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Kazuhiro SA
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ACHI，
Yasuto SATO and N aohito Y AMAGUCHID e p a r t m e n t Pfocilbu htlaeH lo， ohcS Mfoenicide ， Tokyo n'semoW lacideM ytisrevinU ( A c c e p t e d rebotcO 13)6， 102
Background: Mood sredrosid ylsuoires a旺tcecimonoce-oicos sutats and htlaeh ni J .napa The ecnelvaerp fo mood sredrosid Jninapa sah enbe gnisaercni rof esdcaed ， tbu eht sesuac rof siht esaercni era.raelcnu ds:ethoM An atrohoc-doirep-eg sisylana was medforper rof tneitaP yevruS atad ot eaminxe eht ecnelaverp mood fo -rosid d e r s roftneitaptuo stisiv from 5791 ot1102 ni J .napa :stluseR A model thiw eag ， doirep ， and trohoc stceffe was t h
etif-tseb elmdo rof men and women. The mhtiragol foecnelaverp showed a lraeni gnisaercni yncdeent rof mood sredrosid hitw .ega The trohoc tceffe showed taht more tnecer snoitareneg had a hrehgi ecnelaverp fo mood sredrosid naht redlo .snoitareneg On teh rehto hand ， eht doirep tceffe did ton show lsaegra ean 旺tce tsaeh c
o h o r
t e旺tce rof men women. ro :snoitatimiL segnahC niecenlaverp fo mood sredrosid thigm abe 旺detce by c h a n g e s bnilaroivahe srotcaf ， segnahc dnisisongai ， and sgeanch rniespale rroecnerruce .setar :snoisulcnCo Our a g e -p e r i o d -c o h o r
t sisylana rof mood sredrosid stneitap ni J anap showed taht more tnecer snoitareneg ehav a h
i g h e
r etar ofotneitaptu stisiv rofnoisserped naht redlo snoitareneg ， and members tfoeh same noitareneg epke
t h i
s yencndet hgouhrt rieht .efil The doirep e旺tce was elbigilgen compared htiw eht trohoc e妊ce.t
Key W o:sdr mood sredrosid stneit， aptuo ， trohoc ceffe ，t APC mode ，lyoglomiedipe
I n t r o d u c t i o n Mood srderoisd ylsuoires a妊tce icmonoce-ocios s t a t u s and htaleh .wedidlrow According ot eht W odlr Mental htlaeH J apan (WMHJ) Survey ni 2 0 0 2 -2 0 0 3 ， het 12-month eclneaverp mood fo -rosid d e r
s ni Japan was 3.l ，% among which 9.2 % was major niossprede .)l Furthermore ， eht ecalenevrp fostneitap under t r e a t m e n t rof a mood redrosid deseacrin from 27l. per 001 ，000 ni 5197 ot 8.11 per 100 ，000 ni 1201 -aP( t i e n t Survey ， ).1120-5971 tI was tedeporr tath among employees on lrmteng-o kcis eavel rof men-t
a
l serdrsoid ， many sa 8fo3.7 % cfo essa were due ot a mood erdrsoid 2
) .
A vtyeiar rfoksi srotcaf rof mood srerdosid have been rtedrepo ， gnidulcni leemaf gendee) ， young and
m i d d l
e age )1)3ef， il ntseve 4)， and ytiidbrcomo with -aid
b e t e s )5， icolbtame syndrome )6， tarhe esaesid )7， and c a n c e r 7 ) . iskR srotcaf rof erencecurr have osla been r e p o r t e d ， such sa ylrae pegapots a dro asecree ni a n t i -d e p r e s s a n t s 8 )-lO). tI sillits aiservotrnoc ，l how-ever ， whether eesth ksir srotcaf can nialpxe eht -ni c r e a s e ni het ncealeverp fo mood sredroisd ni J a p a n .
The change ni elcenaverp ， ni genera ，lsi caused by complex snoitcaretni changes fo age ni eurtcruts (
a g
e )tceffe ， changes happening tot he whole a-luopp t
i o
n tta eh same time doirep( )tceffe ， and changes ni e x p e r i e n c e s shared by the same htrib rthoco -oc( h o r
t e旺.)tce Some ksir srotcaf mentioned above -fa f e c t het ncealerevp mood fo sredorsid through eht p e r i o d ceffe ，t whereas sretho tceffa cealenprev through eht torhoc ceffe .tfI eth age ceffe ，t doripe e旺c te， and torohc e妊tce can be stedaraep ， we may
図 :otusaY otaS tnmertapeD Pfocilbu htlaeH lo， ohcS Mfoenicide ， oToky n'semoW lacideM ytisrevinU ， 1-8 oh-caadwKa ， S i n j u k u 同ku ，oykoT 666， 8-261 J napa E -m a i l : pj.ca.umwt.hcraeser@otasusay -234 ー
T a b l e 1 sledoM troh AoCf-dooireP-eg A n a l y s i s M o d e l A g e A g e -d r i f t )c8( A g e -C o h o r t A g e -P e r i o d -C o h o r t A g e -P e r i o d A g e -d r i f t )p8( Log λ[i( ，])j f )a( f ()+a c8 f ()+a h )c( f )a( + g ()p + h )c( f ()+a g ()p f ()+a p8 A g e eodm t，rohloC-egA edom -i，relP-egA o d eodmtrohoC-d，oilreP-egA ledom sah s i n g l e rolarulp es旺tce ，ega e旺c te，doirep a n d trohoc e宜cetf.irdt-egA )c8( ledom dna A g e -d r i f t )p8( ledom erlaacitnedi dna si t h eitcesretni o n foehdtoirep-ega dna eht a g e -c o h o r t deom .l be aelb ot niag sthgisni otni het essuac fo eht -ni c r e a s e dfoesaesi ceenalevrp ni
J
.napa laA scitsitat t e c h n i q u e dellac eht otrhCod-rioPe-egA (APC) a n a l y s i s sha been delopeevd ， ni which eht age -fe f e c ，t diorpe e旺e'tc，and trohoc e妊e't cc an be i-itned f i e d from etim ndret atad afocificeps-eg e.cnelaevrp The aim fosiht yduts was ot eyzalna het a-vrep le n c
e aatd mood fo sredrosid ni
J
apan ngsiu APC a n a l y s i s iotyfitned which age ， doierp ， and rtoohc -fe f e c t s yalp a major elor ni eht esarecni ni eht a-vrep l e n c e mood fo sredrosid niJ
.napa MethodsData used by teh sisylana were edtactrxe from t
h
e tneitaP Survey performed by tehscitsitatS and I n f o r m a t i o n Department ， sretsniiM airaterceS ，t M i n i s t r y Hfohltea Labour and erafleW tneitaP( -ruS vey .)1102， -5791 The tneitaP Survey was conducted a n n u a l l y eorfeb 8391 and yllainneirt ecnis .4891 nI t h e urveys ， eht number pfostneita ni a ra-tneesrpe t i v e sample mfo lcadie snoitutitsni edinwiotan ， -soh p i t a l s ， and alreeng 1cscini was tdenuoc on 3 c-uecson t i v e aysd eotetamtis eht number pfostneita under t r e a t m e n
t tni eh whole .yrtnuoc The number pfo -a t i e n t s sideatmtise by sex and raey-5 age 1cssa rof h o s p i t a l i z a t i o n and tneitaptuo stisiv .yletarapes t-uO p a t i e n t stisiv ni1cude both laitini and rntuer .stisiv The esaesid ygorteca we adyzenal was mood rosid 闘
d e r s ， ni1cngidu ralopib evitceffa redrosid ， dneifed by c o d e s between F 30 and F 39 ni eht lanoitanretnI C l a s s i f i c a t i o n Dfoseasesi 01 htnoitide )01-DCI( from 1 9 9 6 2ot 01 ，1 sedoc 0.692 四9.692 ，20.89 - 2.89 ，1 030，4. 3 0 0 .
9 ， ，301.1 and 113 Ini 9D-C from 2981 ot 9319 ， and c o d e s 0.692 - 269 息0.892 凶.892 ， 31 00，4. 030 ゑ and 3 0. 1 i1 ICD-8 n from 5791 ot 891 .c1ificeps-xeS -aevrp l e n c e was ton elbaliava rof eht rseay 0991 and .3991 Because an iesaercn ni ecnleaverp was observed o n l y rof tneitaptuo stisiv .e.i( ， ton rofdezilatipsoh -ap t i e n t s ) ni eht yranimilerp sisylana ， we fedusoc on o u t p a t i e n t stisiv rof rehtruf .sisylana
The tseatad rof eht APC sisylana was -noc s t r u c t e d sa a Lsxie diagram 3fo ・arye age 1csessa from 71-51 8ot38-1 rsyea and raey-3 slavretni tfo eh p e r i o d from 5791 2ot 10 .1 Because cificeps-ega atda were dedovirp by 5raey- eag 1cssa ， eht number fo p a t i e n t s ni each 与arye age 1cssa was edatimste by p o r t i o n i n g eht number fostneitap ni hace 5・arye a g e 1cssa by teh noiatlupop efo ach .ega tnI eh -irp mary approach ， eht lanigiro teastad otuhtiw atda from 0991 and 3991 was .dezylana The testaad ， -ni c 1 gdinu setamitse ni1cgnuid 9091 and 3991 ， was -ana l y z e d ni rdeor ot compare ti thiw lanigiro etsatad u s i n g eht gniwollof .hcaorppa Each etamitse bfo tho men and women ni 0991 and 3919 was deduced from eht same geavera stmneercni fo ega cific閏eps p r e v a l e n c
e fo ICD-9 from 8791 ot .7891 The APC a n a l y s i
s was based on teh drofloH model l11， and -rev
s i o
n 3.0R l.erwatfos (R Ftnoiadnuo roflacitsitatS Computing ， Vienna ， )airtsuA was used rof.sisylana The drfolHo model was nesohc sebecau eht model c o u l d yllufsseccus overcome ehtnoitacifitnedi -obrp l e m
. The APC model can be fdetalumro by teh -lof l
o w i n
g ontiaque ， where 入i(，)j，αiA ， jPs ， and ykC -ed n o t e eht ecnealverp afo eg 1cssa i and diorep j， age e妊e'tc，doriep e妊e'，ct and trohco ceffe ，t -cepser t i v e l y 1 2 ) . L o g [ λi( ]， )j =μ+αiA+ 戸jP+ykC ，=i，…l，j;I，1=…， 1， k = ( I -i ) + j
The tif-tseb model was detceles from id妊tnree models elabT( )1 based on the minimum laudiser -ed v i a n c e deifitnedi by measuring ethtif-fo-ssendoog
and eht N ayman sonPear erauqs-ihc set.tAge tfird i
s a parameter taht assumes taht a utin change by c o h o r t )co( by pro diore )po( sieht same over reffid 司 e n t age 1csessa 2 ).1
T a b l e 2 ecnaiveD dnaeulav-p rofsuoirav sledom dettif 75-201119 ， Men dna Women fstoneitaptuO fo t h e Mood a[]ev妊itce sredrosid gnidulcni( ralopib aev妊itce )redrosid ;93-03F[ ICD 開]01 R e s i d u a l seerged ffomodeer ecnaiveD ecnereffiD neewteb secnaiveD p Men stneitaptuO A g e A g e -d r i f t )co( A g e -C o h o r t A g e - doireP trohoC -A g e -P e r i o d A g e -d r i f t )po( Women stneitaptuO A g e A g e -d r i f t )co( A g e -C o h o r t A g e -P e r i o d -C o h o r t A g e -P e r i o d A g e -d r i f t )po( 2 4 9 2 4 8 2 4 6 244 2 4 6 2 4 8 2 4 9 2 4 8 2 4 6 2 4 4 2 4 6 2 4 8 p -v a l u e s eradesab tnoeh nymaNa nosraeP ihcerau幽qs set.t t h e nsumptioas taht ereth era othb age cific四eps -fe f e c t s and cificeps-xes stceffe ni.encelaverp Sex 圃 s p e c i f i c stceffe have shown catimrad id妊e'sceenr -eb tween men and woman ni yranmiilerp .hcraeser The eag cific圃eps e旺e't was c pectedex be more ot ro
l e s s ngrdicoca ot suoiarv srtoper 13)- 附 . nInoitidda ， w i t h ingga ， ksir srotcaf gnidlucni lanoitcnuf and -ro g a n i c changes tni eh niarb sno， itcailpmoc cfoicnorh d i s e a s e s ， and ssol sfolaico elor and cerovid ;esaercni t h u s ksir srotcaf rof nosiesrped may .teaulumcac For ralopib a旺e'evitc redrosid ， eht ecenalevrp fo f i r s t teson manic etats siaisrevortnoc ，l htiw seiduts showing tiot be more lrosse ni aged ssonper 41
) -1 6 ) . Furthermore t， neitaptuo stisiv a pot tsirtaihcys rof e i t h e r niosserped broralopi evitceffa redroisd endt t o rccuo ylevititeper ， due ot sespaler ro -rucer r e n c e s . For eseth nssoear ， ega tceffe was deilppa ot t h e APC sisylana tnisih .yduts R e s u l t s R e s u l t s fo eth APC sisylana era summarized ni T a b l e .2 The tif-tseb model gnizmiinim eht laudiser d e v i a n c
e was found be tot he APC model rof othb men and women. The edatimste ega ceffe ，t odierp e宜ec t， and torhoc e旺e't from c eht lanigiro tesatda a
r
e shown ni.giF ，1 where eht age tceffe si shown a s teh eecnalverp rpe 010 ，000 noitalpuop ， eht diorpe e f f e c t tsa he etar oitar evitaler tot he eualv rof 6991 ， and eht trhoco e旺tce tsa eh etar oitar evitaler tot eh 3 9 ，134 1 5 ，266 1 2 ，938 1 2，491 1 4，489 1 5 ，266 7 0 ，336 3 0 ，314 2 3 ，084 2 0 ，260 2 8 ，013 3 0 ，314 2 38.，868 26.，723 5 1 9 4. -23.，070 -7 7 6 . 8 40 ，052 7，230 2，824 -7，753 2，300 < 0 . 0 0 1 <0.001 <0.001 < 0 . 0 0 1 < 0 . 0 0 1 < 0 . 0 0 1 <0.001 <0.001 < 0 . 0 0 1 < 0 . 0 0 1 v a l u e rof eht torhco born 1ni.7481-548 The mhtrigaol pfo ecnelaver showed a lraeni -ni c r e a s i n g nyctedne ithw age ， thiw noitcilfni stniop around gea 40 in thob men and women. nI redlo a g e s retfa noitcilfni stniop ， eth ecenalevrp showed a s t e e p e
r esarecni among women ntha men. As t to eh c o h o r t tceffe ， younger strohoc showed a herghi p r e v a l e n c e anht redlo srtohoc ni othb men and women. shiT denetncy was more prominent ni women ntha men. The etar oitar showed dla 1of-9.3 i n c r e a s e from 5.0 rof eht 6981-4981 torhoc 6ot8. rof t h e 8991-6919 trhooc ni men. and a 5dlof-6 esaercni from 3.0 rof eht 6918-4981 trohoc ot 9.61 rof eht 1 9 9 6 -1 9 9 8 rtoohc ni women. On teh rehot d.nha eht p e r i o d e旺tce did tno change much sa tsa eh torhco e f f e
c .tOnly a sllam peak was deversbo 2ni;500 het r
a t
e oitar was .1 f12 ro women and .1 f51ro men. D i s c u s s i o n Our APC sisylana oundf a legra rtohco tceffe ni b o t
h men and women ni eht ecnleeavrp fo mood d i s o r d e r s ni
J
.napa ishT means taht more tencre g e n e r a t i o n s have a hrheig etar ofotneitaptu stisiv f o r mood sredrosid hant redlo sniotaernge ， and members fo eht same noitraeneg keep siht -net dency through rieht .sevil The odirep ceffe ，t on teh ot h e
r hand ， was elbigilgen compared hwti eht -oc h
o r
t e宜ce.t
The rtoohc e妊tce might urocc ausebec members
-236-一 -236-一 -236-一
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i->i->i->i->i->i->i->i->i->i->i->i->i->i->i->i->i->i-> ∞¥D¥D¥D¥D¥D¥D¥D¥D¥D¥D¥D¥D¥D¥D¥Dω ω 毘s sロ 巴 回 出 出 主 宮 思E E豆g虫 記 旨 (Birthyear)- M企nOutpatie nts.---Women Out pattie nts
0.1 0.1
Fig. 1 Age effect， birth cohort effec，tperiod effect of Age-Period-Cohort model from 1971
-2011， Men and Women of Outpatients of the Mood [affective]disorders (including bipolar
affective disorder)[F30-39;ICD-lQ]
Rate ratio of birth cohort effec，tperiod effect is calculated from based on 1845目1847birth
year， 1996 calendar year.
present insuch young members. The comorbidity ofdiabetes5l
， metabolicsyndrome6l， heart disease7l and canceel
， each of which was reportedto be asso
-ciatedwith mood disorderrisk， isnotlikelyto be thecause of thecohorteffect because t， he
comor-of the same birthcohort share a similarlevelof cer
-tain risk factors.Because an increasingtendency
for mood disorderswas observed in allage classes，
includingthe youngest classof15-17years， the risk factors， ifshared by birth cohorts， would likely be
b i d i t y fo eseht sesaesid would ton be tnelaverp among young .elpoep C a u t i o n sha bot eedesicrex ni ehtnoitaterpretni o f teh trohoc tceffe eusaceb eht ecnleaverp ni eht p r e s e n t dytus nca be a旺e'detc by vsuoira srotcaf ni a d d i t i o n ot eht change niksir rof mood .sredrosid F i r s ，t eht ecnealvepr ofotneitaptu stisiv might eb a f f e c t e d by sdellac-o ssenlli roivaheb pfosnorse -fus f e r i n g a mood .redrosid gdniroccA tot eh 3002-2002 WMHJ Survey ， ylno 8.62 % of snsorpe htwi mood d i s o r d e r s edsu some peyt hfoerachtlae secivres ni t h e tsap 21 months ).7l Some eugra taht senepaaJ p e o p l e aveh a lerow dveiecrep need rof tnmeatret and a herhgi lanidutitta reirrab tsniaga erachtlaeh s e r v i c e s rof mood sredrosid ， esucaeb a hfo rehgi -ed s i r e otlortnoc rieht symptoms by trieh own -rep s o n a l e妊stro and a herhgi ycndenet fogniredisnoc t h e i r symptoms ton ssaeerve tsaesoh nees wni-tse e r n seirtnuoc 81 ) . A change sni huc laroivaheb srotcaf w i t h i n eht trohoc members migh ，terofereht tc， effa t h e change niecnelaverp on a ctroho .sisab From t h e s0002 ， niatrec latnmenorivne geshanc have t a k e n ecalp gnidrager mood redrosid stneitap ni J .napa For pelamxe ， segnahc ni eht names hfo-ipso t a l tsmenpartde and scinilc veha been deplementmi ， s o pstneita gnitisiv eseht secalp were ssel ylekil ot f e e l any dnki fo amgtis gnidrgaer rieht alntme lli回 n e s s 91 ) .ylralimiS ， siht gea was edpaprleov hitw eht t i m i n g tfoehytilibaliava new fo ;stnasserpeditna -es l e c t i v e ninotores rotpecer srotibihni were edchnaul i n 9991 J ni .napa ylralimiS ， esaesid ssenerawa cam -p a i g n s by government and lacituceamrahp -sudni t r i e s may osla veha dreeowl sreirrab ot tentmeart f o
r elpoep gnireffus from mood sredrosid 久 Such c h a n g e s anisedutitt and sroivaheb htgim be c-troho s p e c i f i c ， fieht eganhc nideviecrep reirrab ot-tisiv i n g a pnaicisyh si.deniatniam The ecenlaevrp mood fo sredrosid might osla be a妊e'detc by teh noitroporp fostneitap dseognadi w i t h mood sredrosid among esoht gnitisiv -aptuo t i e n t .scinilc gndiorccA otlabolg cigoloimedipe -er s e a r c h by teh W odlr htlaeH noitazinagrO ， eht -ucca r a c y dfosisongai dfonoisserpe by glarene -oititcarp n e r s was detorper bot e oyln 3.91 % i tn eh kiasaagN P r e f e c t u r e Jfo napa 2 1 ) . On teh rehto hand ， a rtnece m e t a -a n a l y s i s detrpoer taht eht etar fo -revo d e t e c t i o n )noitacifitnedisim( by glarene -oititcarp n e r s siylbissop rehigh anth taht fo -rednu r e c o g n i t i o n rof eht sisongaid fonoissreped .)22 nI J pana ， a new etauadrgtsop lanoitacude system taht i n c l u d e s mandatory lacinilc gniniart rofcirtaihcysp d i s o r d e r s rof llaseeniart was detrats ni 4002 23 ) . The c h a n g e ninoitroporp pfostneita yletairporppa -gaid n o s e d thiw a mood redrosid suht anc a妊e't tc eh c h a n g e niecnealverp on a ctroho sisab ， cabe u'es o n c e a ptneita sideosngaid thwi a mood redrosid ， t h e sisongaid siylekil bot ke pte rof tnerrucer .stisiv I t was edtropre taht espaler rroecenrruce etar fo m a j o r noisserped from 1 t 5 yo sare was from 731. % t o 14-)42% 久The tneitaP Survey tneitaP( Survey ， 1 9 7 5 -2 0 1 1 ) was ytlsmo denercnoc hitw stneitap making pu-wollof stisiv ot alntem htlaeh secivres ( d a t a ton .)nwohs fI mood redrosid stneitap have na e a r l i e r tesno emit rof any noaser ， hsuc lsasse -gits m a t i z a t i o n nroevitage efil stneve a yta ounger gea ， s u c h stneitap era ylekil ot abedetceff ylgnorts -eb c a u s e fo eht high espaler ro ecnerurcer etar fo mood .sredrosid The kcal a lfo egra doirep e旺e't was c .detcexpenu b e c a u s e mood sredrosid era thguoht potliaver -rud i n g n ea miconoc .noissecer tnI erms tfo eh-noitaler s h i p between cimonoce-oicos sutats and .noisserped a lrweo ssorg cistemod tucdorp (GDP) rep atipac was detrpoer ot be rdetale ot a herhgi etar lfo-efi t i m e ksir fo a mood drosid re.l72 The GDP ni anJap grew dlof-eerht mfor JPY 841 ，723 1n.oillib ni 5791 ot JPY 7 14，8.013 noillib 2ni110 radnelaC( Year Gfossro D o m e s t i c tucrodP Account ， 0020 ， )5102 ， tbu siht c h a n g e ni GDP did ton etalerroc thiw a change ni mood redrosid ecnealverp J ni .napa I n a rtnece yudst APC fo sisylana dfo ata pfo-ys c h o l o g i c a l ssertsid from eht setinU setatS and Canada ， a pdoire e旺tce was deversbo ， showing eht h i g h e s t level fo doirep e旺e't ic n 2002-1002 28 ) . The a u t h o r s rgueda taht eht W odlr Trade rteenC kcatta might aveh had some atcpmi ， and taht eht doirep -fe f e c t from 7002 2ot 001 US dni ata might be a旺detce by teh labolg laicnanif sisirc ni eht deitnU setatS and tuenseqsub cimonoce noissecer 82 ) . From 5791 ot 2 0 1 1 ni J pana ， ereht were 2 mroja laicnanif :sesirc
-238-one was a bbleub oimcnoce trsbu and espalloc from December 8691 ot November 9391 ， and eht rheto was eht ocimnoce impact by teh labolg laicnanif -irc s i s taht seora ni August .7002 ayrCrtno fotsgnidni f o r eht edUnit setatS and Canada ， no tnacifingis c h a n g e s ni diorpe tceffe rof lacigolhocysp ssertsid were voedresb ni odierp e旺e't fc ro mood sredrosid i
n J .napa Though aatd were gnsiism ni 9091 and 1
9 9
3 ， tisi usth ssel ylekil taht eht enclevarep fo mood sredrosid J ni apan was detceffa by s-oceoico nomic .sgenhac N alarut sretsasid such sa -htrae q uakes era osla dteorepr ot be a rksi rotcaf rof -ed p r e s s i o n 92 ) . neseapaJ elpoep decnriepexe 2 bgi -htrae quakes grindu eht sisylana ;mret one was eht treaG Hanshin Earthquake January ni 5991 and eht rheto was het atGre stEa Japan Earthquake ni March 2
0
1 .1 However ， ti needs be cot deredisno taht -igiro n
a
l aatd from 1120 were ton deduclni from het -nec t e r aear sfo ockh raen Fukushima reuctefreP ， and t h e etar oitar rof doriep e旺e'tc desaercni ynlo s l i g h t l y ngurid siht .mret Thus ， ti arsappe taht an e a r t h q u a k e oesd tno seem otyltnacifingis tceffa changes ni mood redrosid ecenalevrp lla over J a p a n . T h i s study has snoitatimil sa ot tesatad and a n a l y s i s methods taht era detaler otsticifed ni -ad t a s e t
s rof thbo men and women ni 0991 and .3991 There sieblaarpes and wider tesaatd eni ach rtoohc f
o
r thbo men and women from 5971 ot 9319 ， which u s e s sodec 492-292 ， 962 ， 992-972 ， 003 ， 30，1 302 ， -403 3 1
6 from ICD .9・. The detmaitse atad ni 0991 and 1
9 9
3 were dectdiepr from egareva secnereffid -eb tween latot taad and eht atad nisiht study from 1 9 7 5 1ot.789 APC sisylana gniudlcni dateimste atda was delippa sa a pyrainmiler .yduts There sielttil d i f f e r e n c e between eth stluser APC fo sisylana -ni c l u d i n g dteaimste taad and eht stluser fo APC a n a l y s i s tnisih .yduts As fro testaad seussi ， each -oc h o r
t had a wide tyeirav mood fo sredrosid such sa manic edsoipe ， ralopib evitceffa rderosid ， -serped s i v e edoispe ， and erhot mood a(宜)evitce .sredrosid D e p r e s s i o n ， which seduclni evissreped sedsoipe ( F 3 2 : )10CD-I and tnrerucer veissrepde redrosid ( F 3 3 : )01D-CI ， rredocuc ni.15 % t 7o 3.2 % o pf-icitra p a n t s every raey-3 doriep from 5971 2ot 110 ni eht p r e v a l e n c e tfolato stneitaptuo under mtnetraet rof a mood .redrosid ylralimiS ， ralopib evitceffa -rosid d e r :13F( )0-1DIC desaercni from 9.0 % t 2o 4.，% but t h o s e suelav sedulcni ylno atad from 5971 ， 8719 ， 1 9 8 ，1 and .7891 Furthermore ， segnahc ni eht a-vepr l e n c e fo mood sredrosid might be a旺e'edtc by changes nilaroiavheb srotcaf ， changes nisisongaid ， and changes rniespale rro ecnerruce .setar The -tal t e r noitatimil fo our sisylana method may dael ot i d e n t i f i c a t i o n problems and eht noitmpussa taht t h e r e era both cificeps-ega and cificeps-xes .stceffe I n summary ， eht torhco e旺e't oc dbserve rof mood d i s o r d e r enclevaerp fotneitaptuo stisiv ni J apan c a n ylbissop be deinaplxe by cniatre ksir srotcaf s h a r e d by teh same htrib trohoc ， but may osla be e x p l a i n e d by slaico and lariovaheb srotcaf taht -fa f e c t e d het ytilibaborp fo ngieb dosegndia with a mood .redrosid rurtheF hcreaser fo rehto lanoitan s t a t i s t i c s and cigoolimedipe seiduts ni J apan era needed ot niag more sthgisni otni eht esusca tfo eh e p i d e m i c mood fo .sredrosid Acknowledgements The srohtua deviecer tnmeagecourne romf J un I s h i g o o k a ， MD ， PhD ， rosseforP dan anChairm ， and H i t o s h i ishhaaakT ， MD ， PhD e， taicossA rosseforP ， -eD p a r t m e n t foyrtaihcysP ， Tokyo Women's laciedM -inU v e r s i t y . The srohtua nkath ehtyrarbil ats 妊f Moyrtsini o f Hhtlae ， bourLa dan erfaleW rof gnipleh htiw atad -loc l e c t i o n . C o n f l i c t s ifoseretn :tNone .deralced R e f e r e n c e s 1 ) Kawakami N， makeshiTa T， Ono Y ate:l -evlewT m o n t h ecnelaverp ytire， ves ， dnatnemtaert cfo-mo mon latnem sredrosid niseitinummoc J ni:napa -erp l i m i n a r y gnidnif morf eht dlorW latneM htlaeH J napa yevruS .3002-2002 yrtaihcysP nilC icN esoru 5 9 (:)4 2451-44 ， 0502 2 ) imaSh S， otaS :EkciS evael eud otlatnem -rosid d e r s . lanuoJ flaonoitapuccO latneM htlaeH :21 46 -5 3 ， 0420 ni()eseJ napa 3 ) Kawakami N， uzimihS H， inaatraH T e at:l-efiL t i m e dna 6・thonm ecnelaverp foR-III-MSD -ihcysp a t r i c sredrosid ni na nabru ytniummoc ni .J napa P s y c h i a t r y seR 121:)3( 10-3932 ， 0420 4 ) relndeK KS re， lsseK RC ， elaeN MC e at:l The -erp d i c t i o n mforoja noisserped ni:enwmo drawot ina-n t e g r a t e d cigoloite mode .lAm J Pyrtaihcys 051 :)8(
1 1 3 9 -1 1 4 8 ，3991 5 ) Mezuk B， Eaton W W ， trechAlb S e at:l niosesprDe and peyt 2 dsetebai rveo eht:napsefil a m-tae a n a l y s i s . seteabiD areC (13:)21 90233-823 ， 8002 6 ) aitekS A， Arima H， Ninomiya T e at:l edatevlE d e p r e s s i v e symptoms nicilobatem syndrome ni a g e n e r a l noitalupop fo J eseanap men: a c-ssor s e c t i o n a l .yduts BMC Pcilbu htlaeH :31 628 ， 1302 7 ) Polsky D， hiDos JA ， Marcus S e at:l g-termLon r i s k rof evisserped symptoms retfa a mlaicde -gaid n o s i s . Arch nretnI Med 561:)11( 6621-0621 ， 5002 8 ) Glen AI ， Johnson AL ， Shepherd M: Cnotiauninto t h e r a p y hitw muihtil and enilytpirtima niralopinu d e p r e s s i v e :ssenlli a rzedoidnam dnilb-， elbuod ， -noc t r o l l e d airt.llohycsP Med (41:)1 0-573 ，4891 9 ) ienPr RF ， ttelK CJ ， yeffCa EM J:r muihtiL -rac b o n a t e and einamprimi ninoitneverp foevitceffa e p i s o d e s . A cnoisrapmo nitnerrucer evitceffa -lli n e s s . Arch Gen rytahicyPs (92:)3 524-024 ，3791 1 0
) ienPr RF ， Kupfer DJ ， Mansky P A e at:l Drug
t h e r a p y ni eht notinveerp rfoscenreruce ni-opinu l a r and ralopib evitceffa .sredrosid ortRep fo eht NIMH evitaroballoC ydutS Group gnirapmoc -htil ium teaonbarc ， enaimrpimi ， and a lmuihti c a r b o n a t e -i m i p r a m i n e .noitanibmoc Arch Gen -ysP c h i a t r y (14:)11 4011-6901 ，4981 1 1
) Holford T The :R noitamitse afo eg ， doirpe and oc ・
h o r t stceffe roflativ .setar scirtmeoiB (93:)2 11-3 3 2 4 ， 3819 1 2 ) entensrsaC :Btrohoc-doirep-egA sldeom rof eht L e x i s m.argiad tatS Med (26:)51 540-31830 ， 7002 1 3
) Beekman AT ， Copeland JR ， encirP M J: Review fo
community ecnleaverp dfonoissepre lnireta .efil Br J Prytiahycs :471 137-30 ，19991 1 4 ) isibiS CD: Sex secnereffid nieht eag ofotesn bfo-i p o l a r evitceffa .ssenlli Br J Pyrtaichys :651 45-8842 ， 1 9 9 0 1 5 ) rceiSp CC ， Hare EH ， retalS N:Ecitorue and -ysp c h o t i c sform foevissepred :ssenlli cendeiev from a g e -i n c i d e n c e ni a nlanoita .elpmas Br J Pyratichys 1 2 3 : 5 3 5 -5 4 1 ，3791 1 6 ) onClayt :JP The ygoliomedipe bforalopi a旺e'evitc d i s o r d e r . Compr yrtiahcsyP :22 43-31 ， 1891 1 7
) Naganuma Y， Tachimori H， Kawakami N e at:l
Twelve-month esu mfoalent htlaeh secivres fniruo a r e a s ni J n:apa sgnidnif from eht World entalM H e a l t h J apan Survey .3002-2002 yratihcysP nilC N eicsoru (06:)2 48-2402 ， 6002 -240-1 8
) Andrade LH ， Alonso J， Mneimneh Z e at:l -irraB
e r
s ot alntme htlaeh :tnemtaert stluser from eht
WHO World lentaM htlaeH .syevrus lochyPs Med
4 4
(:)6 7131-3031 ， 4012 1
9
) Hirosawa M， Shimada H， Fumimoto H e at:l -eR
s p o n s e fo J eesanap stneitap ot eht ehangc fo -ed p a r t m e n t name rof ehtcirtaihcysp tneitaptuo cinilc i n a uytisrevin atipsoh .lGen Hosp yrtaihcysP (24:)4 2 6 9 -2 7 4 ，2002 2 0 ) Ihara H: Deasesi mongering and ralopib redrosid i n J .napa airtaihcysP te N eaigoloru J acinopa 311 ( 1 2 ) : 5212-1812 ， 1102 ni( J )esenapa 2む)1 nuts TB ， V on Korff M: Pyrmair alMet thaleH S e r v i c e s : essAcc and noitsivorP Cfo.era nI Mental I l l sesn ni lraeneG thleaH :earC anlanoitanretnI S t u d y untUs( TBsui， rotraS N e)sd ， 063-843pp ， John W i l e y & onsS r， etsehcihC ， UK ()5991 2 2 ) llehtciM AJ ， Vaze A， Rao :SlacinilC sisongaid fo d e p r e s s i o n ni marypri :erac .sisyla mana-ate cetLan 3 7 4:)0969( 916-906 ， 9002 2 3
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p s y c h i a t r i c gniniart program rofcirtaihcysp-non r e s i d e n t s ni a J eesanap etaudartgsop noitator -sys t e m . Acad yrtaihcysP (53:)6 81-4174 ， 1102 2 4 ) i n EH ， L Katon WJ ， Vonkorff M e at:l seplaeR fo d e p r e s s i o n ni yarprim .erac teaR and lacinilc -erp d i c t o r s
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T h r e e - otraey-5 evitcesporp pu-wollof fo outcome i n orjma .noisserped lhoycsP Med (82:)3 35731-7 ， 1 9 9 8 2 6
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p r e s s i o n gnridu ehtnoitisnart ot:doohtluda a 5 -y e a r lanidutignol ydtus fo young women. J Am Acad dlihC scledoA yrtaichysP (38:)7 5918-09 ，9991 2 7 ) Hidaka BH: noissrepeD a dsa esaesi mfo:yitnrdeo e x p l a n a t i o n s rof gnisaercni .ecnelaverp J Atceff D i s o r d 041:)3( 412-502 ， 2012 2 8 ) Keyes K M ， nsolohciN R， yenlKi J e at:l Age ， -ep r i o d ， and trohoc stceffe nilacigolohcysp ssertsid ni t h e dteniU setatS and .adanaC Am J Eylogmiodepi 1 7 9:)01( 7221-6121 ，1420 2 9 ) Tang B， i u XUL ， i u Y eL at:l A msisylana-ate fo r i s k srotcaf rofnoisesrped nistluda and nerdlihc -fa t e r larutan .sretsasid BMC cilbuP thleaH :41 362 ， 2 0 1 4
A g e -P e r i o d -C o h o r t モデルによる日本の気分障害の流行分析 東京女子医科大学医学部衛生学公衆衛生学(第二)講座 サ ワ チ カズヒロ サ ト ウ ヤ ス ト ヤマグチ ナオヒト 津 地 和 宏 ・ 佐 藤 康 仁 ・ 山 口 直 人 〔目的〕気分障害は社会経済や健康に深刻な影響を及ぼし， 日本においては数十年間気分障害の患者数が増加し ている.しかしながら，その増加の理由は不明である.本研究の目的として患者調査の結果を用い， d-orie-PeAg C o h o r t (APC) 分析によって時代，年齢，コホート効果のどの効果が気分障害の増加に対して重要な役割をして いるかを検討する. 〔対象および方法〕厚生労働省の患者調査から5971 年から1012 年の気分障害の男女別外来患者数を用いて
APC 分析を試みた分析に用いるデータを 15~17 歳から 81~83 歳までの 3 年区分の Lexisdiagram を作成し
た. APC 分析はdorflHo モデルにより実施し， 0.3R l. F(R natioundo roflacitsitatS Computing ， Vienna )a， irtsuA を
用いて実施した. 〔結果〕年齢効果，時代効果，コホート効果をもっモデルが男女とも最も適したモデルで、あった.年齢効果では， 男女とも受療率が年齢に伴い対数軸において直線的な増加がみられ， 04 歳代で変曲点をもっていた.コホート効 果においても男女共により若年の世代のコホートがそれ以前のコホートに比べて高い受療率となっている現象が みられた一方，時代効果はコホート効果と同じような大きな変化が男女共にみられなかった. 〔考察]APC 分析の結果から男女共に日本の気分障害の受療率は大きなコホート効果を持つことがわかった.こ れは若年の世代がそれ以前の世代に比べて，外来でより高い受診頻度となっていることを意味しており，また，同 じ世代の中で，高い受診頻度が継続していることを意味している.一方，時代効果の結果から社会経済の変化や天 災は受療率に対する影響が少ない事がわかった本研究の限界:気分障害の受療率の変化は行動要因の変化や診 断の変化，再燃，再発の変化による影響を受ける可能性がある. 〔結論〕日本の気分障害患者に対するAPC 分析の結果から，若年世代となるほど外来における受診頻度が増加 し同世代内でも継続して高いことが示唆された一方で時代効果はコホート効果のような大きな変化がないこと が示された.
