The Medicalisation of Social Problems Relating to an Increase in Absent Workers with Depression in Japan

The number of people who are absent from work with a diagnosis of depression is on the rise, and this has become a social problem due to economic losses incurred by companies and society. The aim of this study was to address our research question of whether social factors, separate from medical factors such as the increasing number of illnesses, are influencing the medicalisation of individual and social problems. These social factors include the psychological state of workers who wish to be absent when experiencing stress in strict working environments, responses from patients’ doctors and industrial physicians, corporate in-house systems and state policies relating to mental health, and pressure to use prescription medication. The roles of markets (e.g. companies）and the state (e.g. health policy) were investigated based on semi-structured interviews with 50 male and female workers who had been absent from work due to depression, re-diagnosis of cases by six psychiatrists for case development, international comparisons, and media analyses.

The results revealed the following aspects: (1) patients wish to receive a diagnosis of depression in order to avoid stressful workplaces; (2) patients consult doctors on the belief that they have depression after seeing disease awareness campaigns, advertised as part of sales strategies, by pharmaceutical companies; (3) doctors diagnose depression in order to prescribe medication even though the patient’s symptoms do not correspond to diagnostic criteria, such as those in DSM-5; (4) industrial physicians place too much importance on the diagnoses and treatment policies of patients’ doctors; (5) ironically, companies which have established in-house systems and comply with state policies have higher numbers of absent workers who have been diagnosed with depression.