Work-related stress and psychosomatic medicine

Stress is a term used to define the body's physiological and/or psychological reaction to circumstances that require behavioral adjustment. According to the Japanese National Survey of Health in 2004 [1], 49% of individuals aged 12 years or older reported experiencing stress in their daily lives. This survey examined stress in 28 domains, including work, family, and neighborhood relationships, as well as living-, social-, financial-, and health-related situations. Work-related problems were the most frequent stressors, followed by health-related and then financial problems.The Japanese Society of Psychosomatic Medicine defines "psychosomatic illness" as any physical condition with organic or functional damage affected by psychosocial factors in the process of its onset or development [2]. This definition largely corresponds to that given in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), published by the American Psychiatric Association [3]: "psychosocial factors affecting general medical conditions (code 316.00)." In the previous edition of the DSM (DSM-III) and its revision (DSM-III-R) [4], the psychosocial stressor content was defined according to severity, as shown in Table 1. In our previous study, which used axis IV of the DSM-III-R in a psychosomatic outpatient clinic (n = 868) [5], the majority of patients had mild psychosocial stressors (58%), followed by moderate (21%), none (10%), and severe stressors (5%). In the DSM-IV, axis IV has changed from rating the severity of psychosocial stressors to a simple categorization of psychosocial stressors, as shown in Table 2. Evaluating patients according to this new axis IV (n = 564) showed that the most frequent psychosocial stressors were occupational problems (23%), followed by issues related to the primary support group (21%), social environment (5%), and education (5%) [5].Although psychosomatic patients frequently identify work-r