保健医療科学

2024

Vol.73 No.1 p.16 − 31

Topics: Recent topics in public health in Japan 2024

＜ Review ＞
Prevention and future issues of karoshi and suicide by overwork in JapanYUKAWA Keiko1), SHIMANUKI Mihoko2,3), EGUCHI Hisashi4)
1)

Department of Epidemiology and Biostatistics, National Institute of Public Health
Funabashi Daiichi Law Office3)
National Defense Counsel for Victims of KAROSHI
4)
Department of Mental Health, Institute of Industrial Ecological Sciences, University of Occupational andEnvironmental Health, Japan
2)

Abstract
Since death from overwork became a social problem, the enactment of laws and the establishment ofstandards for certification, as well as improved actions on both the company and worker sides have beenmade. However, there is rarely a day in which news reports on death from overwork, suicide by overwork,
power harassment (bullying in the workplace, which is so-called power harassment in Japanese), etc. are
not heard. This paper discusses “death from overwork/karoshi,” a common social problem worldwide, covering the evolution of “measures against death from overwork in Japan” and major cases, and describes thelatest trends regarding current measures against death from overwork and cooperation, mainly between
healthcare professionals and the legal process.
After summarizing how death from overwork and suicide by overwork became established as a social
problem, as well as preventive policies, the Act on the Prevention of Death from Overwork, a review of thecriteria for certification, activities by workers and their families who are suffering from overwork and stressin the workplace, and the activities of lawyers who have developed nationwide consultation services such as“Death from Overwork 110,” this paper provides a detailed explanation of the legal. In addition, we explainin detail the legal procedures to be taken when death by overwork or suicide by overwork occurs.
Medical professionals in the field of occupational health and judiciary professionals who work on the legal
aspects of labor issues need to work together to combat and provide support regarding death from overwork. Until such time as death from overwork is eradicated, it is necessary to support relief for cases thathave occurred and to educate society at large.
keywords: death from overwork, labor-related suicide, occupational health, Law, KAROSHI, Japan(accepted for publication, December 19, 2023)

I. Introduction: Background of the social
problem of death from overwork
The first use of the term “karoshi” (death from overwork)
was by Uehata, et al. in 1978 [1], when they reported 17
cases of karoshi deaths [2], and in 1982, when they reported
52 cases of karoshi deaths. They referred to deaths causedby overwork as “karoshi (death from overwork)” [3], which

has now become a universal word beyond Japan.
Since death from overwork became a social problem, theenactment of laws and certification standards, as well as
improved measures on the part of companies and workers,
have been implemented. However, there is rarely a day inwhich a news report on death from overwork, suicide by
overwork, or power harassment is not heard. Until preventive measures bear fruit and death from overwork is

Corresponding author: YUKAWA Keiko
2-3-6 Minami, Wako, Saitama 351-0197, Japan.
Tel: 048-458-6311
yukawa.k.aa@niph.go.jp

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J. Natl. Inst. Public Health, 73 (1) : 2024

Prevention and future issues of karoshi and suicide by overwork in Japan
eradicated, it is necessary to support the relief of victims of
the incidents that have occurred, and to alert, and provide
awareness-raising in society.
This study summarizes the history of the problem ofdeath from overwork, and suggests how occupational
health-related professionals who are involved in issues withdeath from overwork should cooperate with workers andtheir families who are suffering from their working environments, as well as with judicial officials who address labor
problems from legal aspects, through programs such as
the “Death from Overwork Hotline 110,” to take measuresagainst and to provide support regarding death from overwork, respectively.

II. What are death from overwork and suicide by overwork workers?
Laws, Revisions to Laws, Guidelines, and events sur-rounding the issue of death from overwork are shown in
Table 1.
1. Death by overwork
Death from overwork is “death caused by overwork.”
The excessive accumulation of fatigue and mental straincaused by long working hours can impair mental and physical health, leading to death (Supreme Court ruling in the
Dentsu Inc. case, March 24, 2000) [4]. Death from overwork is defined as death resulting from physical factors,
such as brain hemorrhage or myocardial infarction, whereas
death resulting from mental factors, such as mental illness,is defined as overwork suicide.
However, after the enactment of labor laws and the riseof the labor movement in the late 1980s, karoshi began toattract social attention, and this term is widely used internationally [5]. In recent years, despite growing awarenessamong employers and employees regarding the need toTable 1 Concerning the events surrounding the issue of death from overwork
Date1947/9

Event
Labor Standards Act, Workersʼ Accident Compensation Insurance Act
Workersʼ Compensation Criteria for Cardiovascular Disease Established in Relation to Overwork (Division, the Labour Standards Bureau of the
1961/2
Ministry of Health, Labor and Welfare)
The term “death from overwork” was used officially for the first time at the 51st Japan Society for Occupational Health in Matsumoto City, Naga1978/6
no Prefecture, with regard to cerebrovascular disease and myocardial infarction from various occupations and jobs.
Revision of the Certification Criteria, “Certification Criteria for Cerebrovascular Disease and Ischemic Heart Disease, etc.” (October 26, Kiho No.
1987/10620)
1988/6
Volunteer attorneys provide the first “Death from Overwork 110” telephone consultation at eight locations nationwide
1988/10/2 The National Liaison Conference of Lawyers for Death from Overwork was formed.
The Chicago Tribune reported on the issue of overwork deaths in Japan, with the headline “JAPANESE LIVE AND DIE FOR THEIR WORK,”
1988/11/13
introducing the Hiraoka case on the papersʼ front page.
1991/11/12 The National Association of Families of Deaths from Overwork was formed.
Revision of the criteria for certification of death from overwork (Notice No. 38, Article 1 of the Inspection Division, the Labor Standards Bureau
1995/2/1of the Ministry of Health, Labor and Welfare)
1997/10/18 Held a “Suicide and Death from Overwork 110” telephone consultation
Criteria for Recognition of Suicide Caused by Overwork, “Criteria for Judgment of Off-the-Job Work for Mental Disorders, etc. Caused by Psycho1999/9/14
logical Overburden.”
2000/3/24 Dentsu Case Supreme Court Decision
2001/6/12 Labor Standards Ombudsman formed in Osaka
Establishment of new standards for certification of death from overwork (Notice No. 1063, Article 1 of the Inspection Division, the Labor Stan2001/12/12
dards Bureau of the Ministry of Health, Labor and Welfare)
Filed an administrative lawsuit in Osaka against non-disclosure of information on 36 agreements (won and finalized at Osaka District Court on
2005/3
2005/3/17)“Comprehensive Measures for the Prevention of health disorders due to Overwork” (March 17, Kiho No. 0317008).
2006/3This indicated that the risk of developing cerebrovascular disease increases when overtime hours are more than 45 hours in a month. This wasrevised in February 2008, February 2011, April 2016, April 2019, and April 2020.
Filed an administrative lawsuit demanding disclosure of the names of companies that caused deaths from overwork (Osaka District Court won on
2009/11/18
2011/11/10, Osaka High Court lost on 2012/11/29, Supreme Court rejected on 2013/10/1)
Establishment of new criteria for certification of suicide from overwork (Notice No. 1226-1, Article 1 of the Inspection Division, the Labour Stan2011/12/26
dards Bureau of the Ministry of Health, Labour and Welfare)
The Executive Committee for Enactment of the Basic Law for Prevention of Death from Overwork was formed．
2011/11/16
Approximately 550,000 signatures were signed by local governments; 143, including 10 from prefectural assemblies.
2012/6/13 The Nonpartisan Diet Members Caucus for the Enactment of a Basic Law for the Prevention of Death from Overwork was formed.
2013/5/17 Recommendation made to the Japanese government by the UN Committee on the Covenant on Social Rights
2014/6/20 The Act Promoting Measures to Prevent Death and Injury from Overwork was established, as Law No. 100 of 2014.
2015/7
Guidelines on measures to prevent death from overwork, etc. approved by the Japanese Cabinet
In September 2016, a female employee in her 20s at Dentsu was found to have committed suicide due to overwork, which was attributed to a
2015/12significant increase in overtime hours and was certified as a work-related accident. In October 2017, Dentsu was found to be in violation by the
Tokyo Summary Court and assessed a fine of 500,000 yen for failing to take measures to prevent illegal overtime.
The Law Concerning the Establishment of Relevant Laws to Promote Workplace Improvement was enacted.
2018/7
The Labor Standards Law, the Industrial Safety and Health Law, the Act on Improvement of Working Hours, etc. were revised.
2020/8
Cerebrovascular Disease and Ischemic Heart Disease Certification Criteria was revised.
Notice of “Self-Diagnosis Checklist for Fatigue Accumulation Level of Workers,” etc.
2023/4(Notice No. 0404-1 of the Labour Standards Bureau of the Ministry of Health, Labour and Welfare)

J. Natl. Inst. Public Health, 73 (1) : 2024

17

YUKAWA Keiko, SHIMANUKI Mihoko, EGUCHI Hisashi
improve mental health and workplace environments, there
have been many cases of death from overwork and suicide
by overwork in the entertainment, art, and medical fields,
making the improvement of workplace environments anurgent issue.
2. Suicide by overwork
The number of suicides in Japan exceeded 30,000 for 14
years starting in 1998, but has declined after 2010, and in
2022, a total of 21,881 suicides were reported (Figure 1). In
2022, a total of 2,968 suicides were attributed to work-related problems [6]. In terms of cause and motive, healthproblems accounted for 12,774 (58.4%), family problems
for 4,775 (21.8%), and economic and lifestyle problems
for 4,697 (21.5%) cases, followed by work problems. The
reasons for work-related suicides included workplace relationships (26.5%), job fatigue (24.4%), and changes in thework environment (19.8%). Slightly more occurrences wereamong older workers: 40–49 (27.5%), 50–59 (25.1%), 30–39(18.2%), and 20–29 (17.4%).
Long hours of overwork are the greatest cause of fatigue
accumulation, which is strongly associated with brain andheart disease. Mental disorders caused by work-related
psychological strain can significantly interfere with propercognition and inhibition, resulting in suicide.
3. Economic background of death from overwork andsuicide by overwork
In both cases, the common denominator was a strong
relationship between the economic situation and deaths
due to overwork. In particular, following the period of higheconomic growth from around 1955 to 1973, the economic
growth rate declined after the oil shock, and overwork-related deaths became a social problem in Japan in the 1980s.

Note that the data prepared by the Ministry of Health, Labor and Welfare from the National Police Agencyʼs original data on suicide statistics weremodified by the authors.
Note: Due to the following changes in the method of recording causes and motives, a simple comparison of the number of suicides by cause and motive is
not possible.
Before 2006: One closely related cause was recorded per suicide.
From 2007 to 2021: Up to three suicide attempts per person were recorded, only in cases where there was a suicide note.
2022: A maximum of four suicide attempts per person, including cases where there is a suicide note and family testimony.

Figure 1 Trends in the number of suicides (total, suicide caused by work problems)

18

J. Natl. Inst. Public Health, 73 (1) : 2024

Prevention and future issues of karoshi and suicide by overwork in Japan
In the late 1980s, real economic growth increased, stock
prices and land prices soared, and the bubble economy
collapsed, leading to long-term economic stagnation afterroughly 1991. Economic stagnation became a long-term
problem in Japan, and suicides due to overwork began tosurface in the late 1990s, when the economy entered a period of economic stagnation. Case reports of overwork suicides by Amagasa, et al. indicate that the causes of suicide
were long working hours, low discretion, low support, life
events, and harassment in the workplace [7,8].
The differences between the two are as follows. The
number of deaths due to overwork has been decreasing,while the number of suicides due to overwork has remained
constant. The industries with the largest number of deaths
were transportation, postal services, accommodation, andfood services for the former, and medical services, transportation, and postal services for the latter. Both were
dominated by males. Death from overwork occurred mostly
among middle-aged and older workers in their 40s and 50s,
while suicide occurred mostly among young workers intheir 20s and 30s. All deaths from overwork involved morethan 60 hours of monthly overtime, while 25% of suicides
involved less than 60 hours of overtime.
4. Changes in the number of persons affected
Of Japanʼs 120 million people, 66.76 million are employed(2022) [9]. The number of work-related fatalities, such as
falls and traffic accidents, declined from 6,712 in 1961 to
802 in 2020, whereas the number of work-related diseases
increased to 8,997. The number of deaths due to overwork
resulting from work-related accidents decreased from 160
in 2002 to 54 in 2022. The number of overwork-relatedsuicides increased from 11 in 1999, when the “Guidelines
for Determination of Work-related Accident Claims” were
established, to 67 in 2022 [6].

III. Background of the establishment of the
Law for Measures to Prevent Death from
Overwork, etc.
The Law for Measures to Prevent Death from Overwork,
etc. (Law for the Prevention of Death from Overwork), enacted on June 14, 2014, defines death from overwork, etc.
(Article 2) [10]. The law defines death and injury from overwork as 1) death due to cerebrovascular or cardiac diseasecaused by work overload, 2) death due to suicide caused bymental disorders due to strong psychological strain at work,and 3) cerebrovascular or cardiac disease or mental disorders caused by such work-related causes.
The enactment of the Law for the Prevention of Deathfrom Overwork was prompted by the activities of the be-reaved families of those who died from overwork, who
appealed for the prevention of death from overwork whilefiling for workersʼ compensation and civil suits. The Executive Committee for the Enactment of the Basic Law for thePrevention of Death from Overwork was formed in November 2011, bringing together bereaved families, supportive
lawyers, academics, and others to collect signatures andadvocate for the reality of overwork death. In May 2013, theCommittee on the Covenant on Social Rights, establishedby a resolution of the United Nations Economic and Social
Council, recommended that Japan strengthen measures toprevent long working hours [11]. Furthermore, the Federation of Diet Members was formed in Parliament, and theLaw for the Promotion of Measures to Prevent Death from
Overwork, etc., was submitted, enacted in June 2014, andenforced in November 2014.
The law requires the government to study deaths fromoverwork, etc. Seven industries are designated as priority
industries, including automobile drivers, educational staff,
IT, food service, medical, construction, and media, and arebeing analyzed by the Research Center for the Preventionof Death from Overwork, etc. The law also requires governments to study deaths from overwork in the IT, foodservice, medical, construction, and media industries [12].

IV. The structure of the problem of death fromoverwork
The structure of the problem of death from overwork isshown in Figure 2. Death from overwork, by narrow definition, refers to cases in which death occurs due to brain andheart diseases caused by overload. In addition, there arecases in which suicide (including attempted suicide) or aleave of absence and medical treatment are necessary due
to mental disorders caused by psychological overload. Even
if the person has not yet reached the point of physical ormental disorder, he or she can be said to be in the “reserve
army for death from overwork” if there are long working
hours, work stress, or power harassment. Since long working hours and power harassment can occur simultaneously,
it is difficult to strictly classify these factors. However, thefollowing is a general description of stressors such as long
working hours and power harassment.
1. Working hours and work stressors
Annual working hours for the general Japanese workforce
continues to be 2000 hours, but have been slowly declining
due to an increase in part-time workers [13]. For major firstworld countries, the rankings in 2022 had South Korea withthe highest number, followed by the United States, Japan,
and the United Kingdom [14]. With the enactment of the

J. Natl. Inst. Public Health, 73 (1) : 2024

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YUKAWA Keiko, SHIMANUKI Mihoko, EGUCHI Hisashi

Brain and heart disease due
to overwork
Death from overwork(broadly defined)
Mental disorders due tostrong psychological stress

Death from overwork
related issues

Death from overwork(narrowly defined)
Sequelae disability
Suicide/attempted suicide(overwork suicide)Long-term medical
treatment, etc.

Extreme overwork
Persons with a risk ofdeath from overwork

Strong work-related stressand power harassment

Figure 2 The structure of the problem of death from overwork“Working Style Change Law” in 2019, the total hours ofwork in 2022 became 1909 hours. The percentage of workers with “60 hours or more per week” has decreased by 5.1%
in recent years [6]. “Comprehensive measures for the prevention of health disorders due to overwork” was stipulated
in 2006 and states that overtime hours of 45 hours or moreincrease the risk of developing cerebrovascular diseases.
This included measures such as Reduction of overtime andholiday work hours, Promotion of taking annual paid leave,
Improvement of working hour arrangements, and Thoroughthe implementation of health management measures forworkers, which has been revised several times afterwards[15].
The percentage of workers who “feel strong anxiety,worry, or stress about their work or professional life” isroughly 60% every year, and is expected to reach 54.2% in
2022. “Strong anxiety, worry, and stress” was at 56.7% for
the quality and quantity of work, 35.0% for job failures andresponsibilities, and 27.0% for personal relationships, including sexual harassment/power harassment [6].
Mental disorders and suicides due to long hours andoverwork have decreased in recent years. However, thenumber of certified cases of mental disorders due to bullying and sexual harassment has been increasing. In addition
to the relationship between long working hours and depression, it can lead to circulatory disease, diabetes mellitus,
metabolic syndrome, other psychological disorders, sleep
condition, cognitive function, and health-related behavior[16]. High job demands, low discretionary work (strain), andeffort-reward imbalance can cause stress and depression,and social support in the workplace can help to alleviate
stress [17]. Job demands and job control are also important,as high-discretion jobs are less likely to cause depression
than low-discretion jobs.
The causal relationship between “harassment” and “bullying”, and depression has an odds ratio of 2.82. Continued
bullying can cause cardiovascular disease, depression, anddeath among workers [18]. Since the collapse of the bubble

20

economy in the late 1990s, the pay-for-performance system
in Japan may have caused various work-related stressors.
In 2007, a Court also ruled that power harassment was a
work-related injury in a case in which a worker at a factory
suffered from depression and committed suicide in 1997,
due to the psychological burden and overwork caused by
overwork and power harassment by colleagues [19]. In addition, awareness-raising on power harassment is currently
provided [20].
In 1999, after the Dentsu lawsuit, the “Guidelines for
Determining Psychological Disorders Caused by Psychological Overload Outside of Work” were formulated, and in
2011, the “Certification Criteria” for workersʼ compensation
for mental disorders were established. Physiciansʼ opinions
play an important role in certifying workersʼ compensation.
The guidelines have since been revised [21]. However,the fact that physicians are unfamiliar with the workersʼ
compensation certification system and certification criteria
is one reason for low workersʼ compensation certification
rates, by approximately 50% for suicide by overwork and
30% for mental disorders, making familiarizing physicianswith the system an urgent issue.
2. Mental health in the workplace
In Japan, owing to the rapid aging of the population anda declining birthrate, the ratio of effective job offers for applicants increased from 0.47 in 2009 to 1.29 in 2023. During
the period of high economic growth and GDP expansion,from the high economic growth period to the Bubble Economy of the late 1980s, it was easy for workers to feel the
positive effects of their work. However, the economy did
not grow for 30 years after the collapse of the Bubble Economy, making it difficult for workers to achieve positive job
outcomes, which may have worsened their mental health.
The 13th Industrial Accident Prevention Plan (from2008 to 2022) [22] indicates the promotion of mental healthmeasures in the workplace, as follows: 1) increase the percentage of workers who have a place to consult regarding

J. Natl. Inst. Public Health, 73 (1) : 2024

Prevention and future issues of karoshi and suicide by overwork in Japananxiety and stress at work, including resources outside of
the workplace, to 90% or more; 2) increase the percentageof workplaces that are taking mental health care actions to
80% or more; and, 3) increase the percentage of workplaces that have a mental health care system to 80% or more.
In addition, 4) the percentage of workplaces that conduct
group analyses of stress checks and utilize the results
should be at least 60%. The percentage of workplaces taking mental health care actions is approximately 63.4%, andover 90% of offices with 50 or more employees had implemented them by 2022 [6].
The criteria for the certification of mental disorders were
presented, and power harassment was added to the 2020
revised version [23]. The number of workersʼ compensation
claims for mental-health disorders due to work-related psychological strain increased to 2,683 in 2022. The number ofcases of workersʼ compensation decisions (certifications)
had stood at approximately 500 since 2012, but in 2022,
there were 710 cases (including 67 suicides and attemptedsuicides). The breakdown included 147 cases of “power
harassment,” such as physical and mental attacks by superiors. In 89 of these cases, the cause was “experiencing or
witnessing a tragic accident or disaster,” while in 66 cases
it was, “being assaulted or bullied by coworkers,” whichwere caused by human relations in the workplace [24,25].
The number of claims for workersʼ compensation for mental-health disorders is increasing, and improvements areurgently required.
The Ministry of Health, Labour and Welfare has established the “Guidelines for the Maintenance and Promotionof Workersʼ Mental Health” to promote mental health careactions in the workplace [26]. This guideline is a policy
under Article 69, Section 1 of the Occupational Health and
Safety Law (consideration of mental health by business
operators for workers), and covers “primary prevention” formental health problems through the use of stress checks
and improvement of current conditions in the workplace,“secondary prevention” to detect problems at an early stage
and take appropriate care, and “tertiary prevention” to support workers who are not in good health by supporting theirreturn to work.
3. Outline and review of measures to prevent deathfrom overwork, etc.
Based on the provisions of the Law for the Prevention of
Death from Overwork, in December 2014, the Ministry of
Health, Labor, and Welfare established the Council for thePrevention of Death from Overwork, composed of bereaved
families of overwork deaths, labor-management representatives, and experts, and prepared the “Outline of Measures
to Prevent Death from Overwork,” published in July 2014.

In accordance with the Law on the Prevention of Deathfrom Overwork, etc. and the Outline, the government andother organizations have been promoting measures to prevent deaths from overwork, such as surveys and research,awareness-raising, and the development of consultation
systems, as well as efforts to support the activities ofprivate organizations, which are reported annually in the“White Paper on Measures to Prevent Death from Overwork, etc.” under Article 6 of the Law.
The Outline was decided in July 2015 after the Council
discussed measures to prevent death from overwork, etc.,
thereafter. Furthermore, based on changes in socioeconomic conditions and other factors, the outline was again
decided after the first review in July 2018. Subsequently, although various efforts were undertaken to reform the work
styles of workers, the need for a review was pointed out,
considering the increase in the number of deaths of overworked workers, especially among younger workers, theresponse to COVID-19, and teleworking [27]. In July 2021,
a new outline was decided.
The new outline included the following points: It is necessary to prevent the occurrence of overwork and otherdeaths due to responses to the novel coronavirus infection
and changes in work styles, as evidenced by overwork atsome medical workplaces and workplaces that are understaffed due to the spread of infections of the novel coronavirus. In addition to disseminating guidelines on teleworking,side/concurrent jobs, and freelancing, which are new ways
of working during the corona and post-corona eras, surveys
and research should be conducted. Measures to prevent
death from overwork, etc. of public servants should be employed.
Major measures include providing support to small- andmedium-sized enterprises which have long work hours, andan inadequate introduction of interoffice interval systems
and mental health care actions. Priority industries, such as
automobile drivers, teaching staff, information technology,
food service, medical care, construction, and media industries, were listed in the surveys and studies. In addition,a determination of the status of working hours under the
influence of the novel coronavirus infection, as well as online utilization of telework and the development of support
tools, such as checklists, should be conducted.
4. Trends in measures against death from overwork
and suicide in other countries
In the UK and France, from a health perspective, in
addition to the upper working hour limit of “48 hours per
week in principle, including overtime,” there is a provision
for a minimum of 11 consecutive hours of rest per 24-hour
period. The percentage of people working 50 hours or more

J. Natl. Inst. Public Health, 73 (1) : 2024

21

YUKAWA Keiko, SHIMANUKI Mihoko, EGUCHI Hisashi
Table 2 Proportion of workers working 49 hours or more per week
Japan
United States of America
CanadaUnited Kingdom
Germany
France
Italy
Netherlands
Belgium
Denmark
SwedenFinland
NorwaySwitzerland
Spain
Portugal
RussiaHong Kong
Korea
Malaysia
ThailandIndonesia
Philippines
Australia
New Zealand
MexicoBrazil

2010

2015

2016

2017

2018

2019

2020

2021

23.1
15.4
12.5
11.6
11.7
12.1
11.1
8.5
11.3
8.6
8.0
8.7
5.7
16.7
10.8
9.4
3.0
37.7
37.6
29.5
39.5
30.4
24.6
15.2
14.8
28.7
-

20.8
15.8
12.1
12.3
9.6
10.6
9.8
8.7
11.6
8.5
7.3
8.2
5.9
14.6
9.6
10.8
3.0
30.0
31.9
21.5
30.8
27.0
22.9
14.2
13.8
28.6
11.6

20.1
15.9
11.9
12.2
9.3
11.0
9.9
8.8
11.4
7.8
7.1
8.4
5.7
14.5
8.9
10.0
2.8
29.9
29.9
21.0
23.8
29.1
25.0
14.3
14.9
28.9
10.8

20.6
15.7
11.6
11.7
8.5
10.4
10.2
8.4
8.6
7.5
6.8
8.1
5.2
14.1
8.3
10.0
28.8
23.0
30.6
22.8
13.8
14.9
28.6
11.2

19.0
15.8
11.9
11.5
8.1
10.6
10.2
8.0
8.1
6.9
6.6
8.1
5.1
14.1
8.0
9.6
25.1
21.8
29.6
23.5
13.1
14.9
28.2
11.7

18.3
15.7
11.1
11.4
7.7
10.6
9.8
7.8
8.1
6.6
6.5
8.1
5.0
13.4
7.2
9.4
23.1
16.0
20.2
28.8
22.8
13.0
14.9
28.2
12.3

15.0
14.2
10.0
5.7
9.5
7.8
6.7
7.0
6.3
5.7
7.3
4.7
11.8
5.9
7.4
19.5
17.1
26.9
17.6
11.8
10.6

15.1
14.6
10.8
5.7
9.1
9.0
5.8
7.9
7.2
5.8
6.9
4.8
10.4
6.6
7.8
18.4
16.8
24.8
19.4
27.4
12.0

1)
2)
2)
3)
2)
2)
2)
2)
2)
2)
2)
2)
2)
2)
4)
5)
6)

2) 7)

ILOSTAT (https://ilostat.ilo.org/data/) December 2022
Modified by the author from “Labor Force Survey (Basic Tabulation)” (February 2022), Statistics Bureau, Ministry of Internal Affairs andCommunications
1) The survey covers persons aged 16 years and older.
2) Subject to both full- and part-time workers.
3) Excludes production workers for own use.
4) Subjects up to 72 years of age; 2010 excludes the institutional population and some territories.
5) Excludes the institutional population; in 2015–2016, government-controlled areas are covered.
6) Subjects up to 64 years of age; 2016 and 2019 exclude the institutional population.
7) Excludes the institutional population, military, and conscripts. Excludes overseas territories; after 2015, excludes production workers forown use.
8) “Long hours” refers to 49 hours or more per week, which is the longest category common to all countries in this table, in ILOSTATʼsstatistics on workers by working hours. In principle, all industries and workers (including part-time workers) are covered. In Japan, thepercentage of workers who worked 49 hours or more per week was calculated using the JILPT.

per week is over 30% in Japan, 12% in the UK, and 9% in
France [28] (Table 2). In May 2021, based on a joint study
with the International Labor Organization on stroke andheart disease caused by long working hours (55 hours ormore per week), the World Health Organization announced
that “long working hours kill 745,000 people per year” [29].
In a famous overseas case, 37 employees of France
Télécom S.A. (now Orange), a major French telecommunications company, attempted suicide between 2008 and 2009,
with 24 of them dying. The suicides were attributed to “workstress,” as all of the employeesʼ on-the-job activities weremonitored and they were forced to respond constantly, evenduring breaks, without leaving their communication devices(France Télécom case) [30]. In 2016, the “loi El Khomri”(Law on El Khomri) was enacted [31], which requires com-22

panies with more than 50 employees to ensure that employees are not allowed to send or receive work emails during
mandatory hours. Khomri workers gained the “right todisconnect” (right to be offline), which means that they did
not have to look at work emails outside of work hours. In
the UK, in 2013, a 21-year-old German intern at the Bankof Americaʼs London office died of a stroke after working
72 hours straight [32]. This led to restrictions on working
hours on Wall Street.
In the United States and Europe, the system evaluates
employees based on ability rather than time. However, long
working hours are more serious in Asian countries such as
India, South Korea, Taiwan, and China. A difference in workvalues between Asia and the West is behind this situation.
In particular, in Asian culture, overtime is seen as working

J. Natl. Inst. Public Health, 73 (1) : 2024

Prevention and future issues of karoshi and suicide by overwork in Japan
hard, and perseverance and hard work are virtues. In thisregard, it is necessary to take measures against death fromoverwork beyond national borders.

V. Collaboration between medical care and the
judiciary
In 2000, the Supreme Court of Japan ruled in a case,
Table 3

“Dentsuʼs Suicide by Overwork,” which fully recognized
the causal relationship between long hours of overwork,
depression, and suicide, as well as the responsibility of thecompany. However, the number of overwork-related suicides has not decreased since then, and in 2014, the Law for
Measures to Prevent Death from Overwork was enacted,
due to the efforts of the Association of Families Affectedby Death from Overwork and the Lawyersʼ Committee for

Major compensation cases for death from overwork or suicide by overwork

Summary of Case1 ）A security guard in his 60s died of a stroke while in security guard service. The
Fuji security
Tokyo District
March 28, 1996
Labor Case No. 694
court found that the company violated its duty of care in failing to conduct mediCase
Court
cal examinations and to reduce the volume of work (62.94 million yen).
An employee in his 20s, who was constantly involved in long hours of overtime
Hanrei Trial Court No.
Dentsu overMarch 24, 2000 Supreme Court
work, suffered from depression and committed suicide. A settlement was reachedwork suicide1028
in which the company paid 168 million yen to the bereaved family.
An employee engaged in computer software development died of a brainstem
hemorrhage. The second trial court found that his death was caused by overSystem ConsulOctober 13, 2000 Supreme Court Labor Case No. 791
tantwork, and that the company was in breach of its duty of care for safety (32 millionyen).
A driver who was engaged in the driving a car as a driver for a branch manager
developed a subarachnoid hemorrhage while driving. The Supreme Court foundTokio Marinethat the work-related factors were attributable to the fact that the excessive
Supreme Court Hanrei Times No. 1041
Branch Manag- July 17, 2000
mental and physical strain. caused by the work he was engaged in before theer's driver
onset of the disease aggravated the underlying disease beyond its natural course,
leading to the onset of the disease.
The work-related nature of the suicide of a male section chief in his 30s in
charge of automobile design work at an automobile company was affirmed on the
grounds that his suicide in 1988 was caused by depression resulting from overOverwork SuiNagoya High
Judgment Litigationcide of a Toyota July 8, 2003
work. The Nagoya High Court upheld the decision of the first trial court, which
Court
Monthly, Vol. 50, No. 6
Section Chief
rescinded the disposition of the Toyota Labor Standards Inspection Office, which
denied recognition of the work-related accident, and dismissed the appeal by the
Labor Standards Office.
An employee of an agricultural cooperative died (committed suicide), and his
Mikumano
February 19,
Wakayama
The law times report No. family demanded for the cooperative to pay damages, as well as damages for deAgriculturallay, based on the right to claim damages for tort or default (breach of duty of care
2002
District Court
1098
Cooperative
for safety). Payment of 8.59 million yen was approved .
A case in which a representative directorʼs breach of his duty of care for healthand the companyʼs breach of its duty of care for safety were affirmed, finding areasonable causal relationship between his work and the acute cardiac death of
Minami Osaka
Osaka District
The law times report No.
an employee of a renovation construction company with an underlying condition
My Home Ser- April 4, 2003
Court
1162
vice
of dilated cardiomyopathy. The court ordered the payment of approximately 19.8
million yen to the surviving wife and 9.9 million yen to each of their two children(39.6 million yen).
In a case in which an employee of the Waterworks Bureau committed suicideTokyo Highdue to harassment and bullying in and outside of the workplace, the Bureau was
Kawasaki WaterMarch 25, 2003
Labor Case No. 849
works Bureau
Courtfound to have breached the cityʼs duty of care for safety, and was liable for damages amounting to 21 million yen under the National Compensation Law.
A pediatrician in his 40s became depressed and committed suicide due to overtime work and duty work, etc. However, the court judged that it was unexpected
Rissho Kosei-kai
Tokyo High
October 22, 2008
Labor Case No. 963
and not a failure of the hospital's duty of care for safety, because he had not talked
Hospital
Court
to anyone around him. Later in 2010, the case was settled by the Supreme Court(the settlement payment was 7 million yen).
A female worker in her 30s developed and aggravated a depressive illness due
to overwork; in determining the amount of damages based on the employer's
Toshiba DepresMarch 24, 2014 Supreme Court Hanrei Times No. 1424 breach of its duty of care for safety, etc., the employer's negligence cannot be
sion
offset by the fact that the worker did not report certain information about her
mental health to the employer.
A male employee in his 20s at JR West who committed suicide admitted toWest Japan RailOsaka District
Labor Case Journal, No.
way Co. (Suicide March 20, 2015
working roughly 113-254 overtime hours per month, which was a failure of the
Court
40
by Depression)company's duty of care for workers' safety (100 million yen).
A female employee in her 20s at a fruit and vegetable brokerage company was
reassigned from accounting to sales in April 2012, but committed suicide in Juneof the same year. She was bullied and power-harassed by two senior female
employees in both departments, and the company ignored this and reassigned
Otoyama Fruit November 30,
Nagoya High
Hanrei Times No. 1449 her without sufficient handover, burdening her with excessive work. As a result,and Vegetable
2017
Court
she suffered a strong mental burden, fell into depression, and committed suicide.
The high court found a reasonable causal relationship between the tort (including
employer's liability) and suicide, and the district court's decision which denied areasonable causal relationship with the suicide was modified.
A male physician in his 30s died in December 2014 due to overwork, averaging
Nagasaki Minato
Nagasaki District
May 27, 2019
Labor Case No. 1235
177 hours of overtime per month, and the court found that the hospital had failed
Medical Center
Court
to consider the safety of the staff (167 million yen).
Regarding a considerable relationship between a chef's death and the restauLa Tortuga
rants' failure to provide appropriate safety care, the court found that the chef had
February 21,
Osaka District(Overwork
Labor Case No. 1221
worked approximately 250 hours of overtime per month, resulting in weakened
2020
Court
Death)
immunity and the occurrence of myocarditis (84 million yen).
Case

Date

Court

Bibliographic Information

1 ）The final monetary amount at the end of the sentence indicates the Amount of compensation/ Settlement.

J. Natl. Inst. Public Health, 73 (1) : 2024

23

YUKAWA Keiko, SHIMANUKI Mihoko, EGUCHI Hisashi

Occurrence of problems
Mental and physical problems due to overwork, power harassment, etc., death from overwork, suicide by overwork.
(i) Understanding of the case: Hear thoroughly from the affected parties and the bereaved family members.
After repeated consultations, the case is ascertained.
(ii) Selection of procedures: After understanding the case, what procedures should be selected should be considered.

1 Consultation

In principle, the applicant should apply for workers‘ compensation insurance first.
According to the case, negotiation or civil litigation may be considered.
If the application for workers' compensation insurance is to be preceded, consider at which stage the attorney will take the case.
It is possible that the victim or surviving family members of the victim file an application for workers’ compensation insurance on their own,
and only the civil lawsuit is handled by the attorney. However, in many cases of death from overwork or suicide by overwork, it is difficult todecide on the payment of workers’ compensation benefits without a lawyer. Therefore, it is desirable that the attorney will take the case.

2 Acceptance of Attorney

When the workers' compensation insurance application process is accepted, the first step is to collect evidence.
(i) Voluntary disclosure requests to employers
Normally, notify the employer of the acceptance of the case first, and at the same time, request voluntary disclosure of materials regarding
evidence of the workers' compensation case that is in the employer's possession.
In cases where there is a possibility of evidence tampering, etc., withholding the request for voluntary disclosure will be considered.

3 Evidence gathering

Evidence required to be disclosed by the worker(a) Evidence related to labor contracts and job descriptions (employment contracts, notices of working conditions, etc.)(b) Evidence related to working hours (timecards, daily work reports, e-mails sent and received, etc.)(c) Evidence related to payroll, etc. (pay stubs, wage ledgers, wage regulations, etc.)(d) Evidence related to the circumstances of accidents (photographs of the accident site, accident reports, etc.)(e) Evidence related to workers’ health condition(periodic health checkup result reports, stress check result records, records of interviews with industrial physicians, etc.)

Meet directly with the employee (evidence is disclosed at the meeting) and ask for an explanation of the content of the evidence.
(ii) Other evidence collection
In addition, the office inspects and copies other criminal case records, such as actual condition records and photographic reports, andcollects various types of evidence through bar association inquiries, etc.
(iii) Collection of evidence by victims and bereaved families
The victims and their bereaved families are requested to disclose evidence regarding the worker's health condition (medical certificates,
medical records, etc.), and the nature of the work, if any.

4 Application for workers'
compensation insurance

After collecting evidence and examining it carefully, prepare documents, etc. for application for workers' compensation insurance.
Specifically, assist in the preparation of attorney's opinion letters, statements by the victims and their bereaved families, and organize theevidence to be submitted.
In the attorney's written opinion, it is necessary to clearly and persuasively describe the circumstances in which work-related injuries arerecognized in accordance with the respective certification criteria.
When all of the documents have been prepared, an application for workers' compensation insurance is filed with the Labor Standards
Inspection Office with jurisdiction.

5 From application todecision

After the application is accepted, an investigation by the Labor Standards Bureau is initiated.
Proactive and regular checks on the progress of the application are made with the officer in charge after the application is filed.

6 After the decision to
pay/not to pay

After the decision is made by the Labor Standards Bureau, visit the Labor Standards Bureau to hear the reasons for the decision to grant/not
grant.

7 Personal Information
Disclosure Request

After the decision is confirmed, the attorney requests that the Labor Bureau disclose its personal information, such as an investigation
reinstatement order.

8 Press conference

In order to prevent overwork deaths, etc., consider holding a press conference not only to resolve the case but also to appeal to society at large.
Consideration will be given to the wishes and privacy of the victims and their bereaved families.

9 Pursuing a NegotiatedSolution

In cases where the decision to grant benefits is found to be due to work-related reasons, after disclosing the retained personal information, we
will set up another meeting with the employer to explore the possibility of resolving the issue through negotiation too.
(i) Request for examination: In the case of out-of-work certification, prepare a statement of reasons for the request for review, in order toapply for review to the Labor Insurance Examiner.
(ii) Request for re-examination: In the case of an examination decision, if dissatisfied, file a petition for re-examination with the Industrial
Accident Compensation Insurance Examination Board.
(iii) Litigation for revocation: If dissatisfied with the result of the request for review or the result of the request for re-examination, file alawsuit for revocation of the disposition of nonpayment of benefits against the government.

10 Appeals process

If the negotiations break down
1 Filing a civil lawsuit

After discussing the way forward with the victims and their families, a civil lawsuit is usually filed.
If the case needs to be widely publicized, a press conference should be held at the same time as
the lawsuit is filed, after discussing the matter with the parties involved.
During the press conference, care should be taken to ensure that it does not constitute libel or slander.

2 Post-Petition Defense

Both the worker and the employer sides present their arguments and proof.

3 Post-Petition Gathering
evidence

If voluntary disclosure is refused at the negotiation stage, evidence is collected after the lawsuit is filed.
This may include party inquiry requests, commissions to send documents, orders to submit documents, commissions to investigate,
preservation of evidence, etc.

Merits of Settlement
Settlement
・Early resolution compared to a judgment.
・Flexible settlement, such as including an apology clause or a clause toprevent recurrence, etc., is possible.
Disadvantages of settlement
・Employers often require inclusion of a confidentiality clause.
It is necessary to choose between settlement and judgment after careful
discussions with the parties concerned.

Judgment
If there is dissatisfaction with the content of thejudgment, the case is appealed.
Depending on the case, a press conference may be heldon the day of the judgment.

Figure 3 Legal procedures for issues related to the death of overwork

24

J. Natl. Inst. Public Health, 73 (1) : 2024

Prevention and future issues of karoshi and suicide by overwork in Japan
Death from Overwork. Every year, the National Networkof 110 Hotlines for Death from Overwork, composed oflawyers and others, provides free telephone counseling on
death from overwork and harassment in Japan. The network has conducted nearly 40 such calls since 1988, targeting workers and bereaved families.
Death from overwork and suicide by overwork are terms
used in public health, and are not fully recognized by thegeneral public, including medical professionals. There is
not enough cooperation between the medical and judicial
systems in the recognition of workersʼ compensation andin trials for death from overwork. Table 3 shows the major
compensation cases, and the legal procedures related todeath from overwork are shown in Figure 3.
1. Impressive events that occurred during the actual
activities of the lawyersʼ group
As a member of the Death from Overwork Defense Lawyers Group, while working on several cases of death fromoverwork, we found that death from overwork can change
not only the lives of the victims themselves, but also thelives of the bereaved families and the families who support
the victims [33,34].
A system engineer who was forced to work overtime exceeding 100 hours per month developed depression at the
young age of 30 years, and even after 10 years, he was still
unable to lead a normal life. His wife supported him in his
daily life while raising their young child, while simultaneously collecting evidence and preparing documents for his
application for workersʼ compensation insurance, and continuing to support him in the civil lawsuit process after thedecision was made. As a result of exposure to such harshconditions, the wife suffered from a mental disorder. Although the case was resolved by settlement, the wife, who
had supported the victim for many years, tearfully complained to the company executives on the settlement datethat the life of the victim and his family had been changed,
leaving a strong impression on the legal team.
With the enforcement of the Law for Measures to Prevent Death from Overwork, etc., which came into effect in2014, November is designated as a month for raising awareness to prevent death from overwork, etc., and symposiums
on the prevention of death from overwork are held in various parts of Japan. At the symposiums, there is an opportunity for survivors of death from overwork to share theirstories, and their experiences make us keenly aware thatdeath from overwork, etc. can transform the lives not onlyof the victims but also of the survivors and their supporting
family members.
2. Complaints from bereaved families and workers

whose health was harmed by overwork
At symposiums on the prevention of death from overwork, etc. and in cases involving death from overwork, etc.,
victims and their bereaved families earnestly appealed thatthey did not want a tragedy like theirs to happen to anyone.
To realize the wishes of the victims and bereaved families,
we believe that lawyers involved in the issue of death fromoverwork have an important responsibility not only to provide relief to individual victims, but also to work to build asociety in which death from overwork is eliminated [35].
Below, we introduce some of the specific legal activities
that our lawyers are engaged in to help victims of deathfrom overwork and to prevent such deaths.
3. Legal defense activities prior to court trials
When an attorney receives a consultation regarding acase of death from overwork, etc., the response varies depending on the case and the attorney. However, the following presents an example of such activities. [36-39].
(1) Consultation stage
1) Understanding the caseFirst, it is important to fully understand the circumstances of the affected party and bereaved family. Since it is difficult to hear everything in a single consultation, the case isascertained through repeated consultations.
2) Selection of procedures
After gaining an understanding of the case, the attorneyconsiders the procedures that should be selected. As a general rule, we first file an application for workersʼ compensation insurance to determine whether the injury was caused
by work. However, if there is a high probability of non-recognition, negotiation or civil litigation will be considered.
(2) Timing of receiving an appointment by an attorney
When an application for workersʼ compensation insurance is filed in advance, the attorney considers the stage at
which to accept the case.
It is possible that the victim or surviving family membersof the victim file an application for workersʼ compensation
insurance on their own, and only the civil lawsuit is handled by the attorney. However, in many cases of death fromoverwork or suicide by overwork, it is difficult to applicate
for workerʼs compensation insurance without a lawyer.
(3) Evidence gathering
When an attorney accepts a clientʼs request for a workersʼ
compensation application, first of all, the attorney collectevidence regarding the application for workersʼ compensation insurance.
1) Voluntary disclosure requests to employers
Normally, we first notify the employer of our acceptanceof the case, and simultaneously request that the employer
voluntarily disclose evidence concerning the workersʼ com-

J. Natl. Inst. Public Health, 73 (1) : 2024

25

YUKAWA Keiko, SHIMANUKI Mihoko, EGUCHI Hisashi
pensation case, since the employer often possesses such
evidence.
However, when there is a risk of evidence tampering,
withholding the request for voluntary disclosure will beconsidered.
Workers may request the following types of evidence.
The requested content varies depending on the case.
a) Evidence related to labor contracts and the natureof work
Employment contracts, written notices of working conditions, work rules, company organization charts, etc.
b) Evidence related to working hours
Timecards, daily work reports, attendance records,
entry/exit records, sent/received emails on the workerʼs
computer, log-in/log-out, server access records, records ofovertime work requests, contents of sent/received emails
on work cell phones and their sending/receiving history,
telephone calling/receiving histories, etc.
c) Evidence related to payroll, etc.
Pay stubs, wage ledgers, wage regulations, etc.
d) Evidence related to accident circumstances, etc.
Photographs of the accident site, accident reports, work
procedure manuals, work content reports, etc.
e) Evidence related to the workersʼ health conditions
Periodic health checkup result reports, stress check
result records, records of interviews with industrial physicians, etc.
After receiving the disclosure of this evidence, the employer should meet directly with the employee (or they are
asked to disclose the evidence during the meeting) and ask
for an explanation of its content.
Subsequently, we examine the disclosed evidence closely,
and if there is a need for further disclosure of evidence, we
may request additional evidence disclosure.
2) Collection of other evidence
In addition, we can inspect and copy criminal case records, such as actual investigation records and photographic
reports, or use bar association inquiries to collect various
types of evidence.
For example, in the case of an emergency medical evacuation due to suicide by overwork, we may request thatthe fire department disclose emergency dispatch records
by making an inquiry to the bar association, in addition toinspecting and copying criminal case records.
3) Collection of evidence by victims and bereaved
family members
Victims and their bereaved families will be asked to disclose any evidence regarding the workerʼs health condition(medical certificates, medical records, etc.) and the natureof the work, if any.
(4) Application for workersʼ compensation insurance

26

After collecting and examining the evidence, the lawyer
prepares the documents to apply for workersʼ compensation
insurance. Specifically, they will assist in the preparation of
written opinions from lawyers, and written statements fromdisaster victims and their bereaved families, and in organizing the evidence to be submitted. The lawyerʼs written
opinion must clearly and persuasively describe the circumstances deemed to be caused by the work, in accordancewith each certification standard. Once you have all of the
documents, an application is made for workersʼ compensation insurance at the Labor Standards Inspection Officewith jurisdiction.
(5) Activities from application to decision
After the application is received, the Labor Standards Office will begin the investigation. After filing an application,
it is not sufficient to simply wait for a decision to be made.
Immediately after filing an application, the lawyer willcontact the officer in charge, either at the Labor Standards
Office or over the phone, to directly explain an outline of
the case to the officer and request any particular points thatshould be investigated. In addition, when the applicant isinterviewed, a lawyer will be present. Subsequently, we will
periodically check on progress with the officer in charge,
and depending on the content of the response, we will consider submitting additional evidence.
(6) After the decision to pay (or not to pay)
After the Labor Standards Bureauʼs decision is made, theattorney visits the Labor Standards Bureau to hear the reasons for the decision to grant or deny benefits.
(7) Request for disclosure of personal information
After the decision is confirmed, the client requests that
the Labor Bureau disclose its personal information, such as
an investigation reinstatement order.
(8) Press releaseTo prevent deaths due to overwork, it is important not
only to solve the case, but also to alert society at large by
appealing to the public. Therefore, some patients may require press releases after the disclosure of the investigation
report. In such cases, press releases should be held for theaffected workers and their families. It is important to consider the privacy of the clients and their wishes.
(9) Pursuing a resolution through negotiation
In cases where the employer is found to be at fault, after
personal information is disclosed, the attorney arranges
another meeting with the employer to pursue a solution to
the problem through negotiation. Generally, it takes a considerable amount of time to settle a civil lawsuit; therefore,
it is important for clients to be aware of the emotional andprocedural burden of such a lawsuit. The mental and procedural burden on the client cannot be ignored. For this reason, it is necessary to explore the possibility of a resolution

J. Natl. Inst. Public Health, 73 (1) : 2024

Prevention and future issues of karoshi and suicide by overwork in Japanthrough negotiation as much as possible, to reduce suchburdens.
(10) Complaint procedures against the judgment
1) Request for examination
If the case is found to be out-of-work, the attorney may
request an examination from the Labor Insurance Examiner. We analyze the disclosed personal information (e.g.,
investigation reinstatement order, etc.) and prepare a statement of the reasons for the request for examination.
2) Request for re-examination
If a review decision is issued on a request for review
filed with the Labor Insurance Examiner and the decision
is unsatisfactory, a petition for re-examination against thedecision can be filed with the Workersʼ Accident Compensation Insurance Board of Appeals. In the re-examination
request, a statement of oral opinion is made, and an attorney is present to state their opinion. Although it is rare fora conclusion to be overturned in a re-examination request,
it is necessary to not give up. In addition, by requesting a
re-examination, a set of documents (referred to as a caserecord) from the investigation stage of the Labor Standards
Inspection Office to the stage of requesting an examination
sent to the applicant. This case record will be useful in subsequent litigation procedures, making the request for re-examination meaningful.
3) Litigation for revocation
If the client is dissatisfied with the result of the request
for review, or if the client is dissatisfied with the result of
the request for re-examination, the client may file a lawsuit
against the government to rescind the disposition of nonpayment.
4. Defense activities after the filing of lawsuits(1) Filing a civil lawsuit
When negotiations break down, the attorney discusses
the next action with the client and family, and usually files
a civil lawsuit. If the case requires a broad public appeal, apress conference may be held at the same time as the lawsuit is filed. In some cases, a settlement is reached outsideof court before the first date of the lawsuit, due to media
coverage of the press conference at the time of filing thelawsuit. Care should be taken to avoid defamation during
press conferences.
(2) Defense activities after the lawsuit is filed
After the lawsuit is filed, both sides, the worker and employer, present their arguments and proof.
(3) Gathering of evidence after the lawsuit is filed
If voluntary disclosure is refused during the negotiation
stage, evidence is gathered only after a lawsuit is filed. Specifically, this includes party inquiries, document delivery
requests, document submission orders, investigative com-missions, and evidence preservation.
(4) Cases of resolution by settlement
The cases are sometimes resolved by settlement rather
than judgment. Compared with a judgment, a settlement
has the advantages of early resolution (the parties are notburdened with interrogation, etc.) and flexible resolution (ifthe employer does not refuse), such as including an apology
clause or a clause to prevent recurrence. However, employers often require confidentiality agreements in settlements,
which is a disadvantage if it is desired to appeal widely tothe public. The choice between settlement and judgment
should be made after careful discussions with the client,and a settlement proposal should be carefully prepared.
(5) Judgment
If the client is dissatisfied with the judgment, an appeal
should be filed. If necessary, prepare to hold a press conference on the Day of Judgment.
5. Need to inform occupational health professional of
the issue of death from overwork and the system
In cases such as death from overwork, the cooperationof medical professionals is indispensable. In particular, theopinion and medical certification of the attending physician plays an important role in the certification of workersʼ
compensation. Unfortunately, there are cases in which a
decision not to grant workersʼ compensation benefits ismade due to a physicianʼs insufficient understanding of theworkersʼ compensation procedures and certification criteria.
Even when attorneys ask attending physicians to prepare
opinion letters and medical certifications, they may not befamiliar with the system, and efforts are made to improvetheir understanding by providing explanations and materials
on workersʼ compensation application procedures.
To provide relief for workers related to overwork, theunderstanding and cooperation of medical professionals
is very important. It is desirable for the workersʼ accident
compensation system and certification criteria to be better
known to medical professionals, and for medical professionals and judicial officials to cooperate to provide relief forvictims.

VI. Perspectives for the future to eradicate
death from overwork
In 2006, the Occupational Health and Safety Law established “long-hour worker counseling,” followed in 2014 by
the “stress check program.” In 2018, the “Working Conditions Improvement Law” gradually introduced a maximum
overtime working hour requirement, which will be extended to doctors, automobile drivers, and the constructionindustry by 2024. Efforts to improve the working conditions

J. Natl. Inst. Public Health, 73 (1) : 2024

27

YUKAWA Keiko, SHIMANUKI Mihoko, EGUCHI Hisashi
of long-hour workers have been progressing.
In addition, the 2019 “Revised Law on Comprehensive
Promotion of Labor Policies and Initiatives” made prevention policies against power harassment mandatory for large
companies from 2020, and from 2022 for small and medium
companies. The Industrial Safety and Health Law requires
companies with 50 or more employees to appoint industrial
physicians. As described above, measures have been established to prevent long working hours and workplace stress.
Future research should be conducted in an appropriate andeffective manner.
If by any chance death from overwork, suicide by overwork, or work-related disorders occur, it is necessary for
medical professionals and judicial professionals to understand and cooperate with each other more than ever before,
to provide relief.
To eradicate death from overwork, it is desirable to analyze not only working hours and workplace environments,
but also many other factors and relationships, such asindustry-specific environments, lifestyles, and other conditions on the worker side, and to continue research andeducation toward more effective preventive measures froma multifaceted, interdisciplinary perspective.

Conflicts of Interest
The authors declare that there are no conflicts of interest.

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30

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Prevention and future issues of karoshi and suicide by overwork in Japan＜総説＞
日本における過労死・過労自死の状況・対策と今後の課題
湯川慶子 1 ），島貫美穂子 2,3 ），江口尚 4 ）1）

国立保健医療科学院疫学・統計研究部
船橋第一法律事務所

2）
3）

過労死弁護団全国連絡会議

4）

産業医科大学産業生態科学研究所産業精神保健学研究室

抄録
過労死が社会問題となって以降，法律や認定基準の制定，また企業側，労働者側での対策が充実してきた．しかし，過労死や過労自殺，パワーハラスメントなどに関する報道を聞かない日はない．世界共通の社会問題である「過労死／ KAROSHI」について「日本の過労死対策」の変遷や主要な事件を取り上げ，現在の最新の過労死対策の動向や医療と司法を中心に連携について解説する．
過労死・過労自殺が社会問題として確立した経緯から，予防策，過労死防止法，認定基準の見直し，
過重労働や職場でのストレスに悩む労働者や家族の活動，「過労死 110 番」といった相談窓口を全国に展開した弁護士の活動などを整理したうえで，過労死・過労自殺が生じた時の法的手続きを詳説す
る．
労働衛生分野の医療関係者と，労働問題に法的側面から取り組む司法関係者とが連携し，過労死対策や支援に取り組み，過労死が根絶されるまでは，発生した事件の救済を支援し，社会に広く啓発していく必要がある．
キーワード：過労死，過労自殺，労働衛生，法律，KAROSHI，日本

J. Natl. Inst. Public Health, 73 (1) : 202431