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Background: Depression is frequently seen among pregnant women. This is called antenatal depression (AND). Aim: Our aim was to identify clusters of AND and its core symptoms. Methods: The Patient Health Questionnaire-9 (PHQ-9), Pregnancy-Unique Quantification of Emesis and Nausea (PUQE-24), and Nausea and Vomiting of Pregnancy Quality of Life Questionnaire (NVP-QOL) were distributed to 382 pregnant women with a gestational age of 10 to 13 weeks who were attending antenatal clinics. The two PHQ-9 subscale scores were entered into a 2-step cluster analysis. The PHQ-9 items’ capacity to identify AND were examined in terms of the area under curve (AUC) of a receiver operating characteristic (ROC) analysis. The selected symptom items were examined for their diagnostic capability in terms of the graded response model (GRM) in the item response theory (IRT) analysis. Results: Three clusters emerged. Cluster 3 scored highly in the scores of the two PHQ-9 subscales and the two emesis scales. In the ROC, five items showed an AUC > 0.80. The GRM identified four items with high information: ‘loss of interest’, ‘depressed mood’, ‘self-esteem’, and ‘poor concentration’. Conclusions: The core symptoms of antenatal depression were four non-somatic symptoms; particularly, ‘depressed mood’ and ‘loss of interest’. AND did not exist alone, but was accompanied by nausea and vomiting. Hence, we propose a new category: emesis–depression complex among pregnant women.

Insomnia is associated with adverse outcomes in women in the perinatal period; thus, the assessment of insomnia is important for pregnant women. The Insomnia Severity Index (ISI) is an instrument used globally to assess the severity of insomnia. However, its factor structure and structural invariance for pregnant women have not been studied. Therefore, we aimed to conduct factor analyses to search for the best model to fit its structural invariance. A cross-sectional study with the ISI was conducted at one hospital and five clinics in Japan from January 2017 to May 2019. A set of questionnaires was administered on two occasions with a one-week interval. The study included 382 pregnant women ranging in gestational age from 10 to 13 weeks. One week later, 129 participants answered the retest. After exploratory and confirmatory factor analyses, the measurement and structural invariance between parity and two time points was tested. The two-factor structure model showed an acceptable fit for the ISI in pregnant women (χ2 (12) = 28.516, CFI = 0.971, RMSEA = 0.089). The model also showed satisfactory measurement and structure invariance between parity and time points. The findings indicate that the ISI’s use would be appropriate for pregnant women as a two-factor subscale of “severity” and “impact”, regardless of the parity or time point. The ISI’s factor structure may vary by subject; hence, it is necessary to confirm the measurement and structural invariance of the subject for whom the ISI will be used. Furthermore, interventions that focus not only on total scores and cutoff points but also on the phenomenon of subscales should be considered.

Background Despite the research and clinical significance of the Postpartum Bonding Questionnaire (PBQ), its psychometric properties have not been studied intensively. The goodness-of-fit of proposed factor models of the PBQ is poor. Configural and measurement invariance have never been reported. Methods As a secondary analysis of the previous paper ( Ohashi et al., 2016a , Ohashi et al., 2016b ), we analysed the PBQ data at 5 days and 1 month after childbirth among 247 mothers of a singleton. We created 9 parcels of PBQ items to perform confirmatory factor analysis (CFA). We also examined configural and measurement invariances of the PBQ factor structure between the two observation times. Results The CFI of the 3-factor model of the PBQ was .936 and .968 for 5 days and 1 month after childbirth, respectively. Configural, measurement (metric, scalar, and residual), and structural (factor variance and factor covariance) invariances were accepted. The mean of only ‘anger and restrictedness’ factor was scored higher at 1 month than 5 days after childbirth. Conclusion The 3-factor model of the PBQ was good in its fit with the data as well as robust in its measurement between the two observation time periods.

The Infant Behavior Questionnaire-Revised (IBQ-R) assesses the temperament of infants in Western and non-Western countries. Although its factor analyses revealed three factors—surgency, negative affectivity, and effortful control—in the Western culture, the degree to which these are universal or culturally specific is unclear. This study developed a Vietnamese version of the IBQ-Revised Very Short Form (R-VSF) and examined its factor structure in a Vietnamese population. The Vietnamese IBQ-R VSF was administered to 292 mothers of infants between the ages of 3 and 18 months in Nha Trang city, Vietnam, between July and September 2019. After deleting items to achieve sufficient Cronbach’s alphas for each scale (surgency, negative affectivity, and orienting/regulation), the remaining 28 items were aggregated to parcels subjected to exploratory factor analyses (EFAs). EFAs revealed a 3-factor model corresponding to the original theory, and confirmatory factor analyses indicated a good fit of this structural model. The final 3-factor model with parcels indicated measurement and structural invariance between mothers of boys and girls.

Intense fear of childbirth by expectant women is called tokophobia. Because there are no qualitative studies targeting women with an intense fear of childbirth in Japan, it is unknown whether there is any link between the type of fear of objects/situations among tokophobic women and their psychological/demographic background. Furthermore, there is no available summary of the lived experience of Japanese women with tokophobia. This study aims to identify the intensity patterns of various types of fear among the participants and summarize the lived experience of having intense fear of childbirth. A qualitative descriptive study was conducted using a semi-structured interview. Pregnant women with an intense fear of childbirth participated in individual interviews facilitated by a psychiatrist and a midwife. Audio recordings of the interviews were transcribed and analyzed using a content analysis approach. The number of participants was ten. The types of feared objects varied individually and these were categorized as being related to either prospective or retrospective fear. The participants’ experiences were grouped into three categories: difficulty in daily life, preoccupied negative expectation towards childbirth, and psychological adaptation to the upcoming childbirth. The results imply that women with tokophobia continuously suffer from fear in their daily life; hence, a special approach is needed to detect and reduce their fear.

Little is known about the causality of antenatal depression (AND). We focused on the causal relationships between AND, fear of childbirth (FOC), and obsessive-compulsive symptoms (OCS) during the COVID-19 pandemic in Japan. We also examined whether the perceived threat of COVID-19 is associated with AND. Participants were recruited for an Internet survey conducted in December 2020. A total of 245 pregnant women completed the online survey at 12 to 15 weeks’ gestational age (Time 1) and approximately 10 weeks later (Time 2). AND was estimated using the first two diagnostic items of Major Depressive Episode. The estimated prevalence of AND was 4.5% and 2.9% at Time 1 and Time 2, respectively. At both time points, no association was found between AND and the perception of COVID-19 threat. Structural equation modeling showed that AND predicted OCS (β = 0.16, p < 0.001), which, in turn, predicted FOC (β = 0.09, p = 0.042); FOC, in turn, predicted AND (β = 0.23, p < 0.001). AND, OCS, and FOC were predicted by borderline personality traits. Insecure adult attachment influenced AND and FOC via the perceived negative impact of the current pregnancy. Perinatal care providers should assess the personality and perception of pregnancy to prevent depression and pay attention to symptoms such as FOC and OCS in addition to those of depression.

Background: Many pregnant women experience impairments in social, occupational, or other important functioning. Aim: This study aimed to confirm measurement and structural invariance of the Sheehan Disability Scale (SDS) and its validity during early pregnancy. Design: Longitudinal study with two observations. Methods: Questionnaires were distributed to pregnant women attending antenatal clinics at gestational weeks 10–13. Of 382 respondents, 129 responded to the SDS again 1 week later. Results: Confirmatory factor analysis shows good fit with the data: χ2/df = 0, comparative fit index (CFI) = 1.000, standardized root mean square residual (SRMR) = 0, and root mean square error of approximation (RMSEA) = 0.718. There is acceptable configural, measurement, and structural invariance of the factor structure between primiparas and multiparas as well as between two observation occasions. The Pregnancy–Unique Quantification of Emesis and Nausea, Patient Health Questionnaire-9, and Insomnia Severity Index subscales explain 47% of the variance in SDS scores. Conclusion: Perinatal health care professionals should pay more attention to the difficulties and disabilities that pregnant women face.

The Caesarean section rate in urban Vietnam is 43% in 2014, which is more than twice the recommended rate (10%&ndash, 15%) by the World Health Organization. This qualitative study aims to identify the perceptions of pregnant mothers and health care professionals on the medical and social factors related to the increased Caesarean section rate in Vietnam. A qualitative descriptive study was conducted among pregnant mothers and healthcare professionals at two public hospitals in Nha Trang city. A content analysis was adopted in order to identify social and medical factors. As a result, 29 pregnant women and 19 health care professionals were invited to participate in the qualitative interviews. Private interviews were conducted with 10 women who wished to have a Caesarean section, and the others participated in focus group interviews. The main themes of the social factors were &lsquo, request for Caesarean section,&rsquo, &lsquo, mental strain of obstetricians,&rsquo, and &lsquo, decision-making process.&rsquo, To conclude, this qualitative study suggests that there were unnecessary caesarean sections without a clear medical indication, which were requested by women and family members. Psychological fear occurred among women and family, and doctors were the main determinants for driving the requests for Caesarean section, which implies that education and emotional encouragement is necessary by midwives. In addition, a multi-faced approach including a mandatory reporting system in clinical fields and involving family members in antenatal education is important.

Background Accuracy of temperament assessment is a prerequisite in research studies. To identify the extent to which parental assessment of child temperament is biased by their personal attributes, we proposed a new structural equation model, in which biases of parental attributes in their assessment of child temperament can be separated from the true (i.e. non-biased) associations between the two. Methods We examined 234 father–mother pairs using questionnaires including Emotionality, Activity, Sociability, and Impulsivity; Social Desirability Scale; Hospital Anxiety and Depression Scale; Temperament and Character Inventory; and State–Trait Anger Expression Inventory. Results Paternal Depression and Persistence, maternal Trait Anger, and parental Novelty Seeking showed significant bias in assessment of Emotionality. Maternal Self-transcendence showed significant bias in assessment of child Impulsivity. Conclusion Researchers should be cautious about biases in parental assessment of children's Emotionality and Impulsivity, but other temperament traits may be free from such biases.

Aims and objective: The aim of this study was to determine whether the training would influence the psychological mindedness of nurses and midwives. In addition, we explored the relationship of the change of psychological mindedness before and after the training and the correlation with their personality traits. Background: It is important for perinatal health professionals such as nurses and midwives to acquire intervention skills such as psychotherapy and counselling techniques. We think that one of the essential requisites is psychological mindedness. Method: A total of 45 perinatal health professionals who participated in the postpartum depression prevention programme were distributed a set of questionnaires including the Psychological Mindedness Scale (PMS) and Temperament and Character Inventory (TCI) at the beginning and end of the training. Results: The PMS scores increased significantly after the training. A structured equation modelling suggested that PMS and self-directedness predicted each other whereas PMS predicted low harm avoidance. Conclusion: These findings indicate that the psychological mindedness of nurses and midwives could be advanced by a course of training and that this could be supported by high self-directedness. The harm avoidance trait may be reduced by increased psychological mindedness. Relevance to clinical practice: Nurses and nursing students are apt to psychological skill training in the advancement of psychological mindedness.

This study examined the reliability and validity of the Japanese version of the Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM), a standardized, brief, but comprehensive outcome measurement. The target population consisted of 1684 Japanese company employees, hospital staff, and university students. A confirmatory factor analysis proved that our data fit the factor structure of the original CORE-OM. We also examined its internal consistency, test-retest reliability, convergent validity, and sensitivity in discriminating between clinical and nonclinical samples. After demonstrating these results, we discuss how the Japanese version of the CORE-OM can be used both in clinical and research settings. © 2011 Elsevier Inc. All rights reserved.

Unhealthy use of the Internet and mobile phones is a health issue in Japan. We solicited participation in this questionnaire-based study from the employees of a city office in Kumamoto. A total of 92 men and 54 women filled in the Internet Addiction Questionnaire (IAQ), the Self-perception of Text-message Dependency Scale (STDS), and the Hospital Anxiety and Depression Scale (HADS). The prevalence of ''light Internet addiction'' and ''severe Internet addiction'' were 33.7% and 6.1% for men whereas they were 24.6% and 1.8% for women. The prevalence of ''light mobile phone text-message addiction'' was 3.1% for men and 5.4% for women. There were no cases of ''sever text-message addiction''. We found a two-factor structure for the IAQ and a three-factor structure for the STDS. We also performed an EFA of the IAQ and STDS subscales, and this revealed a two-factor structure - Internet Dependency and Text-message Dependency. An STDS subscale, Relationship Maintenance, showed a moderate factor loading of the factor that reflected unhealthy Internet use. In a path analysis, Depression was associated with both Internet Dependency and Text-message Dependency whereas Anxiety was associated negatively with Text-message Dependency. These results suggest applicability of the IAQ and STDS and that Internet and Text-message Dependences are factorially distinct.

This longitudinal study was undertaken to clarify the relationships among self-esteem, interpersonal dependency, and depression, focusing on a trait and state component of interpersonal dependency and depression. In a sample of 466 working people, self-esteem, interpersonal dependency, job stressor, and depression were assessed at 2 points of time. A structural equation model (SEM) was created to differentiate the trait component of interpersonal dependency, depression and the state component of interpersonal dependency, depression. The model revealed that self-esteem influenced trait interpersonal dependency and trait depression but not state interpersonal dependency or depression. Setting a latent variable as a trait component to differentiate trait and state in interpersonal dependency and depression in SEM was found to be effective both statistically and clinically.

Objective: The Temperament and Character Inventory (TCI) is a widely used self-report measure of adult personality. Method: We studied 586 Japanese university and college students with the 125-item version of the Japanese TCI. Results: The factor structure of the TCI scales was similar to that reported in other languages. Depression was positively correlated with Novelty Seeking and Harm Avoidance but inversely correlated with Persistence, Self-Directedness, and Cooperativeness. Good Self-Image in the framework of adult attachment was correlated positively with Self-Directedness but inversely with Harm Avoidance and Reward Dependence. Good Other-Image in the framework of adult attachment was positively correlated with Reward Dependence and Cooperativeness. The scores of the TCI scales were stable over a time span of 1.5 to 2 months. Conclusion: The Japanese version of the TCI may be a valid and reliable measure of temperament and character, at least among the adolescent and young adult population. © 2010 Elsevier Inc. All rights reserved.

Background: In order to further investigate the relationship of psychological wellbeing with depression and anxiety. Method: Students from five universities were solicited to participate in this study and 545 students with a mean age of 20.1 (SD = 2.2) years were finally accessed to analysis. Result: All six dimensions— autonomy (AU), environment mastery (EM), personal growth (PG), positive relationships with others (PR), purpose in life (PL), and self-acceptance (SA)—of the Scales of Psychological Well-being Inventory (SPWB) were moderately negatively correlated with depression and anxiety as measured by the Hospital Anxiety and Depression Scale (HADS). Furthermore, due to a good fit with the present data, the model of SPWB on depression and anxiety was consistent with the theory of psychological well-being and indicated that HADS depression was predicted by EM, PR, and SA, while HADS anxiety was predicted by AU, EM, PG, PR, and SA. Conclusion: SPWB is a reliable measure of well-being for Japanese young adults, and the negative affectivity such as depression and anxiety is to some extent determined by the lack of psychological well-being. Depression and Anxiety 26:E99–E105, 2009. & 2009 Wiley-Liss, Inc.

Nursing students face stressful situations during a clinical training. This two-wave (between June and December 2004) study explored the relationship between the coping styles and stressful life events in terms of the occurrence of depression and anxiety among 97 Japanese female nursing students before (Time 1) and after (Time 2) a clinical training. In a structural equation modelling, Time 2 depression was significantly predicted by Time 1 depression and stressful life events whereas Time 2 anxiety was predicted by Time 1 anxiety, stressful life events and emotion-oriented coping. Moreover, Time 1 depression predicted the impact of stressful life events and Time 1 anxiety predicted emotion-oriented coping.

Objective: Prognostic studies of major depression have mainly focused on episode remission and relapse, and only a limited number of studies have examined long-term course of depressive symptomatology at threshold and subthreshold levels. Method: The Group for Longitudinal Affective Disorders Study has conducted prospective serial assessments of a cohort of heretofore untreated major depressive episodes for 10 years under naturalistic conditions. Results: Of the 94 patients in the cohort, the follow-up rate was 70% of the 11 280 person-months. Around 77% of the follow-up months were spent in euthymia, 16% in subthreshold depression and 7% in major depression. Duration of the index episode before reaching recovery was the only significant predictor of the ensuing well time. Conclusion: On average, patients with major depression starting treatment today may expect to spend three quarters of the next decade in euthymia but the remaining one quarter in subthrehold or threshold depression.

In order to examine the relationships between parenting styles and personality traits over generations, a cross-sectional questionnaire study was conducted for fathers and mothers of school-age children of grades 5–9. The parenting styles measured by the Parental Bonding Instrument (PBI) and the personality traits measured by the Temperament and Character Inventory (TCI) were correlated within and between the consecutive generations (the grandparents and the parents for the PBI and the parents and the children for the TCI). A series of structural equation modeling showed that (1) while the parenting styles were transmitted directly from the grandparents to the parents, it was partly mediated by the fathers’ Co-operativeness (C) but not so for the mothers, (2) while the personality traits were transmitted directly from the parents to the children, it was only the fathers’ parenting styles that mediated C, and (3) the parents’ parenting styles had independent effects upon the children’s personality traits.

The present study examines the effects of stressful life events, depression, and depressogenic cognitive patterns on suicidal ideation in 500 Japanese undergraduate students. The above factors were assessed at baseline (T1) and two weeks later (T3). At T1, structural equation modeling confirmed that (1) cognitive patterns and depression, but not stressful life events, influence suicidal ideation, and (2) cognitive patterns also influence suicidal ideation through depression. These findings were confirmed in a longitudinal analysis. The results suggest that the effects of stressful life events on suicidal ideation are indirect and are mediated by depressogenic cognitive styles and depressed mood.

After examining the definitions of persecutory and penitential types of guilt, based on Melanie Klein's view, we developed a single-item measure of these types and examined reliability and validity of the measure in three studies. Concurrent validity of the measure was shown among a university student population using the Test of Self-Conscious Affect-3 as an external validator. The questionnaire was not influenced by a socially desirable response style. Concurrent validity was demonstrated by studying different external variables: the two types of guilt feelings are moderately correlated with each other, but penitential guilt is more strongly correlated to variables related to ego maturation. Test-retest stability is only modest, suggesting that the constructs of measured guilt feelings may fluctuate over time.

Services provided to rape victims by human service professionals are usually helpful but are occasionally very harmful in that the victim ends up feeling 're-victimized'. This may be caused by the attitudes of the professionals towards the victims based on beliefs regarding rape and gender roles. Japanese human service professionals were solicited for responses to the Rape Myth Scale (RMS) and the short form of the Scale of Egalitarian Sex Role Attitudes (SESRA-S). One interpretable factor was extracted according to an exploratory factor analysis. Impact of the participants' age, sex, residential area, and type of profession on rape myth acceptance were examined by four-way layout ANOVA. Nurses had significantly higher rape myth acceptance than any other professional group. Furthermore, a structural equation model showing the contribution of sex role egalitarian attitude to rape myth acceptance was established.

It is believed in Japan that only psychiatrists are capable of providing reliable psychiatric diagnosis. However, more awareness of mental health issues related to perinatal care means that midwives are now required to have psychiatric diagnostic skills. The purpose of the present paper was to examine how well Japanese midwives agreed with a psychiatrist on diagnoses of different psychiatric disorders. Vignettes of 29 cases including DSM-IV mood disorders (major depressive disorder and bipolar disorder) and anxiety disorders (generalized anxiety disorder, panic disorder, phobic disorders, and obsessive-compulsive disorder) were distributed to 12 Japanese midwives. They decided the DSM-IV diagnoses independently and compared them with those made by an expert. The kappa coefficients of the diagnoses with a base rate of 0.1 or more were moderate to almost perfect (0.64-0.83). The accuracy of symptom assessment was also satisfactory. Appropriately trained Japanese midwives can use the diagnostic criteria for psychiatric disorders reliably. It is therefore feasible to dispatch midwives who are trained in psychiatric diagnosis to antenatal clinics.

Coping styles and self-efficacy have been recognized as important determinants of dysphoric mood. The objectives of this study were to determine the influence of these two factors on depression and anxiety in Japanese students. A set of questionnaires, including the Hospital Anxiety and Depression (HAD) Scale, the Coping Inventory for Stressful Situations (CISS), and the Self-efficacy Scale (SES) was distributed to 146 nursing students. Structural equation modelling was conducted to specify the relationships between measured variables. The HAD depression and anxiety scores were predicted by emotion-oriented coping. The HAD depression alone was predicted by avoidance-oriented coping. Self-efficacy scores predicted the emotion-oriented coping and HAD depression scores. Students’ dysphoric moods were influenced by emotional-oriented coping that mediated the effects of low self-efficacy, and self-efficacy also had a direct effect on depression.

This study explored the factorial structure of the Parental Bonding Instrument (PBI) in the Japanese population. Several differences between the structure model in the current study and Parker et al.'s original model were identified. We also examined the adaptability of the inventory to children currently being raised by parents. We also developed a structural equation model that takes into account the impacts of the respondents' generation and gender and the caregivers' gender. The cultural, developmental, generational, and gender influences on the factorial structure of the PBI as well as the implications for clinical settings were discussed.

The psychometric properties of the short form of the Scale of Egalitarian Sex Role Attitudes (SESRA-S) were studied among human service professionals. An exploratory factor analysis yielded two factors interpreted as reflecting women's rights (e.g. women at home and men at work [a reverse item]) and women's independence (e.g. working outside is equally important for women [a non-reverse item]), respectively. Confirmatory factor analysis showed a good fit. Impact of participant age, sex, residential area, and type of profession on sex role egalitarianism were examined by four-way layout anova. Men in rural areas had the lowest score in the women's rights subscale and psychiatrists in rural areas had the lowest score in the women's independence subscale.

A multicentre study on the epidemiology of perinatal depression was conducted among Japanese women expecting the first baby (N = 290). The incidence rate of the onset of the DSM-III-R Major Depressive Episode during pregnancy (antenatal depression) and within 3 months after delivery (postnatal depression) were 5.6% and 5.0%, respectively. Women with antenatal depression were characterised by young age and negative attitude towards the current pregnancy, whereas women with postnatal depression were characterised by poor accommodation, dissatisfaction with sex of the newborn baby and with the emotional undermining. Antenatal depression was a major risk factor for postnatal depression.

Informed consent has become a central part of medical decision-making. It is based on disclosure of medical information to support patients' rights for autonomous decision-making from a legal point of view. However, information disclosure may also benefit patients. Research indicates that information disclosure reduces stress among patients and that the more patients desire relevant information, the more stress-reductive information disclosure may be. In psychiatry, too, studies have shown that educating psychiatric patients may not necessarily reduce compliance or increase relapse rate. These findings are in line with patients' desires and their legal right to know their own medical matters. It has long been believed that patients, be they psychiatric or non-psychiatric, should be protected and not given information that would potentially cause distress or harm to them. However, patient's competency may be a function of the physicians' efforts to make patients understand necessary information. Therefore, a patient's right to give informed consent leads to a physician's duty to disclose individually tailored information understandable to patients.

The Zung-Self-rating Depression Scale (SDS) was distributed to 28,588 first-year university students. Factor analysis using PROMAX rotation revealed three factors interpretable as affective, cognitive, and somatic symptoms. The confirmatory factor analysis showed a goodness-of-fit index of 0.976 and an adjusted goodness-of-fit index of 0.967. The two sexes exhibited virtually the same factor structure. The result suggests that studies with this scale should use these three subscales rather than a total score.

Objective: To examine psychosocial predictors of successful pregnancy after recurrent spontaneous abortions (RSA). Method: We administered two waves of semi-structured interview and self-report questionnaire battery to a consecutive series of 46 couples who had had two RSAs (baseline before third pregnancy, and immediately after third pregnancy was ascertained), and followed them through their third pregnancy. Results: Of the 46 couples, four miscarried for karyotypal abnormalities and six without any known cause. When the latter six were compared with the remaining 36 women, they reported less social support satisfaction, a more stable attribution for the causes of past abortions, and more depressed mood in the preceding year. Taken altogether, this psychosocial model was able to predict 93% of the pregnancy outcomes correctly. Conclusion: Psychosocial variables (depression, attribution and social support) are robust predictors of the prospective pregnancy and suggest possible points of intervention in couples with RSA.

The theoretical model of psychological well-being that encompasses six domains (self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life, and personal growth) was tested with a Japanese university student population ( N = 574) using a Japanese translation of Ryff's 1989 Psychological Well-being Inventory. A factor structure similar to Ryff's original model emerged. Both depression and anxiety correlated only moderately with scores on some subscales of the inventory, suggesting the relative independence of these dimensions of psychological well-being and negative affectivity. With negative affectivity controlled, some early life experiences were significantly linked with psychological well-being: relationships with romantic partners were linked with greater autonomy and experiences which enhance self-esteem were liked with greater personal growth. Careful psychometric work on the Japanese version is required to use the scale; then a replication and extension of the present study would be feasible.

We conducted a community-based interview survey of a random sample of residents aged 20 years or older in an urban community in Japan using the University of Michigan Version of the WHO Composite International Diagnostic Interview for selected mood and anxiety disorders and alcohol abuse/dependence according to DSM-III-R. The final sample consisted of 1029 respondents (response rate, 57%). The lifetime and 6-month prevalences of selected mood, anxiety and alcohol use disorders were low in general. Alcohol abuse/dependence was more prevalent in men than in women. Younger respondents had a greater risk of generalized anxiety disorder and alcohol dependence. A greater risk of mood, anxiety and alcohol use disorders was observed among a recent birth cohort. We confirmed a lower prevalence of mood and anxiety disorders and alcohol use disorders in a community population in Japan than in Western countries, observations that were similar to previous ones in East-Asian countries. The patterns of demographic correlates and comorbidity are similar to those of most other countries.

Although several studies have indicated that persons with a high ruminative coping style experience higher depression after the loss of a loved one, the relationship between ruminative coping and the occurrence of clinical depression and anxiety disorders after a loss has not been thoroughly investigated. This study investigated the relationship between response styles (ruminative coping v distractive coping) and the onset of major depression and anxiety disorders in a sample of parents who had experienced sudden child-loss (N = 106). The incidence of major depression after the loss of a child was very high (69%). After controlling for demographic variables and psychiatric history, ruminative coping was significantly associated with the onset of major depression, as defined by DSM-IV, but not with the onset of anxiety disorders. Thus ruminative coping after the loss of a child appears to be a risk factor specifically for major depression.

The purpose of the present paper was to examine the reliability and validity of the Japanese version of the Social Adjustment Scale-Self Report (SAS-SR) and to present its normative data. The SAS-SR was administered to a random sample of all the employees of a large general hospital, together with the General Health Questionnaire (n = 363). It was also administered to a representative subset of first-visit patients at 33 psychiatric hospitals and clinics from all over Japan, along with the semistructured psychiatric interview to ascertain the patients' diagnoses (n = 1581). For the internal consistency reliability of the subscales and the overall scale of the SAS-SR, Cronbach's alpha was between 0.61 and 0.73. The Pearson product-moment correlations between the subscale and overall scale scores with the GHQ score were mostly >0.3. The scores were statistically significantly and substantively different between the normal sample and the patient samples, and were also meaningful, differentiating between various diagnostic subgroups. The reference ranges of the SAS-SR scores for mentally healthy subjects were calculated as 95% prediction intervals; for example, 1.22-2.22 for the overall score. The Japanese version of the SAS-SR has good reliability and satisfactory validity. The present study provided reference ranges for its scores in order to increase their interpretability. With its ease of administration and its rich subscales, the scale promises to offer a psychometrically sound measure with which to assess social adjustment in people with various psychiatric disorders.

The aim of this study was to examine the pathoplastic effects of childhood parental separation experiences on depressive symptoms. Patients with acute major depression were identified in a large 31-center study of affective disorders in Japan. Information regarding the patients' childhood losses was collected using a semistructured interview, and their depressive symptomatology was assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). Patients reported significantly higher CES-D total scores when they had experienced early object loss of the same-sex parent. In terms of the CES-D subscores derived by factor analysis, early object loss significantly aggravated symptoms that people normally could cope with but could no longer cope with when depressed (e.g. 'poor appetite', 'cannot shake off the blues' and 'everything an effort.'). Once depression develops, early object loss may act as a pathoplastic factor by making it severer especially by rendering people less able to perform what they normally could do.

Inclusions, such as corpora amylacea, axonal spheroids and ubiquitin-positive granular structures, are present in aged brains. We found a phosphorylated tau-positive inclusion in brain tissues obtained from 13 non-demented subjects and five patients with Alzheimer's disease. This inclusion was spherical and 3-20 microm in size. It was most frequently detected in the hippocampal CA1 region and in the prosubiculum but was not present in the white matter. The density of this inclusion increased significantly with aging and decreased after the occurrence of neurofibrillary tangles. The presence of the inclusion was confirmed using immunoelectron microscopy. These findings show a possibility that the inclusion is a novel aging-related structure in the human brain.

Previous studies from our laboratory demonstrated that N(epsilon)-(carboxymethyl)lysine (CML), one of the major advanced glycation end products (AGE), was accumulated in human pyramidal neurons in the hippocampus in an age-dependent manner. This suggests a potential link between AGE-accumulation and the aging process in neurons. The purpose of the present study was to examine whether this notion could be extended to other AGE structures, such as imidazolone and pentosidine. This was done using 19 human brains that were not affected by dementia. The immunohistochemical survey on distribution in brain tissues of imidazolone and pentosidine was carried out with monoclonal antibodies specific for imidazolone and pentosidine. A parallel control experiment was carried out with anti-CML antibody. The results showed that pentosidine and imidazolone were localized in neurons in different areas of human brain tissue, especially in neurons of CA4 in the hippocampus. The characteristic distribution of pentosidine and imidazolone is very similar to that of CML. Furthermore, when the accumulation of these AGE structures was compared with the age of individual brains it was found that accumulation of imidazolone, pentosidine and CML in the CA4 region increased with age. These findings taken together support the notion that the accumulation of AGE structures in the CA4 region might be closely related to the aging process in neurons.

To examine the influence of early experiences on the development of personality, we used the Temperament and Character Inventory to assess 98 young women who had first entered a company. Different early experiences were linked, albeit weakly, to test scores. Both partial correlations and multiple regression analyses indicated that Self-directedness was higher if women reported more care of parents. Partial correlation, but not multiple regression analyses, showed that Cooperativeness was greater if women reported more care of parents and less frequent abuse. Reports of early parental loss or negative or positive early life events showed no correlation with scores on any of the Temperament and Character Inventory subscales.

Correlations of three aspects of quality of life (QOL) (health perception, life satisfaction, and self-confidence) with personality traits and early experiences were examined. Quality of life aspects were examined using 220 inhabitants in a rural community in Japan. Health perception was better among men than among women. Life satisfaction and self-confidence were better in people aged 55 or over than in those under 55. Among the current predictor variables, the Eysenck Personality Questionnaire neuroticism score was correlated with poor life satisfaction in the younger women; the extraversion score with the older women's health perception, the older men's life satisfaction, and the women's self-confidence; and the psychoticism score with the older men's life satisfaction. Among early life predictors, self-confidence was lower among those older men who had reported early parental loss. Childhood paternal overprotection was correlated with poor health perception in younger people and with good health perception in older women. Some negative life events experienced during childhood were correlated with poorer QOL measures in some subgroups, while positive life experiences were correlated with the older women's life satisfaction. These findings suggest that the three aspects of the QOL are discrete in their psychosocial correlates and that interventions on health education and care should take into account individual's psychosocial attributes.

Systematic investigations on the emotional impacts of repeated spontaneous abortions have been few. We mounted a prospective study of a cohort of couples who had experienced two consecutive first trimester spontaneous abortions and for whom no clearly identifiable causes were found. The present report is based on the first part of the study and examines: (1) emotional distress reported by the miscarrying women at six months (median, range 1-12 months) after two abortions; and (2) psychosocial predictors influencing such distress. The mean score of the women on the Symptom Checklist 90-Revised--one of the most popular self-report scales for psychopathology--was 0.38, whereas that for the general population is reported to be 0.26 (the higher the score, the more psychopathology). Fourteen percent of the cohort scored above the cutoff point for mental disorders screening. Factors examined and found non-influential upon the level of emotional distress include: the maternal age; whether the last pregnancy was planned and wished for or not; and coping styles of the women after the abortions. Control by the husbands over the marital relationship and neurotic personality traits of the women increased the emotional distress, whereas the social support the women perceive decreased it. These findings suggest that martial and social support are important in determining the level of psychiatric morbidity after repeated abortions.