Tetsuya Ishida’s research while affiliated with Kurume University and other places

Background: Although the therapeutic relationship (or ‘alliance’) is well known to be a key component of psychiatric treatment, there has been no simple way to objectively measure the patient-therapist relationship. Here, we measured the psychological distance between patients and their therapists by using the Pictorial Representation of Illness and Self Measure (PRISM). Patients and Methods: We analyzed the patient-therapist relationship of 112 patients from two hospitals in Japan (54 males, 57 females, 1 unknown; age 46.20 ± 15.03 years [mean ± SD]) who completed the PRISM and self report questionnaires (LSNS-6, K6, and BASIS-32) about their social network, psychological distress, and outcomes of mental health treatment. Results: PRISM measurements were available for all patients who consented to participate. In the comparison by disease category, schizophrenia recorded the closest distance to the psychiatrist in charge, followed by bipolar disorder, depression, and neurotic disorder. Regarding the distance to the psychiatrist in charge, PRISM showed a weak negative correlation (r = −0.23, p < 0.05) with age, indicating that with increasing age, the therapeutic rela tionship was more important to the patients. Conclusion: Our findings indicate the possibility of implementing PRISM to assess the impact of the therapeutic relationship in patients with a wide range of psychiatric disorders, and they suggest that PRISM holds great potential for clinical application.

Background: The impact of traumatic experiences or adverse life experiences has been shown to potentially affect a wide range of mental health outcomes. However, there was no brief instrument to screen for a range of psychological problems in different domains after a potentially traumatic event, and for risk factors and protective factors. Objective: The aim of this study is to examine the internal consistency and concurrent validity of the Japanese version of the Global Psychotrauma Screen (GPS) in a traumatized sample in Japan. Method: A total sample (n = 58) with varying levels of potential posttrauma symptoms due to domestic violence or other events were recruited into this study. Self-rating measures of posttraumatic stress disorder (PTSD), depression, anxiety, and alcohol problems were conducted to investigate the concurrent validity. Results: The results show that a range of posttrauma symptoms assessed by the GPS were highly endorsed by this traumatized sample in all domains except for self-harm, derealization, and depersonalization. The GPS sum score was highly correlated (r > 0.79) with other measures of PTSD, depression, and anxiety symptoms. Also, the subdomain scores showed acceptable correlations with corresponding domain measures. Participants who had been sexually assaulted or had unwanted sexual experiences, and participants who had been physically assaulted during childhood, had higher scores on the total GPS and on subdomains of PTSD, as well as symptoms associated with Complex PTSD. Conclusions: This study provides an initial indication that the GPS may be a useful screening tool for trauma survivors and elucidates that the consequences of trauma are not limited to PTSD.

Workplace violence (WPV) in healthcare settings has drawn attention for over 20 years, yet few studies have investigated the association between WPV and psychological consequences. Here, we used a cross-sectional design to investigate (1) the 12-month prevalence of workplace violence (WPV), (2) the characteristics of WPV, and (3) the relationship between WPV and burnout/secondary traumatic stress among 599 mental healthcare nurses (including assistant nurses) from eight hospitals. Over 40% of the respondents had experienced WPV within the past 12 months. A multivariate logistic regression analysis indicated that occupation and burnout were each significantly related to WPV. Secondary traumatic stress was not related to WPV. Our results suggest that WPV may be a long-lasting and/or cumulative stressor rather than a brief, extreme horror experience and may reflect specific characteristics of psychological effects in psychiatric wards. A longitudinal study measuring the severity and frequency of WPV, work- and non-work-related stressors, risk factors, and protective factors is needed, as is the development of a program that helps reduce the psychological burden of mental healthcare nurses due to WPV.

The aim of this study was to explore cross-cultural differences in symptoms of burnout, anxiety, depression, general psychological distress, and secondary traumatic stress between Asian (Japan) and European (Switzerland) midwives. One hundred seventy midwives participated in the study. There were significant differences in age group [χ²(3) = 24.2, p < 0.01], marital or relationship status [χ²(2) = 28.4, p < 0.01], and years of experience [χ²(2) = 17.8, p < 0.01] between the two countries. The Japanese staff were younger, more often unmarried, and had less experience than the Swiss staff. The mean score of depersonalization was significantly higher in Switzerland (4.8 ± 3.8) than in Japan (3.2 ± 3.7; |z| = 2.71, p < 0.01). The mean score of general psychological distress in the Swiss sample (12.8 ± 6.5) was significantly higher than that in the Japanese sample (10.3 ± 6.2; |z| = 2.04, p = 0.04). In addition, the mean score of secondary traumatic stress was higher in the Swiss sample (31.8 ± 9.7) than in the Japanese sample (24.1 ± 8.6; |z| = 4.56, p < 0.01). These results may reflect cultural differences such as working conditions or family environment between Japan and Switzerland.

Psychoeducation is usually positioned as the preliminary step toward cognitive-behavioral psychotherapy, however, psychoeducation itself also has therapeutic aspects. We herein report on two cases, who underwent a short-term psychoeducational program (4~6 sessions, once every two weeks, 50 minutes per session). In the course of this program, we understood that it is not only important to provide information to the participants, but it is also important to reflect on the experience gained during such a program. We discuss the aims of therapeutic intervention in psychoeducation using the spectrum ranging from supportive psychotherapy to expressive psychotherapy.

Numerous studies have determined that lifestyle factors (smoking, drinking, snacking, etc.) and the bedroom environment can influence sleep. We developed a new sleep scale—the 3-Dimensional Sleep Scale (3DSS)—which measures three elements of sleep: phase, quality, and quantity. The purpose of this study is to determine which risk factors of sleep complaints are associated with these sleep elements. Data were obtained from 366 Japanese day workers (302 men and 64 women). Sleep condition was assessed with the 3DSS, and we also assessed various habits within 2 h of going to bed, including smoking, drinking, snacking, caffeine intake, mobile phone use, and working. We also asked about bedroom environmental conditions (noise, lighting, and temperature and humidity). Multivariate logistic regression analysis using the backward selection method (likelihood ratio) was used, with 3DSS scores as the outcome (i.e., over or under the cutoff). The results showed that smoking was associated with significantly greater odds ratio [2.71 (1.65–4.44)] of disordered sleep phase, while lighting as well as temperature and humidity led to greater odds [3.67 (1.55–8.68), 1.93 (1.20–3.11)] of poor sleep quality. Finally, only noise was significantly related to greater odds [1.98 (1.13–3.46)] of low sleep quantity. These findings indicated the various risk factors of sleep complaints could be associated with different sleep elements. This might help in the effective treatment of sleep complaints.

Both a higher suicide rate and widespread sleep problems are serious health concerns in Japan when compared with those of other countries. We investigated the relationship between suicidal ideation and sleep problems in Japanese day workers using the 3-dimensional sleep scale (3DSS), which measures three sleep elements (phase, quality, and quantity). Data from 635 Japanese day workers (461 mens and 174 womens) were included. The 3DSS was used to assess participants’ sleep condition. Participants were classified into eight sleep types based on scores of phase, quality, and quantity: All Good Sleep, Owl (poor phase), Inefficient (poor quality), Short (poor quantity), Owl + Inefficient (poor phase and quality), Owl + Short (poor phase and quantity), Inefficient + Short (poor quality and quantity), and All Poor Sleep. We assessed participants’ suicidal ideation using question 19 of the self-rating depression scale (SDS); 119 cases (18.7 %) had ratings of 2–4 for this question and were considered to have suicidal ideation. The higher the number of sleep problems, the higher the risk of suicidal ideation compared to sleep types not indicative of problems. All Poor Sleep had the highest risk of the eight sleep types. Individuals with Owl + Short, Inefficient + Short, or All Poor Sleep had a significant risk of suicidal ideation even after adjusting for hopelessness and nightmares. Our findings suggested that sleep problems assessed by the 3DSS were related to suicidal ideation. Analysis of various aspects of sleep could be helpful for suicide prevention. Electronic supplementary material The online version of this article (doi:10.1007/s41105-016-0067-5) contains supplementary material, which is available to authorized users.

抄録 目的：ピッツバーグ睡眠質問票（PSQI)に代表される睡眠尺度の多くは，実際の睡眠時間や日中の眠気といった量的問題や，睡眠の維持・導入といった質的問題を捉えてある．それらに加えて，24時間型社会となった今日では起床時刻・就寝時刻といった位相の問題まで視野に入れていく必要があり，かつ睡眠の位相・質・量のいずれに問題があるのかを把握するためには各々に測定・評価しなければならない．そこで我々は位相・質・量の3つの睡眠関連問題について測定する3次元型睡眠尺度（3 Dimentional Sleep Scale; 3DSS）の日勤者版を開発した．本研究はその信頼性・妥当性を検証することを目的とする．対象と方法：対象は製造業およびサービス業に従事する日勤労働者635名（男性461名，女性174名）で，平均年齢は40.5歳であった．質問紙は全17項目から成り，事前研究結果および専門家との討議を参考に睡眠の位相・質・量に関する質問を設定した．回答偏向分析後，探索的および確認的因子分析を行った．信頼性はクロンバックα信頼性係数を算出して求め，尺度の得点化・上位－下位分析を行った．仮説検定ではPSQIおよびSDSより位相・質・量それぞれに関連した項目を抜粋し，3DSSの各尺度得点との相関をみて収束的妥当性および弁別的妥当性の検証を行った．また，PSQIの総合点と3DSSの各尺度得点との相関についても検証を行った．結果：回答偏向分析にて回答に大きな偏りはみられなかった．探索的因子分析の結果2項目が削除されたが3つ因子が抽出され，位相に関する質問5項目，質に関する質問5項目，量に関する質問5項目の計15項目となり，確認的因子分析においても15項目モデルの方が適合度が高かった．α 信頼性係数は下位尺度毎では位相 = 0.685，質 = 0.768，量 = 0.717であった．仮説検定では，収束的妥当性については仮説がすべて採択された．弁別的妥当性については新尺度および既存尺度の質尺度と量尺度の間で仮説をやや上回る相関がみられていた．PSQIの総合点と3DSSの各尺度得点との相関についてもすべて仮説が採択された．考察：本研究において，我々の開発した3次元型睡眠尺度（3DSS）の日勤者版について，日勤労働者を対象として使用するにあたり，必要と考えられる信頼性・妥当性が示された．今後さらに対象者数を増やし調査を重ねることで尺度の標準化およびカットオフ値の設定を行っていきたい．