What is the purpose of the Stress Check Program?

Since December 1, 2015, the Japanese government has required employers to conduct the Stress Check Program. The Ministry of Health, Labour and Welfare announced that this program should focus on the primary prevention of mental health problems. Although employers are obliged to perform screening for mental health problems and a physician's interview, employees are not mandated to participate in this program. Classical occupational health studies have accumulated evidence indicating that quantitative or qualitative workload is associated with mental health problems. Therefore, workload reduction is a major approach proposed for individuals with mental health problems; however, this approach exacerbates conflicts between mental health professionals and employers. We cannot achieve employers' understanding by only emphasizing that hard work can cause depression. Recently, the concepts of work engagement and organizational justice have spread in Japanese workplaces. Organizational justice is one of the necessary conditions for promoting positive mental health and can serve as a guiding compass for improving the work environment. If we can apply the Stress Check Program for the promotion of work engagement and organizational justice, the launch of this program could constitute a chance to improve this working environment. The Stress Check Program is not a process to search for and eliminate individuals with mental disorders.

Since December 1, 2015, the Japanese government has required employers to conduct the Stress Check Program in all workplaces with 50 or more employees[1)]. The Ministry of Health, Labour and Welfare announced that this program should focus on the primary prevention of mental health problems. Although employers are obliged to perform screening for mental health problems and a physician's interview, employees are not mandated to participate in this program.

To assess mental health problems, this program requires questionnaires that include the following three dimensions: (1) occupational stressors, (2) stress reactions, and (3) social support for worker. The manual of the program recommends the use of the Brief Job Stress Questionnaire (BJSQ), which consists of 57 items used for the assessment of job stressors, stress reactions, and modulating factors, such as social support. After screening for mental health problems, high-stress workers are defined based on expert consensus criteria[2)].

This program requires an employer to provide each worker with a report regarding each individual worker's results, and to arrange a physician's interview when a high-stress worker desires. After a physician's interview, an employer has to consider the opinions of the physician and improve the working conditions for the worker. In addition to these mandatory processes, employers have obligations to make efforts to improve the work environment based on an anonymous group analysis.

As mentioned previously, the results of stress checks are provided to the individual employees who participate in this program. However, there exists only weak evidence that feedback from the stress survey is effective at reducing employees' psychological health problems[3],[4)]. The Stress Check Program, which focuses on assessing stress among individual workers, is unique relative to the global trend for psychosocial risk management[5)].

Classical occupational health studies have accumulated evidence indicating that quantitative or qualitative workload is associated with mental health problems[6]-[8)]. Therefore, reducing workload is a main measure proposed for individuals with mental health problems; however, this approach exacerbates conflicts between mental health professionals and employers. Are these conflicts solely attributable to employers' poor mental health literacy? Should mental health professionals consider organizational vitality to avoid diminishing productivity? We cannot achieve employers' understanding by only emphasizing that hard work can cause depression.

Recently, the concepts of work engagement and organizational justice have spread in Japanese workplaces. Work engagement is characterized by high levels of energy, vigor, and dedication with respect to one's work[9)]. From the viewpoint of occupational health, motivating workers is important for achieving positive change. In fact, managers and individuals responsible for personnel affairs should primarily lead efforts to promote positive mental health.

Organizational justice is one of the necessary conditions for promoting positive mental health and can serve as a guiding compass for improving the work environment. Several studies have demonstrated that organizational justice can affect both work efficiency and health outcomes[10]-[13)]. A recent factor analysis revealed that organizational justice has a four-factor structure (distributive justice, procedural justice, interpersonal justice, and informational justice)[14)]. Organizational justice is dependent on superiors in various contexts, such as decision making in daily meetings, work sharing, personnel affairs, provision of platforms for skill enhancement, and support in terms of child rearing for women workers. Although official instruction by a superior should be accepted, treatment such as abuse or loud criticism that disrespects others is outrageous. Superiors who lack communication skills and have many subordinates are catastrophic for an organization. However, we have heard of cases involving inadequate workplaces. Should we not encourage workers in settings with poor organizational justice to leave their workplaces? Firms known as "black companies" are characterized by poor organizational justice rather than a heavy workload.

There are two proposals regarding the effectiveness of the Stress Check Program in promoting worker mental health. First, the questionnaire employed for this program should take into account recent developments in the field of occupational health psychology. As a result, a new version of the BJSQ (New BJSQ) would be recommended because it also includes organizational factors or positive psychology[15)]. Second, improvements to the work environment, which are currently considered obligations that require effort, should be encouraged. The cooperation of workers, which is essential to improving the work environment, could have positive effects on the program effectiveness and procedural justice.

The Stress Check Program is not a process to search for and eliminate individuals with mental disorders. Furthermore, this program has the potential to motivate workers and increase organizational productivity. In fact, the working environment in Japan is severe, and individuals' workloads inevitably increase. However, the launch of the Stress Check Program could constitute a chance to improve this working environment.

Conflicts of interest: The authors declare that they have no competing interests in this work.