is required between patients and psychiatrists. Psychiatrists should be open about their limitations. Patients cannot leave social problems to psychiatrists. However, some chronically depressed patients may be capable of managing their social problems. In such cases, respecting patients' autonomy promotes clinical practice and prevents them from entering a state of chronic patienthood.

Purpose: In Japan, mental health problems due to work stress among white-collar workers have become an important topic which needs to be addressed. As for the support for workers who are returning to work after sick leave, reliable findings have not yet been reported. The purpose of the present study was to obtain findings concerning support for workers who are returning to work after sick leave., Method: We analyzed cases studies of white-collar workers between Jan. 1983 and May 2009., Results: We identified 9 types of support; sick leave, change of work place, change of boss, change of work, decreasing work load, introduction of a decreased work load period, limiting work, consultation with corporate health care staff, and intervention by a party other than the company., Discussion: Generally speaking, it has been revealed that each support has both positive and negative influences upon employees returning to work. In addition, consulting with corporate health care staff (p<0.01) showed significantly higher rates of no relapse into depression than in the absence of such consulting. However, this finding might be accompanied with a problem of potential bias with respect to published articles, and the relationship between health care professionals (i.e., physicians, occupational nurses, counselors, etc.) and a depressive worker. In addition, the content and date of a company's support for a worker returning to work might vary significantly. Thus, we need to be very careful in interpreting these findings.

Research has reported that depressed individuals often experience intrusive thoughts during thought suppression. We examined whether the use of an attention focusing strategy was associated with the high frequency of intrusive thoughts in depressed individuals. Thirty-two participants were asked (a) to suppress their thoughts about negative targets, (b) to suppress the same thoughts and perform a memory task at the same time, and (c) to think about anything they like. The results showed that in the suppression with memory task condition, depressed individuals did not focus their attention on the memory task, and experienced more intrusive thoughts than non-depressed individuals. These results suggest that the non-use of an attention focusing strategy is associated with a high frequency of intrusive thoughts in depressed individuals. Implications for cognitive behavioral therapy for depressed individuals are discussed.

This study investigated self-worth as a mediator between socio-environmental experiences and depression. A sample of 255 fifth and sixth grade students completed self-report questionnaires assessing self-worth, depression, and socio-environmental experiences of social support and stressors. Data for both males and females showed a direct effect of "friend support" on depression. However, for males, but not females, self-worth also mediated the influence of "friend support" on depression.

Recently, it has been suggested that depressive patients with avoidance tendency are increasing in number. They are inclined to become depressed under specific stressful circumstances, for example, in their workplace. They also show such features as being able to enjoy private activities, to show an almost normal vegetative function, and to blame others or circumstances, etc. Although their symptoms are mild in general, they tend to be prolonged and make it difficult for the patients to return to work. In this article, we report a male middle manager who presented mild depression with avoidance tendency. We tried to reduce his excessive workload, and, at the same time, to keep him going to work. As a result, the rhythm of his daily activities became stable, and work reinstatement was successful. Matussek says that the self has two aspects: the 'private self' and the 'official self'. For depressive patients, the private self is more important, but in public, they tend to do what others want them to. Such behavior with the public self conflicting against the private self makes them exhausted. This is common to the avoidance type of depression, and a typical major depression. The main difference between them is that the orderliness which patients show their behavior, that is, the basic character of the public self, is weak in the former and strong in the latter. In therapy for the avoidance type of depression, it is necessary to both reduce the excessive workload of patients and help them to continually relate to their workplaces, considering the degree of orderliness of their personality.

Recently, numerous brain imaging studies have been performed to clarify the pathophysiology of depression. These studies suggest that the neural network, physiological function, and their interaction are related to the development of depressive symptoms. In this article, we present our neuroimaging studies employing functional magnetic resonance imaging (fMRI) and magnetoencephalography (MEG) on the functional basis of depression involving the brain. At first, because of the influence of stressful life events on depression, sex differences in the cognition of psychosocial stressors, the change in the sensory gating system under stressful conditions, and the mechanism of psychological ways to adapt to stressful events were examined. The results revealed the importance of prefrontal cortex (PFC) function in stress regulation. Next, some important changes in the PFC were shown in depression using well-known neuropsychological tasks and originally created tasks related to depressive symptoms. Moreover, these changes in the brain might be a possible biological marker of the treatment response and functional recovery. Then, we focused on the neurophysiological role of serotonin in higher cognitive function in the human brain. It was found that serotonin differentially regulated reward-predictive activities at different time scales in the striatum-PFC network. Finally, the brain mechanism of cognitive behavioral therapy (CBT) was examined. Brain activation in the PFC and functional connectivity between the PFC and amygdala on receiving negative emotional stimuli were weakened after CBT. From these findings, the functional basis of the pathophysiology of depression in the brain was discussed.

We report the case of a female in her 40s diagnosed with depression. She was raised by an eccentric father, suspected of having pervasive developmental disorder, and a dominant mother. After graduating from high school, she worked as a clerk in a company for twenty years or so; however, a change in her work environment made her fall into a depressive state. Her worsening depression caused her impulsive resignation and disappearance for about four months. She spent the duration of her disappearance traveling the country, with no dissociative episodes. After returning, she received treatment for depression as an inpatient for about four months. During the first month of hospitalization, she mainly complained of a depressive mood and anxiety over the prognosis of her disorder, while she made scarcely any progress in introspection. In the second month, she gradually advanced with introspective work, but, as her introspection progressed, her depressive mood became aggravated. The therapist avoided intervention to modify her cognition, and told her the following: "it is better not to persist in managing your depressive mood itself because curing depression does not mean resolving the superficial depressive mood, but to achieve a condition not directly influenced by mood." Then, at the beginning of the third month, she became aware of "the presence of God" and, at the same time, her depressive mood greatly improved. She extended her sympathy to her mother with her unfortunate life history, and expected her mother to change as she herself had experienced, but, disappointed by her mother, she experienced anxiety attacks and came to realize her own internal rage against significant persons in her life including her mother. After "the Great being" experience, she, who had formerly attended Christian church for a short time, started to read the Bible, but she still hesitated about committing herself to "religious following." One day during the last month of hospitalization, as she prayed to God for healing when she read a part in the Bible about a woman suffering from a hemorrhage for twelve years who touched the hem of Jesus' garment and was healed immediately (Matthew 9:20-22 and Luke 8:43-48), the patient suddenly experienced "the salvation of God" and realized what trust really meant. Through the experience, her clinical problems became totally cured, and the therapy concluded with her discharge from hospital. Several months later, she sent the therapist a letter including the following message: "I am grateful to the Lord for salvation from anxiety and irritation, but to the therapist for helping me realize it." This clinical course can be understood based on the patient's clinical problems (e.g., despair, anxiety, and depression), arising from the breakdown of her efforts to maintain stability by founding her psychological base on her feelings of omnipotence, avoiding facing her internal negative psychological factors (e.g., rage), and these were automatically resolved when her psychological base was switched to the transcendent level through "the Great being" experience and "the salvation of God." Such a sudden, marked improvement resembles what Miller and C'de Baca reported as "quantum change," of which the characteristics are vividness, surprise, benevolence, and permanence. The therapist paid attention to maintain a constant psychological distance from the patient, not persisting in modifying her cognition, with the transcendent level being the basis for the entire therapy. This stance of the therapist itself was considered to prompt her transcendence and bring about her eventual cure. This clinical course seemed to be highly suggestive of a psychotherapeutic mechanism, indicating the close relationship between the transcendent level and basic trust.

The incidence of depression is higher than that of dementia in the elderly. Unlike depression in other age groups, that in the elderly is characterized by frequent physical complaints, irritation, and delusional tendencies. The treatment of depression in the elderly requires the complex incorporation of psychiatric and gerontological viewpoints. Psychiatrically, difficulty in accepting decreases in psychological and physical functions and solitude is important, as a psychological characteristic, inducing the development of depression. Biochemically, there is an underlying decrease in the function of brain monoaminergic nerve activated, such as by serotonin and noradrenalin. Radiologically, damage to the cerebral white matter and a decrease in the frontal lobe function have been frequently reported. Depression is difficult to differentiate from dementia and is also often complicated by dementia. Since a depressive state often precede Alzheimer's disease, evaluation of cognitive function is also necessary in patients with a depressive state. Although apathy is often observed as a symptom of dementia and tends to be confused with a depressive symptom, caution is necessary because of differences in the treatment method. Gerontologically, depression is one of geriatric syndrome and isa frequently observed in the elderly in the later stage and closely associated with a decrease in activities of daily life. Depression is also closely associated with lifestyle-related diseases, and its incidence is high in the presence of cerebrovascular disease, ischemic heart disease, hypertension, and diabetes mellitus, and conversely, depression is often complicated by lifestyle-related disease. Anxiety and depression are frequently observed in the frail elderly, but few studies on the assessment and appropriate approach for psychological matters. Further studies are necessary. The treatment of depression in the elderly could be classified into 3 stages. In the acute stage, the treatment method is the same as that in other age groups, mainly consisting of physical and psychological rest and medication. The drug of first choice is a selective serotonin re-uptake inhibitors (SSRI). In intractable cases, electroconvulsive therapy (ECT) is recommended. In the chronic stage, the prevention of disuse syndrome is necessary, and activating approaches such as exercise therapy are used. In addition, support for patients with decreased activities of daily living and the establishment of a community-based cooperation system for the prevention of suicides are future areas to be tackled. It is important that concomitant dementia and physical illness are appropriately assessed and treated in all stages.

Self-focused attention is considered to be a cognitive characteristic of depression. However, some articles report that self-focused attention is also related to anxiety. This study examines the differential relationships of self-focused attention to depression and anxiety. The Preoccupation Scale, Self-rating Depression Scale, and State-Trait Anxiety Inventory T-Form were administered to 454 undergraduate students. The results showed a partial correlation between self-focused attention and anxiety that was significant while controlling for depression, but the partial correlation between self-focused attention and depression was not significant while controlling for anxiety. In addition, the results of an analysis of covariance structure revealed that self-focused attention was related to anxiety, and the relationship between self-focused attention and depression was due to the mediating effect of anxiety. Therefore, it was suggested that self-focused attention appears to be a significant component of cognitive operations for anxiety, but not for depression.