Karoshi: Death from Overwork

in Mood and Affect, Hurrell, Jr., Joseph J.,Levi, Lennart,Murphy, Lawrence R.,Sauter, Steven L., Editor, Encyclopedia of Occupational Health and Safety, Jeanne Mager Stellman, Editor-in-Chief. International Labor Organization, Geneva. © 2011.

What Is Karoshi?

Karoshi is a Japanese word which means death from overwork. The phenomenon was first identified in Japan, and the word is being adopted internationally (Drinkwater 1992). Uehata (1978) reported 17 karoshi cases at the 51st annual meeting of the Japan Association of Industrial Health. Among them seven cases were compensated as occupational diseases, but ten cases were not. In 1988 a group of lawyers established the National Defense Counsel for Victims of Karoshi (1990) and started telephone consultation to handle inquiries about karoshi-related workers’ compensation insurance. Uehata (1989) described karoshi as a sociomedical term that refers to fatalities or associated work disability due to cardiovascular attacks (such as strokes, myocardial infarction or acute cardiac failure) which could occur when hypertensive arteriosclerotic diseases are aggravated by a heavy workload. Karoshi is not a pure medical term. The media have frequently used the word because it emphasizes that sudden deaths (or disabilities) were caused by overwork and should be compensated. Karoshi has become an important social problem in Japan.

Research on Karoshi

Uehata (1991a) conducted a study of 203 Japanese workers (196 males and seven females) who had cardiovascular attacks. They or their next of kin consulted with him regarding workers’ compensation claims between 1974 and 1990. A total of 174 workers had died; 55 cases had already been compensated as occupational disease. A total of 123 workers had suffered strokes (57 arachnoidal bleedings, 46 cerebral bleedings, 13 cerebral infarctions, seven unknown types); 50, acute heart failure; 27, myocardial infarctions; and four, aortic ruptures. Autopsies were performed in only 16 cases. More than half of the workers had histories of hypertension, diabetes or other atherosclerotic problems. A total of 131 cases had worked for long hours—more than 60 hours per week, more than 50 hours overtime per month or more than half of their fixed holidays. Eighty-eight workers had identifiable trigger events within 24 hours before their attack. Uehata concluded that these were mostly male workers, working for long hours, with other stressful overload, and that these working styles exacerbated their other lifestyle habits and resulted in the attacks, which were finally triggered by minor work-related troubles or events.

Karasek Model and Karoshi

According to the demand-control model by Karasek (1979), a high-strain job—one with a combination of high demand and low control (decision latitude)—increases the risk of psychological strain and physical illness; an active job—one with a combination of high demand and high control—requires learning motivation to develop new behaviour patterns. Uehata (1991b) reported that the jobs in karoshi cases were characterized by a higher degree of work demands and lower social support, whereas the degree of work control varied greatly. He described the karoshi cases as very delighted and enthusiastic about their work, and consequently likely to ignore their needs for regular rest and so on—even the need for health care. It is suggested that workers in not only high-strain jobs but also active jobs could be at high risk. Managers and engineers have high decision latitude. If they have extremely high demands and are enthusiastic in their work, they may not control their working hours. Such workers may be a risk group for karoshi.

Type A Behaviour Pattern in Japan

Friedman and Rosenman (1959) proposed the concept of Type A behaviour pattern (TABP). Many studies have showed that TABP is related to the prevalence or incidence of coronary heart disease (CHD).

Hayano et al. (1989) investigated the characteristics of TABP in Japanese employees using the Jenkins Activity Survey (JAS). Responses of 1,682 male employees of a telephone company were analysed. The factor structure of the JAS among the Japanese was in most respects equal to that found in the Western Collaborative Group Study (WCGS). However, the average score of factor H (hard-driving and competitiveness) among the Japanese was considerably lower than that in the WCGS.

Monou (1992) reviewed TABP research in Japan and summarized as follows: TABP is less prevalent in Japan than in the United States; the relationship between TABP and coronary heart disease in Japan seems to be significant but weaker than that in the US; TABP among Japanese places more emphasis on “workaholism” and “directivity into the group” than in the US; the percentage of highly hostile individuals in Japan is lower than in the US; there is no relationship between hostility and CHD.

Japanese culture is quite different from those of Western countries. It is strongly influenced by Buddhism and Confucianism. Generally speaking, Japanese workers are organization centred. Cooperation with colleagues is emphasized rather than competition. In Japan, competitiveness is a less important factor for coronary-prone behaviour than job involvement or a tendency to overwork. Direct expression of hostility is suppressed in Japanese society. Hostility may be expressed differently than in Western countries.

Working Hours of Japanese Workers

It is well known that Japanese workers work long hours compared with workers in other developed industrial countries. Normal annual working hours of manufacturing workers in 1993 were 2,017 hours in Japan; 1,904 in the United States; 1,763 in France; and 1,769 in the UK (ILO 1995). However, Japanese working hours are gradually decreasing. Average annual working hours of manufacturing employees in enterprises with 30 employees or more was 2,484 hours in 1960, but 1,957 hours in 1994. Article 32 of the Labor Standards Law, which was revised in 1987, provides for a 40-hour week. The general introduction of the 40-hour week is expected to take place gradually in the 1990s. In 1985, the 5-day work week was granted to 27% of all employees in enterprises with 30 employees or more; in 1993, it was granted to 53% of such employees. The average worker was allowed 16 paid holidays in 1993; however, workers actually used an average of 9 days. In Japan, paid holidays are few, and workers tend to save them to cover absence due to sickness.

Why do Japanese workers work such long hours? Deutschmann (1991) pointed out three structural conditions underlying the present pattern of long working hours in Japan: first, the continuing need of Japanese employees to increase their income; second, the enterprise-centred structure of industrial relations; and third, the holistic style of Japanese personnel management. These conditions were based on historical and cultural factors. Japan was defeated in war in 1945 for the first time in history. After the war Japan was a cheap wage country. The Japanese were used to working long and hard to earn their subsistence. As labour unions were cooperative with employers, there have been relatively few labour disputes in Japan. Japanese companies adopted the seniority-oriented wage system and lifetime employment. The number of hours is a measure of the loyalty and cooperativeness of an employee, and becomes a criterion for promotion. Workers are not forced to work long hours; they are willing to work for their companies, as if the company is their family. Working life has priority over family life. Such long working hours have contributed to the remarkable economic achievements of Japan.

National Survey of Workers’ Health

The Japanese Ministry of Labour conducted surveys on the state of employees’ health in 1982, 1987 and 1992. In the survey in 1992, 12,000 private worksites employing 10 or more workers were identified, and 16,000 individual workers from them were randomly selected nationwide based on industry and job classification to fill out questionnaires. The questionnaires were mailed to a representative at the workplace who then selected workers to complete the survey.

Sixty-five per cent of these workers complained of physical fatigue due to their usual work, and 48% complained of mental fatigue. Fifty-seven per cent of workers stated that they had strong anxieties, worries or stress concerning their job or working life. The prevalence of stressed workers was increasing, as the prevalence had been 55% in 1987 and 51% in 1982. The main causes of stress were: unsatisfactory relations in the workplace, 48%; quality of work, 41%; quantity of work, 34%.

Eighty-six per cent of these worksites conducted periodic health examinations. Worksite health promotion activities were conducted at 44% of the worksites. Of these worksites, 48% had sports events, 46% had exercise programmes and 35% had health counselling.

National Policy to Protect and PromoteWorkers’ Health

The purpose of the Industrial Safety and Health Law in Japan is to secure the safety and health of workers in workplaces as well as to facilitate the establishment of a comfortable working environment. The law states that the employer shall not only comply with the minimum standards for preventing occupational accidents and diseases, but also endeavour to ensure the safety and health of workers in workplaces through the realization of a comfortable working environment and the improvement of working conditions.

Article 69 of the law, amended in 1988, states that the employer shall make continuous and systematic efforts for the maintenance and promotion of workers’ health by taking appropriate measures, such as providing health education and health counselling services to the workers. The Japanese Ministry of Labour publicly announced guidelines for measures to be taken by employers for the maintenance and promotion of workers’ health in 1988. It recommends worksite health promotion programmes called the Total Health Promotion Plan (THP): exercise (training and counselling), health education, psychological counselling and nutritional counselling, based on the health status of employees.

In 1992, the guidelines for the realization of a comfortable working environment were announced by the Ministry of Labour in Japan. The guidelines recommend the following: the working environment should be properly maintained under comfortable conditions; work conditions should be improved to reduce the workload; and facilities should be provided for the welfare of employees who need to recover from fatigue. Low-interest loans and grants for small and medium-sized enterprises for workplace improvement measures have been introduced to facilitate the realization of a comfortable working environment.

Conclusion

The evidence that overwork causes sudden death is still incomplete. More studies are needed to clarify the causal relationship. To prevent karoshi, working hours should be reduced. Japanese national occupational health policy has focused on work hazards and health care of workers with problems. The psychological work environment should be improved as a step towards the goal of a comfortable working environment. Health examinations and health promotion programmes for all workers should be encouraged. These activities will prevent karoshi and reduce stress.

 

Back

Mental Health Additional Resources

Click the Button below to view additional resources for this topic.

button

Mental Health References

American Psychiatric Association (APA). 1980. Diagnostic and Statistical Manual of Mental Disorders (DSM III). 3rd edition. Washington, DC: APA Press.

—. 1994. Diagnostic and Statistical Manual of Mental Disorders (DSM IV). 4th edition. Washington, DC: APA Press.

Ballenger, J. 1993. The co-morbidity and etiology of anxiety and depression. Update on Depression. Smith-Kline Beecham Workshop. Marina del Rey, Calif., 4 April.

Barchas, JD, JM Stolk, RD Ciaranello, and DA Hamberg. 1971. Neuroregulatory agents and psychological assessment. In Advances in Psychological Assessment, edited by P McReynolds. Palo Alto, Calif.: Science and Behavior Books.

Beaton, R, S Murphy, K Pike, and M Jarrett. 1995. Stress-symptom factors in firefighters and paramedics. In Organizational Risk Factors for Job Stress, edited by S Sauter and L Murphy. Washington, DC: APA Press.

Beiser, M, G Bean, D Erickson, K Zhan, WG Iscono, and NA Rector. 1994. Biological and psychosocial predictors of job performance following a first episode of psychosis. Am J Psychiatr 151(6):857-863.

Bentall, RP. 1990. The illusion or reality: A review and integration of psychological research on hallucinations. Psychol Bull 107(1):82-95.

Braverman, M. 1992a. Post-trauma crisis intervention in the workplace. In Stress and Well-Being at Work: Assessments and Interventions for Occupational Mental Health, edited by JC Quick, LR Murphy, and JJ Hurrell. Washington, DC: APA Press.

—. 1992b. A model of intervention for reducing stress related to trauma in the workplace. Cond Work Dig 11(2).

—. 1993a. Preventing stress-related losses: Managing the psychological consequences of worker injury. Compens Benefits Manage 9(2) (Spring).

—. 1993b. Coping with trauma in the workplace. Compens Benefits Manage 9(2) (Spring).

Brodsky, CM. 1984. Long-term workstress. Psychomatics 25 (5):361-368.

Buono, A and J Bowditch. 1989. The Human Side of Mergers and Acquisitions. San Francisco: Jossey-Bass.

Charney, EA and MW Weissman. 1988. Epidemiology of depressive and manic syndromes. In Depression and Mania, edited by A Georgotas and R Cancro. New York: Elsevier.

Comer, NL, L Madow, and JJ Dixon. 1967. Observation of sensory deprivation in a life-threatening situation. Am J Psychiatr 124:164-169.

Cooper, C and R Payne. 1992. International perspectives on research into work, well-being and stress management. In Stress and Well-Being at Work, edited by J Quick, L Murphy, and J Hurrell. Washington, DC: APA Press.

Dartigues, JF, M Gagnon, L Letenneur, P Barberger-Gateau, D Commenges, M Evaldre, and R Salamon. 1991. Principal lifetime occupation and cognitive impairment in a French elderly cohort (Paquid). Am J Epidemiol 135:981-988.

Deutschmann, C. 1991. The worker-bee syndrome in Japan: An analysis of working-time practices. In Working Time in Transition: The Political Economy of Working Hours in Industrial Nations, edited by K Hinrichs, W Roche, and C Sirianni. Philadephia: Temple Univ. Press.

DeWolf, CJ. 1986. Methodological problems in stress studies. In The Psychology of Work and Organizations, edited by G Debus and HW Schroiff. North Holland: Elsevier Science.

Drinkwater,  J. 1992. Death from overwork. Lancet 340: 598.

Eaton, WW, JC Anthony, W Mandel, and R Garrison. 1990. Occupations and the prevalence of major depressive disorder. J Occup Med 32(111):1079-1087.

Entin, AD. 1994. The work place as family, the family as work place. Unpublished paper presented at the American Psychological Association, Los Angeles, California.

Eysenck, HJ. 1982. The definition and measurement of psychoticism. Personality Indiv Diff 13(7):757-785.

Farmer, ME, SJ Kittner, DS Rae, JJ Bartko, and DA Regier. 1995. Education and change in cognitive function. The epidemiological catchment area study. Ann Epidemiol 5:1-7.

Freudenberger, HJ. 1975. The staff burn-out syndrome in alternative institutions. Psycother Theory, Res Pract 12:1.

—. 1984a. Burnout and job dissatisfaction: Impact on the family. In Perspectives on Work and Family, edited by JC Hammer and SH Cramer. Rockville, Md: Aspen.

—. 1984b. Substance abuse in the work place. Cont Drug Prob 11(2):245.

Freudenberger, HJ and G North. 1986. Women’s Burnout: How to Spot It, How to Reverse It and How to Prevent It. New York: Penguin Books.

Freudenberger, HJ and G Richelson. 1981. Burnout: How to Beat the High Cost of Success. New York: Bantam Books.

Friedman, M and RH Rosenman. 1959. Association of specific overt behavior pattern with blood and cardiovascular findings. J Am Med Assoc 169:1286-1296.

Greenberg, PE, LE Stiglin, SN Finkelstein, and ER Berndt. 1993a. The economic burden of depression in 1990. J Clin Psychiatry 54(11):405-418.

—. 1993b. Depression: A neglected major illness. J Clin Psychiatry 54(11):419-424.

Gründemann, RWM, ID Nijboer, and AJM Schellart. 1991. The Work-Relatedness of Drop-Out from Work for Medical Reasons. Den Haag: Ministry of Social Affairs and Employment.

Hayano, J, S Takeuchi, S Yoshida, S Jozuka, N Mishima, and T Fujinami. 1989. Type A behavior pattern in Japanese employees: Cross-cultural comparison of major factors in Jenkins Activity Survey (JAS) responses. J Behav Med 12(3):219-231.

Himmerstein, JS and GS Pransky. 1988. Occupational Medicine: Worker Fitness and Risk Evaluations. Vol. 3. Philadelphia: Hanley & Belfus.

Hines, LL, TW Durham, and GR Geoghegan. 1991. Work and self-concept: The development of a scale. J Soc Behav Personal 6:815-832.

Hobfoll, WE. 1988. The Ecology of Stress. New York: Hemisphere.

Holland, JL. 1973. Making Vocational Choices: A Theory of Careers. Englewood Cliffs, NJ: Prentice Hall.

Houtman, ILD and MAJ Kompier. 1995. Risk factors and occupational risk groups for work stress in the Netherlands. In Organizational Risk Factors for Job Stress, edited by SL Sauter and LR Murphy. Washington, DC: APA Press.

Houtman, I, A Goudswaard, S Dhondt, M van der Grinten, V Hildebrandt, and M Kompier. 1995.
Evaluation of the Monitor on Stress and Physical Load. The Hague: VUGA.

Human Capital Initiative (HCI). 1992. Changing nature of work. APS Observer Special Issue.

International Labour Organization (ILO). 1995. World Labour Report. No. 8. Geneva: ILO.

Jeffreys, J. 1995. Coping With Workplace Change: Dealing With Loss and Grief. Menlo Park, Calif.: Crisp.

Jorgensen, P. 1987. Social course and outcome of delusional psychosis. Acta Psychiatr Scand 75:629-634.

Kahn, JP. 1993. Mental Health in the Workplace -A Practical Psychiatric Guide. New York: Van Nostrand Reinhold.

Kaplan, HI and BJ Sadock. 1994. Synopsis of Psychiatry—Behavioral Sciences Clinical Psychiatry. Baltimore: Williams & Wilkins.

Kaplan, HI and BJ Sadock. 1995. Comprehensive Textbook of Psychiatry. Baltimore: Williams & Wilkins.

Karasek, R. 1979. Job demands, job decision latitude, and mental strain: Implications for job redesign. Adm Sci Q 24:285-307.

Karasek, R and T Theorell. 1990. Healthy Work. London: Basic Works.
Katon, W, A Kleinman, and G Rosen. 1982. Depression and somatization: A review. Am J Med 72:241-247.

Kobasa, S, S Maddi, and S Kahn. 1982. Hardiness and health: A prospective study. J Personal Soc Psychol 45:839-850.

Kompier, M, E de Gier, P Smulders, and D Draaisma. 1994. Regulations, policies and practices concerning work stress in five European countries. Work Stress 8(4):296-318.

Krumboltz, JD. 1971. Job Experience Kits. Chicago: Science Research Associates.

Kuhnert, K and R Vance. 1992. Job insecurity and moderators of the relation between job insecurity and employee adjustment. In Stress and Well-Being at Work, edited by J Quick, L Murphy, and J Hurrell Jr. Washington, DC: APA Press.

Labig, CE. 1995. Preventing Violence in the Workplace. New York: AMACON.

Lazarus, RS. 1991. Psychological stress in the workplace. J Soc Behav Personal 6(7):114.

Lemen, R. 1995. Welcome and opening remarks. Presented at Work, Stress and Health ’95: Creating Healthier Workplaces Conference, 15 September 1995, Washington, DC.

Levi, L, M Frandenhaeuser, and B Gardell. 1986. The characteristics of the workplace and the nature of its social demands. In Occupational Stress: Health and Performance at Work, edited by SG Wolf and AJ Finestone. Littleton, Mass: PSG.

Link, BP, PB Dohrenwend, and AE Skodol. 1986. Socio-economic status and schizophrenia: Noisome occupational characteristics as a risk factor. Am Soc Rev 51 (April):242-258.

Link, BG and A Stueve. 1994. Psychotic symptoms and the violent/illegal behaviour of mental patients compared to community controls. In Violence and Mental Disorders: Development in Risk Assessment, edited by J Mohnhan and HJ Steadman. Chicago, Illinois: Univ. of Chicago.

Lowman, RL. 1993. Counseling and Psychotherapy of Work Dysfunctions. Washington, DC: APA Press.

MacLean, AA. 1986. High Tech Survival Kit: Managing Your Stress. New York: John Wiley & Sons.

Mandler, G. 1993. Thought, memory and learning: Effects of emotional stress. In Handbook of Stress: Theoretical and Clinical Aspects, edited by L Goldberger and S Breznitz. New York: Free Press.

Margolis, BK and WH Kroes. 1974. Occupational stress and strain. In Occupational Stress, edited by A McLean. Springfield, Ill: Charles C. Thomas.

Massel, HK, RP Liberman, J Mintz, HE Jacobs, RV Rush, CA Giannini, and R Zarate. 1990. Evaluating the capacity to work of the mentally ill. Psychiatry 53:31-43.

McGrath, JE. 1976. Stress and behavior in organizations. In Handbook of Industrial and Organizational Psychology, edited by MD Dunnette. Chicago: Rand McNally College.

McIntosh, N. 1995. Exhilarating work: An antidote for dangerous work. In Organizational Risk Factors for Job Stress, edited by S Sauter and L Murphy. Washington, DC: APA Press.

Mishima, N, S Nagata, T Haratani, N Nawakami, S Araki, J Hurrell, S Sauter, and N Swanson. 1995. Mental health and occupational stress of Japanese local government employees. Presented at Work, Stress, and Health ‘95: Creating Healthier Workplaces, 15 September 1995, Washington, DC.

Mitchell, J and G Bray. 1990. Emergency Service Stress. Englewood Cliffs, NJ: Prentice Hall.

Monou, H. 1992. Coronary-prone behavior pattern in Japan. In Behavioral Medicine: An Integrated Biobehavioral Approach to Health and Illness, edited by S Araki. Amsterdam: Elsevier Science.

Muntaner, C, A Tien, WW Eaton, and R Garrison. 1991. Occupational characteristics and the occurrence of psychotic disorders. Social Psych Psychiatric Epidemiol 26:273-280.

Muntaner, C, AE Pulver, J McGrath, and WW Eaton. 1993. Work environment and schizophrenia: An extension of the arousal hypothesis to occupational self-selection. Social Psych Psychiatric Epidemiol 28:231-238.

National Defense Council for Victims of Karoshi. 1990. Karoshi. Tokyo: Mado Sha.
Neff, WS. 1968. Work and Human Behavior. New York: Altherton.

Northwestern National Life. 1991. Employee Burnout: America’s Newest Epidemic. Survey Findings. Minneapolis, Minn: Northwestern National Life.

O’Leary, L. 1993. Mental health at work. Occup Health Rev 45:23-26.

Quick, JC, LR Murphy, JJ Hurrell, and D Orman. 1992. The value of work, the risk of distress and the power of prevention. In Stress and Well-Being: Assessment and Interventions for Occupational Mental Health, edited by JC Quick, LR Murphy, and JJ Hurrell. Washington, DC: APA Press.

Rabkin, JG. 1993. Stress and psychiatric disorders. In Handbook of Stress: Theoretical and Clinical Aspects, edited by L Goldberger and S Breznitz. New York: Free Press.

Robins, LN, JE Heltzer, J Croughan, JBW Williams, and RE Spitzer. 1981. NIMH Diagnostic Interviews Schedule: Version III. Final report on contract no.  278-79-00 17DB and Research Office grant no. 33583. Rockville, Md: Department of Health and Human Services.

Rosch, P and K Pelletier. 1987. Designing workplace stress management programs. In Stress Management in Work Settings, edited by L Murphy and T Schoenborn. Rockville, Md: US Department of Health and Human Services.

Ross, DS. 1989. Mental health at work. Occup Health Safety 19(3):12.

Sauter, SL, LR Murphy, and JJ Hurrell. 1992. Prevention of work-related psychological disorders: A national strategy proposed by the National Institute for Occupational Safety and Health (NIOSH). In Work and Well-Being: An Agenda for 1990’s, edited by SL Sauter and G Puryear Keita. Washington, DC: APA Press.

Shellenberger, S, SS Hoffman, and R Gerson. 1994. Psychologists and the changing family-work system. Unpublished paper presented at the American Psychological Association, Los Angeles, California.

Shima, S, H Hiro, M Arai, T Tsunoda, T Shimomitsu, O Fujita, L Kurabayashi, A Fujinawa, and M Kato. 1995. Stress coping style and mental health in the workplace. Presented at Work, Stress and Health ‘95: Creating Healthier Workplaces, 15 September, 1995, Washington, DC.

Smith, M, D Carayon, K Sanders, S Lim, and D LeGrande. 1992. Employee stress and health complaints in jobs with and without electronic performance monitoring. Appl Ergon 23:17-27.

Srivastava, AK. 1989. Moderating effect of n-self actualization on the relationship of role stress with job anxiety. Psychol Stud 34:106-109.

Sternbach, D. 1995. Musicians: A neglected working population in crisis. In Organizational Risk Factors for Job Stress, edited by S Sauter and L Murphy. Washington, DC: APA Press.

Stiles, D. 1994. Video display terminal operators. Technology’s biopsychosocial stressors. J Am Assoc Occup Health Nurses 42:541-547.

Sutherland, VJ and CL Cooper. 1988. Sources of work stress. In Occupational Stress: Issues and Development in Research, edited by JJ Hurrell Jr, LR Murphy, SL Sauter, and CL Cooper. New York: Taylor & Francis.

Uehata, T. 1978. A study on death from overwork. (I) Considerations about 17 cases. Sangyo Igaku (Jap J Ind Health) 20:479.

—. 1989. A study of Karoshi in the field of occupational medicine. Bull Soc Med 8:35-50.

—. 1991a. Long working hours and occupational stress-related cardiovascular attacks among middle-aged workers in Japan. J Hum Ergol 20(2):147-153.

—. 1991b. Karoshi due to occupational stress-related cardiovascular injuries among middle-aged workers in Japan. J Sci Labour 67(1):20-28.

Warr, P. 1978. Work and Well-Being. New York: Penguin.

—. 1994. A conceptual framework for the study of work and mental health. Work Stress 8(2):84-97.
Wells, EA. 1983. Hallucinations associated with pathological grief reaction. J Psychiat Treat Eval 5:259-261.

Wilke, HJ. 1977. The authority complex and the authoritarian personality. J Anal Psychol 22:243-249.

Yates, JE. 1989. Managing Stress. New York: AMACON.

Yodofsky, S, RE Hales, and T Fergusen. 1991. What You Need to Know about Psychiatric Drugs. New York: Grove Weidenfeld.

Zachary, G and B Ortega. 1993. Age of Angst—Workplace revolutions boost productivity at cost of job security. Wall Street J,  10 March.

Home >> Part I. The Body >> Mental Health >> Mood and Affect >> Karoshi: Death from Overwork