According to preliminary results, adherence and competence are unrelated to the helping alliance as judged by patient and therapist. Implications for the identification of effective treatment components (e.g. therapist performance) are discussed. Stress at work has been shown to influence both incidence and progression of cardiovascular disease (CVD), but psychosocial interventions to reduce stress and CVD have produced inconsistent Results: Moreover, meta-analysis has indicated that psychosocial interventions have been more effective in reducing CVD in men than in women. One possible explanation is that men and women have different needs in terms of stress reduction. Thus, it appears that family problems constitute stronger emotional stressors and provoke more depressive feelings in women than men, and that women, even when working outside the home are more endangered by family stress than by work stress. Therefore, the Stockholm Women's Intervention Trial (SWITCHD) was specifically designed to meet the needs of women CVD patients in terms of tailored stress reduction. This randomized clinical trial decreased CVD mortality in women receiving the intervention compared to women receiving standard care, providing evidence that an intervention designed to satisfy the gender related needs of women may prolong life in women with CVD. Randomized controlled trials (RCT) that have used behavioral interventions designed to reduce morbidity and/or mortality in patients who have had major adverse coronary events (MACE) have reported positive, null and negative Results: In general RCT that have been successful used group based interventions, behavior change strategies, at least 20 sessions during the course of a year, and have followed patients for at least several years. Some successful studies (e.g., Stockholm Women's Intervention Trial for Coronary Heart Disease: SWITCHD) have employed relaxation training, suggesting that stress reduction is important. SWITCHD also found that the interaction between behavioral intervention and the use of statins also appeared to decrease mortality. And in research conducted in animals we have found that social affiliation can attenuate the development of atherosclerosis by decreasing inflammation and oxidative stress. Because patients with CAD typically are prescribed multiple medications, medication adherence may be a useful intervention target. Similarly, because most CAD patients are overweight, physically inactive, and may have metabolic syndrome, behavioral intervention strategies to increase weight loss and improve fitness could be useful for addressing these issues. This presentation will compare and contrast RCT in terms of the biological and behavioral bases of the intervention strategies used to treat CAD patients. The "hikikomori" (social withdrawal) describes a psychopathological and sociological phenomenon in which people, and especially younger generations, become completely withdrawn from society for six months or longer. The "hikikomori" was first reported in Japan, and had been thought as a culture-bounded psychopathology. But cases of "hikikomori" were reported also in Oman and Spain. Recently, a large-scale community-based epidemiology study in Japan, the World Mental Health Japan Survey, as well as other studies, reported that the prevalence, psychiatric comorbidity, and childhood risk factors of "hikikomiri". Also a qualitative study from Hong Kong reported that "hikikomiri" was a psychopathology with difficulties in interacting with others and it was not unique to the Japanese society. In this symposium, each speaker will present their recent research findings. The advances in epidemiology and qualitative research could provide a new perspective of the nature of "hikikomori" as a unique psychopathology developed in the context of the society. In Japanese, Hikikomori are people who voluntarily withdraw into social isolation for over six months . Etiology and epidemiology are poorly understood, and evidence for interventions is lacking. The purpose of this study is to describe onset and maintenance of hikikomori. Direct recruitment, snowballing and participant observation in on-line chat rooms were used to recruit participants and obtain data, which was then subject to grounded theory analysis. Of 168 participants several were unconnected with Japan, the oldest being 60 years old. Three major themes emerged of hikikomori as passive coping, trust and existence. Each theme comprised one or more categories, which in turn evidenced a number of different elements. Definitive characteristics of hikikomori were obtained from respondents through virtual participant observation. The emergent theoretical framework and the list are mutually supportive in the results obtained from this study, which suggested emotional pain exists in hikikomori in relation to human relationships. The results of the present study suggest that hikikomori is characterized by more diffuse features, including difficulties in coping with people or tasks, difficulties with trust, unhappiness about life and poor concept of time. There was no evidence of violent or aggressive behaviours.We conclude that Hikikomori is not unique to Japanese youth, but more widespread and diverse anomic coping style for dealing with social disaffection seen cross-culturally. Aims: Epidemiology of "hikikomori (acute social withdrawal)" in a community population is not clear, although it has been noted for the decade in Japan. The objective of this study is to clarify the prevalence of "hikikomori" and to examine the relation between "hikikomori" and psychiatric disorders. Methods: Face-to-face household survey was conducted of community residents (n=4,134). We defined "hikikomori" as a psychopathological phenomenon in which people become completely withdrawn from society for six months or longer. We asked all respondents whether they had any children currently experiencing "hikikomori". For respondents aged 20-49 years old (n=1,660), we asked whether they had ever experienced "hikikomori". Also respondents were asked another question if they had a child with "hikikomori". Results: A total of 1.2% had experienced "hikikomori" in their lifetime. Among them, 54.5% had also experienced a psychiatric (mood, anxiety, impulse control, or substance-related) disorder in their lifetime. A total of 78% of the "hikikomori" cases in our study reported that they had felt worried or irritable about their "hikikomori" situation. Most of the "hikikomori" cases did not feel the desire to go to work or attend school even if they still had such a duty. There was no case in this study who reported violent behaviors during "hikikomori". Respondents who experienced "hikikomori" had 6.1 times higher the risk of mood disorder. Among respondents, 0.5% currently had at least one child who had experienced "hikikomori". On the other hand, about 0.5% of respondents reported that they had a child who had or was experiencing "hikikomori". Discussion: The study suggests that "hikikomori" is common in the community population in Japan. Approximately 232,000 households are estimated to currently have a child with "hikikomori" in Japan. While psychiatric disorders were often comorbid with "hikikomori", a half of the cases seem to be the "primary hikikomori" without a comorbid psychiatric disorder. "Hikikomori", a form of social withdrawal among youths who retreat from social interaction for protracted periods of time, is widely acknowledged in Japan and some other countries. This study examines childhood adversities and family environments as childhood risk factors for "hikikomori" using the retrospective data derived from a population-based survey, the World Mental Health Japan. A random sample of residents aged 20 or older in nine communities in Japan was used, and interviews were conducted using the WHO Composite International Diagnostic Interview 3.0 (n=4,134, response rate=51%). The subjects of this study were a subsample who responded to the second part of the interview (Part 2), and were aged between 20-49 years (n=708). Multiple logistic regression was used to explore the association between the lifetime experience of "hikikomori" and childhood risk factors; social class, parental psychopathology, parents' child rearing style, and other adverse events during a respondent's childhood. The statistical model was adjusted for sex, age, and respondents' experience of common mental disorders using a sampling weight for Part 2. Among the 708 respondents, 15 experienced "hikikomori" in their lifetime (n=9.7 or 1.2% in a weighted analysis). Father's high educational level (OR=6.0, CI=1.6-22.9), mother's common mental disorders (OR=6.5, CI=1.1-38.0), and mother's panic disorders (OR=6.6, CI=1.1-39.1) were significantly and positively associated with the experience of "hikikomori" after controlling for respondents' sex, age, and history of mental disorders. Significant associations were not found for parents' child rearing styles or childhood adversities. Our findings suggest that "hikikomori" cases are more likely to occur in families where the parents have high levels of education. Maternal panic disorder may influence the development of "hikikomori" among children, possibly due to reactions of children to their mothers' disorder. Most observers agree that the category of hikikomori encompasses a wide range of problems and provocations. Furthermore, recent studies have found that a substantial portion of the hikikomori population reports symptoms of mental illness (Kawakami, forthcoming). Taking a cultural anthropological approach, this paper explores the social context that allows withdrawing from society to be a prevalent and viable coping mechanism in Japan. The paper draws on ethnographic, participant-observation data from three clinical facilities in the Tokyo area which treat hikikomori populations, and four special education programs which treat children who missed school for long periods due to learning disabilities and social maladjustment. The paper concludes by reviewing recent literature on mental health in Japan in order to hypothesize about whether Japanese psychiatry will move away from relying so heavily on families and towards psychopharmacological treatments as the dominant method and perceived "cure" for addressing psychopathology. Objective: To prospectively study the development of socioeconomic health differences in the Netherlands and to investigate possible explanations for socioeconomic variation in childhood health. Methods: The PIAMA study follows a birth cohort of 3,963 Dutch children during their first 8 years of life. Common childhood health problems, i.e. eczema, asthma symptoms, general health, frequent respiratory infections, overweight, and obesity were assessed yearly using questionnaires. Maternal educational level was used to indicate socioeconomic status. Possible explanatory lifestyle determinants (breastfeeding, smoking during pregnancy, smoking in the first 3 months and the use of day-care facilities) and biological determinants (maternal age at birth, birth weight and older siblings) were analyzed using General Estimating Equations (GEE). Results: Socioeconomic differences in a broad range of health problems are present early in life and persist during childhood. Socioeconomic differences in maternal age at birth, breastfeeding, and day-care center attendance contribute substantially to childhood socioeconomic health disparities. Conclusion: This study shows that health disparities already occur in the very early years of life, also in the Netherlands. The less healthy parental lifestyle among lower socioeconomic groups explains most of the observed socioeconomic health differences in childhood. Background: Several studies have shown that social capital in terms of social participation and trust are linked to better health. However, there are few studies on the effect of community interventions attempting to benefit from this. Methods: A large scale intervention by means of participatory methods, aiming at improving the physical and social environment in an inner city area characterised by a low-income and an ethnically diverse population was launched in a midsize city in southern Sweden. Interviews concerning environmental, sociodemographic factors (including social capital), and health (including mental health measured by GHQ12) were made with 630 randomly selected individuals at baseline. A follow-up with an identical interview was made with those who still lived in the area after three years. The response rate was 66%.