Japan Studies

Burn(out) Rate in Japan: The Japanese workforce is overworked, stressed, and tired out.

The social, psychological, and physical pressures accompanying a society in transition, the long period of recession, increased uncertainty regarding employment, and changes in eating habits away from the traditionally healthy Japanese diet are each factors that might be anticipated to increase the fatigue felt by the average Japanese. And fatigue makes one more easily susceptible to serious physical and mental illness, or in extreme cases can lead to karoshi (death from overwork).

Clearly, a nation of fatigued automatons is not in the country's best interest, and the Ministry of Health and Welfare (MHW) has begun funding a research program entitled "Fact Finding Surveys on Fatigue, and Research in Regard to Ways of Recovery From Fatigue in Order to Create More Healthful Life." The most recent report from this group was issued in March 2000. As the title implies, this is a wide-ranging program. Among the topics covered are clinical and laboratory research on chronic fatigue syndrome (CFS), and the relationship of factors such as stress, depression, immunological disorders on fatigue, PET imaging of the fatigue state in brains of CFS patients, and so on.

The above-mentioned research is highly specialized and beyond the scope of studies normally covered in this column. However, some of the fact-finding studies, in particular a study conducted under the leadership of Masumi Minowa (director of Epidemiology at the National Institute of Public Health) on the incidence of fatigue and associated risk factors, are of interest and relevance to readers.

This study was conducted in July/August 1999 in two cities and four towns under the jurisdiction of the Toyokawa Public Health Center in Aichi Prefecture (near Nagoya in central Japan). The total population in this area aged 15-65 years is 178,417, and an attack sample of a total of 4,000 randomly selected males and females in this age bracket was used for the study. A self-administered anonymous mail-back questionnaire was used. To further ensure anonymity as well as a higher response rate, when respondents mailed back their anonymous questionnaire they also mailed back separately a post-card with their name on it stating that they had filled in the questionnaire and mailed it off. This enabled researchers to determine which respondents had not yet responded, and non-responders were followed up twice. Using this approach a total of 3,015 usable questionnaires were obtained, a 75.4 percent completion rate. This is a very high response rate for a study of this nature, and therefore provides us with statistically valid and meaningful results.

Topics covered included whether or not respondents felt fatigue, the perceived cause of fatigue, the degree of severity, the length of time this condition had continued, various symptoms of fatigue, and patient history. Additionally, alcohol consumption, smoking, sleep problems, stress, food consumption habits, use of air conditioners, major life events such as a death in the family, pets, foreign travel, type of job, and so on were also investigated. In short, a comprehensive study. So let us now look at some of the results.

Fifty-nine percent of total respondents admitted to currently feeling fatigued. Females had the higher claimed level of fatigue (61 percent) compared to 57 percent for males. This level of almost 60 percent of the population feeling fatigued is at least double that of the figures (15-30 percent) in comparable studies in Europe and North America according to the summary commentary by Professor Teruo Kitani, the leader of the overall research program. For both males and females, the highest percentage of respondents claiming to currently feel fatigued was in the 25-34 and 35-44 years age groups. See Table 1.

For analytical purposes, the cause of fatigue was broken down into three broad categories -- fatigue caused by some form of illness (9 percent for the total sample), fatigue for which the cause was known but was not illness related (29 percent), and fatigue for which the cause was unknown (21 percent). For illness-related fatigue, the major causes were diabetes, high blood pressure, and liver ailments. For fatigue for which the cause was known but was not illness related, the major causes were too much work/overwork, long working hours/extensive overtime, stress, and insufficient sleep. For women, additional factors were child raising and working in a job that required standing up for long periods.

In regard to how long this condition had continued, 36 percent of the total sample stated that their fatigue had persisted for six months or more. In other words, more than one in three Japanese in the sample suffer from chronic fatigue, a staggering figure. Professor Kitani describes the incidence figure of 36 percent for chronic fatigue as being "extremely high" (kiwamete kohritsu). The incidence of chronic fatigue is split fairly evenly between males (37 percent) and females (35 percent). Further, almost half of those suffering from chronic fatigue -- or 17 percent of total respondents -- reported that it had disrupted their life in various ways, for example, having to reduce the amount of work they do or take days off from work/school.

What age groups are the most prone to chronic fatigue? The table below shows the incidence of chronic fatigue broken down by age and category type. As can be seen there, chronic fatigue caused by illness is highest among those aged 45 and over. For males in the 25-34 and 35-44 age groups, the major cause of chronic fatigue is fatigue that is not illness related but whose cause is known, e.g., overwork, stress, and insufficient sleep. For women, chronic fatigue seems to be spread more evenly across age groups.

The study also analyzed the incidence of chronic fatigue versus various lifestyle factors, and some clear indicators emerged. Table 3 below shows the incidence of certain lifestyle factors among those persons who do not have fatigue versus those with chronic fatigue. Sleep disorders, being very busy, and stress were factors that were highly correlated with the incidence of chronic fatigue. Diet, consumption of alcohol, smoking, not playing sports/not exercising, and frequent use of air-conditioning in summer were factors that appeared to have some correlation, but were less significant than the factors mentioned above. Having high-tension electrical wires nearby and having a pet appear to have no influence on the incidence of chronic fatigue.

Some of the major symptoms reported by chronic fatigue sufferers were headaches, muscle pain, pain in the joints, dimness of sight, dizziness on standing up, lack of sleep, too much sleep, reduction in ability to focus one's thoughts, and forgetfulness.

So what does it all mean? First, the study confirms in quite stark terms the very high incidence of fatigue in Japanese society. Second, the highest incidence of chronic and normal fatigue occurs among the younger male group, precisely that group which make up the majority of the Netpreneurs in Japan. Thus, while hard work and long hours are considered to be normal for workers in startups, it behooves the management of these companies to be mindful of the health of their employees. Success without the health to enjoy it is meaningless.

This level of fatigue, overwork, and stress in society also offers significant business opportunities for those with the right products and services. As well as traditional approaches to the treatment of fatigue and stress, aromatherapy, reflexology, alternative and holistic approaches to medicine are growing rapidly in Japan. A Web-based service targeted at fatigue sufferers would also appear to be a good bet.