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This study aimed to examine the effect of Japanese policies for appropriate hypnotics use and novel hypnotics (e.g., melatonin receptor agonist [MRA] and orexin receptor antagonist [ORA]) on long-term prescriptions of hypnotics.This retrospective study was conducted using a large-scale health insurance claims database. Among subscribers prescribed hypnotics at least once between April 2005 and March 2021, those prescribed hypnotics for the first time after being included in the database in three periods (period 1, April 2012-March 2013; period 2, April 2016-March 2017; and period 3, April 2018-March 2019) were eligible. These were set considering the timing of the 2014 and 2018 medical fee revisions (2014 for polypharmacy of three or more hypnotics, 2018 for long-term prescription of benzodiazepine receptor agonists for12 months). The duration of consecutive prescriptions of hypnotics over 12 months was evaluated. Factors associated with short-term prescriptions of hypnotics were also investigated.In total, 186,535 participants were newly prescribed hypnotics. The mean duration of prescriptions was 2.9 months, and 9.3% of participants were prescribed hypnotics for 12 months. Prescription periods were not associated with short-term prescriptions of hypnotics. ORA use was associated with short-term prescriptions of hypnotics (adjusted hazard ratio, 1.077; 95% confidence interval, 1.035-1.120; p0.001), but MRA use was not.Japanese policies had no statistically significant effect on long-term prescriptions of hypnotics. Although this study suggests initiating ORA for insomniacs as a candidate strategy to prevent long-term prescriptions of hypnotics, further research is necessary to draw conclusions. This article is protected by copyright. All rights reserved.

Background: The average sleep duration of Japanese people is shorter than that of people from other countries, and bedtime procrastination is suspected to be one of the factors contributing to this issue. This study aimed to develop and validate the Japanese version of the Bedtime Procrastination Scale (BPS-J). Methods: The BPS-J was developed through procedures including the translation and back-translation of the scale, cognitive interviews with 100 participants who reported insufficient sleep syndrome (ISS) using open-ended online questionnaires, and expert checking. To investigate the scale’s validity and reliability, an online survey was conducted with daytime workers aged 20-65 years without sleep disorders other than ISS. Half of the participants were retested using the same survey after 14 days. Participants’ responses to the Brief Self-Control Scale (BSCS), General Procrastination Scale (GPS), and Munich ChronoType Questionnaire (MCTQ), and data on sleep-related variables such as sleep duration on workdays and the days per week of fatigue or sleep loss, sex, and age, were collected. Results: We analyzed data from 574 participants to assess scale validity. We then analyzed data from 280 participants to determine test-retest reliability. Confirmatory factor analyses revealed that the two-factor model without Item 2 was most suitable for the BPS-J, unlike other language versions. Regardless of the full-item model or the model with Item 2 eliminated, sufficient reliability and significant correlations with the BSCS, GPS, MCTQ, and sleep-related variables such as sleep duration per night on work days, days per week of feeling fatigued, and days per week of sleep losswere observed. Logistic and linear regressions showed that the relationships between the BPS-J, sleep-related variables, and MCTQ were maintained after adjusting for sex and age. Conclusion: The BPS-J was found to have sufficient validity and reliability. Further, eliminating Item 2 from the original version of the Bedtime Procrastination Scale was found to be better to adapt the scale for Japanese daytime workers.

Pregabalin is a drug that can cause psychiatric symptoms via pregabalin withdrawal. Prior reports on pregabalin withdrawal have mainly focused on cases with pregabalin dependence or abuse, and little attention has been paid to patients who are prescribed regular doses of pregabalin. Herein, we report three cases of pregabalin withdrawal in patients without psychiatric disorders, taking regular doses of pregabalin, who developed psychiatric symptoms such as insomnia and anxiety after abrupt discontinuation of pregabalin. In addition, we conducted a systematic review of six case reports (previous studies) of pregabalin withdrawal under regular doses of pregabalin. Among the six cases, three patients had no comorbid mental or substance use disorders, the dose of pregabalin ranged from 150 to 600 mg/d, and the duration of pregabalin use ranged from a few weeks to many years. Of these six cases of pregabalin withdrawal, five had psychopathological symptoms, three had vegetative symptoms, and three had neurologic and physical complications. We concluded that since pregabalin withdrawal can occur even with regular doses and short‐term use, clinicians must carefully reduce pregabalin doses when reducing or discontinuing treatment, paying close attention to withdrawal symptoms. Our case series sheds light on the scant evidence from previous research on physical dependence in patients who are taking regular doses of pregabalin. Furthermore, our cases were also valuable in demonstrating that pregabalin withdrawal can occur even after a relatively short period of 2 months., This case series shows pregabalin withdrawal in patients without psychiatric disorders taking a regular dose of pregabalin. Our cases demonstrated that pregabalin withdrawal can occur even after a relatively short period of 2 months following regular doses of pregabalin.

Background Training non-specialist workers in mental healthcare improves knowledge, attitude, confidence, and recognition of mental illnesses. However, still little information is available on which type of mental health training is important in the improvement of these capacities. Methods We studied web-based survey data of 495 public health workers to examine training types associated with knowledge and experience in supporting individuals with mental illness. Multivariable logistic regression analysis was conducted to evaluate the association between a lack of knowledge and experience (outcome) and mental health training (exposure). We fitted three regression models. Model 1 evaluated unadjusted associations. Model 2 adjusted for age and sex. Model 3 adjusted for age, sex, years of experience, mental health full-time worker status, and community population. Bias-corrected and accelerated bootstrap confidence intervals (CIs) were used. Results For all training types, the association between a lack of knowledge and experience and mental health training attenuated as the model developed. In Model 3, a lack of knowledge and experience was significantly associated with training in specific illness (OR, 0.54; 95% CI, 0.32–0.93) and screening and assessment (OR, 0.63; 95% CI, 0.39–0.99). Non-significant results were produced for training in counseling, psychosocial support, collaborative work, and law and regulation in Model 3. Conclusions We believe that the present study provides meaningful information that training in specific illness and screening and assessment may lead to knowledge and experience of public health workers. Further studies should employ a longitudinal design and validated measurements.

Yu Itoh,1 Masahiro Takeshima,1 Yoshitaka Kaneita,2 Naohisa Uchimura,3 Yuichi Inoue,4 Makoto Honda,5 Wataru Yamadera,6 Norio Watanabe,7 Shingo Kitamura,8 Isa Okajima,9 Naoko Ayabe,10 Kyoko Nomura,11 Kazuo Mishima1 1Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan; 2Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan; 3Department of Neuropsychiatry, Kurume University, Fukuoka, Japan; 4Department of Somnology, Tokyo Medical University, Tokyo, Japan; 5Sleep Disorders Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; 6Division of Bioregulatory Medicine, Department of Katsushika Medical Center, The Jikei University, Tokyo, Japan; 7Health Promotion and Human Behavior, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan; 8Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan; 9Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan; 10Department of Regional Studies and Humanities, Faculty of Education and Human Studies, Akita University, Akita, Japan; 11Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, JapanCorrespondence: Kazuo MishimaDepartment of Neuropsychiatry, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita, 010-8543, JapanTel +81-18-884-6122Fax +81-18-884-6445Email mishima@med.akita-u.ac.jpPurpose: Large-scale natural disasters have an enormous physical and mental impact, immediately after they occur, on people living near the central disaster areas. It is known that, in the early stages, a seismic disaster triggers high rates of symptoms for insomnia, depression, and anxiety. However, little information is available about their medium- to long-term clinical outcomes. In this study, we conducted a repeated cross-sectional nationwide questionnaire survey to clarify changes in the prevalence of insomnia and its background factors after the Great East Japan Earthquake, a huge earthquake with a moment magnitude of 9.0 that occurred on March 11, 2011.Methods: We conducted a repeated cross-sectional survey in November 2009 (pre-earthquake, 1224 participants), July 2011 (4 months post-earthquake, 1259 participants), and August 2012 (18 months post-earthquake, 1289 participants) using stratified random sampling from 157 Japanese sites.Results: Compared to 2009, the prevalence of insomnia statistically increased nationwide immediately post-disaster (11.7% vs 21.2%; p < 0.001) but significantly decreased in 2012 compared to immediately after the earthquake (10.6% vs 21.2%; p < 0.001). In 2011, insomnia was most frequent in the central disaster area. Multivariable logistic regression models demonstrated the association between the following factors and increased risk of insomnia: being a woman (odds ratio [OR] 1.48, 95% confidence interval [CI]: 1.00– 2.19), being employed in 2009 (OR 1.74, 95% CI: 1.15– 2.62), and being of younger age group (20– 64 years) in 2011 (OR 1.64, 95% CI: 1.12– 2.42) and 2012 (OR 2.50 95% CI: 1.47– 4.23). Post-earthquake, the prevalence of insomnia symptoms in men increased, while the gender difference decreased and was no longer statistically significant. Additionally, insomnia was associated with psychological distress (scores ≥ 5 on the Kessler Psychological Distress Scale) in 2011 and 2012.Conclusion: This study demonstrated that the prevalence of insomnia was significantly higher after the earthquake. Moreover, individuals with insomnia were more likely to experience psychological distress after the earthquake that continued until 2012.Keywords: disaster, earthquakes, insomnia, psychological stress

In this study, we measured the physical quantity of light (irradiance) in several wavelength bands at eye and wrist level for 8 h under laboratory conditions simulating daily life. Twenty-two healthy male participants (mean age ± SD, 29.95 ± 8.13 years) were able to move freely, and eye-level data were compared with irradiance data obtained at the wrist. We estimated circadian phase shift from the differences of DLMO before and after light exposure while considering natural drift. In addition, we investigated the influence of activities and body positions on light exposure and validated the effect of irradiance on circadian phase response. We found lower average irradiance at eye level compared with wrist level in all three RGB bands. The blue light irradiance measured at eye level was significantly correlated with circadian phase shift, possibly because the irradiance at eye level more accurately reflected its effect on the biological clock than did the measurement at the wrist. It follows that quantitative measurements of wavelength spectra at eye level are necessary to assess the effect of ambient light on the human biological clock.

This study aimed to determine whether both subjective sleep quality and sleep duration are directly associated with quality of life (QOL), as well as indirectly associated with QOL through insomnia symptoms. Individuals aged 20–69 years without mental illness (n = 9305) were enrolled in this web-based cross-sectional survey. The Short Form-8 was used to assess physical and mental QOL. We used the Pittsburgh Sleep Quality Index (PSQI) and extracted items related to subjective sleep quality and sleep duration. Insomnia symptoms were also extracted from the PSQI. The hypothesized models were tested using structural equation modeling. Worse sleep quality, but not shorter sleep duration, was related to worse physical QOL. Both worse sleep quality and shorter sleep duration were related to worse mental QOL. Insomnia symptoms mediated these relationships. Subgroup analyses revealed a U-shaped relationship between sleep duration and physical/mental QOL. However, the relationship between sleep quality and physical/mental QOL was consistent regardless of sleep duration. The results suggest that subjective sleep quality has a more coherent association with QOL than subjective sleep duration. Because of its high feasibility, a questionnaire on overall sleep quality could be a useful indicator in future epidemiological studies of strategies for improving QOL.

ObjectivesThere are numerous reports on the psychological burden of medical workers after the COVID-19 outbreak; however, no study has examined the influence of developmental characteristics on the mental health of medical workers. The objective of this study was to examine whether the developmental characteristics of medical workers are associated with anxiety and depression after the COVID-19 outbreak.DesignWe conducted an online cross-sectional questionnaire survey in October 2020.Participants and settingThe data of 640 medical workers were analysed. The questionnaire included items on sociodemographic data, changes in their life after the COVID-19 outbreak and symptoms of depression, anxiety, attention-deficit/hyperactivity disorder (ADHD) traits and autism spectrum disorder traits.Main outcomesDepression symptoms were assessed by the Patient Health Questionnaire-9 and anxiety symptoms were assessed by the Generalised Anxiety Disorder-7. A series of hierarchical multiple regression analyses were performed to test the effects of developmental characteristics on depression and anxiety symptoms after controlling for sociodemographic factors and changes in participants’ lives after the COVID-19 outbreak.ResultsIncreases in physical and psychological burden were observed in 49.1% and 78.3% of the subjects, respectively. The results of a multiple regression analysis showed that ADHD traits were significantly associated with both depression (β=0.390, pConclusionGlobally, the burden on medical workers increased. This study suggested that medical workers with higher ADHD traits may need special attention during the COVID-19 pandemic.

Background Training non-specialist workers in mental healthcare improves knowledge, attitude, skills, and confidence as well as clinical practice and skills. However, still little information is available on what type of mental health training is specifically associated with the improvement of such capacities. Japan reportedly has a poor quality of community mental health, and such information is crucial to improve the mental health service. Methods We studied web-based survey data of 495 public health workers in Japan to examine training types associated with knowledge/experience to support individuals with mental disorders. Multivariable logistic regression analysis was conducted to evaluate the association between lack of knowledge/experience (outcome) and mental health training (exposure). We fitted three regression models. Model 1 evaluated unadjusted associations. Model 2 adjusted for age and sex. Model 3 adjusted for age, sex, years of experience, mental health full-time worker status, and community population. Results For all training types, the association between lack of knowledge/experience and mental health training attenuated as the model developed (i.e., Model 1 showed the smallest odds ratio). In Model 3, lack of knowledge/experience was significantly associated only with training about mental disorder and screening/assessment (OR, 0.54; 95% CI, 0.33–0.90: and OR, 0.63; 95% CI, 0.40–0.97, respectively). Conclusions We believe that the present study provides meaningful information that training about mental disorder and screening/assessment may lead to knowledge/experience of public health workers. Further studies should employ a longitudinal design with a larger sample.

BACKGROUND There are numerous reports on the psychological burden of medical workers after the COVID-19 outbreak; however, no study has examined the influence of developmental characteristics on the mental health of medical workers. OBJECTIVE The objective of this study was to examine whether the developmental characteristics of medical workers are associated with anxiety and depression after the COVID-19 outbreak. METHODS An online questionnaire survey was conducted in October 2020. The questionnaire included items on sociodemographic data, changes in their life after the COVID-19 outbreak, and symptoms of depression, anxiety, attention deficit/hyperactivity disorder (ADHD) traits, and autism spectrum disorder traits. We performed hierarchical multiple regression analyses. RESULTS The data of 640 medical workers were analyzed. Increases in physical and psychological burden were observed in 49.1% and 78.3% of the subjects, respectively. The results of a multiple regression analysis showed that ADHD traits were significantly associated with both depression (β=0.390, P CONCLUSIONS Globally, the burden on medical workers increased. This study suggested that medical workers with higher ADHD traits may need special attention during the COVID-19 pandemic.

Background To date, no previous studies have evaluated the relationship between sleep duration and quality of life (QOL) or depression in the general population after controlling for daytime sleepiness and sleep disturbances. Methods A web-based cross-sectional survey was conducted with 8698 subjects aged 20–69 years. We examined the relationships between weekday sleep duration and daytime sleepiness, sleep disturbance, QOL and depression, using the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (without the item for sleep duration), 8-item Short Form and Center for Epidemiological Studies Depression Scale (CES-D). Results Daytime sleepiness tended to increase in proportion to shorter weekday sleep durations. Sleep disturbances, physical and mental QOL, and CES-D scores were worse in both the shorter and longer sleep groups compared with the group with 7–8 h of sleep. Hierarchical logistic regression analyses revealed that short sleep duration but not long sleep duration was significantly associated with reduction of both physical and mental QOL, even after controlling for the presence of daytime sleepiness and sleep disturbance. Both short and long sleep duration were independently and significantly correlated with depression after controlling for daytime sleepiness; however, there was no statistically significant association after adjusting for the effects of sleep disturbance. Conclusions The results suggested adverse effects of short sleep but not long sleep on both physical and mental QOL. In addition, the negative impact of specific types of sleep disturbance on depression may be greater than the impact of shortening of sleep duration.

Greater use of a norm-violating coping strategy relates to higher risk of negative social interactions and to higher distress. We examined the factors that are linked to the use of a norm-violating coping strategy and those that moderate the relationship between the coping strategy used and social interaction. Results of a cross-sectional survey for 74 Japanese undergraduate students and 68 Japanese workers indicated that, in a group with frequent contact, misconceptions about group norms concerning coping strategy relate to more negative social interactions. To draw causal inferences, a replication study with a large sample from heterogeneous cultural backgrounds is necessary.