Occupational Medicine

doi:10.1093/occmed/kqy080

Incidence of overwork-related mental disorders

and suicide in Japan
T. Yamauchi1, T. Sasaki2, T. Yoshikawa2, S. Matsumoto2 and M. Takahashi2
Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan, 2Research
1

Center for Overwork-Related Disorders, National Institute of Occupational Safety and Health, Kawasaki, Japan.
Correspondence to: M. Takahashi, Research Center for Overwork-Related Disorders, National Institute of Occupational Safety
and Health, 6-21-1 Nagao, Tama-ku, Kawasaki 214-8585, Japan. Tel: +81-44-865-6111 (ext. 8265);
e-mail: takaham2@e-mail.ne.jp

Background Mental disorders and suicide resulting from overwork or work-related stress have become major
occupational health issues worldwide, particularly in Asian countries. However, no studies have
reported incidence rates of mental disorders and suicide by sex, age group and industry, using a
national database containing all cases involving compensation in Asian countries.
Aims The present study examined incidence rates of occupational mental disorders and suicide by sex,
age group and industry using a database containing all cases involving compensation for mental
disorders and suicide in Japan over a 5-year period.
Methods Cases involving compensation for mental disorders and suicide in Japan between January 2010 and
March 2015 were analysed. Incidence rates over the 5-year study period were calculated by sex, age
group and industry.
Results In total, 1990 cases involving compensation for mental disorders and suicide (619 women and 1371
men) between January 2010 and March 2015 were analysed. The incidence rate involving compen-
sation was higher in employees aged between 30 and 39 years. In men, incidence rates were higher
in ‘accommodation/eating/drinking services’, ‘information/communication’ and ‘scientific research,
professional and technical services’. In these industries, incidence rates were particularly high for
those aged 29 years or younger.
Conclusions Our findings highlight the importance of promoting mental health support for younger employees
and increasing awareness of their working conditions. Differences in incidence rates by sex, age and
industry should be taken into consideration in the development of a national policy and industry-
and age-specific preventive measures for overwork-related mental disorders and suicide.
Key words Incidence; mental disorders; overwork; suicide; workers’ compensation.

Introduction work- and economy-related factors, such as economic

Mental disorders and suicide associated with overwork
or work-related stress caused by long working hours or
workplace bullying have become major occupational
health issues worldwide [1–3], particularly in Asian
countries [4–7]. The proportion of workers who work
49  h or longer per week is higher in Asian countries
than in Western countries. In particular, the number of
Industrial Accident Compensation Insurance (IACI)
claims for mental disorders, including suicide following
the onset of mental disorders, has increased substantially
in Japan, from 155 in 1999 to 1586 in 2016 [8,9]. In
addition, suicide rates among men of working age have
increased since 1998, and this has been attributed to
recession, increased unemployment rates and major
changes in the working environment (e.g. introduction of
performance evaluation and non-regular employment).
According to the National Police Agency of Japan, 1978
people committed suicide in 2016 due to work-related
issues such as exhaustion caused by overwork and work-
place bullying/harassment [10].
In June 2014, the Japanese government passed the
‘Act on Promotion of Preventive Measures Against
Karoshi and Other Overwork-Related Health Disorders’
(hereafter, ‘the Act’) [7,8,11]. Japan is the first coun-
try to pass a law specifically aimed at promoting pre-
ventive measures against overwork-related disorders.
One of the basic principles of the Act is that research

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 Page 2 of 8  OCCUPATIONAL MEDICINE
on overwork-related disorders should be conducted to
clarify the prevalence in Japan and to promote preven-
tive measures. Following the enactment of the Act in
November 2014, the Research Centre for Overwork-
Related Disorders (RECORDS) was established within
the National Institute of Occupational Safety and Health,
Japan (JNIOSH).
Previous studies in Asian countries found that the
prevalence of occupational mental disorders and suicide
differs by industry and occupation [4,7,12]. However,
no study has examined incidence rates of cases involving
workers’ compensation for mental disorders and suicide
in Asian countries by sex, age group or industry using
a national database containing all cases involving com-
pensation. This could contribute to the development of
a national policy to promote the prevention of overwork-
related disorders, especially with regard to industry- and
age-specific prevention measures for employees.
Based on the legal foundation of the Act, the present
study examined incidence rates of occupational mental
disorders and suicide by sex, age group and industry
using a database containing all cases involving com-
pensation for mental disorders in Japan over a 5-year
period.
Methods
The RECORDS collected information regarding all
IACI compensation claims for mental disorders for
which approval decisions were made between January
2010 and March 2015, with administrative support pro-
vided by the Japanese Ministry of Health, Labour and
Welfare (MHLW) [8]. In 2014, ~55 million workers
were covered by the IACI [13]. The Prefectural Labour
Bureau and Labour Standards Inspection Offices pro-
vided official investigation and decision reports for all
compensation cases during the 5-year study period.
For each case, the presence/absence of work-related
adverse events was investigated by the Labour Standard
Inspection Offices using the list of work-related adverse
events in the Recognition Criteria for Occupational
Mental Disorders by the MHLW [8]. In Japan, the ver-
dict of suicide is based on results of medicolegal exam-
inations by licensed physicians and police investigations,
while the work-relatedness of compensation claims for
suicide is investigated and determined by officials of the
Labour Standards Inspection Offices.
Compensation cases with incorrect or duplicate data,
or those that an approval decision was not made during
the study period were considered ineligible for inclusion
in the study.
An anonymous database of all cases of compensation
for mental disorders was specifically developed for this
study and analysed. The database included information
regarding year of compensation, sex, age at onset of men-
tal disorders and industry.
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Data from the Labour Force Survey conducted by
the Ministry of Internal Affairs and Communications
Statistics Bureau of Japan were included to obtain the
total number of employees according to year, sex, age
group and industry [14]. These were used as denomina-
tors in incidence rate calculations.
This study was approved by the JNIOSH review board
(no. H2708). Participants were informed of the study
goals and given the opportunity to opt out if they did not
want their information to be used for research purposes
via the official website of the MHLW and JNIOSH.
Those who did not actively opt out of participation were
included in the study.
Incidence rates (i.e. numbers of cases involving com-
pensation for mental disorders per 1 million employees)
over the 5-year study period were calculated by sex, age
group (≤29, 30–39, 40–49, 50–59 or ≥60 years) and indus-
try. Industry was categorized using the ‘Japan Standard
Industrial Classification’ established by the Ministry of
Internal Affairs and Communications in order to set the
statistical standards that classify all economic activities by
industry [15].
Results
Details of 2056 compensation cases were provided; of
these, 56 were considered ineligible for inclusion in
the study. Of the 2000 eligible cases, a further 10 were
excluded due to missing data regarding industry and/or
age at onset of mental disorders. Data from 1990 eligible
cases involving compensation for mental disorders (619
women and 1371 men; mean age: 39.1 [SD 11.4] years),
including 379 suicide cases (17 women and 362 men),
were analysed (Figure 1).
Tables 1 and 2 show the numbers of cases involving
compensation for mental disorders and incidence rates
of mental disorders by sex, age group and industry.
Potential subjects (n = 2056)
Incorrect or duplicate data or
the approval decision was not
made during the study period
(n = 56)
Eligible subjects (n = 2000)
Missing data regarding
industry and age (n = 10)
Included subjects
(n = 1990)
Figure 1.  Flow diagram for subject selection.
 T. YAMAUCHI ET AL.: OVERWORK-RELATED MENTAL DISORDERS AND SUICIDE IN JAPAN  Page 3 of 8

Regardless of sex, the number of cases involving
compensation for mental disorders was higher in the
30–39 years age group compared with other age groups.
Incidence rates per 1 million employees were 9.3 for
men, 5.4 for women and 7.6 for all participants. In men,
those in the 30–39 years age group had the highest inci-
dence rate (12.4), whereas in women, those ≤29  years
and in the 30–39 years age group had the highest inci-
dence rate (7.7).
The number of cases involving compensation for
mental disorders was highest in the ‘manufacturing’
industry in men, followed by ‘wholesale and retail trade’,
‘transport and postal activities’ and ‘construction’.
Although the numbers of cases involving compensation
for mental disorders were low in ‘fishing’ and ‘mining’
industries, these industries had the highest incidence rate
due to the small sample size. High incidence rates were
also observed in ‘accommodation and eating/drinking
services’, ‘information and communication’, ‘scientific
research, professional and technical services’ and ‘trans-
port and postal activities’. In ‘information and com-
munication’ and ‘scientific research, professional and
technical services’, incidence rates were highest in those
≤29 years. However, incidence rates were highest in the
age group of 40–49 years in ‘accommodation and eating/
drinking services’, and in those of 30–39 years in ‘trans-
port and postal activities’.
In women, the number of cases involving compensa-
tion for mental disorders was highest in the ‘medical,
health and welfare’ industry, followed by ‘wholesale and
retail trade’ and ‘manufacturing’. In contrast, the highest
incidence rate of mental disorders was in ‘transport and
postal activities’, followed by ‘information and commu-
nication’ and ‘scientific research, professional and tech-
nical services’. In these industries, incidence rates were
highest in those ≤29 years.
Tables 3 and 4 show the numbers of cases involving
compensation for suicide and incidence rates of sui-
cide by sex, age group and industry. Notably, 96% (362
of 379)  of cases involving compensation for suicide
occurred in men.
In men, the number of cases involving compensation
for suicide was the highest in the 40–49 years age group,
followed by the 30–39 years age group. In women, 10 of
17 cases involving compensation for suicide during the
5-year study period were those ≤29 years.
Incidence rates per 1 million employees were 2.5 in
men, 0.1 in women and 1.4 in all participants. In men,
the incidence rate those ≥60  years was lower than in
other age groups.
By industry, the number of cases involving compen-
sation for suicide in men was highest in the ‘manufac-
turing’ industry, followed by ‘wholesale and retail trade’,
‘construction’ and ‘transport and postal activities’. In

Table 1.  Numbers of employees and compensation cases and IRs for mental disorders according to age group and industry (men)

Industrya <30 years 30–39 years 40–49 years 50–59 years ≥60 years Total

Casesb IR Casesb IR Casesb IR Casesb IR Casesb IR Casesb IR

Medical/health/welfare 12 7.5 17 7.8 11 7.5 10 8.5 1 0.8 51 6.7

Transport/postal activities 19 13.4 59 20.2 60 17.4 26 8.6 12 4.8 176 13.2
Wholesale/retail trade 50 10.6 61 10.9 51 9.6 28 6.8 3 0.9 193 8.3
Scientific/technical services 14 22.0 21 16.5 21 16.5 10 9.8 4 4.7 70 13.8
Education/learning support 3 2.8 9 7.7 9 6.5 10 6.0 1 1.0 32 5.1
Fishing 0 0.0 2 66.7 1 22.2 1 20.0 2 20.0 6 24.0
Finance/insurance 2 4.1 5 7.0 8 7.1 8 8.6 0 0.0 23 6.4
Construction 17 7.6 36 9.0 39 10.1 33 8.9 12 3.5 137 7.9
Mining 0 ー 2 ー 0 ー 0 ー 1 ー 3 ー
Other services 17 11.0 35 14.5 31 13.9 12 5.5 5 1.6 100 8.7
Accommodation/food services 26 10.9 27 23.0 23 24.6 11 15.2 0 0.0 87 14.8
Information/communication 25 19.4 38 16.7 25 12.7 9 8.8 0 0.0 97 14.0
Entertainment 5 5.0 11 12.1 10 14.9 4 7.8 0 0.0 30 8.0
Manufacturing 62 10.8 86 9.8 79 8.5 46 6.6 17 3.9 290 8.3
Electricity/gas/heating/water 1 5.6 5 15.6 2 5.1 4 10.7 0 0.0 12 8.5
Agriculture/forestry 0 0.0 5 16.7 4 16.0 4 16.7 2 4.9 15 10.2
Compound services 1 5.1 5 13.5 1 2.6 3 7.9 0 0.0 10 6.8
Real estate/leasing 7 20.3 12 19.0 17 27.0 2 3.9 1 1.0 39 12.5
Total 261 10.4 436 12.4 392 11.3 221 7.7 61 2.6 1371 9.3

Because data regarding the employee population were unavailable for the period from January to March 2015, IRs were overestimated slightly. IR, incidence rate (per
1 million employees).
a
Public service employees and central and local government officers were excluded.
Total number of cases involving compensation between January 2010 and March 2015 (includes cases involving workers’ compensation claims made before
b

December 2009).

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Table 2.  Numbers of employees and compensation cases and IRs for mental disorders according to age group and industry (women)

Industrya <30 years 30–39 years 40–49 years 50–59 years ≥60 years Total

Casesb IR Casesb IR Casesb IR Casesb IR Casesb IR Casesb IR

Medical/health/welfare 35 6.7 59 9.7 43 6.7 28 5.1 14 4.9 179 6.9

Transport/postal activities 10 19.8 7 10.1 15 17.0 6 9.2 0 0.0 38 12.3
Wholesale/retail trade 33 6.1 27 5.4 21 3.7 14 2.9 2 0.6 97 4.0
Scientific/technical services 9 16.2 8 10.0 4 5.8 1 2.3 0 0.0 22 8.2
Education/learning support 5 3.2 15 9.9 2 1.1 3 1.8 0 0.0 25 3.5
Fishing 0 ー 0 ー 0 ー 0 ー 0 ー 0 ー
Finance/insurance 10 11.2 9 9.4 3 2.5 8 9.7 0 0.0 30 7.2
Construction 1 3.2 3 4.5 6 7.7 1 1.5 0 0.0 11 3.5
Mining 0 ー 0 ー 0 ー 0 ー 0 ー 0 ー
Other services 10 9.5 16 9.1 11 6.0 6 3.9 2 1.1 45 5.7
Accommodation/food services 22 7.6 11 6.3 7 3.5 5 2.9 2 1.2 47 4.7
Information/communication 10 13.2 10 12.7 6 11.1 2 8.5 0 0.0 28 11.6
Entertainment 8 5.3 2 1.8 4 3.9 1 1.1 0 0.0 15 2.8
Manufacturing 21 9.2 19 5.9 13 3.5 5 1.6 1 0.5 59 4.1
Electricity/gas/heating/water 1 ー 0 0.0 0 0.0 0 0.0 0 ー 1 5.7
Agriculture/forestry 0 0.0 0 0.0 0 0.0 2 7.5 0 0.0 2 1.7
Compound services 2 10.5 2 8.9 2 7.0 1 4.8 0 0.0 7 7.3
Real estate/leasing 3 10.2 7 18.9 3 8.1 0 0.0 0 0.0 13 7.2
Total 180 7.7 195 7.7 140 5.1 83 3.6 21 1.4 619 5.4

Because data regarding the employee population were unavailable for the period from January to March 2015, IRs were overestimated slightly. IR, incidence rate (per
1 million employees).
a
Public service employees and central and local government officers were excluded.
Total number of cases involving compensation between January 2010 and March 2015 (includes cases involving workers’ compensation claims made before
b

December 2009).

addition, high incidence rates were observed in ‘sci-
entific research, professional and technical services’,
‘information and communication’, ‘electricity, gas,
heating and water’, ‘construction’ and ‘real estate and
leasing’. Although the incidence rate was also high in
the ‘mining’ industry, this is likely to be due to the small
sample size. However, the number of cases involving
compensation for suicide was low in the ‘electricity,
gas, heating and water’ industry. Moreover, incidence
rates in ‘scientific research, professional and technical
services’ and ‘information and communication’ were
higher in those ≤29 years compared to other age groups.
In contrast, ‘construction’ and ‘real estate and leasing’
had the highest incidence rate in the 40–49  years age
group.
Discussion
This study examined incidence rates of occupational
mental disorders and suicide by sex, age group and
industry, in Japan over a 5-year period. Incidence rates
of mental disorders, including suicide, differed by sex,
age group and industry. In particular, the incidence rate
involving compensation for mental disorders/suicide was
higher among young employees.
Regardless of sex, the 30–39 years age group had the
highest incidence rate of mental disorders. On the other
hand, during the study period, incidence rates of cardio-
vascular/cerebrovascular diseases involving IACI com-
pensation per 1 million employees in Japan were highest
in the 50–59  years age group [7,12]. As suggested by
a previous study [16], stress resulting from long work-
ing hours, heavy workload or interpersonal conflict with
supervisors or managers could have contributed to the
higher incidence rates of mental disorders among young
people.
Incidence rates of mental disorders were high in
‘accommodation and eating/drinking services’, ‘infor-
mation and communication’, ‘scientific research, pro-
fessional and technical services’ and ‘transport and
postal activities’ in men. Although incidence rates were
also high in ‘fishing’ and ‘mining’, these are likely to
be due to their small sample size [14]. In addition, in
‘scientific research, professional and technical services’
and ‘information and communication’, the highest
incidence rate was observed in those ≤29 years. These
results could be explained by the fact that full-time
male workers in these industries are more likely to work
long hours, relative to those engaged in other industries
in Japan [8].

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 T. YAMAUCHI ET AL.: OVERWORK-RELATED MENTAL DISORDERS AND SUICIDE IN JAPAN  Page 5 of 8

Table 3.  Numbers of employees and compensation cases and IRs for suicide according to age group and industry (men)

Industrya <30 years 30–39 years 40–49 years 50–59 years ≥60 years Total

Casesb IR Casesb IR Casesb IR Casesb IR Casesb IR Casesb IR

Medical/health/welfare 2 1.3 4 1.8 4 2.7 4 3.4 0 0.0 14 1.8

Transport/postal activities 3 2.1 10 3.4 10 2.9 5 1.7 2 0.8 30 2.3
Wholesale/retail trade 16 3.4 16 2.9 12 2.3 12 2.9 1 0.3 57 2.5
Scientific/technical services 6 9.4 4 3.1 7 5.5 6 5.9 1 1.2 24 4.7
Education/learning support 1 0.9 0 0.0 3 2.2 3 1.8 0 0.0 7 1.1
Fishing 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Finance/insurance 2 4.1 2 2.8 3 2.7 4 4.3 0 0.0 11 3.0
Construction 4 1.8 12 3.0 17 4.4 15 4.1 7 2.0 55 3.2
Mining 0 ー 0 ー 0 ー 0 ー 1 ー 1 ー
Other services 4 2.6 7 2.9 5 2.2 1 0.5 0 0.0 17 1.5
Accommodation/food services 3 1.3 2 1.7 2 2.1 3 4.1 0 0.0 10 1.7
Information/communication 8 6.2 8 3.5 8 4.1 3 2.9 0 0.0 27 3.9
Entertainment 2 2.0 0 0.0 1 1.5 1 2.0 0 0.0 4 1.1
Manufacturing 11 1.9 18 2.1 26 2.8 19 2.7 10 2.3 84 2.4
Electricity/gas/heating/water 0 0.0 2 6.3 0 0.0 3 8.0 0 0.0 5 3.5
Agriculture/forestry 0 0.0 1 3.3 0 0.0 1 4.2 1 2.5 3 2.0
Compound services 0 0.0 1 2.7 1 2.6 1 2.6 0 0.0 3 2.0
Real estate/leasing 1 2.9 4 6.3 5 7.9 0 0.0 0 0.0 10 3.2
Total 63 2.5 91 2.6 104 3.0 81 2.8 23 1.0 362 2.5

Because data regarding the employee population were unavailable for the period from January to March 2015, IRs were overestimated slightly. IR, incidence rate (per
1 million employees).
a
Public service employees and central and local government officers were excluded.
Total number of cases involving compensation between January 2010 and March 2015 (includes cases involving workers’ compensation claims made before
b

December 2009).

In women, the number of cases involving compensa-
tion for mental disorders was the highest in the ‘medical,
health and welfare’ industry. According to previous stud-
ies [17], female healthcare professionals, such as nurses
in psychiatric care or caregivers for elderly people, are
more frequently exposed to work-related adverse events,
including physical assault and violence by service users.
However, the relatively low incidence rate in the ‘medical,
health and welfare’ industry compared to other indus-
tries could be explained by the larger number of female
employees (i.e. the size of the denominator for calculat-
ing the rate) in Japan during the study period [14].
With respect to suicide, almost 95% of cases were
reported among male workers, with a lower incidence in
those ≥60 years. Previous Japanese studies [8] reported
that long working hours, which have been associated
with depression [1,18], were more prevalent in men than
in women. Moreover, depression is one of the strong-
est risk factors for suicidal behaviour [19]. These factors
could explain the higher number of cases involving com-
pensation for suicide among men compared to women
in Japan.
In the present study, 379 (19%) of 1990 eligible cases
involving compensation for mental disorders were sui-
cide cases. This finding reflects the fact that the compen-
sation rate for mental disorders has remained at about
35% in recent years, while the rate for suicide cases alone
has been roughly 45% [9].
Both the number of suicides and incidence rate were
slightly higher in the 40–49  years age group compared
to other age groups. These findings were consistent with
reports by the National Police Agency of Japan, which
suggested that, among employed individuals, the num-
ber of suicides attributable to work-related issues (e.g.
changes in work environments, making critical mistakes
at work and exhaustion due to overwork) was the highest
in men aged between 40 and 49 years in 2015 [10].
Among the various industries, ‘scientific research,
professional and technical services’, ‘information and
communication’, ‘electricity, gas, heating and water’ and
‘construction’ had the highest incidence rates of suicide
in men. Previous reports have suggested higher preva-
lence of long working hours in these industries, particu-
larly in the ‘information and communication’ industry
[8]. However, the number of suicide cases in the ‘elec-
tricity, gas, heating and water’ industry was considerably
lower compared to other industries. Previous system-
atic reviews and meta-analyses have found long working
hours (i.e. >55  h per week) to be associated with the
onset of depression and suicidal ideation [1,20], which
are the strongest risk factors for suicidal behaviour [19].
Thus, male sex, long working hours and depression may

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Table 4.  Numbers of employees and compensation cases and IRs for suicide according to age group and industry (women)

Industrya <30 years 30–39 years 40–49 years 50–59 years ≥60 years Total

Casesb IR Casesb IR Casesb IR Casesb IR Casesb IR Casesb IR

Medical/health/welfare 5 1.0 1 0.2 1 0.2 1 0.2 0 0.0 8 0.3

Transport/postal activities 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Wholesale/retail trade 3 0.6 1 0.2 0 0.0 0 0.0 0 0.0 4 0.2
Scientific/technical services 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Education/learning support 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Fishing 0 ー 0 ー 0 ー 0 ー 0 ー 0 ー
Finance/insurance 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Construction 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Mining 0 ー 0 ー 0 ー 0 ー 0 ー 0 ー
Other services 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Accommodation/food services 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Information/communication 1 1.3 1 1.3 0 0.0 0 0.0 0 0.0 2 0.8
Entertainment 1 0.7 0 0.0 0 0.0 0 0.0 0 0.0 1 0.2
Manufacturing 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Electricity/gas/heating/water 0 ー 0 0.0 0 0.0 0 0.0 0 ー 0 0.0
Agriculture/forestry 0 0.0 0 0.0 0 0.0 1 3.8 0 0.0 1 0.9
Compound services 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Real estate/leasing 0 0.0 1 2.7 0 0.0 0 0.0 0 0.0 1 0.6
Total 10 0.4 4 0.2 1 0.0 2 0.1 0 0.0 17 0.1

Because data regarding the employee population were unavailable for the period from January to March 2015, IRs were overestimated slightly. IR, incidence rate (per
1 million employees).
a
Public service employees and central and local government officers were excluded.
Total number of cases involving compensation between January 2010 and March 2015 (includes cases involving workers’ compensation claims made before
b

December 2009).

have contributed to the higher incidence rates of suicide
in these industries, in particular, in young employees in
‘scientific research, professional and technical services’
and ‘information and communication’.
The present study analysed information regarding
all IACI compensation claims for mental disorders
for which approval decisions were made over a 5-year
period in Japan. To the best of our knowledge, this is
the first study to examine incidence rates of occupa-
tional mental disorders and suicide in employees by
sex, age group and industry using national data in Asian
countries.
There were, however, some limitations to this study.
Firstly, cases of compensation involving local author-
ity employees, such as police officers, fire workers and
school teachers, and central government officers were
not included in this study. For instance, the total num-
ber of local public employees in Japan was about 2.7 mil-
lion in 2014 [21]. However, the Japanese compensation
insurance system provided for central and local public
employees differs from that provided for employees at
private companies (i.e. the IACI) [22]. Secondly, the
present study examined cases involving compensation
for mental disorders; ‘uncompensated’ cases (i.e. cases
in which IACI claims were denied) were not included,
as relevant data were not available. In addition, there
must be workers and workers’ family members hesitat-
ing to claim compensation due to stigma and negative
public attitudes towards mental disorders and suicide
in Japan, leading to the underreporting of the com-
pensation claim. Therefore, caution is required when
interpreting the results of the present study, especially
with regard to the representativeness of work-related
adverse events and mental disorders/suicide among
company employees in Japan. Thirdly, the present study
did not include information regarding attempted sui-
cide. Previous studies suggested that attempted sui-
cide, including deliberate self-harm, was the strongest
risk factor for completed suicide [19,23]. Fourthly, the
reasons why incidence rates differed by sex, age group
and industry remain unclear due to the lack of rele-
vant data. Future studies should examine work-related
adverse events that are observed more frequently in
high-incidence groups (e.g. young employees in ‘scien-
tific research, professional and technical services’ and
‘information and communication’), in order to develop
industry- and age-specific preventive measures for
mental disorders related to overwork. Furthermore, it
would be useful to examine whether there were any pro-
tective factors against work-related adverse events (e.g.

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 T. YAMAUCHI ET AL.: OVERWORK-RELATED MENTAL DISORDERS AND SUICIDE IN JAPAN  Page 7 of 8
increased awareness of issues regarding long working
hours and health disorders due to overwork, working
style or business practices) in industries with a relatively
low incidence rate.
Key points
•• Mental disorders and suicide resulting from over-
work or work-related stress have become major
occupational health issues worldwide, particularly
in Asian countries.
•• The present study used a database containing all
cases involving workers’ compensation for mental
disorders in Japan over a 5-year period and showed
that the incidence rate involving compensation for
mental disorders was highest in young employees,
especially those aged 29 years or younger in specific
industries (e.g. information and communication).
•• Differences in incidence rates by sex, age group
and industry, and the potential background factors
underlying these differences, should be considered
in the development of industry- and age-specific
preventive measures for occupational mental dis-
orders and suicide.
Funding
This work was supported by Industrial Disease Clinical
Research Grants from the Ministry of Health, Labour
and Welfare, Government of Japan (150903-01) and JSPS
KAKENHI (grant number JP17K10348).
Acknowledgements
We thank Dr Shigeki Koda, Deputy Director-General of the
National Institute of Occupational Safety and Health, Japan,
for providing important insight. We also thank the staff mem-
bers of the Research Center for Overwork-Related Disorders,
National Institute of Occupational Safety and Health, Japan,
for their assistance with data collection.
Competing interests
None declared.
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