Scientific base for the Japanese Stress Check Program.

Our journal publishes an original article "A Japanese Stress Check Program screening tool predicts employee long-term sickness absence: a prospective study" authored by Tsutsumi et al. in this issue[1)]. The program's goal is the primary prevention of mental health disorders of employees, announced by the Ministry of Health, Labour and Welfare (MHLW), Japan[2],[3)]. There is scanty scientific base for the goal[4)]. The article would contribute to forming this scientific base.

The assessment and management of health risks at workplace should be improved by defining essential interventions for the prevention and control of psychosocial risks in the work environment. This is stated by the World Health Organization as an objective to protect and promote health at workplace[5)]. In this context, the Psychosocial Risk Management Excellence Framework (PRIMA-EF)[6)] was developed in Europe, which proposes systematic and stepwise intervention for psychosocial risk assessment and actions for the reduction of risks at the enterprise level. In Japan, the Stress Check Program has come into force since December 2015. For detailed information, please read the review article that our journal has published previously[4)]. To put it plainly, the program comprises the following three processes: (1) Employees themselves check their work-related psychosocial stressors and physical/mental stress responses; (2) At the request of highly stressed-over employees, employers provide them with an opportunity to interview with physician and take subsequent measures following the physician's advice; (3) Data on employees' stressors and stress responses are analyzed by work-related group to improve the work environment (Fig.). The Japanese Stress Check Program chiefly focuses on employees, whereas the PRIMA-EF focuses on the work environment[4)].

Fig.

Flowchart of the Japanese Stress Check Program[2]-[4)])

Processes (1) and (2) are mandatory. Process (3) is not mandatory but obligated to make effort.

Tsutsumi et al. prospectively observed nearly 15,000 employees in a financial service company in Japan for 1 year[1)]. The Brief Job Stress Questionnaire (BJSQ) was used to evaluate work-related psychosocial stressors and physical/mental stress responses of employees; those with a high BJSQ score showed a high incidence of long-term sickness absence. The impact of such stressors and stress responses on the long-term sickness absence was quantitated by calculating the population attributable risk. In another article, Tsutsumi et al. have shown the capacity of BJSQ to screen employees for psychological distress[7)]. Reporting these findings, the authors have presented the usefulness of BJSQ in measuring work-related psychosocial stressors and physical/mental stress responses of employees. In the implementation manual of the Stress Check Program, the MHLW, Japan recommends the BJSQ for the survey of employees' stressors and stress responses, i.e., process (1)[2],[3)]. Findings of Tsutsumi et al. have provided scientific validation to process (1) and the recommendation.

Meanwhile, the findings do not provide scientific validation to the entire program, as mentioned by the authors. For instance, in their article in this issue[1)], they found no difference in the incidence of the long-term sickness absence between highly stressed-over employees who did/did not take the interview with the occupational health staff. Only approximately 10% of these employees took the interview. The figure would be too small to conclude the effectiveness of the interview and the subsequent measures that were executed by the employers, i.e., process (2). Moreover, selection biases may exist regarding whether to take the interview. Further studies are necessary regarding this concern, as mentioned by the authors.

Conflicts of interest: The author declares that there are no conflicts of interest.