A 2-year cohort study on the impact of an Employee Assistance Programme (EAP) on depression and suicidal thoughts in male Japanese workers



Depression and suicide-related behaviours are important issues for workers, and the number of Japanese companies contracting with the Employee Assistance Programme (EAP) to promote employees’ mental health has recently increased. However, no longitudinal studies have reported that the EAP maintains or improves the overall level of depression among employees qualitatively. Thus, we attempted to assess the impact of the EAP on depression and suicide-related behaviours in the workplace.


A cohort study was conducted on 283 male Japanese employees aged 22–38 years at a Japanese information-technology company introducing the EAP. Because the privacy policy of the EAP service made it difficult to perform a randomised design in the workplace, 22 men working at an affiliated company without the EAP were used as a reference group. All the subjects completed the 17-item Hamilton Depression Scale (HAM-D) and Job Content Questionnaire (JCQ) consisting of job demands, control, and social support before the EAP was introduced to establish a baseline and after 2 years.


In the EAP group, the total HAM-D scores significantly decreased after the 2-year study period (P = 0.0011); the changes in the scores of the five HAM-D items (i.e., suicidal thoughts, agitation, psychomotor retardation, guilt, and depressed mood) were significant. Specifically, 19 (86%) of the 22 workers with a positive response to the suicidal thoughts item (i.e., score ≥ 1) at baseline reported that they no longer had suicidal thoughts (i.e., score = 0) after the 2 year study period. No significant changes were observed in the reference group. The three JCQ scores were not significantly different between the baseline and after the 2 year study period in both groups.


Although further studies are needed, EAPs may be a promising strategy for maintaining the good mental health of workers.

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  1. Bertolote JM (1999) Foreword. In: World Health Organization (ed), Figures and facts about suicide. World Health Organization, Geneva, pp 3–10

  2. Colantonio A (1989) Assessing the effects of employee assistance programs: a review of employee assistance program evaluations. Yale J Biol Med 62:13–22

    PubMed  CAS  Google Scholar 

  3. Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62

    PubMed  CAS  Article  Google Scholar 

  4. Japanese Ministry of Health, Labour, and Welfare (2001) Guideline for promoting mental health care in enterprise. Japanese Industrial Safety and Health Association, Tokyo (in Japanese)

  5. Japanese Ministry of Health, Labour, and Welfare (2002) A proposal for suicide prevention. Online at http://www.mhlw.go.jp/houdou/2002/12/h1218-3.html (in Japanese)

  6. Karita K, Nakao M, Nishikitani M, Iwata T, Murata K, Yano E (2006a) Effect of overtime work and insufficient sleep on postural sway in information-technology workers. J Occup Health 48:65–68

    PubMed  Article  Google Scholar 

  7. Karita K, Nakao M, Nishikitani M, Nomura K, Yano E (2006b) Autonomic nervous activity changes in relation to the reporting of subjective symptoms among male workers in an information-service company. Int Arch Occup Environ Health 79:441–444

    PubMed  Article  Google Scholar 

  8. Kawakami N, Fujigaki Y (1996) Reliability and validity of the Japanese version of Job Content Questionnaire: replication and extension in computer company employees. Ind Health 34:295–306

    PubMed  CAS  Google Scholar 

  9. Moore T (1989) Employee assistance program evaluation. Employee perceptions, awareness, and utilization. AAOHN J 37:508–512

    PubMed  CAS  Google Scholar 

  10. Murray J, Banerjee S, Byng R, Tylee A, Bhugra D, Macdonald A (2006) Primary care professionals’ perceptions of depression in older people: a qualitative study. Soc Sci Med 63:1363–1373

    PubMed  Google Scholar 

  11. Nakao M, Takeuchi T (2006) The suicide epidemic in Japan and strategies of depression screening for its prevention. Bull World Health Organ 84:492–493

    PubMed  Article  Google Scholar 

  12. Nakao M, Nomura K, Karita K, Nishikitani M, Yano E (2004) Relationship between brachial-ankle pulse wave velocity and heart rate variability in young Japanese men. Hypertens Res 27:925–931

    PubMed  Article  Google Scholar 

  13. Nakao M, Nishikitani M, Nomura K, Karita K, Yano E (2006a) Gastric electrical activity and cardiovascular risk factors in relation to autonomic nervous function, hormonal responses and health-related lifestyles in young men. J Gastroenterol 41:855–861

    PubMed  Article  CAS  Google Scholar 

  14. Nakao M, Takeuchi T, Nomura K, Teramoto T, Yano E (2006b) Clinical application of paroxetine for tapering benzodiazepine use in non-major-depressive outpatients visiting an internal medicine clinic. Psychiat Clin Neurosci 60:605–610

    Article  CAS  Google Scholar 

  15. Nishikitani M, Nakao M, Karita K, Nomura K, Yano E (2005) Influence of overtime work, sleep duration, and perceived job characteristics on the physical and mental status of software engineers. Ind Health 43:623–629

    PubMed  Article  Google Scholar 

  16. Nomura K, Nakao M, Karita K, Nishikitani M, Yano E (2005) Association between work-related psychological stress and arterial stiffness measured by brachial-ankle pulse wave velocity in young Japanese males in an information-service company. Scand J Work Environ Health 31:352–359

    PubMed  Google Scholar 

  17. Ramanathan CS (1992) EAP’s response to personal stress and productivity: implications for occupational social work. Soc Work 37:234–239

    PubMed  CAS  Google Scholar 

  18. SAS Institute Inc. (1999) SAS Institute SAS/STAT User’s Guide, Release 8.01 Edition. SAS Institute Inc, Cary, NC, USA

    Google Scholar 

  19. Shima S, Tanaka K, Ohba S (2002) Employee assistance program (in Japanese). Jpn J Occup Health (San Ei Shi) 44:50–55

    Google Scholar 

  20. Stewart SM, Felice E, Claassen C, Kennard BD, Lee PW, Emslie GJ (2006) Adolescent suicide attempters in Hong Kong and the United States. Soc Sci Med 63:296–306

    PubMed  Article  Google Scholar 

  21. Takaki J, Nakao M, Karita K, Nishikitani M, Yano E (2006) Relationships among effort-reward imbalance, overcommitment, and fatigue in Japanese information-technology workers. J Occup Health 48:62–64

    PubMed  Article  Google Scholar 

  22. Tatara K (2001) Guideline of “Health in Japan toward the 21st century (Kenko-Nippon-21)”. Gyousei, Tokyo (in Japanese)

    Google Scholar 

  23. Taylor R, Page A, Morrell S, Harrison J, Carter G (2005) Mental health and socio-economic variations in Australian suicide. Soc Sci Med 61:1551–1559

    PubMed  Article  Google Scholar 

  24. Tousignant M, Brosseau R, Tremblay L (1987) Sex biases in mental health scales: do women tend to report less serious symptoms and confide more than men? Psychol Med 17:203–215

    PubMed  CAS  Article  Google Scholar 

  25. Verbrugge LM (1985) Gender and health: an update on hypotheses and evidence. J Health Soc Behav 26:157–177

    Article  Google Scholar 

  26. Walsh DC, Hingson RW (1985) Where to refer employees for treatment of drinking problems. J Occup Med 27:745–752

    PubMed  CAS  Google Scholar 

  27. White RK, McDuff DR, Schwartz RP, Tiegel SA, Judge CP (1996) New developments in employee assistance programs. Psychiat Serv 47:387–391

    CAS  Google Scholar 

  28. World Health Organization (2006) Prevention of suicidal behaviour. Online at http://www.who.int/mental_health/prevention/suicide/supresuicideprevent/en/

  29. Zarkin GA, Bray JW, Qi J (2000) The effect of employee assistance programs use on healthcare utilization. Health Serv Res 35:77–100

    PubMed  CAS  Google Scholar 

  30. Zhang J, Yu KF (1998) What’s the relative risk? A method of corrected the odds ratio in cohort studies of common outcomes. JAMA 280:1690–1691

    PubMed  Article  CAS  Google Scholar 

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This research was supported in part by the Occupational Health Promotion Foundation (2005) and by Health and Labour Sciences Research Grants (2003–2005) from the Ministry of Health, Labour and Welfare, Japan.

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Correspondence to Mutsuhiro Nakao.

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Nakao, M., Nishikitani, M., Shima, S. et al. A 2-year cohort study on the impact of an Employee Assistance Programme (EAP) on depression and suicidal thoughts in male Japanese workers. Int Arch Occup Environ Health 81, 151–157 (2007). https://doi.org/10.1007/s00420-007-0196-x

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  • Depression
  • Employee Assistance Programme
  • Job demands
  • Suicide
  • Worker’s health examination