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Purpose The individual placement and support (IPS) model of supported employment is a leading evidence-based practice in community mental health services. In Japan, individualized supported employment that is highly informed by the philosophy of the IPS model has been implemented. While there is a body of evidence demonstrating the association between program fidelity and the proportion of participants gaining competitive employment, the association between fidelity and a wider set of vocational and individual outcomes has received limited investigation. This study aimed to assess whether high-fidelity individualized supported employment programs were superior to low-fidelity programs in terms of vocational outcomes, preferred job acquisition, and patient-reported outcome measures (PROMs). Methods A prospective longitudinal study with 24-month follow-up analyzed 16 individualized supported employment programs. The Japanese version of the individualized Supported Employment Fidelity scale (JiSEF) was used to assess the structural quality of supported employment programs (scores: low-fidelity program, ≤ 90; high-fidelity program, ≥ 91). Job acquisition, work tenure, work earnings, job preference matching (e.g., occupation type, salary, and illness disclosure), and PROMs such as the INSPIRE and WHO-Five Well-being index were compared between groups. Results There were 75 and 127 participants in the low-fidelity group (k = 6) and high-fidelity group (k = 10), respectively. The high-fidelity group demonstrated better vocational outcomes than the low-fidelity group, i.e., higher competitive job acquisition (71.7% versus 38.7%, respectively, adjusted odds ratio (aOR) = 3.6, p = 0.002), longer work tenure (adjusted mean difference = 140.8, p Conclusion High-fidelity individualized supported employment programs resulted in good vocational outcomes in a real-world setting. However, enhancing service quality to increase desired job acquisition and improve PROMs will be important in the future. Clinical Trial Registration UMIN000025648

This study examined the association between job tenure and job preference matching for five job preference domains for people with mental disorders enrolled in Individual Placement and Support (IPS) programs in Japan. The domains include occupation type, monthly income, weekly work hours, commute time, and illness disclosure.We conducted secondary analysis of participants who obtained employment in a longitudinal study during the 24-month follow-up period at 16 agencies routinely providing IPS programs. We included 112 participants who expressed job preferences and were employed at least once. A total of 130 employment cases were analyzed. Matches in the five domains were determined using participants' job preferences and employment information. The Match Level (0-5) indicates the number of domains that match the participant's job preferences. Job tenure (weeks worked) was compared between the matched and unmatched groups in each domain and between each match levels using linear regression mixed-effects models.A match for a given domain did not show a significant relationship with job tenure, whereas Match Levels 3 (A higher match level may be related to a longer job tenure. The results suggest that employment specialists should prioritize clients' preferences in job searches. Further replication studies in other settings and countries should be conducted to verify the findings in this study. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

ObjectivesMental health symptoms and mental illnesses are common in elite athletes. There is an urgent need to develop care systems to support the mental health of elite athletes. Understanding elite athletes’ preferences in mental health help seeking can help explore strategies to develop such systems. Therefore, this study aims to investigate with whom/where elite athletes feel comfortable discussing mental health concerns and seeking help.MethodsWe analyse data from 219 Japanese male rugby players out of 612 players (565 Japanese, 47 foreigners) aged 18 and over who belong to the Japan Rugby Players Association using a cross-sectional design and an anonymous, web-based, self-administered questionnaire. In the questionnaire, the players are asked to rate on a 5-point Likert scale how comfortable they feel talking about their mental health concerns with affiliation/team staff, family/relatives, friends, mental health professionals, rugby-related seniors and teammates. Analysis of variance and Dunnett’s test are performed to detect differences in their preferences for sources of help.ResultsDunnett’s test shows that the mean scores for preferring to consult affiliation/team staff are significantly lower than for all the other groups (pConclusionRegarding mental health concerns, for elite male rugby players as elite athletes, it can be difficult to ask for help or talk to team staff.

Background The Japanese version of the individualized Supported Employment Fidelity scale (JiSEF) was developed by modifying the 25‐item Individual Placement and Support Fidelity Scale (IPS‐25). While a preliminary study partly confirmed the concurrent validity with vocational outcomes, this replication study aimed to examine the stability of the concurrent validity and the inter‐rater reliability of the JiSEF and to test its convergent validity with IPS‐25. Methods Fidelity assessments were conducted in 2016 (n = 17), 2017 (n = 13), and 2018 (n = 18) to examine the employment rate and the fidelity scores at the agency level. We also evaluated the fidelity scores for the IPS‐25 in 2018. We examined the associations between the fidelity scale scores and vocational outcomes for the concurrent validity and between the fidelity scales for convergent validity. The inter‐rater reliability was examined in the 2016 and 2017 assessments. Results High intraclass correlation coefficients (0.93 in 2016 and 0.92 in 2017) were obtained for the inter‐rater reliability. The JiSEF score in each year was associated with the agency employment rate (r = 0.710, P = 0.001 in 2016; r = 0.722, P = 0.005 in 2017; and r = 0.665, P = 0.003 in 2018). A supplementary longitudinal data analysis also confirmed the association between the JiSEF score and the employment outcomes. Additionally, the JiSEF was significantly correlated with the IPS‐25 (r = 0.760, P, This study stably replicated a good inter‐rater reliability and concurrent validity of the Japanese version of the individualized Supported Employment Fidelity scale (JiSEF).

School-based education is a potentially effective approach for improving mental health literacy (MHL) in adolescents. This study evaluated the effects of the "Short MHL Program (SMHLP)", a brief (50 min), school teacher-led program, on MHL in adolescents in a quasi-cluster randomized controlled trial.A total of 975 high school first graders (age 15-16) in Japan were allocated to classes such that gender and academic achievement ratios were almost equivalent at the time of admission to the high school. They were assigned at the class level to the SMHLP (n = 364 from 10 classes) or a control group (n = 611 from 17 classes). The program consisted of a 50-minute session and was delivered by a school teacher. The students completed a self-report questionnaire at 3 time points: pre-, (immediately) post- and 2-month follow-up. Outcomes included "Knowledge about mental health/illnesses", "Recognition of the necessity to seek help", "Intention to seek help", and "Intention of helping peers". Mixed effects modeling was employed for analyses.Scores of all outcomes were significantly improved in the intervention group compared to the control group post-intervention (p.001). These improvements were maintained at 2-months follow-up for all outcomes (p.001-.05). Questionnaire scores did not differ between groups at baseline.The effect of the SMHLP was confirmed in grade 10 students. Brief, yet effective programs can be a viable option to promote understanding of mental health problems and have the potential to be incorporated into regular school curriculum. ".

Aims Improving mental health literacy through school-based education may encourage mental health promotion, prevention and care and reduce stigma in adolescents. In Japan, instruction about mental illness has been formulated in a Course of Study that reflects governmental curriculum guidelines, which will be enforced from 2022 to promote an understanding of current issues of adolescent health. Educational resources available to schoolteachers have been developed. This article describes the development processes and contents of these resources. Methods Our collaborating team, consisting of mental health professionals and schoolteachers, developed educational resources, based on feedback from high school students in general and young people who had experienced mental health problems. Results The new Course of Study covers: (1) mechanisms of mental illness, prevalence, age at onset, risk factors and treatability; (2) typical symptoms of mental health problems and illnesses; (3) self-help strategies for prevention of and recovery from mental illness; (4) enhancing help-seeking and helping behaviour and (5) decreasing stigma associated with people with mental health problems. The educational strategy is targeted at high school students (grades 10-12) and is conducted by teachers of health and physical education. The educational resources include short story animated films, filmed social contact and educators' manuals, which are freely available through the internet and open to all concerned including schoolteachers in Japan. Conclusions Our efforts are expected to help implement mental health education of the public throughout Japan and other countries and promote the practice of early intervention and prevention of mental illnesses in adolescents.

Background Several previous observational studies have reported the risk factors associated with readmission in people with mental illness. While patient-reported experiences and outcomes have become increasingly important in healthcare, only a few studies have examined these parameters in terms of their direct association with readmission in an acute psychiatric setting. This project will investigate multiple factors associated with readmission and community living in acute psychiatric patients in Japan. This study will primarily investigate whether patient-reported experiences at discharge, particularly quality of life (QoL), are associated with future readmission and whether readmission after the index hospitalization is associated with changes in patient-reported outcomes during the study period. Here, we describe the rationale and methods of this study. Methods This multicenter prospective cohort study is being conducted in 21 participating Japanese hospitals, with a target sample of approximately 600 participants admitted to the acute psychiatric ward. The study has four planned assessment points: time of index admission (T1), time of discharge (from the index admission) (T2), 6 months after discharge from the index admission (T3), and 12 months after discharge from the index admission (T4). Participants will complete self-reported measures including a QoL scale, a subjective disability scale, and an empowerment- and self-agency-related scale at each assessment point; additionally, service satisfaction, subjective view of need for services, and subjective relationships with family members will be assessed at T2 and T3. We will assess the participants’ hospitalization during the study period and evaluate several potential individual- and service-level factors associated with readmission and patient-reported experiences and outcomes. Multivariate analyses will be conducted to identify potential associations between readmission and patient-reported experiences and outcomes. Discussion The present study may produce evidence on how patient-reported experiences at discharge influence readmission and on the influence of readmission on the course of patient-reported outcomes from admission to community living after discharge. The study may contribute to improving care for both patients’ subjective views of their own health conditions and their community lives in an acute psychiatric setting. Trial registration University Hospital Medical Information Network—Clinical Trials Registry (UMIN-CTR) UMIN000034220. Registered on September 20, 2018.

Background There is increasing international interest in clinical practice and research related to mental health in the international sports society. The athlete-specific psychological distress assessment tool that addresses potential mental health needs can help promote early detection and recovery of mental illness, as well as physical illnesses. Currently, little is known about the applicability of the useful assessment tool for Japanese elite athletes. The Athlete Psychological Strain Questionnaire (APSQ) is a brief, effective and reliable screening tool to identify early signs of athlete-specific distress and potential mental health symptoms. We examined the applicability and reliability of a Japanese version of the APSQ (APSQ-J) in a Japanese elite athlete context. Further, we examined the construct validity of the APSQ-J. Methods We collected web-based anonymous self-report data from 219 currently competing Japanese professional male rugby players. A two-stage process was conducted to validate the factor structure of the APSQ-J using exploratory factor analysis (EFA) in a randomly partitioned calibration sample and confirmatory factor analysis (CFA) in a separate validation sample. Cronbach’s alpha is used to assess internal consistency. Pearson product-moment correlation coefficients were calculated to determine if the APSQ-J was significantly associated with measures of psychological distress and well-being using Kessler-6 (K6) and the WHO-5 Well-Being Index, respectively. Results We identified a one-factor structure for the APSQ-J. Confirmatory factor analysis supports this one-factor model, revealing good model fit indices. The standardized path coefficients for each of the items were β = 0.41–0.83 (p r = 0.80, p r = −0.58, p Conclusion The APSQ-J can be an appropriate and psychometrically robust measure for identifying athlete-specific distress in elite athletes in Japan. Widely disseminating and utilizing this scale in Japanese sports society may support athletes' mental health via early detection of symptoms of psychological distress.

Clinical and research interest is growing in mental health support for elite athletes, based on findings from epidemiological surveys conducted in Australia, the United States, and European countries. However, little is known about the mental health status of elite athletes in Asia, including Japan. In the current study, we examine the prevalence of mental health problems and suicidal ideation and its risk factors in Japan Rugby Top League players. We analyze anonymous web-based self-reported data from 251 currently competing Japan Rugby Top League male players. During the off-season from December 2019 to January 2020, data on anxiety and depression symptoms were collected using the Japanese version of the 6-item Kessler-6. Suicidal ideation was assessed using the Baron Depression Screener for Athletes. Among the players, 81 players (32.3%) had experienced symptoms of mild anxiety and depression during the previous 30 days, while 12 (4.8%) and 13 (5.2%) had suffered from moderate and severe symptoms, respectively. Nineteen athletes (7.6%) reported that they had experienced suicidal ideation during the previous 2 weeks. Players with mental health problems experienced more events in competitions and daily life, including reduced subjective performance, missing opportunities to play during the last season, changes in health condition, and thinking about a career after retirement, compared with players without such problems. Mental health issues in Japan Rugby Top League players, as elite athletes, may be common, and research and practice development is expected in the near future.

The Baron Depression Screener for Athletes (BDSA) is a brief, valid, and reliable athlete- specific assessment tool developed in the US to assess depressive symptoms in elite athletes. We examined the applicability and reliability of a Japanese version of the BDSA (BDSA-J) in a Japanese context, and further examined the construct validity of the BDSA-J. Web-based anonymous self-report data of 235 currently competing Japanese professional male rugby players (25–29 years = 123 [52.3%]) was analyzed. A two-stage process was conducted to validate the factor structure of the BDSA-J using exploratory factor analysis in a randomly partitioned calibration sample, and confirmatory factor analysis in a separate validation sample. Cronbach’s alpha was used to assess internal consistency. Spearman’s rank-order correlation coefficients were calculated to examine convergent validity with the Kessler-6. We identified a one-factor structure for BDSA-J. Confirmatory factor analysis supported this one-factor model, revealing good model fit indices. The standardized path coefficients for each of the items were β = 0.52 to 0.79 (p &lt, 0.001). A Cronbach’s alpha of 0.71 was obtained for the BDSA-J. BDSA-J showed significant positive correlations with the Kessler-6. The BDSA-J is an appropriate and psychometrically robust measure for identifying depressive symptoms in Japanese male rugby players.

This study aims to investigate independent associations of habitual sleep durations and sleep timings on weekdays and weekends with depressive symptoms in adolescents who have classes in the morning. We studied grade 7–9 students (942 males and 940 females, aged 12–15 years), who had classes in the morning, at public junior high schools in Japan in a cross-sectional design. The students answered a self-report questionnaire, which covers habitual sleep durations, bedtimes and wake-up times on weekdays and weekends, and depressive symptoms. The Short Mood and Feelings Questionnaire (SMFQ) was used to determine the level of depressive symptoms. The relationship between the variables on sleep habits and the SMFQ score were studied using multivariate linear regression and generalized additive models (GAM), controlling for sex, age and school. Multivariate linear regression analysis revealed that sleep duration on weekdays and relative mid-sleep time on weekdays (i.e. mid-sleep time on weekdays – mid-sleep time on weekends) were independently significantly (p p

Aim A concise teacher-led program for mental health literacy (MHL), suitable for schools with tight schedules was developed, and its effects were examined in pre-teens. Methods Participants comprised 662 grade 5 to 6 students from nine Japanese elementary schools. The program consisted of a 45-minute session, delivered by school teachers using a 10-minute animated film. Program focuses included: mental health problems are common, can be associated with lifestyle and that seeking help from reliable adults is a key to finding solutions. Participants filled out self-report questionnaires before, immediately after and 3 months post-intervention. Changes in MHL were analyzed using multilevel models. Results Knowledge about mental health/illnesses, recognition of mental health state and intention to help peers/seek help when suffering from mental health problems, were significantly improved immediately and 3 months post-intervention. Conclusions Concise teacher-led programs administered in schools can have positive and lasting effects on MHL in pre-teens.

Previous studies have suggested the consequence of mental health-related public stigma: the problem of knowledge may develop into problem of attitude and behaviour. However, this has not been directly explored in a longitudinal study. As the secondary analysis from our previous randomized controlled trial (RCT) for 219 participants who completed the survey at the 12-month follow-up, we aimed to investigate whether the knowledge and attitude components of stigma toward people with schizophrenia affect each other. At baseline and at 12 months, three types of stigma scales were measured: favorable understanding, negative stereotype, and social distance toward people with schizophrenia. A structured equation model was fitted to the trajectory of stigma scales taking into account the effect of the other stigma components and the interventions. The results showed that greater social distance toward people with schizophrenia at baseline was associated with less favorable understanding and more negative stereotype at the 12-month follow-up. This was not in line with the existing consequences from the previous studies; however, in line with the recent RCTs showing that social contact is the most effective intervention to reduce stigma. Future observational studies with a larger sample size are needed to clarify this relationship further.

Background Globally increasing clinical and research interests are driving a movement to promote understanding and practice of mental health in elite athletes. However, few studies have yet addressed this issue. This study aims to describe the association of the intention to seek help with mental health knowledge and stigma and the severity of depressive symptoms in Japan Rugby Top League players. Methods As a target population, we studied 233 Japan Rugby Top League male players (25–29 years = 123 [52.8%]), who were born in Japan, using a cross-sectional design. Surveys were conducted using anonymous, web-based self-administered questionnaires. Structural equation modelling was performed to evaluate the hypothesis of an interrelationship between mental health knowledge, stigma, and severity of depressive symptoms as factors influencing the intention to seek help. Results Players with more severe depressive symptoms were more reluctant to seek help from others (β = - 0.20, p = 0.03). Players with greater knowledge about mental health tended to have less stigma toward others with mental health problems (β = 0.13, p = 0.049), but tended not to seek help with their own mental health problems. Conclusions Rugby players in need of mental health support, even with greater knowledge, tend not to seek help from others, while having less stigma toward people with mental health problems. Rugby players might require approaches other than a knowledge-based educational approach to encourage them to seek help.

Renaming schizophrenia is a potential strategy to reduce the stigma attached to people with schizophrenia. However, the overall associations between renaming schizophrenia and stigma-related outcomes have not been fully elucidated. We conducted a systematic review of studies that empirically examined the outcomes between new or alternative terms and old or existing terms for schizophrenia. We searched for relevant articles in eight bibliographic databases, conducted a Google search, examined reference lists, and contacted relevant experts. We found a total of 2601 reference records, and 23 articles were included in this review. Overall, in countries where schizophrenia has been renamed, the name changes may be associated with improvements in adults’ attitudes toward people with schizophrenia, and with increased diagnosis announcement. However, studies conducted in countries where schizophrenia has not been renamed report inconsistent findings. In addition, renaming may not influence portrayals of schizophrenia in the media. Most studies included in our review had a risk of bias in their methodology, and we employed a vote-counting method to synthesize study results; therefore, the impacts of renaming are still inconclusive. Future studies are needed to address the following issues: use of univariate descriptive statistics, adjustment for confounding variables, use of reliable measures, and employing a question that addresses the image of split or multiple personalities. Evidence is limited regarding the associations between renaming and stigma experienced by both people with schizophrenia and their families (e.g., perceived stigma, self-stigma, discrimination experience, and burden). Further research in these populations is needed to confirm the effects of renaming schizophrenia.

Background Insufficient mental health literacy (MHL) of the general public is one of the major factors that prevent early intervention for mental illness. Insufficient MHL may exacerbate the stigma attached to people with mental illness. In Japan, there have been few large-scale surveys to determine the MHL level of the general public. Hence, we conducted a large-scale internet-based survey of 3000 citizens, to clarify the knowledge, attitudes and behaviors of the general public with respect to “prevention of and recovery from mental illness.” Methods We conducted a survey of 3000 citizens (aged 18 to 79 years, 1483 males and 1517 females) to determine their MHL level, using a questionnaire posted on the internet. The survey consisted of 22 questions about MHL, grouped into 8 categories. Results The results of our survey were as follows: (1) Impression of mental illness: Regarding the question on their impression of mental illness, more than 70% of the respondents answered, “I think it is scary.” This answer was especially likely to be given by younger respondents. (2) Knowledge of mental illness: Regarding the question on whether mental illness is related to the living environment and also to suicide, more than 90% of the respondents answered, “I think so.” However, a small proportion of the respondents were aware that mental illness begins in adolescence (65.0%) and that only physical symptoms manifest in some cases of mental illness (40.2%). (3) Awareness of the importance of mental health: Regarding the importance of mental health, 94.1% of the respondents answered, “I think so.” (4) Attitudes and behaviors toward people with mental illness: Of the respondents, 20% to 30% had interacted with people with mental illness at home, school, workplace or in their neighborhood. Of these, 62.0% thought that they could maintain friendship with them. However, 39.6% of the respondents did not want to live with them, 25.2% did not want to work with them, and 32.0% did not want to live near them; thus, many of the respondents had negative thoughts about establishing close relationships with people with mental illness. The percentage of respondents with such negative thoughts increased with age. (5) Identification by the subjects of the survey of depression, schizophrenia, anxiety disorder and eating disorder using vignettes: The identification rates of the diseases were as follows: depression (27.3%), schizophrenia (33.7%), anxiety disorder (63.5%), and eating disorder (82.2%). The identification rate of schizophrenia was higher in respondents between the ages of 20s to 40s and decreased in older age groups. Discussion It was found that in Japan, many citizens were aware of the importance of mental health, but that there was still a stigma attached to people with mental illness. In addition, they were found to be still poorly aware of representative mental illnesses, such as depression and schizophrenia. For improving these aspects, the MHL level of the general public needs to be further improved. In Japan, it has been pointed out that education on mental health is insufficient. However, education on mental health as a course on “prevention of and recovery from mental illness” is expected to be started in high schools in 2022. This would be expected to further improve the MHL level of the general public in the near future.

Aims Mental health-related stigma is a major challenge associated with the huge mental health treatment gap. It has remained unclear what kind of educational content is effective in reducing the stigma. Whether biomedical messages (BMM) about mental illness are effective or harmful in decreasing stigma is controversial. To investigate whether BMM can improve practically useful knowledge of mental illness, comparably to recommended messages (RCM) advocated by experts, of types such as ‘recovery-oriented’, ‘social inclusion/human rights’ and ‘high prevalence of mental illnesses’ through a randomised controlled trial (RCT). Method This study is an individual-level RCT with a parallel-group design over 1 year, conducted in Tokyo, Japan. A total of 179 participants (males n = 80, mean age = 21.9 years and s.d. = 7.8) were recruited in high schools and universities, and through a commercial internet advertisement in June and July 2017, without any indication that the study appertained to mental health. Participants were allocated to the BMM and RCM groups. They underwent a 10-min intervention, and completed self-report questionnaires during baseline, post-test, 1-month follow-up and 1-year follow-up surveys. The primary outcome measures were practically useful knowledge of mental illness at the post-test survey using the Mental Illness and Disorder Understanding Scale (MIDUS). Analysis was conducted in October 2018. Results Both groups demonstrated improved MIDUS score in the post-test survey, and showed similar intervention effects (F(1, 177) = 160.5, p < 0.001, η2 = 0.48). The effect of the interventions continued until the 1-year follow-up survey (B [95% CI] = −2.56 [−4.27, −0.85], p < 0.01), and showed no difference between groups. The reported adverse effect that BMM increase stigma was not confirmed. Conclusions BMM may have a positive impact on stigma, comparable to RCM. These findings may encourage reconsideration of the content of messages about mental health, as it is indicated that combining BMM and RCM might contribute to an effective anti-stigma programme.

Aims.Public stigma alters attitudes towards people with mental illness, and is a particular concern for young people since most mental health problems occur in adolescence and young adulthood. However, little is known about the long-term effects of repeated filmed social contact (FSC) on reducing mental health-related stigma among young adults in the general population, compared with self-instructional Internet search (INS) and control interventions.Methods.This study is a parallel-group randomised controlled trial over 12 months conducted in Tokyo, Japan. A total of 259 university students (male n = 150, mean age = 20.0 years, s.d. = 1.2) were recruited from 20 colleges and universities between November 2013 and July 2014, without being provided information about the mental health-related survey or trial. Participants were assigned to one of three groups before completion of the baseline survey (FSC/INS/control = 89/83/87). The FSC group received a computer-based 30-min social contact film with general mental health education and five follow-up web-based FSCs at 2-month intervals. The INS group undertook a 30-min search for mental health-related information with five follow-up web-based reminders for self-instructional searches at 2-month intervals. The control group played PC games and had no follow-up intervention. The main outcome measures were the future (intended behaviour) domain of the Reported and Intended Behaviour Scale at 12 months after the intervention. Analysis was conducted in September 2015.Results.At the 12-month follow-up, 218 participants completed the survey (84.1%, 75:70:73). The FSC group showed the greatest change at the 12-month follow-up (FSC: mean change 2.11 [95% CI 1.49, 2.73], INS: 1.04 [0.29, 1.80], control: 0.71 [0.09, 1.33]; FSC v. INS p = 0.037, FSC v. controls p = 0.004). No adverse events were reported during the follow-up period.Conclusions.FSC was more successful in reducing stigma at 12 months after intervention than INS or control interventions. FSC could be used to reduce stigma in educational lectures and anti-stigma campaigns targeted at young people.Study registration.This study is registered at UMIN-CTR (No. UMIN000012239).

AIM Mental-health-related stigma affects help-seeking behavior and service utilization among young people. Whether mental-health-related stigma is different or correlated between parents and their children is unknown. It is also unknown whether the name change of schizophrenia in 2002 has had long-term effects on reducing stigma for adults in the general population. METHODS We recruited 143 parent-child pairs (mean ages [SD]: 51.5 [3.6] and 21.2 [1.2] years, respectively) to complete self-report questionnaires regarding mental-health-related stigma and experience. We also assessed negative stereotypes for three psychiatric disease names (old and new names of schizophrenia, and depression), and for diabetes mellitus as a physical illness comparison. The questionnaires also asked respondents to identify the old and new names of schizophrenia and dementia, respectively, among 10 names for mental and physical illnesses and conditions. RESULTS Parents showed lower stigma levels toward mental illness and diabetes mellitus, but similar or greater stigma levels toward schizophrenia, compared with their children. Stigma levels toward mental illness in parents and their children were significantly correlated. The rate of correct identification of the old and new names for schizophrenia was higher in parents than in their children (64.7% vs 41.4%, P < 0.001). Parents who responded correctly endorsed more negative stereotypes toward the new name of schizophrenia compared with those who responded incorrectly (P = 0.049). CONCLUSION The present findings suggest that stigma toward mental illness is shared between family members, and the name change of schizophrenia has effectively reduced stigma levels toward this disorder in adults of various ages.

Chronic traumatic encephalopathy (CTE) results from repetitive brain injuries and is a common neurotraumatic sequela in contact sports. CTE is often accompanied by neuropsychiatric symptoms, which could escalate to suicidal ideation (SI) and suicidal behaviour (SB). Nevertheless, fairly limited emphasis about the association between suicidality and CTE exists in medical literature. Here, we report two cases of retired professional athletes in high contact sports (boxing and ice hockey) who have developed similar clinical trajectories characterized by progressive neuropsychiatric symptoms compatible with a CTE diagnosis and subsequent SB in its severe forms (medical serious suicide attempt (SA) and completed suicide). In addition to the description of outlining clinical, neuropsychological, neuroimaging, and differential diagnosis elements related to these cases, we also hypothesized some mechanisms that might augment the suicide risk in CTE. They include those related to neurobiological (neuroanatomic/neuroinflammatory) dysfunctions as well as those pertaining to psychiatry and psychosocial maladaptation to neurotraumas and retirement from professional competitive activity. Findings described here can provide clinical pictures to improve the identification of patients with CTE and also potential mechanistic insights to refine the knowledge of eventual severe SB development, which might enable its earlier prevention.

Sleep problems during adolescence affect current and subsequent mental health and are associated with experiences of psychotic symptoms. Recent studies have suggested that short sleep duration increases the risk of experiencing psychotic symptoms in the general adolescent population; however, whether long sleep duration is associated with an increased risk of psychotic symptoms in adolescence remains unclear. The present study aimed to examine the relationships between long sleep duration, short sleep duration, and the risk of experiencing psychotic symptoms in adolescence. Cross-sectional survey data from 15,786 junior and senior high school students (12- to 15-year-olds and 15- to 18-year-olds, respectively) in Japan were collected and analyzed using logistic regression analysis after controlling for covariates, including depressive symptoms. Long sleep duration was associated with a 1.6- to 2.8-fold increased risk of psychotic symptoms in male but not in female adolescents. Short sleep duration was also related with a 1.6- to 2.9-fold increased risk of experiencing psychotic symptoms, except for 15- to 18-year-old female adolescents. The present study suggested that adolescents with long and short sleep duration should be assessed for their risk of experiencing psychotic symptoms regardless of concurrent depressive symptoms.

Renaming schizophrenia is a potential strategy to reduce the stigma attached to people with schizophrenia. However, the overall associations between renaming schizophrenia and stigma-related outcomes have not been fully elucidated. We conducted a systematic review of studies that empirically examined the outcomes between new or alternative terms and old or existing terms for schizophrenia. We searched for relevant articles in eight bibliographic databases, conducted a Google search, examined reference lists, and contacted relevant experts. We found a total of 2601 reference records, and 23 articles were included in this review. Overall, in countries where schizophrenia has been renamed, the name changes may be associated with improvements in adults' attitudes toward people with schizophrenia, and with increased diagnosis announcement. However, studies conducted in countries where schizophrenia has not been renamed report inconsistent findings. In addition, renaming may not influence portrayals of schizophrenia in the media. Most studies included in our review had a risk of bias in their methodology, and we employed a vote-counting method to synthesize study results; therefore, the impacts of renaming are still inconclusive. Future studies are needed to address the following issues: use of univariate descriptive statistics, adjustment for confounding variables, use of reliable measures, and employing a question that addresses the image of split or multiple personalities. Evidence is limited regarding the associations between renaming and stigma experienced by both people with schizophrenia and their families (e.g., perceived stigma, self-stigma, discrimination experience, and burden). Further research in these populations is needed to confirm the effects of renaming schizophrenia.

STUDY OBJECTIVES To investigate sleep duration associated with the least depression/anxiety in adolescence. METHODS Grades 7-12 Japanese students (n = 18,250, aged 12-18 y) from public junior high/high schools were studied in a cross-sectional design. Due to missing/implausible data, 15,637 out of the 18,250 students were statistically analyzed. Relationship between sleep duration on school nights and depression/anxiety, measured using self-report questionnaires, including the General Health Questionnaire-12 (GHQ-12), were studied by sex and grade, controlling for bedtime regularity. RESULTS When sleep duration was classified by 1-h intervals, rate of adolescents with a GHQ-12 score ≥ 4 was the lowest in males and females who slept 8.5-9.5 h and 7.5-8.5 h, respectively, (designated "references") in both grades 7-9 and 10-12. The rate was significantly higher than the references in both males and females who slept < 7.5 h, regardless of grade (P < 0.05, logistic regression). GHQ-12 tended to be worse in adolescents (2.0%-13.5%) who slept longer than the references. Sleep duration for the minimum GHQ-12 score was estimated to be 8.8 and 8.5 h in males, and 8.0 and 7.5 h in females, in grades 7-9 and 10-12, respectively, using the General Additive Model. CONCLUSIONS Sleep duration of ≥ 8.5 h on school nights may be associated with the lowest risk of depression/anxiety on average in male adolescents. Although the duration was estimated to be shorter in females (≥ 7.5 h) than males, this should be interpreted carefully. Most adolescents may currently be sleeping less than the optimal duration. COMMENTARY A commentary on this article appears in this issue on page 1491.

Mental-health-related stigma affects help-seeking behavior and service utilization among young people. Whether mental-health-related stigma is different or correlated between parents and their children is unknown. It is also unknown whether the name change of schizophrenia in 2002 has had long-term effects on reducing stigma for adults in the general population.We recruited 143 parent-child pairs (mean ages [SD]: 51.5 [3.6] and 21.2 [1.2] years, respectively) to complete self-report questionnaires regarding mental-health-related stigma and experience. We also assessed negative stereotypes for three psychiatric disease names (old and new names of schizophrenia, and depression), and for diabetes mellitus as a physical illness comparison. The questionnaires also asked respondents to identify the old and new names of schizophrenia and dementia, respectively, among 10 names for mental and physical illnesses and conditions.Parents showed lower stigma levels toward mental illness and diabetes mellitus, but similar or greater stigma levels toward schizophrenia, compared with their children. Stigma levels toward mental illness in parents and their children were significantly correlated. The rate of correct identification of the old and new names for schizophrenia was higher in parents than in their children (64.7% vs 41.4%, P 0.001). Parents who responded correctly endorsed more negative stereotypes toward the new name of schizophrenia compared with those who responded incorrectly (P = 0.049).The present findings suggest that stigma toward mental illness is shared between family members, and the name change of schizophrenia has effectively reduced stigma levels toward this disorder in adults of various ages.

UTokyo Research掲載「統合失調症の病名変更が新聞報道に与えた影響」 URI: http://www.u-tokyo.ac.jp/ja/utokyo-research/research-news/effect-of-name-change-of-schizophrenia-on-mass-media.html, UTokyo Research "Effect of name change of schizophrenia on mass media" URI: http://www.u-tokyo.ac.jp/en/utokyo-research/research-news/effect-of-name-change-of-schizophrenia-on-mass-media.html

AIM: Improving knowledge and beliefs about mental health (or mental health literacy: MHL) may promote appropriate help-seeking by adolescents who are suffering from mental health problems. We develop a concise, school-staff led MHL program and examine its effects. METHODS: The participants comprised 118 grade-9 students (61 males and 57 females). The program consisted of two 50-min sessions, and was given by a school teacher. The effects of the program were evaluated before, immediately after and 3 months after the program, using a self-report questionnaire. RESULTS: Knowledge of mental health/illnesses and desirable behavior for help-seeking was significantly improved immediately after (post-test, p CONCLUSION: A concise, school staff-led program may have a significant effect on the improvement of MHL in secondary school students. Language: en

Improving knowledge and beliefs about mental health (or mental health literacy [MHL]) may promote appropriate help-seeking by adolescents who are suffering from mental health problems. We developed a concise, school-staff-led MHL program and examined its effects.The participants comprised 118 grade-9 students (61 boys and 57 girls). The program consisted of two 50-min sessions, and was given by a schoolteacher. The effects of the program were evaluated before, immediately after and 3 months after the program, using a self-report questionnaire.Knowledge of mental health/illnesses and desirable behavior for help-seeking were significantly improved immediately after (post-test, P 0.001, and P 0.001, respectively) and 3 months after the program (3-month follow up, P 0.001 and P 0.001, respectively), compared with the test before the delivery of the program (pre-test, Wilcoxon signed rank test). Proportions of the correct diagnoses of vignette cases of major depression and schizophrenia were significantly (P 0.001) elevated from 38.3% and 19.1% (pre-test) to 94.7% and 93.6% (post-test), and 91.5% and 86.2% (3-month follow up). Intentions to seek help and to provide peers with help with mental health problems were also significantly (P 0.001) elevated at post-test and at 3 months compared with the pre-test.A concise, school-staff-led program may have a significant effect on the improvement of MHL in secondary school students.

A name change for schizophrenia was first implemented in Japan for reducing stigma in 2002; however, little is known of its long-term impact. Total 259 students from 20 universities answered an anonymous self-administered questionnaire about their mental health-related experiences, and stigma scales including feasible knowledge and negative stereotypes for four specific diseases, including schizophrenia (old and new names), depression, and diabetes mellitus. We also asked to choose the old and new names of schizophrenia and dementia among ten names for mental and physical illnesses and conditions. The participants had more feasible knowledge and fewer negative stereotypes for the new name of schizophrenia than the old name, but were still significantly worse than for depression and diabetes mellitus (p