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BACKGROUND: Return-to-work (RTW) programs are provided as rehabilitation for people who have taken sick leave from work because of mental health problems. However, methods to present this information to workplaces objectively remain limited. OBJECTIVE: This study aimed to conduct an exploratory investigation of the relationship between duration of sick leave and time variation of words used in RTW programs for depression from textual data collected from electronic medical records as a new evaluation indicator. METHODS: The study subjects were those who had taken sick leave because of major depressive or adjustment disorder and had participated in an RTW program. The study data comprised demographic characteristics and texts. Textual data were collected from electronic medical records and classified based on the SOAP note. Thereafter, the textual data were quantified into category scores based on a standard text analysis dictionary. A generalized linear mixed model was used for the statistical analysis, with the score for each category (emotional, social, cognitive, perceptual, biological, motivational, relativity, and informal) as the dependent variable and the duration of sick leave, time, and interaction between the duration of sick leave and time as the independent variables. The level of statistical significance was set at 0.05. RESULTS: In total, 42 participants were included in the analysis. The results revealed a significant interaction between the social (p = 0.001) and emotional (p = 0.002) categories. CONCLUSION: The findings suggest a relationship between word changes in electronic medical records and the duration of sick leave. [ABSTRACT FROM AUTHOR]

The problem of ‘social withdrawal’ among young adults is the focus of considerable attention in Japan today. Among the various manifestations of social withdrawal, a ‘primary social withdrawal’ group has been identified that cannot be diagnosed by the established classification of mental disorders. In an earlier report it was suggested that the onset mechanism for primary social withdrawal is not merely a problem of the withdrawn person themselves, but also includes problems of family relationships. The aim of the present study was to identify the characteristics and problems in family relationships associated with primary social withdrawal. For that purpose a survey was conducted using David H. Olson's Family Adaptability and Cohesion Evaluation Scale as well as a questionnaire that the present authors devised on family interactions and the personal situation of the withdrawn person. The results pointed to the following four characteristics of primary social withdrawal families: (i) there are definite rules within the family; (ii) the families share values and an unfounded pride; (iii) there is a lack of emotional exchange in the family, and it is difficult for members to sympathize with each other's negative feelings; and (iv) although concerned about each other, there is little verbal exchange. From these family characteristics, the onset mechanism for withdrawal is triggered by insignificant matters such as minor setbacks in the developmental issues of youth. Then, given the person's personality traits and aforementioned characteristics in family relationships, the person becomes mired in social withdrawal. [ABSTRACT FROM AUTHOR]

This article attempts to clarify the psychopathological features of "primary social withdrawal". Since the concept of "social withdrawal" in general may include various diseases, we isolated and defined "primary social withdrawal" by excluding cases that could be diagnosed by established classifications of mental disorders. First, we examined two cases of "primary social withdrawal" which could not be classified using DSM-IV. We then compared these patients' psychopathological features to those seen in apathy syndrome, taijin kyofu sho and personality disorders. Based on this comparison, we identified five pathological features of "primary social withdrawal": (1) episodes of defeat without a struggle, (2) protecting the ideal image of the expected self, (3) parents' investment in that ideal self, (4) holding an ideal self image shaped more by the desires of others than those of themselves, and (5) avoidance behavior to maintain the positive opinion of others. Finally, we discuss the socio-cultural background of social withdrawal and possible therapies.