AIG Institute InsightApril, 2019

Survey on Mental Health for Workers and Future Issues
Manabu Fujii, Executive Fellow, AIG Institute
NOTICE: This represents an English translation of an original report released in Japanese by the AIG Institute on April 24,
2019. In the event that there are any inconsistencies between the Japanese version and the English one, the Japaneseversion shall control and supersede the substance of the English translated version.

Overview
I set a hypothesis that there is a problem about employees' perceptions, including "a sense ofresistance to psychiatry and psychosomatic medicine" as a factor that hinders the promotion ofself-care by employees themselves as a first step for corporate mental health management.
Based on this hypothesis, I planned a survey on mental health perception and behavior andconducted it on working men and women in their twenties to sixties to obtain the following
findings:
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Approximately 90 % of the workers feel or have felt stressed about their work.
Majority of people have experienced the early symptoms of "depression" such as insomnia.
As a method of coping with their deteriorated mental health, many people assume that"coping by themselves while talking with their families" as the first option.
In the case when their mental health is deteriorated, the workers have a clear tendency
not to rely on their supervisors or seniors/colleagues in their offices to receive advice.
About half of the people feel a sense of resistance against the medical examination by
psychiatry and psychosomatic department, which is derived from their negative view on
the medicine and cost required for the treatment, as well as such disease itself.
There are a lot of people who positively evaluate a fact that their family members,
subordinates, and colleagues visit a psychiatric department for consultation when they
suffer from mental health problem, while they share a slightly negative view on thetreatment taken without suspending their work.
When the respondents were classified by cluster analysis, four clusters of "moderateconscience", "indifference", "high awareness" and "surfaced preconception" were found.
Although it was the last cluster who has a strong preconception against psychiatric andpsychosomatic medicine and mental illness, the composition ratio was relatively smaller
as 18% of the total, which can be considered as minority.
According to the relationship between the levels of stress the respondents receive andtheir clusters, an interesting tendency that the respondents who receive stronger stressare more clustered as “surfaced preconception” is suggested.
A "layer of those who are suffered from dilemma” was found because they feel thatpsychiatry and psychosomatic medicine were “reliable”, while they “will not rely” on
psychiatry and psychosomatic medicine when they have mental health problems.

With this survey and AIG Institute Insight #2, "The framework and the present situation of1

AIG Institute InsightApril, 2019

corporate mental health management" already published, this report raises three discussion
points for the mental health management at the workplace such as (1) Re-construction of thecare by line (care by the workplace manager) mainly for improvement of the workplaceenvironment, (2) Elimination of barriers that prevent access to care by specialized doctors, and(3) Establishment of measures to maintain sound mental health in SMEs.

Background and objective of the survey
The first step of the mental health management at companies is prevention based on"self-care", which means that the employees should learn about mental health and discover
their mental health problems at earlier stages to stop deterioration. The main measures topromote prevention based on self-care can include (1) development of mechanisms and training
programs that help employees to discover (risks of) their mental health problems at earlystages, and (2) secured contacts (internal and external specialists) for advice when theemployees notice their mental health problems.
However, even if such a mechanism is established, if the employees who have encountered
their mental health problems are “not motivated to talk with doctors or counsellors”, it will not
function effectively. In other words, in order to make the preventive measures based on self-careeffective, (3) removal of barriers before actions to talk with psychiatrists and counselors, will be
another, extremely important measure.
There are, of course, some physical barriers (no people to consult with, or no time to consult,for example) exist, but more importantly, the presence of psychological barriers is suggested.
This means that even if someone notices their mental health problem and knows that they can
get support from a psychiatrist, they may feel uneasy about or concerned with taking
counseling services or discouraged to visit the psychiatry. Eventually, they may decide not totake any counseling services due to their psychological statuses.
Therefore, in order to verify such a hypothesis, we conducted perception survey on mental
health.

Outline of the survey(1) Subject of the survey: Men and women in their twenties to sixties employed by companies(2) Survey methodology: Online survey for internet survey monitor members(3) Study period: November 22-29, 2018(4) Survey items: See the questionnaire attached to this document.
(5) Number of valid responses: 1,400
Out of 1,723 responses obtained, 104 responses as the selection of “Stop to answer thequestionnaire” in Question 1 were excluded. Also, 219 responses as the selection of the sameanswer choice for the rest of all the questions were excluded as inappropriate answers.

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AIG Institute InsightApril, 2019

Major findings(1) Approximately 90% of the total number of people feel or have felt stressed about their work.
89.6% or nearly 90% of the total respondents said that they feel or have felt stressed about
their work or working environment. This is a much higher number than stress on their own
illness or financial problems. Also, about 70% of the people feel the "stress in their family
relationships", which are said to indirectly affect the mental health at the workplace.
The ratios of “to feel or have felt stressed”
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Your own work and working environment

17.6%Your own illness, disability, injury, etc.

5.7% 20.8%

Financial issues such as debt and living expenses

11.4%

31.0%

89.6%

34.4%

21.4%

34.4%

Family relationships, illness or nursing care of family
9.3% 22.8%
members, parenting, etc.
Relationships with relatives, acquaintances,
6.0% 19.1%
neighbors, etc.
I feel a strong stress

41.1%

38.6%
42.6%
I rarely feel a stress

I feel a stress(2) Majority of people have experienced the early symptoms of "depression", such as thecontinuation of insomnia and depressed mood.
The initial symptoms of "depression" such as a continued depressed mood, the loss ofinterest and motivation, insomnia were specifically presented, and a question about theexperiences of the respondents was asked. 58.6% or more than a half of the respondents said
that they had experienced any of such symptoms.
Responses about their experiences of "initial symptoms of depression"
0%10%

Currently I have (a)symptom(s), 19.9%

20%

30%
Currently I have no
symptom, but, I had
before frequently,
13.9%

40%

50%

60%

Currently I have no
symptom, but, I had
before, 24.8%

58.6%(3) Many people assume that "self-support + talking with their family members" as a method of
coping with their mental health problems. Psychosomatic medicine and psychiatry havebeen relied upon, but not the first choice to solve their problems. Their supervisors are notrelied on as someone they could talk to about their problems.
To a question,” In the future, what kinds of actions would you take if you encounter a mental
health problem such as depression?”, the most of the respondents answered that while "they3

AIG Institute InsightApril, 2019

collect information by themselves", they assume that they would “talk to their family
members”.
While more respondents feel that they can rely on psychosomatic medicine and psychiatry,
they choose them as the second or third options as solutions.
There are an extremely small number of people who assume that they would "talk to theirsuperiors, seniors, and colleagues" or feel that their supervisors are “reliable”. In contrast, abigger number of people clearly express their concerns that they “will not talk to theirsupervisors” or their supervisors are not “reliable”. Even though there are many people who
feel stress at work, it is suggested that their supervisors at work are not regarded as someone
they could talk to when they have mental health problems.
How to cope with mental health problem
0%
I will collect information on the internet or from books to try
to overcome my problems by myself.

10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

8.4%

40.7%

I will try supplements and health foods in the market. 2.9%17.9%
I will stop activities such as work which is regarded as a
5.6%
cause of my stress.
I will talk to any of my family members.

I will talk to my supervisors, seniors, or colleagues.

32.6%
33.6%
27.5%

2.4% 15.4%

I always do

I probably do

9.9%Neither

32.5%

14.3% 8.6%

24.9%

24.0%

6.4%6.4%

21.2%

20.4%

11.4%4.6%

23.3%
23.3%

I will visit industrial physicians or counselors, or take
4.8% 19.1%
counseling services.
I will visit psychosomatic medicine or psychiatry forcounseling services.

17.6% 4.8%8.0%

23.8%

8.8%

I will talk to my friends or acquaintances. 4.8%

20.4%

26.5%
30.5%

29.4%

26.4%

23.1%

25.9%
26.1%

I probably do not

12.9%5.0%

13.0% 7.9%

19.7%

I never do

5.4%

9.9% 7.9%

I do not know

Who or what to rely on in case of mental health problem
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Information on the internet, books 7.2%
FamilyFriends, acquaintancesSupervisors at workCounselors or consulting services for mental health
Psychosomatic medicine and psychiatry
Reliable

Somewhat reliable

42.5%

19.1%
9.6%
3.0%13.4%
12.4%
21.4%
Neither

36.6%
32.9%

33.4%

8.9%8.1%

26.8%

10.3%7.1%

35.9%

36.9%
35.6%

11.9% 9.7%

21.1%

25.6%

37.2%
38.3%

Somewhat unreliable

8.0%6.7%

29.6%

5.9%4.8%

Not reliable

4AIG Institute InsightApril, 2019(4) About half of the people feel a sense of resistance against visit to psychiatry andpsychosomatic medicine possibly because they have a negative view on “medicine”,“expense”, “diagnosis itself”.
To a question about preconception against and negative views on mental health, psychiatry,and psychosomatic medicine, more than half of the total of people answered that they feel
resistance to psychiatric and psychosomatic checkups (52.8%). "I do not know what kind oftreatment would be given," "A lot of medicine would be prescribed," "It costs a large amount ofmoney," exemplify the factors of such a sense of resistance, which lead to a suggestion that
there is a lack of information about and preconception against psychiatry and psychosomatic
medicine. In addition, many respondents gave their answers such as "I do not want to bediagnosed as having a mental health issue”, or "I do not want my acquaintances and relatives
to find that I have visited psychiatry.", which represents that they emotionally want toprevent people they know from finding that they took some medical consultation for theirmental health.
View on psychiatry, psychosomatic medicine and mental health0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%
I feel a sense of resistance against visit to psychiatry medicine
and psychosomatic.
52.8%

19.1%

33.6%

19.1%

15.7% 12.4%

I do not have much knowledge about treatment thatpsychiatric and psychosomatic medicine provide.

19.1%

31.3%

20.5%

15.9% 13.3%

Multiple types of medicines are prescribed when I visit
psychiatry and psychosomatic medicine.
If I visit psychiatry and psychosomatic department, I will be
hospitalized for a long time.

14.6%

35.6%

4.8%13.2%

36.0%

Large expense has to be paid for visit to psychiatry andpsychosomatic medicine.

14.6%

I am afraid that my personality and ability will change with the
medicine provided by psychiatric and psychosomatic medicine.

8.8%

I cannot expect effective result of treatment by psychiatric andpsychosomatic medicine.

7.9% 21.0%

Family and friends are more reliable than psychiatric andpsychosomatic medicine.

12.1%5.9%

25.1%

20.9%

29.1%

33.7%
23.7%

31.8%

14.6% 7.9%

17.5%

36.1%
43.9%

6.5% 17.6%

13.9%

18.1% 9.1%

46.2%

17.6% 12.1%

It is disadvantageous if my company knows about my visit topsychiatry and psychosomatic medical for treatment.

11.6%

I do not want my friends or relatives to know about my visit topsychiatry and psychosomatic medical.

13.6%

26.6%

34.4%

15.1% 10.4%

I do not want to be diagnosed as having mental healthproblem such as depression.

16.0%

25.4%

33.2%

14.1% 11.2%

23.1%

I think mental illness is caused to only a subset of people whoare not mentally strong.

6.4% 16.1%

Even if symptoms of mental illness appear, it can be cured
over time or by transforming my consciousness.

8.1% 24.1%

I may not be aware of mental illness caused to me.

12.1%

I feel that I cannot do anything about my mental healthproblem because of such stressful environment.

11.6%

Agree

Somehow agree

38.1%

33.4%

17.4% 9.8%

22.9%
40.9%

40.9%
28.4%
Neither

21.3%
16.7% 10.1%

31.4%
38.4%

10.0%
5.5%
13.4%8.2%

Somehow disagree

Disagree5AIG Institute InsightApril, 2019

(5) For a mental health problem, majority of people support visits of their family members to
psychiatry and have positive views on the visits of their subordinates and co-workers to thepsychiatry, while another large number of people share their relatively negative views on
the treatment without stopping to work.
82.8% of the respondents said that they would agree (the total of “strongly agree” and“slightly agree”) if any of their family members requests for their advice regarding visiting a
psychiatric department because of their mental health problems. In addition, 65.1% orapproximately 2/3 of the respondents said that the visit of their subordinates or colleagues to
psychiatry to treat their mental illness would be positively evaluated.
On the other hand, 59.1% or nearly 60 % of the respondents said that their subordinates orcolleagues should take a leave of absence to concentrate on their treatment, and over 40% of
the respondents said that it would be difficult for them to rely on their workmates if they
continue to work. This indicates that not a small number of people have their concerns with
their staff members or colleagues who take treatment while they continue to work and hopethat they should concentrate on their treatment, taking a leave of absence.
Perceptions and feelings when finding subordinates and colleagues taking treatment for theirmental illnesses by going to psychiatric department
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
I think it will be difficult for them to continue their current
assignment (job titles) or to seek for more advanced works.

13.2%

I would feel that I cannot comfortably assign tasks to them.

9.4%

I would feel that they need to take a leave of absence toconcentrate on their treatment.
59.1%
I would feel that they have to stop their visit to psychiatry
at an earliest stage.
I would positively evaluate the fact that they are actively
65.1% taking treatment for their mental illness.
Overall, I would not be able to treat them the same way as I
had done before I found their visit to psychiatry.

36.4%
32.0%

23.4%
10.9%

I think so

29.7%
35.6%

15.8% 20.9%

25.6%
8.1%

29.4%

15.2% 11.0%
24.5%

18.4%

39.4%

22.9%

11.4%7.5%

32.4%

I somehow think so

10.6%
4.4%

30.6%
23.9%
15.3%

2.6%
6.9%

18.2%
Neither

Results of factor analysis and cluster analysis
The results of this questionnaire were used for factor analysis and cluster analysis. Also, regarding
perceptions about mental health, psychiatry and psychosomatic medicine, the profiles of the
respondents were analyzed.
(1) Factor analysis based on the tendencies of answers to the questions
A response to each question by respondent was used for factor analysis, and questions withmore similar tendencies found in their responses were grouped. As a result, the following ninefactors were found.

6

AIG Institute InsightApril, 2019

a-1：Relying on family and acquaintances → A factor of relying on family and acquaintances when mental
health problem is perceived.
a-2：Rely on a specialist → A factor of relying on a specialist such as psychiatry in the case of mental
health problem.
a-3：Relying on oneself → Factor of trying to support oneself in the case of a mental health problem.
b-1：Preconception against the psychiatry department → A factor of negatively perceiving or viewing
psychiatry.
b-2：Concern with what other people think → A factor of not wanting to let other people know visits to a
psychiatry for treatment.
b-3：Lack of knowledge about psychiatry → A factor of unsecured feeling due to lack of knowledge about
psychiatryb-4：Preconception against depression → A factor of thinking that depression is caused to people who havemental vulnerability and can cure it by strengthening their mentality.
c-1：Preconception against depression of other people → A factor of thinking that people with depression
cannot be relied on for work.
c-2：Evaluation of treatment → A factor of positively evaluating a fact that their workmates taketreatment to cure their mental illness.

* The nine factors discovered and the questions related to each factor

Item
q5s3
q4s5
q5s2
q5s4
q4s6
q4s4
q4s8
q4s7
q5s6
q5s5
q4s3
q4s1
q5s1
q4s2

Relying on Rely on a Relying onfamily etc. specialist oneself
Factor a1 Factor a2 Factor a3 Communality.8 4 6-.114-.032.638 Q5-3. Friends, acquaintances.6 8 8.006.040.496 Q4-5. I will talk to my friends or acquaintances.6 2 0-.072.108.403 Q5-2. Family.5 4 1.202-.139.378 Q5-4. Supervisors at work
.5 0 0.245-.013.402 Q4-6. I will talk to my supervisors, seniors, or colleagues.4 9 8.069.148.353 Q4-4. I will talk to any of my family members-.102.7 8 9.016.575 Q4-8 I will visit psychosomatic medicine or psychiatry for counseling services.043.6 9 9.050.537 Q4-7 I will visit industrial physicians or counselors, or take counseling services.002.6 9 6.009.488 Q5-6. Psychosomatic medicine and psychiatry.130.6 2 9-.023.469 Q5-5. Counselors or consulting services for mental health.089.2 3 6.154 Q4-3. I will stop activities such as work regarded as a cause of my stress
.195
-.036
.003
.8 2 4.663 Q4-1. I will collect info on the internet etc. to overcome my problems by myself
.105
-.007
.4 8 5.275 Q5-1. Information on the internet, books
.002
.065
.4 5 6.229 Q4-2. I will try supplements and health foods in the market

Precon. Concern
Lack ofPrecon.
agst
with what knowledge
agst
psychiatry other ppl
about
depression
dept.
think
psychiatry
CommunItem Factor b1 Factor b2 Factor b3 Factor b4

ality

q6s6

.6 5 5

.168

-.047

.011

.541

q6s4
q6s5
q6s7
q6s3
q6s15
q6s10

.6 3 6.6 2 2.5 3 3.4 9 8.2 2 0
-.065

-.019
.063
.014
-.022
.196
.8 0 0

.013
.091
.119
.247
-.087
.157

.077
-.035
.045
-.078
.054
-.030

.459 Q6-4. If I visit psychiatry and psychosomatic department, I will be hospitalized for a long time
.483 Q6-5. Large expense has to be paid for visit to psychiatry and psychosomatic medicine.413 Q6-7. I cannot expect effective result of treatment by psychiatric and psychosomatic medicine.380 Q6-3. Multiple types of medicines are prescribed when I visit psychiatry and psychosomatic medicine.122 Q6-15. I feel that I cannot do anything about my mental health problem because of such stressful environment.714 Q6-10. I do not want my friends or relatives to know about my visit to psychiatry and psychosomatic medical
Q6-9. It is disadvantageous if my company knows about my visit to psychiatry and.559
psychosomatic medical for treatment.511 Q6-11. I do not want to be diagnosed as having mental health problem such as depression.141 Q6-14. I may not be aware of mental illness caused to me.574 Q6-1. I feel a sense of resistance against visit to psychiatry medicine and psychosomatic.414 Q6-2. I do not have much knowledge about treatment that psychiatric and psychosomatic medicine provide
Q6-13. Even if symptoms of mental illness appear, it can be cured over time or by.408transforming my consciousness.444 Q6-12. I think mental illness is caused to only a subset of people who are not mentally strong.326 Q6-8. Family and friends are more reliable than psychiatric and psychosomatic medicine

q6s9

.171

.7 0 8

-.118

.000

q6s11
q6s14
q6s1
q6s2

.022
-.023
.145
.244

.4 3 2.1 8 2
.074
-.011

.188
.124
.6 3 2.4 1 6

.221
.173
-.023
.102

q6s13

-.090

.052

.034

.6 4 1

q6s12
q6s8

.171
.265

.035
-.049

-.069
.115

.5 7 5.3 3 6Q6-6. I am afraid that my personality and ability will change with the medicine provided bypsychiatric and psychosomatic medicine

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AIG Institute InsightApril, 2019

Precon.
Evaluation
agst
ofdepression
treatmentof other ppl

Item
q9s2
q9s1
q9s6
q9s4
q9s5
q7
q9s3

Factor c1 Factor c2 Communality.8 8 8-.020.780 Q9-2. I would feel that I cannot comfortably assign tasks to themQ9-1. I think it will be difficult for them to continue their current assignment (job
.6 9 4.027.493
titles) or to seek for more advanced works
Q9-6. Overall, I would not be able to treat them the same way as I had done before.4 6 3-.233.214
I found their visit to psychiatry.2 0 7.012.044 Q9-4. I would feel that they have to stop their visit to psychiatry at an earliest stage
Q9-5. I would positively evaluate the fact that they are actively taking treatment for-.059.6 6 6.428
their mental illness
Q7. If any of your family members (spouse, sibling, parent, child, relative, etc.) asks-.106
.5 0 0.235 for your advice about their visit to psychiatry for treatment for their potential mental
health problem, how do you feel about it?
Q9-3. I would feel that they need to take a leave of absence to concentrate on.387.4 5 4.444
their treatment(2) Cluster analysis based on factor scoring
The following four clusters were found after the factor scores of the individual factors
identified by the factor analysis in (1) above-mentioned had been calculated for each
respondent, and cluster analysis had been performed based on such values.

* Cluster analysis results by respondent based on the response tendency to each question
1.000
0.800
0.600
0.400

D
A

0.200
0.000
-0.200-0.400B-0.600C-0.800-1.000a-1
Relying onfamily etc.

a-2
Rely on a
specialist

a-3

b-1

b-2

Concern
Precon. agst
Relying onwith what
psychiatry
other ppl
oneself
dept.
think

b-3

b-4

c-1

c-2

Lack ofPrecon. agst Evaluation
knowledge Precon. agst
depressionofabout
depressionof other ppl treatment
psychiatry

Cluster A

0.504

0.510

0.490

0.289

0.322

0.357

0.267

0.272

0.261

Cluster B-0.489-0.542-0.670-0.109-0.148-0.128-0.103-0.632-0.711Cluster C

0.116

0.436

0.085

-0.833-0.817-0.869-0.681-0.147

0.422

Cluster D-0.282-0.661

0.051

0.846

0.826

0.812

0.661

0.679

0.016

① Cluster A (420 respondents applicable)：Moderate conscience
All average factor scores are positive, and the average factor score for "rely" of each factor
from a-1 to a-3 is the highest in all the clusters. Although there is some degree of8

AIG Institute InsightApril, 2019preconception against psychiatry and depression, this cluster has a certain interest in andknowledge of mental health and is ready to actively take actions for treatment if needed.
② Cluster B (371 respondents applicable)：Indifference
All average factor scores are negative, especially the factor of "relying" from a-1 to a-3,
and the factor of “preconception against other people’s depression” of c-1 and c-2 havelowest scores. This cluster has less interest in their own and other people’s mental healthand is less motivated to take actions for mental health problems.
③ Cluster C (355 respondents applicable)：High awarenessThis is a cluster that shows a moral and exemplary response trend. It has lower scores
about preconception against psychiatry and depression, and it is obvious that it tends tostrongly support psychiatrist's specialty and treatment in the psychiatry department.
However, its enthusiasm is smaller than Cluster A in terms of actions to cope with theirown mental health problems. A little uneasiness remains with this cluster regardingwhether their high awareness would really motivate them to take specific actions or not.
④ Cluster D (254 respondents applicable)：Surfaced preconception

This is a cluster that has a strong preconception about psychiatry and depression. It is
assumed that they do not have sufficient understanding about mental health, although
the level of insufficiency is lower than other clusters (over 18% of the total). In case if thiscluster encounters mental health problems or anyone they know have mental healthproblems, they have a higher risk of causing issues.

(3) Distribution and deviation of cluster by attribute
For each attribute such as the respondent's age and gender, the respondents belonging toeach cluster were aggregated to analyze the trends of deviation to certain clusters by attributebased on the gaps between the distribution of the aggregation and the overall distribution.
① Deviation due to age and gender
The cluster distributions by the age as well as the gender of the respondents werecompared against the overall distribution, and the following trend was found:The percentage of Cluster B (indifference) is higher among younger generations, andas the age gets older, the ratio of Cluster C (high awareness) increases.
Cluster D, which represents those who lack understanding, does not necessarily
include more aged people. Rather, it has higher ratios of thirties and forties in theprime of life. In addition, women have a stronger tendency to belong to Cluster D
than men.
Perceptions about mental health tend to shift from Cluster B (indifference) to D
(preconception) to C (understanding) as the age increases.

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AIG Institute InsightApril, 2019

Cluster deviated distribution ratio by age and gender (index when the total cluster composition ratio is 100)

Male

FemaleMale＋
FemaleAge 20-29
30-39
40-49
50-59
60-69
Su btotal
Age 20-29
30-39
40-49
50-59
60-69
Su btotal
Age 20-29
30-39
40-49
50-59
60-69
Total

Cluster A
Moderate
conscience

Cluster B
Indifference

Cluster C
Highawareness

Cluster D
Surfacedpreconception

95
109
82
94
85
94
91
92
125
113
105
106
92
100
104
102
95
100

196
128
79
85
112
111
132
97
54
92
83
89
160
112
66
88
98
100

49
69
122
129
134
103
69
90
122
91
108
97
60
80
122
111
121
100

41
87
129
92
59
89
112
131
95
104
104
111
81
111
112
98
82
100

② Deviation due to experience of stress
When the cluster distribution of each stress level the respondents felt was compared withthe overall distribution, it was discovered that more people did not feel much stress inCluster C (high awareness), and less people did not feel stress in Cluster D (surfaced
preconception). As stress becomes stronger, the trend of increase starts at Cluster A(moderate conscience) and then moves to Cluster B (indifference) and eventually to
Cluster D.
This is a surprising result, suggesting that people who feel stress are more likely to have astrong preconception about mental illnesses or psychiatric departments. In part, it may
be possible to refer to the opposite correlationship, that is, preconception about mental
health may discourage people to take sufficient actions, resulting in continued situations
that give strong stress, while it may not explain everything.
In any case, it would be fair to say that this point suggests an important point of view formental health management in companies.
Cluster deviated distribution ratio per stress score*Low(0-3)
Mid(4-6)
High(7-9)
Very High(10-15)
Total

Cluster A
Moderate
conscience

Cluster B
Indifference

Cluster C
Highawareness

Cluster D
Surfacedpreconception

100
112
83
99
100

87
94
119
105
100

121
99
91
78
100

90
90
112
124
100

* For the five stress factors asked in Q2 in the questionnaire, points were given as stress is"felt strongly" = 3, "felt" = 2, "rarely felt" = 1, " not felt" =0, and they were aggregated.

10

AIG Institute InsightApril, 2019

Analysis of "conflicting layer" that cannot take actions while it relies on psychiatry
As an awareness of the issues held through this survey, I was interested in a layer of people who
felt a sense of resistance to access to psychiatric departments. In fact, even though some
respondents felt that "psychiatric and psychosomatic medicine is reliable (Q5)" for their mental
health problems, they were not going to visit psychiatry and psychosomatic medicine” (Q4). Their
understanding and behavior do not match, and that is why I would call them “conflicting layer”,
and I tried to analyze their attribute distribution and response tendency to other questions.
(1) Attribute distribution of “conflicting layer”
The next table shows the attribution distribution of “conflicting layer”.
Based on the age and the gender, we can see that “conflicting layer” is more found among
men at older ages. On the other hand, although "conflicting layer" is relatively smaller
among women, it is understood that there is a strong presence of "negative layer" which does
not rely on psychiatry and is less motivated to see doctors.
Interestingly, according to the distribution by stress score, "conflicting layer" is larger
among people who feel a moderate level of stress, and people who feel a stronger level ofstress can be grouped in “positive layer” who rely on and actually visit specialists and“negative layer” who does not rely nor visit specialists. This is due to the fact that understrong stress, people would reach a stage where they have to make decisions about their own
mental health problems. In other words, "conflicting layer" might be “moratorium layer” whois not ready to make “final decisions” about their mental health problems.
* Distribution of "conflicting layer"* by age and genderGe n de r

Male

FemaleMale +
Female

Age
20-29
30-39
40-49
50-59
60-69
Su btotal
20-29
30-39
40-49
50-59
60-69
Su btotal
20-29
30-39
40-49
50-59
60-69
Total

Composition Ratio

Index

Positive Conflicting Negative

Positive Conflicting Negative

38.3%
35.6%
40.5%
40.8%
28.7%
3 7 .4 %
29.1%
29.2%
44.0%
37.8%
34.7%
3 5 .2 %
33.2%
32.2%
42.3%
39.4%
31.7%
3 6 .3 %

23.5%
27.7%
26.6%
32.2%
38.3%
2 9 .5 %
28.2%
24.3%
23.2%
25.0%
23.2%
2 4 .6 %
26.1%
25.9%
24.8%
28.9%
30.7%
2 7 .0 %

38.3%
36.7%
32.9%
27.0%
33.0%
3 3 .0 %
42.7%
46.5%
32.7%
37.2%
42.1%
4 0 .2 %
40.8%
42.0%
32.8%
31.7%
37.6%
3 6 .7 %

105
98
112
112
79
103
80
80
121
104
96
97
91
89
117
109
87
100

87
103
98
119
142
109
104
90
86
93
86
91
97
96
92
107
114
100

104
100
90
74
90
90
116
127
89
101
115
110
111
114
89
86
102
100

* For Q4-8, “I will visit psychosomatic medicine or psychiatry for counseling services.”, the respondents who had
selected ” I always do.” or “I probably do.” were categorized as “positive layer”. The respondents who had selected “Iprobably do not.”, “I never do.”, ”Neither”, “I do not know.” to this question and selected “Reliable.” Or “Somehow
reliable.” For Q5-6 “Psychosomatic department and psychiatry” were categorized as “conflicting layer” and anothergroup of respondents who had selected “Neither”, “Somewhat unreliable”, “Unreliable” were categorized as “negative
layer”. The same hereinafter.

11

AIG Institute InsightApril, 2019

* Distribution of "conflicting layer" by stress score

Low(0-3)
Mid(4-6)
High(7-9)
Very High(10-15)
Total

Composition Ratio

Index

Positive Conflicting Negative

Positive Conflicting Negative

36.7%
33.3%
36.5%
43.0%
36.3%

25.8%
31.3%
27.3%
17.2%
27.0%

37.5%
35.3%
36.2%
39.8%
36.7%

101
92
101
119
100

96
116
101
64
100

102
96
99
108
100

(2) Perception on mental health of “conflicting layer”
Next, I will share the characteristics of perspections and values for mental health problems,
psychiatric and psychosomatic medicine, etc. in "conflicting layer".
What stands out in "conflicting layer" is the sense of resistance and anxiety that comesfrom lack of knowledge; "I feel a sense of resistance against visit to psychiatry medicine andpsychosomatic.", "I do not have much knowledge about treatment that psychiatric andpsychosomatic medicine provide." In addition, this layer shows the highest ratios of theanswers that suggest fear or preconception about mental health problems; "I do not want tobe diagnosed as having mental health problem such as depression.", "Even if symptoms ofmental illness appear, it can be cured over time or by transforming my consciousness.". On
the other hand, their expectation for the effect of the treatment by psychiatry andpsychosomatic medicine exceeds that is held by “positive layer”, which exactly indicatesantinomic conflict.
Overall, “conflicting layer" has a conflict between their "negative views on mental healthillness” and "a positive views on the effects of treatments by specialists", and they think that
"good results may follow their visits to specialists, but, I do not want to receive counselingservice because I do not want to be diagnosed that I have mental health illness”.
* Response tendency of "conflicting layer" about perception about mental healthI feel a sense of resistance against visit to psychiatry medicine and psychosomatic.
I do not have much knowledge about treatment that psychiatric and psychosomatic
medicine provide.
Multiple types of medicines are prescribed when I visit psychiatry and psychosomatic medicine.

If I visit psychiatry and psychosomatic department, I will be hospitalized for a long time.
Large expense has to be paid for visit to psychiatry and psychosomatic medicine.
I am afraid that my personality and ability will change with the medicine provided bypsychiatric and psychosomatic medicine.
I cannot expect effective result of treatment by psychiatric and psychosomatic medicine.
Family and friends are more reliable than psychiatric and psychosomatic medicine.
It is disadvantageous if my company knows about my visit to psychiatry and psychosomatic
medical for treatment.
I do not want my friends or relatives to know about my visit to psychiatry andpsychosomatic medical.
I do not want to be diagnosed as having mental health problem such as depression.
I think mental illness is caused to only a subset of people who are not mentally strong.
Even if symptoms of mental illness appear, it can be cured over time or by transforming myconsciousness.
I may not be aware of mental illness caused to me.
I feel that I cannot do anything about my mental health problem because of such stressfulenvironment.

Ratio of "Agree" "Somehow agree"
Index
Conflict Negativ Positiv Conflic Negati
Average Positive
ing
e
e
ting
ve
52.8%
39.4%
62.2%
59.1%
75
118
112
50.4%

41.7%

59.5%

52.1%

83

118

104

50.2%
18.0%
48.3%

49.0%
16.3%
45.3%

49.2%
17.7%
48.4%

52.1%
19.8%
51.2%

98
91
94

98
98
100

104
110
106

32.5%

29.5%

34.7%

33.9%

91

107

104

28.9%
24.1%

25.4%
17.7%

23.3%
24.6%

36.4%
30.2%

88
73

81
102

126
125

34.8%

38.0%

34.4%

31.9%

109

99

92

40.2%

39.6%

42.6%

39.1%

98

106

97

41.4%
22.5%

39.2%
21.7%

46.8%
23.5%

39.7%
22.6%

95
96

113
105

96
100

32.3%

33.3%

35.4%

29.0%

103

110

90

53.1%

59.1%

57.4%

44.0%

111

108

83

40.0%

43.7%

42.1%

34.8%

109

105

87

12

AIG Institute InsightApril, 2019

Issues for discussions led by research and analysis
The results of this survey found that most people, regardless of their gender or age, work withstress every day, and majority of the respondents have experienced mental health problems.
In addition, despite a large number of people who are stressed by their work and working
environments, it became clear that their supervisors who are supposed to be responsible forstress management and can influence for improvement are not always relied as someone they
could talk to for their advice. As reasons, it is suggested that they are concerned with “potential
disadvantage once their mental health problems are known to their companies”, and not a small
number of their supervisors or colleagues think that “their subordinates or colleagues shouldtake a leave of absence to concentrate on treatment because it would be hard to rely on them forwork once treatment for their depression is noticed.”.
Moreover, because the supervisors at work are not experts of the mental care, it is necessary toconsult with occupational physicians, psychiatrists or psychotherapists, but a certain number of
respondents hesitate to access specialists because of their negative views such as "I do not knowwhat kind of treatment I will be given" "excessive medicines will be provided", "the cost oftreatment will be expensive" or a preconception about depression such as “depression is adisease caused to people who are not strong enough and can be cured by enhancing their mental
strength.”. In addition, despite the positive evaluation of the therapeutic effects by psychiatricand psychosomatic medicine, certain people (conflicting layer) try to avoid their visits to such
medical services because "I do not want to be diagnosed that I have mental health illness.”.
In addition to the results of this survey, based on insight obtain from “Framework and Current
Environment of Corporate Mental Health Management in Japan AIG Institute #2(http://www-510.aig.co.jp/about-us/institute/insight/2018-11-26.html), I would like to define the next threepoints as key discussion points about mental health management at work.
① The need to reconstruct "line care" with a focus on improving the workplace environment
It is suggested that "care by line" positioned between "self-care" by workers themselves and"care by specialists" in and outside the company is not working well, contrary to its
importance.
Because supervisors at work are not experts for mental health and are certain
stakeholders, it is difficult to talk with them about mental health problems, andhesitation is contextually formed about relying on them.
“Care by line” includes actions to prevent problems because the workplaceenvironment would be improved in addition to advice from supervisors, but, not many
companies have not implemented it yet.

Mental health problems arise from reciprocal actions between factors of individual
employees and factors in the workplace environment. "Care by line" should not represent aformat where supervisors would give their advice to approach “factors of individual
employees”. It should represent another format where supervisors would leverage their13

AIG Institute InsightApril, 2019

administrative authorities to improve “factors of the workplace environment”.
Specific initiatives and case studies regarding improvement of workplace environment for
the first defense line for mental health are available at “the workplace environment
improvement tool” (http://kokoro.mhlw.go.jp/manual/) in the mental health portal site of
Ministry of Health, Labor and Welfare.
② Removal of barriers to access to medical care by (internal and external) specialists
In the event of a mental health problem, not a small number of people hesitate to accessindustrial physicians and external psychiatric and psychosomatic physicians, andconsidering this, it is required to remove physical and mental barriers.
Among workers who can be most active at work and are exposed to big stress and most
likely to have highest mental risks, a layer of people who have preconception about mental
health exists at a higher rate. Also, “conflicting layer” cover a range of people, mainly
middle-aged men, who will not access medical services because they do not know theactual status of treatment, even if they understand effectiveness of treatment byspecialized doctors. This suggests that training programs and information sharing are
required as "risk communication" for mental health risks with attentions to different
perceptions (diversity) about specialized doctors or mental health illness.
In addition, currently, if you wish to be interviewed by industrial physicians for
consultation based on the result of stress check, then, it will be reported to your company,
which structurally leads to a negative incentive to access to industrial physicians,
therefore, initiatives to allow workers to individually, optionally, and anonymously talkwith industrial physicians or to arrange regular conversations for all employees to havewith physicians would be effective to remove barriers that block access to “industrial
physicians for advice” (and to consider financial support for required expenses fromadministration organizations to promote public health).

③ Development of effective mental health measures for small and medium enterprises
As a part of the so-called "work style reform", was amended and the Occupational Healthand Safety Act for the protection of workers ' mental and physical health, was amended
and enacted in April, 2019. While progress has been made on mental health managementin the workplace, such as strengthening the authority of industrial physicians, obligationof execution is limited to relatively large companies with more than 50 employees, andonly obligation of to make best efforts is imposed to small and medium-sized companies,
which is the same as before.
From the standpoint of solving the serious issue of insufficient human resource, as well as
another viewpoint of implementing "health management" which has attracted attention
recently, it is turning more and more important for small and medium-sized companies toimprove their workplaces for their employees to more comfortably work, including theenhancement of the mental health management program. Even for large companies andfor the stable operation of the supply chain, progresses of “work style reform” including
mental health measures by small and medium-sized companies who are their business
14

AIG Institute InsightApril, 2019

partners should not be ignored.
However, it is difficult for small and medium-sized enterprises to downsize the mental
health management program designed for large enterprises because of an assumption thatoccupational physicians and sanitary committees are available, and small andmedium-sized companies tend to end up in only introducing the stress check just forformality without completely executing such program.
I would like to remind you of the focus on the approach to improve workplace environment
for the first defense line for mental health mental as ① above-mentioned. In a small andmedium-sized companies where managers have visibility over the entire whole workplaceand can more easily take leadership for workplace reforms, compared to large companies
where offices and departments are subdivided, there is a possibility that efforts to improve
the workplace environment can be carried out faster and more appropriately than large
companies.
The development of specific mental health management programs for small andmedium-sized businesses, with a focus on improving the workplace environment, will be
an extremely beneficial initiative for majority of workers working in small andmedium-sized enterprises, as well as for the sustainable growth of Japanese economies.

* 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.
* The copyright of the results of the research is attributed to JustSystems Corporation, and AIG uses the results of the survey
based on the research membership agreement for the service.

15

AIG Institute InsightApril, 2019

[Reference material] Questionnaire
Q1 In this questionnaire, you will be specifically asked about whether you feel stress (includinginterpersonal and financial problems, health conditions, etc.), your experience of mental andphysical symptoms that are said to be the initial symptoms of "depression" and how you cope withthem, and your view on "depression”. Some questions address the initial symptoms of "depression",but they are not supposed to judge whether you have "depression" or not. If you acknowledge themand are ready to continue to answer this questionnaire, please select “Start to answer thequestionnaire.”.
（Answer choices: Start to answer the questionnaire, Stop to answer the questionnaire.）In this questionnaire, you will be asked about your perception and view on mental health.
Q2. How much mental stress do you currently feel about each subject below?
（Answer choices：I feel a strong stress. I feel a stress. I rarely feel a stress. I do not feel a stress.）
1. Your own work and working environment
2. Your own illness, disability, injury, etc.
3. Financial issues such as debt and living expenses
4. Family relationships, illness or nursing care of family members, parenting, etc.
5. Relationships with relatives, acquaintances, neighbors, etc.
Q3. The following symptoms are said to be the initial symptoms of "depression", which is one of themental health problems.
Melancholic feeling continues.
I see no interest in work or hobby and do not feel happy.
I do not fall asleep at night, I wake up early in the morning and cannot go back to sleep.
I have no motivation for anything. I cannot concentrate.

Have you ever experienced any of those mental and physical symptoms?
（Answer choices：Currently I have (a) symptom(s). Currently I have no symptom, but, I had before
frequently. Currently I have no symptom, but, I had before. I have no experience.）
Q4. In the future, what kinds of actions would you take if you encounter a mental health problem suchas depression? If you currently have any of these symptoms, please describe what kinds of actions
you planned when it occurred.
（Answer choices：I always do. I probably do. Neither. I probably do not. I never do. I do not know.）
1. I will collect information on the internet or from books to try to overcome my problems by myself.
2. I will try supplements and health foods in the market.
3. I will stop activities such as work which is regarded as a cause of my stress.
4. I will talk to any of my family members.
5. I will talk to my friends or acquaintances.
6. I will talk to my supervisors, seniors, or colleagues.
7. I will visit industrial physicians or counselors, or take counseling services.
8. I will visit psychosomatic medicine or psychiatry for counseling services.
Q5. When you have a mental health problem, please answer whether you feel the following persons orthings are "reliable as cure for the problem".
（Answer choices：Reliable, Somewhat reliable, Neither, Somewhat unreliable, Not reliable）
1. Information on the internet, books
2. Family
3. Friends, acquaintances
4. Supervisors at work

16

AIG Institute InsightApril, 2019

5. Counselors or consulting services for mental health
6. Psychosomatic medicine and psychiatry
Q6. Share your candid thoughts on the following options related to mental health problems.
（Answer choices：Agree, Somehow agree, Neither, Somehow disagree, Disagree）
1. I feel a sense of resistance against visit to psychiatry medicine and psychosomatic.
2. I do not have much knowledge about treatment that psychiatric and psychosomatic medicine
provide.
3. Multiple types of medicines are prescribed when I visit psychiatry and psychosomatic medicine.
4. If I visit psychiatry and psychosomatic department, I will be hospitalized for a long time.
5. Large expense has to be paid for visit to psychiatry and psychosomatic medicine.
6. I am afraid that my personality and ability will change with the medicine provided bypsychiatric and psychosomatic medicine.
7. I cannot expect effective result of treatment by psychiatric and psychosomatic medicine.
8. Family and friends are more reliable than psychiatric and psychosomatic medicine.
9. It is disadvantageous if my company knows about my visit to psychiatry and psychosomatic
medical for treatment.
10. I do not want my friends or relatives to know about my visit to psychiatry and psychosomatic
medical.
11. I do not want to be diagnosed as having mental health problem such as depression.
12. I think mental illness is caused to only a subset of people who are not mentally strong.
13. Even if symptoms of mental illness appear, it can be cured over time or by transforming

my consciousness.

14. I may not be aware of mental illness caused to me.
15. I feel that I cannot do anything about my mental health problem because of such stressfulenvironment.
Q7. If any of your family members (spouse, sibling, parent, child, relative, etc.) asks for your advice
about their visit to psychiatry for treatment for their potential mental health problem, how do you
feel about it?
（Answer choices：Strongly agree, Somewhat agree, Neither, Somewhat disagree, Strongly disagree）
Q8. Why do you feel so? Please describe any reason.
（Free text）
Q9. How do you feel if you know that your subordinates or colleagues are going to psychiatry fortreatment for their mental illness?
（Answer choices：I think so, I somehow think so, Neither, I somehow do not think so, I do not think so,
I have no idea.）
1. I think it will be difficult for them to continue their current assignment (job titles) or to seek formore advanced works.
2. I would feel that I cannot comfortably assign tasks to them.
3. I would feel that they need to take a leave of absence to concentrate on their treatment.
4. I would feel that they have to stop their visit to psychiatry at an earliest stage.
5. I would positively evaluate the fact that they are actively taking treatment for their mental
illness.
6. Overall, I would not be able to treat them the same way as I had done before I found their visit topsychiatry.
Q10. Please feel free to describe what you feel and what you think about mental health, depression,
psychiatric and psychosomatic medicine. Please write down if you do not have anything to share.
（Free text）

17