[Access to, and exit from, medical treatment for depression: issues related to diagnosis and rehabilitation]

The number of persons in Japan visiting a medical institution for depression in 2009 exceeded one million, a fact that is attracting particular attention in the context of the more than 30000 completed suicides that take place in Japan every year. There has never been a time when it was more urgent to address issues related to healthcare for depression. While it is true that the consultation rate for mood disorders has been increasing annually, it is not known whether this reflects an actual increase in the incidence of mood disorders, or whether it is simply due to an increase in the number of people seeking treatment. An epidemiologic survey of this shift has not been conducted, and therefore accurate figures are not available, but a 2002 epidemiologic survey indicated that 74% of people experiencing a major depressive episode did not consult a physician. In order to promote "entry to treatment" for depression-i.e., early diagnosis and early treatment-it is necessary to enhance access to healthcare for those who have not consulted a physician. At the same time, if the number of people seeking to consult a physician for depression increases from where it currently stands, psychiatrists alone will not be able to handle the load. Cooperation with primary care physicians and treatment by psychologists will become inevitable. This article discusses what information psychiatrists should provide when seeking the cooperation of primary care physicians, and also looks at recent research trends related to objective indicators, with a focus on NIRS, which are expected to be great aids to diagnosis. Concerning "exit from depression," or the reintegration of patients into society, major corporations have traditionally been encouraged to establish schemes that are primarily supportive in nature, but over the past 10 years the Ministry of Health, Labour and Welfare has also been promoting other measures. One product of these efforts is the "2004 Manual on Workplace Reentry Support for Workers Returning from Leave Due to Mental Health Issues," which was issued in 2004. This manual was revised and improved in 2009, and highlights the significant issue of employees who have taken long leaves of absence, or who have left their jobs due to depression, not being accommodated upon their return to work. This paper therefore also introduces a number of recent systems that support workplace reentry.