J-HOPE
Japanese study of Health, Occupationand Psychosocial factors related Equity© sato - Fotolia.com

J-HOPE Outline

Japanese study of Health, Occupationand Psychosocial factors related Equity

J-HOPE (Japanese study of Health, Occupation and Psychosocial factors related to Equity)
is a study that was started with the aim of elucidating the state of the health status
disparity amongst workers and its mechanisms. This study was initiated in 2009 as a
Multipurpose Panel Survey in a novel academic ﬁeld (research area proposal type) andwith a KAKENHI Grant-in-Aid for Scientiﬁc Research by the Ministry of Education, Culture,Sports, Science and Technology (MEXT). It is being conducted within the framework of apanel study that repeatedly investigates important indices each year.
Because the problem of the health status disparity amongst workers cannot be solved
with simple medical knowledge, research teams are composed of not only medical
specialists, but also experts in psychology, economics and social studies. By 2014, 14,000
workers spanning 12 business sites throughout Japan had been surveyed over 4 years. In
some workplaces, follow-up surveys were conducted over the following 4 years.
In this panel study, socioeconomic attributes of workers with diverse backgrounds andoccupational stress scales that are newly garnering attention, together with detailed
questionnaires on lifestyle-related diseases, typical cardiovascular disease risk factors andmental health indicators such as for depression, undergo yearly measurement and data
storage with standardized methods.

Multipurpose worker panel
Basic structure
Subjects

Workers: Total 14,000
From multiple workplaces with diﬀering industries and occupational roles (diverse)

Measurement details ‒ Comprehensive measurement items related to health,society and economicsSocioeconomic indices: Position, income, academic history
Psychosocial indices: Occupational stress according to an established stress model
Lifestyle: Health-related behavior
Biological indices: Cardiovascular disease risk factors, stress-related biomarkers,
anxiety genes
Mental health status: Identify depression, anxiety disorder

Outcomes

Disease exacerbation including cardiovascular diseases/poor mental health andtime oﬀ work due to illness
Presence of major depression/anxiety disorder (WHO structured diagnosticinterview)Hierarchy change, quitting job

Occupational ﬁeld cohort characteristics

High follow-up precision

Comprehensive and highly precise health management data by means of health diagnosis

1Coordination withother planned
research teams
Correlation between brain
function and job rank/workburdenCorrelation between mental
disorder and job rank/workburdenHealth status of workers indiﬃcult economic conditions
Disparity in access to health,
medical and social services,
and associated health status
disparity

Basic measurement items

As of February 2018, panel data following up 14,000 workers at domestic workplaces
over 4 years (for some subjects, 8 years) has been registered and we are measuring
individual attributes, socioeconomic factors, occupational stress and health behavior witha comprehensive questionnaire. Occupational stress can be measured by conventional
demand ‒ control models as well as by more recent models such as eﬀort-reward
imbalance, organizational justice and work engagement using internationally establishedquestionnaires. At workplaces where this is possible, the online version of WHOinternational comprehensive structured diagnostic interviews is used to evaluate the onsetof major depression and anxiety disorders. Health diagnosis opportunities are also used
to measure biomarkers that can link stress with physical disease. At almost all
workplaces, health checkups are used to measure blood pressure, height, weight,abdominal circumference and blood test values (blood glucose, HbA1c, blood lipids) and,in workplaces where this is possible, stress-related genes, inﬂammatory markers, andobjective sleep indices using Actiwatch activity monitoring are measured.

Psychosocial factors/indicesBiological indices・ Psychosocial factors/indices
Level of demand, control-Level of demand-Control・ Cardiovascular disease riskfactors-Support from superior-Support from colleagues
・ Eﬀort/reward imbalance-Eﬀort-Reward・ Organizational justice-Procedural justice-Interactional justice・ Work engagement
・ Social capital
・ K6Options
・ Stress-related biomarkers-IL6-High sensitivity CRP-Homocysteine-DHEA-Cortisol-NT-proBNP・ Sleep patterns/autonomous
nervous system examination
・ Serotonin transporter genes(5-HTTLPR)

Eﬀects of stress resulting
from job conditions etc.
related to job rank

2

Japanese study of Health, Occupationand Psychosocial factors related Equity

Mechanisms linking stress and disease
that are being investigated by J-HOPE
Occupational stressSympathetic nervoussystem

heart rate variability

Hypothalamic‒pituitary‒adrenal axis

Cortisol/DHEA-S

Immune system

Healthbehavior
Dietaryhabits
Smoking

Alcoholconsumption

Physicalactivity

IL6/CRP

Influence of genes

Psychological neural endocrine system

Risk factors

Disease＊Blood pressure＊Impaired glucose tolerance＊Metabolic disorder＊Dyslipidemia

Current disclosure status

In response to requests by researchers in the ﬁelds of social medicine, psychology,
economics and policy studies who are interested in social health disparities, aDVD-ROM is provided to transmit information free of charge with the approval of theData Management Committee.
To encourage use of this data by many, we hold research (database) information
brieﬁngs as necessary to researchers deemed eligible by the Data ManagementCommittee.

3Future plans
Cleaning of the J-HOPE data, including biological datathat was measured between 2009 and 2013 andsome workplace data that was followed up between
2014 and 2017, has been just ﬁnished. While
conﬁrming procedures to make it possible to respondto changes such as ethical policies in accordancewith revisions to the Protection of Personal
Information Act, data cleaning is being performed. Asa result, the data is becoming completely anonymized
and rules for data use are being prepared. There areplans to make the data fully accessible, including tooverseas researchers.

Expectations for this study
1) Veriﬁcation of the impact of socioeconomic factors such as income andeducation, and occupational stress on worker health2) Possible clariﬁcation of genetic mutations that aﬀect occupational stress eﬀects
and are susceptible to the harmful eﬀects of occupational stress.
3) Clariﬁcation of not only the eﬀects of occupational stress on biomarkers using thestructure of panel data, but also determination of whether biomarkers aﬀect
mental stress in the opposite direction.
4) It is also anticipated that the results of this study will be used to contribute to thecollective formulation of prevention measures for various stress factors; individuals
with certain genetic predispositions can be provided with health guidance andclinical intervention to establish future preventive measures for health disorders
caused by occupational stress.
5) It is anticipated that the database planned for public release going forward will beused by researchers around the world who are interested in social disparity inhealth and are active in the ﬁelds of social medicine, psychology, economics andpolicy studies, and that it will be utilized as basic data for elucidating social
disparities in worker health and to promote the health of workers.

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Presentation of results

Japanese study of Health, Occupationand Psychosocial factors related Equity

Since its predecessor study in a novel academic ﬁeld, J-HOPE has produced many notable results.
Here, we will present results that have recently garnered attention for demonstrating thatpsychologically positive workplace elements are related to worker health, and results regarding
dietary patterns that contribute to worker health.

Workers who feel that they have much support from their superior andcolleagues, and with strong work engagement have low CRP (inﬂammation)

Workplaces with strong ties (social capital)
produce good mental health

1.0

1.0

Odds ratio

Odds ratio

The concept of social capital is garnering attention. It has been shown that workers have better
psychological well-being in workplaces with high social capital in the form of stronger eﬀorts at theworkplace, and trusting one s colleagues.

Low

Odds ratio

Odds ratio

1.9

Low

Middle

High

Low

1.0

1.0Middle

HighOshio et al, Ind Health 2014

Low

MiddleHigh

Risk of CRP (inﬂammatory reaction) increaseby work engagement level (low to high)

6.26

6.07
4.18
Low
HighWorkplace support

4.16
Low
High
Workplace social capital

Workers who intake a well-balanced
Japanese diet tend to be less depressed

Activity quantity measurement/
sleep time (%)

Depressive tendency

PSQI total score

Workplace social capital is related to good sleep
quality and quantity

5.5

94.4

93.3

94.8
92.8

Activity quantity measurement/
sleep time (time)

Low
High
Workplace support

Low
High
Workplace social capital

6.66

6.63

6.14

6.14

Low
High
Workplace support

Low
High
Workplace social capital

5.3

5.3
5.1

5.1

5.1

5.0

5.0

4.8

Low

Takahashi et al, J Sleep Res 2014

5High

Support from one s superior and being able to actively be involved in one s work (workengagement) are also positive psychological factors at workplaces that have recently beengarnering attention. It has been found that when these are in a good state, inﬂammatory response
markers measured 1 year later are also low.

Risk of lower psychological well-being by workplace social
capital level (low to high) on a workplace level

Results have demonstrated that in addition tosocial capital, good workplace support
results in good sleep quality and quantity.

Middle0.5

Eguchi et al, Am J Ind Med 2015

1.0

Risk of lower psychological well-being by workplace social
capital level (low to high) on a workplace level

0.6

Risk of CRP (inﬂammatory reaction) increaseby superior support level (low to high)

1.4
3.6

0.6

0.7

MiddleJapanese diet

HighLow

MiddleHighLow
Fish-based diet
Dietary intake pattern and depressive tendency

MiddleWestern diet

HighSuzuki et al, J Aﬀect Disord 2013

Interesting results were also obtained with regards to diet. It was found that workers who consumed awell-balanced diet and those who ate a Japanese diet in particular had a tendency for less depression.
Dietary balance is an important health behavior that supports overall health.
The J-HOPE database was constructed with the support of grants in the form of a MEXT Multipurpose
Panel Study in a novel academic ﬁeld (research area proposal type) (2009 ‒ 2013) and a KAKENHI
Grant-in-Aid for Scientiﬁc Research A by MEXT (2014 ‒ 2017) as Comprehensive elucidation of theeﬀects of occupational stress on health according to a multipurpose panel follow-up of 10,000 workers .
6

Presentation of results

Japanese study of Health, Occupationand Psychosocial factors related Equity

Women have greater depressive tendencies
the higher their occupational position

Although the number of women with important corporate positions is increasing, it was found thatwomen had greater depressive tendencies the higher their occupational standing. Not receiving
adequate remuneration for their work volume was found to be among the top reasons for this.

Workers with medium work engagement
have the lowest risk of depression onset

It was found that when workers who do not exercise at all start performing light exercise that does
not leave them breathless or cause palpitations at least once per week, their regular health checkup
results (in particular, LDL cholesterol and hemoglobin A1c in men and hemoglobin A1c in women) 1
year later improve.

Women

21.9

38.4

22.8

25.6

24.1

Hazard ratio

Ratio with depressive tendency

Men
1.0
24.1

22.8

21.9

20.8

0.6

20.8

0.2

Low (standard)

MediumHigh

Depression risk by work engagement level (low to high)Non-clerical work,
service industry

Clerical work

Managerial/specialized work

Ratios of depressive tendencies by work type/genderUmeda et al, SSM Popul Health 2015

The results of regular health checkups are
improved by starting with light exercise

Regular male employees have increased depressive tendencies
as their employment is unstable and workplace role is vague

Employment anxiety is becoming more common with the increase in non-regular employees andregular employees are also aﬄicted without exception. Male regular employees in particular were
found to have strong depressive tendencies when in workplaces with unstable employment andvague roles.

Depressive tendency

It was found that when workers who do
not exercise at all start performing light
exercise that does not leave thembreathless or cause palpitations at least
once per week, their regular healthcheckup results (in particular, LDL
cholesterol and hemoglobin A1c in men
and hemoglobin A1c in women) 1 year
later improve.

Imamura et al, PLOS ONE 2016

Role vagueness (low)

8.2

Role vagueness (high)
5.7

5.4
3.7

Oshio et al, J Occup Health 2016
Employment instability (low)

Employment instability (high)Depressive tendencies by employment instability and role vagueness (low to high) (male regular employees)
Inoue et al, Int Arch Occup Environ Health 201878