AIG Institute Insight

November, 2018

Framework and Current Environment of Corporate Mental
Health Management in Japan
Manabu Fujii, Executive Fellow, AIG Institute
NOTICE: This represents an English translation of an original report released in Japanese by the AIG Institute on
November 26, 2018. In the event that there are any inconsistencies between the Japanese version and the English one, theJapanese version shall control and supersede the substance of the English translated version.

Introduction

For companies, the appropriate management of their employees’ mental health is becoming amore significant challenge. With this, the Japanese government enforced revised Industrial
Safety and Health Act in December, 2015 and introduced “Stress Check” as a specific framework
for companies to manage mental health of their employees. It also obligates them to establish
organizational structures for that.
However, according to a fact-finding investigation regarding industrial safety and healthconducted by Ministry of Health, Labour and Welfare, some companies have established theirmental health management structures after the enforcement of the act, while their follow-ups
have not been sufficient after stress check, therefore, some of their employees could not stop
their mental health problems from being worsened and had to take sick leaves or even resign.
For both companies and their employees, it is extremely important to construct structures topractically prevent any issues of employees’ mental health and in their working environments or
make improvement once such issues are detected at earlier stages by stress check or training
instead of merely focusing on completion of conventional structures.

Framework for mental health management by company

The number of claimed and approved workers compensations for mental problem including
depression has been sharply increased in the last few years.
Trend of workers compensation for mental illness
1600
The no. of claims for

1400

workers comp.
The no. of recognized

1200

claims for workers comp.
The no. of claims for

1000

suicideThe number of claims

800

recognized for suicide

600
400
200
0

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

(This chart is prepared by the author based on the statistics regarding workers compensation for mental
problem by MHLW)

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November, 2018

Upon this situation, the government revised Industrial Safety and Health Act which is meant toprotect the physical and mental health and safety of workers and defines a basic framework formental health management by companies with obligation to execute stress check as a coremeasure (enforced in December, 2015). In addition to this, Ministry of Health, Labour, andWelfare released “The guide for maintenance and enhancement of mental health of workers”
with specific actions taken by companies. (revised on the November 30th, 2015. Hereinafterreferred to as the Guide.)
Revised Industrial Safety and Health Act obligates employers to have doctors or health nurses
conduct stress check on regular basis for their permanent employees. (If your business operation
has fifty workers or more, stress check is mandatory, and in case of less than fifty workers, you
are obligated to make effort.)
Also, according to the Guide, companies are requested to plan and execute comprehensive
initiatives as follows with main focus on stress check.
(1) Planning mental health promotion
Companies are requested to have full discussions at their safety and health committees set up
in accordance with Industrial Safety and Health Act and to make “a plan for mental healthpromotion” by incorporating the next items.
Announcement by an employer regarding their active promotion of mental health care
Construction of a structure for mental health promotion in the workplace
Understanding of issues in the workplace, execution of activities for mental health care
Allocation of human resources required for mental health care, utilization of external
resources⑤ Protection of information regarding worker’s health⑥ Measuring the progress of the mental health promotion plan, revision of the plan
⑦ Other measures for the mental health promotion for workers

①
②
③
④

To be more specific, documents with major components such as action plans (positioning,objective) and activities (stress check, guidance through interview, consultation framework,
education and training) would be developed.
(2) “Four cares” for mental health management
The Guide requests execute initiatives with the specific actions for mental health care bycompanies categorized into the four types below.
① Self-care Correct understanding of stress or mental health Awareness of stress with utilization of stress check Response to stressThis means that employees themselves are aware of their stress, acquire knowledge andlearn how to cope with their stress, and take actions. Companies execute initiatives toprovide education, training, and information regarding mental health, introduce stresscheck, and construct structures or environments that enable their employees to2

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November, 2018

voluntarily talk to their supervisors or occupational doctors.
② Care by reporting line Understanding and improving working environment
 Advising workers
 Assisting workers for returning to their works
Since supervisors (managers) are able to understand the statuses of their subordinates
and the conditions in their workplaces on daily basis and to improve such conditions, they
are required to give advice to the employees when they are requested and understandand improve the conditions in their workplaces. Also, companies are requested to provide
training or information to managers to enable care by line managers.
③ Care by employer’s occupational health staff members
 Planning for specific activities for mental health care
 Handling personal health information
 Networking with external resources, contacts for communication with external
parties Assisting return to work
This means care by employer’s occupational health staff members ＊ . Companies are
required to establish and maintain structures and environments for smoother care.
※This refers to occupational doctor, health controller, health nurse at employer, dedicated staff members
for mental health promotion, and staff members for personal management and labor relation.

④ Care by external resources
 Utilization of services such as information provision or advice
 Networking of resources Assistance for return to work
This means that supports from various types of resources with expertise are utilized
depending on issues or services requested by companies. Also, if employees do not want totake consultation services at their workplaces, it is desirable to offer opportunities forthem to utilize external resources.
(3) “Three preventions” for mental health management
The Guide identifies the next three stages of preventions for mental health problem＊ anddefines the next four specific measures.
※This is not only about mental problem or suicide categorized as mental disturbance or behavior problem.
It broadly includes mental and behavior problem such as stress, serious worry, or anxiety, for example,
that could impact to the mental and physical health of workers, as well as their livings in the society or
the qualities of their lives.

Primary prevention (prevention of mental health problem)① Offering education, training and information for mental health care promotion
Offering education, training, and information to workers, supervisors/managers, andemployers’ occupational health staff members, depending on their duties② Understanding and improving working environment
Leveraging collected opinions from daily workplace management and workers and stress
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November, 2018

check programs to assess their workplace environments to capture problems and make
improvement
Secondary prevention (Earlier detection of mental health problem, execution of appropriate
measures)③ Awareness of mental health problem, actions required
Earlier detection of mental health problem and appropriate actions in case if any workers
encounter that.
For this, structures for the three items below should be constructed.
 Voluntary request from workers for consultation, self-check Consultation by supervisors/managers and employers’ occupational health staff
members
 Awareness by or support from the families of workers
Tertiary prevention (Supporting workers who have encountered mental health problem fortheir return to work)④ Support for return to work
For those who took sick leaves due to their mental health problem to be able to smoothly
return to their work and continue their employment, programs for support for return towork should be planned and executed with necessary structures constructed.
(4) Cautions
For mental health care promotion, companies are requested to consider the items below
related to the specific nature of mental health.
① Characteristics of mental health issue
The fact that the mental health issue is “not easily visible”, and people tend to
misunderstand or be biased against it should be well considered.
② Consideration of personal information protection for workers
Protection of personal information including health information of workers should beconsidered, and their intention should be respected.
③ Collaboration with personal management and labor relation
Mental health of workers is largely affected by factors closely related to personal
management and labor relation such as worksite arrangement, staff reassignment,
organization structure at workplace, therefore, mental health care should beappropriately executed with collaboration with personal management and labor relation.
④ Issues outside workplace such as family or personal life
Mental health issues could be affected by stress factors form workers’ families or theirpersonal lives on top of stress factors at their workplaces in many cases, and this fact
should be considered.

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November, 2018

The current status of initiatives for mental health, their challenges in companies

Since revised Industrial Safety and Health Act obligates the implementation of a mechanism forstress check, initiatives by companies for mental health are becoming more common. Also, in the
13th industrial accident prevention plan officially announced by Ministry of Health, Labour andWelfare for measures for mental health in workplaces, it is aimed to achieve the quantitative
targets below by 2022.
① Over 90% of workers know who they could talk to including external human resources about
their anxiety, worries, or stress in their works.
② Over 80% of companies take measures for mental health.
③ Over 60% of companies conduct group analysis of the results of stress checks and utilize
such results.
According to Survey on Industrial Safety and Health (fact-finding survey) by Ministry of Health,Labour and Welfare in 2016, 56.6% of companies responded that they took some measures formental health. (In the survey in 2017, 58.4% of companies responded the same, which indicates aslight increase. The following discussions are based on the survey in 2016 with their details of
the result released.)
However, the execution rate of the measure differs depending on the sizes of companies. Whileapproximately 90% of the companies with over fifty employees executed measures such as
setting up safety health committees and conducting stress check, approximately only 50% of thecompanies with less than fifty employees executed such measures.
No. of employees

Rate of measure execution
for mental healthDistribution rate

1,000 or over

100.0%

0.2%

500 ～ 999

99.8%

0.4%

300 ～ 499

99.2%

0.8%

100 ～ 299

96.1%

4.5%

50 ～

99

85.2%

9.3%

30 ～

49

62.5%

14.1%

10 ～

29

48.3%

70.8%

(50 or over)

89.7%

15.2%

(Less than 50）

50.7%

84.9%

(Total)56.6%

100.0%(The ratios of the companies who responded that they had conducted measures for mental health.
Developed by the author based on Survey on Industrial Safety and Health (fact-finding survey)
Ministry of Health, Labour and Welfare in 2016.)

The responses to the question about specific measures the companies took suggest that not manyof the companies who had conducted measures for mental health took comprehensive measures
shown in the Guide.

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November, 2018

Measures for mental health (multiple answers allowed / Excerpt)
Executionof stress
check

An establishedstructure for
consulting intheorganization

1,000 or over
500 ～ 999
300 ～ 499

96%
93%
97%

85%
72%
65%

100 ～ 299
50 ～ 99
30 ～ 49
10 ～ 29(Total)

91%
84%
53%
55%
62%

300 or overLess than 30
Difference of

95%
55%

No. of employees

Selection ofAssessment
Study andTraining
Training
resources
deliberation
and
and
and
Supportresponsible forat security information information
improvement for return
execution ofand healthoffered tooffered toof working
to workmeasures forenvironment
committee
workers
supervisors
mental health

77%
68%
67%

82%
68%
63%

77%
64%
60%

66%
61%
57%

66%
57%
59%

78%
56%
51%

46%
39%
31%
33%
36%

56%
49%
23%
18%
27%

48%
42%
38%
35%
38%

41%
32%
28%
26%
29%

48%
40%
23%
19%
26%

46%
37%
23%
21%
27%

30%
18%
15%
15%
18%

70%
33%

69%
18%

67%
35%

63%
26%

60%
19%

59%
21%

57%
15%

1.7
2.1
3.9
1.9
2.4
3.1
2.8
3.7
execution rate
(Specific measures taken by only the companies who had responded that they had taken measures for mental health. Developed by
the author based on Survey on Industrial Safety and Health (fact-finding survey) Ministry of Health, Labour and Welfare in 2016.)

As to stress check, many of the companies running their initiatives for mental health conduct it,
while not many companies have made progress in other actions such as internal consultation
services, education and training for their employees, as well as their supervisors (superiors),
assessment and improvement of their working environments, or support for return to work after
leaves.
In particular, the gaps of the execution rates due to the different sizes of the companies require
more attentions. Approximately 1% of the companies who responded to the questionnaire are theones with 300 or more employees, and approximately 70% are the ones with less than 30
employees. For “Execution of stress check”, the difference of the execution rates between those
two sizes of the companies is 1.7 times, which is relatively minor, while, for “Support for return
to work”, the difference is 3.7 times.
According to this survey, it is known that the smaller companies have not been as active as
bigger companies for mental health, and even the companies taking actions for mental healthhave merely executed stress check and offered training to their employees, and it is estimatedthat not many companies have taken comprehensive actions to turn mental care more effective.
This can also be confirmed with the responses to other questions in the same survey.
Ratios of workers who took consecutive leaves more than one month or retired
from their companies due to their mental health illness for last one year
No. ofemployees
1,000 or overWorkers who took theirWorkers who
consecutive sick leaves
retiredfor more than 1 month
0.7%
0.1%

500 ～ 999

0.6%

0.1%

300 ～ 499

0.6%

0.2%

100 ～ 299

0.4%

0.1%

50 ～

99

0.4%

0.2%

30 ～

49

0.2%

0.1%

10 ～

29

0.2%

0.3%

(Total)

0.4%

0.2%

(Developed by the author based on Survey on Industrial Safety and Health (fact-finding survey), 2016)6

AIG Institute Insight

November, 2018

While the ratios of those who took their consecutive sick leaves for more than one month in thepast year are clearly declining for smaller companies (0.7% for companies with 1,000 or more
employees and 0.2% for less than 30 employees), this trend is not observed as to the ratios of
those who retired due to their mental health problem, and in fact, the ratio is the highest for thesmallest companies with less than 30 employees. (It is 0.1% for the companies with 1,000 or more
employees, while it is 0.3% for less than 30 employees.)
This potentially suggests that bigger companies have some levels of mechanisms to support theiremployees who have encountered mental health problem to offer them recovery routes from sickleave to return-to-work, that is, the secondary prevention to tertiary prevention, but, smaller
companies do not have such mechanisms sufficiently, therefore, their employees could not go
through a process of taking sick leave, which means that more employees with mental healthproblem could directly decide to leave their companies.
The survey does not provide data that can be used to compare the occurrence ratios of such
employees who took their sick leaves or retired across companies that had or had not taken
actions for mental health, and details are not available to understand how effective the mental
health initiatives can be to reduce the number of employees who would decide to take their sickleaves or leave their companies, but, at least, sufficient effectiveness of mental health initiatives
could not be expected for cases where mental health problem of employees or issues withworking environments were suggested, unless a mechanism to make specific improvements isestablished.
Also, another issue that can be derived from the survey is the lower execution rate of actions “toassess and improve working environments”. The total average execution rate is 27%, and it isless than 60% for bigger companies with over 300 employees, and around 20% for companies
with less than 30 employees.
As major risk factors that could cause mental health problem at workplaces, long-hour working,large workload for unplanned tasks, lack of communication between employees and theirsupervisors, harassment, for example, can be considered, but, only individual-level actions suchas training or stress check have been focused, and it is concerned that assessment andimprovement of working environments have been insufficient.

Risk on overweighed stress check

As seen so far, the initiatives for mental health were originated from stress check and extended
in their structures.
As the concept of “physical” health management originating from regular medical checkup,“mental” health management is originated from regular stress check. It is aimed to detect
mental health problem at earlier stages through stress check and to take earlier actions toprevent mental health from being deteriorated and to maintain and improve the states of
employees’ minds.
The following diagram summarizes the main flow of stress check according to revised Industrial
Safety and Health Act. (Preparation before execution or post-execution inspection are omitted.)

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November, 2018

Execution of stress check（Obligation to make effort）

Notification result to worker

Result totaled and analyzed per workplace（In case of high risk score)

Recommendation to worker for interview

Utilization of analysis result for improvement

for guidanceof working environment（Only those who wish)

Interview for guidance by doctor
Execution of actions for work wheneverneededStress check is periodically (once a year or more) conducted, and the result is individually
notified to workers. In particular, for those who are diagnosed as having higher risks of mental
health problem, individual interviews for guidance will be recommended. Once workers accept
such recommendation, occasions for interviews by doctors for their guidance will be set up. As
the result of such interviews, if doctors judge that certain measures (sick leave, for example) are
required, then, their judgement will be notified to the companies so that necessary measures canbe taken.
On top of these measures for individual workers, the results can be summarized and analyzed on
the workplace level to detect any areas with higher risks of mental health problem, which can be
another route to leverage stress check to improve working environments.
If expected values can be obtained from stress check, then, it would be a useful initiative formental health in companies. However, focus on stress check only as a measure for mental healthcould cause some risks, according to feedbacks from doctors.
For example, upon revised Industrial Safety and Health Act, in August, 2016, to thequestionnaire offered by “MedPeer”, a community site exclusive to doctors, over 60% of doctors
responded that stress check would not be effective.
Question: Stress check will be effective as the primary prevention of mental health problem?
Nevereffective,
16.8%

Very
effective,
2.3%

Rathereffective,
35.6%
Rathernoteffective,
45.3%(From “MedPeer”, a site exclusive to doctors. 4,031 responses were given.)

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November, 2018

According to this questionnaire, doctors suggested issues of stress check as follows:(1) Inaccuracy of screening
Stress check is done as self-assessment and meant to check the state of mind which is notalways visible. Many of the questions are related to working and labor environment such as
working hours, quality of business operation, communication with supervisors or colleagues,
therefore, those who “are assertive” or “have dissatisfaction about their works” are tended tobe diagnosed as having high risks. In other words, there is a risk of not being able toeffectively find workers who try to solve their strong stress as their own issues without
sharing them with others or actually have increasing depressive tendency.
(2) Interview for guidance not offered to workers who need
As the result of stress check, even if high risks are diagnosed, it is workers’ decisions to takeor not to take interviews by doctors for guidance, and interviews are not always offered tothose who need them. Furthermore, in order to take interviews for guidance, requests should
be submitted to companies, and “chilling effect” could be caused because workers do not let
their companies know that they are going to take such interviews, and workers who wish totake interviews may not take actual actions (requesting for interview for guidance).
(3) Overweight on personal issues of workers, insufficient improvement of working environment
In not a few cases, mental health problems are caused by overloaded work, harassment, lackof communication, for example, rather than personalities or ways of work of workers
themselves. Initiatives to offer opportunities for self-care based on stress check or interviewsfor guidance for those who are diagnosed as having high risks could limit the causes topersonal issues of workers themselves.
Revised Industrial Safety and Health Act supposes a framework to summarize and analyze
stress check results to detect issues with working environments for discussions by healthcommittees, for example, but, only obligation to make effort is identified in the act. According
to Survey on Industrial Safety and Health (fact-finding survey) in 2016, only 27% ofcompanies really took such actions.
Even if personal issues of workers are responded, issues with their working environments
conditions are not solved, and it is more likely that they would repeatedly encounter the same
issues after they return to their works.
This questionnaire identified the issues of stress check as the primary prevention, and too much
focus on stress check actually causes other risks as follows.
(4) Insufficient actions for the secondary and tertiary preventions
In a certain aspect, stress check could function as “medical check” does for health of physicalhealth, but, it should be positioned as a tool for the primary prevention. In other words, it
should help workers to find themselves with stronger stress before they are trapped in mental
health problems at earlier stages.
In order to enable the secondary prevention to stop existing mental health problem of workers
from getting worse, as well as the tertiary prevention to block the reoccurrence of suchproblem when workers have returned to their work from their sick leaves they had taken due
to their mental health problem, comprehensive initiatives would be required to provide
9AIG Institute Insight

November, 2018training programs or information to their entire workplaces including their supervisors, tosecure more accessible channels for consultation including industrial physicians or external
resources, and to establish supportive programs for return-to-work.
Without understanding that the implementation of stress check is merely “an entry point” tosuch comprehensive initiatives, the other initiatives for the secondary and tertiary
preventions would not be sufficient, which could result in a higher risk of missing benefits
from stress check implementation and actions for mental health (or workers who could not
avoid taking sick leaves or leaving their companies).
Too heavy dependency on stress check for actions for mental health by companies could
deteriorate the efficacy of planned and executed initiatives, and the risk of losing workers due totheir mental health problem could turn higher, despite the fact that they could have continued towork, only if getting appropriate supports.

Points at issue of actions for mental health by company

Based on the issues identified in the previous sections, the major points at issue that requirein-depth discussions regarding actions for mental health conducted by companies as follows.

(1) 【Primary prevention】Methodology to improve accuracy of diagnosis to determine individuals
with higher risks of mental health problem
In the current stress check those who are not satisfied by their workplaces or who are more
assertive tend to be judged as having higher risks, while those who do not have much of suchtendency are likely to be judged as having lower risks, therefore, methodologies to improveaccuracy to judge those who have risks of mental health problem need further discussions
and researches.
For example, discussions can be held to prove if the current questionnaire method can beused as basis to add more questions or change the current questions to improve accuracy ofjudgement or if the current stress check done with questionnaire method can be replaced orenhanced by psychological examinations, biomarkers of heart rate test or saliva test, or big
data to track changes to the history of daily behaviors. In particular, consistent monitoring
utilizing IoT equipment that has been technically advanced in a last few years has great
potential hidden.
(2) 【 Primary prevention】 Establishment of an approach from the perspective of working
environment
The current initiatives for mental health tend to put focus on individual employees only by
allowing them to take training classes and stress check to be aware of their problems to takeactions such as contacting occupational doctors or external resources. In case if they decide
to take sick leaves, they need to get their mental health recovered to return to their works.
However, in fact, “external factors” that cause healthy employees to be caught in mental
health problem, such as the contents of works given, working hours, sizes of their
responsibilities, relationships with their supervisors or colleagues, impact a lot, needless tosay.
The current, revised Industrial Safety and Health Act does not necessarily structure
initiatives to appropriately asses such external factors for improvement. It only supposes
initiatives (obligation to make effort) to leverage stress check to improve working
10AIG Institute Insight

November, 2018environment. It is possible to increase efficiency of the primary prevention by selecting more
impacting factors out of various external factors, measuring such individual factors to
calculate scores for individual workplaces (that is, stress check of working environment),
and connecting the resulting scores to specific improvement of working environment.
As a precedent, in Europe, PRIMA-EF (The European Framework for Psychosocial Risk
Management) exists and identifies specific risks in working environments such as contents
of works, workload, speed of work, schedule, independency, environment and facility,
organizational culture, function, role in organization, visibility of career path, work-lifebalance.
(3) 【 Primary to secondary prevention 】 Smooth connection from self-care to utilization of
external resource, method to remove sense of resistance
Currently, stress check is anonymously conducted to companies, and the results are only
shared with individual workers only. For workers who are diagnosed as having higher risks
to take interviews for guidance after they are notified, that fact then is shared with theircompanies.
This framework of stress check is inevitable in one aspect, but, it is also true that workers
would have sense of resistance, which could give negative impact that discourages them totake interviews for guidance.
Discussions should be held to suggest how to develop a structure to help workers when they
are exposed to higher risks of mental health problem, or initial symptoms are observed forthem, in such a way that they can be connected with external resources of occupational
doctors or external medical or supportive services, ahead from “self-care”.
Through this type of structural discussion, development of process to facilitate voluntaryinterviews for guidance or to refer workers to external consultation services such as
psychodiagnosis medical or psychiatric services, maintaining anonymity to companies canbe reviewed. However, this process could increase cost for companies, it is important toreview a direction to keep an appropriate balance between cost and benefit in the structure.
“Psychological” discussions would be essential, as well. To refer workers to external
psychodiagnosis medical or psychiatric services, communication to them will be a key
because they themselves may have bias or a sense of resistance about depression, which
could prevent earlier contacts to such external services. It is necessary to discuss how tounderstand where such prejudice or a sense of resistance is from and design training
programs or communications to remove it.
(4) 【Secondary to tertiary prevention】Fulfilment of leave of absence program/return-to-worksupport program
As the above-mentioned Survey on Industrial Safety and Health reveals, initiatives formental health problem prevention between sick leave and return to work, as well as after
return to work as the tertiary prevention have not been executed by many companies yet,compared to other types of initiatives. In particular, smaller companies have not madeprogresses fast enough.
To mitigate commercial losses of companies after their employees left due to their mental
health problem, discussions and research on how to develop the frameworks of programs
easily implementable regardless of the sizes of companies to support their employees to takesick leaves and to return to their works, as well as how to expand the use of and fulfil such
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November, 2018

programs are required.
Specifically, more broad use of and expansion of the scope of supports for small- andmid-sized businesses offered in Regional Industrial Health Centers governed by Japan
Organization of Occupational Health and Safety, or effective usage of “rework program”
more serviced by medical institutes can be main themes for such discussions.
Also, through the discussions, how to leverage latest technologies should be scoped in as
development of programs of “work as rehab” with both work at home (telework) utilizing IT
and shorter working hours.

Acknowledgment

The author is grateful to Mr. Norio Fujii M.D., Occupational Health Physician of AIG Japan and
Mr. Toru Yoshikawa, M.D., Ph.D., Deputy Director, Senior Researcher of Research Centre for the
Overwork-related Disorders (RECORDS), National Institute of Occupational Safety and Health,Japan for suggesting the topic treated in this document.
<References>
Ministry of Health, Labor and Welfare “Payment of worker’s compensation due to death from overwork;
attachment; payment of worker’s compensation for cases of mental problem” Publicly announced in 2017 andprevious years
Ministry of Health, Labor and Welfare “Guideline for maintenance and promotion of mental health of workers”
Revised on November 30, 2015; Public release No. 6 , Guidance for maintenance and promotion of health
Ministry of Health, Labor and Welfare・(Germany) Japan Organization of Occupational Health and Safety “Relax:
Development of mental health at workplace – Guidance for maintenance and promotion of mental health ofworker” 2017
Ministry of Health, Labor and Welfare “The 13th plan for Industrial Accident Prevention Plan” Publicly
announced on March 19, 2018
Ministry of Health, Labor and Welfare “2017 Overview of Survey on Industrial Safety and Health (fact-finding
survey)” Publicly released in August, 2018
Ministry of Health, Labor and Welfare “2015 Overview of Survey on Industrial Safety and Health (fact-finding
survey)” Publicly released in September, 2017
A question, “Stress check program will be effective as the primary prevention of mental health problem?”, at a
community site exclusive to doctors, MedPeer, over 60% of doctors responded that stress check would not beeffective. August 16, 2016 < https://medpeer.jp >Stavroula Leka and Tom Cox, “The European Framework for Psychosocial Risk Management: PRIMA-EF”,(visited Nov 15, 2018) < http://www.prima-ef.org/prima-ef-book.html >* This document is not intended to sell or recommend any insurance or other financial products. Also, it does not propose any
specific and concreate transactions nor guarantee their feasibility.
* AIG Institute (hereinafter referred to as AIG) shall not represent nor guarantee the accuracy, granularity, or reliability as touse or the result of use of this document nor being responsible for the use of the document. AIG shall not represent that thisdocument is always appropriate and being able to be used in any locations. AIG has made practical efforts to provide accurate
and latest information through this document, but, errors or omissions may not be avoided.
* AIG or any parties engaged in panning, developing, or providing this document shall not be held responsibility for direct,
coincidental, consequential, indirect, or punitive damages attributable to use or non-use of this document by our customers.
* The copyright of the contents included this document shall belong to AIG or the copyright holder AIG acquired a license for.
Unauthorized copy, reproduction, or change is prohibited.

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