Executive Summary
47.1% of workers who took leave for depression return to leave within five years (MHLW, 2017), and 53.7% of those who returned to work or changed jobs experienced a subsequent period of leave (Leverages, 2025). Meanwhile, only 25.1% of establishments have developed a formal return-to-work support program, dropping to 21.3% among those with 10–29 employees (MHLW, 2024). Re-leave is not a personal failing — it is a systemic gap. Phased workload adjustment, regular check-in interviews that capture changes in condition, and early detection of warning signs: institutionalizing these three practices is the key to reducing re-leave rates while fulfilling the employer's duty of care.
Definitions and Current Landscape
Definition: Re-leave (再休職, sai-kyūshoku) refers to a worker who previously took leave for a mental health condition, returned to work, and subsequently takes leave of one or more consecutive months again due to a mental health condition.
Re-leave is not merely an added burden of repeated treatment. Depression becomes more likely to recur, more severe, and more impairing to social functioning with each episode, significantly affecting quality of life (Nitta et al., 2024). At the organizational level, the impact extends beyond the individual's loss of confidence and credibility — it reinforces the stigma that "mental illness is incurable," discourages early help-seeking, and ultimately leads to an increase in long-term absenteeism across the organization.
The proportion of establishments reporting employees who took leave of one or more consecutive months or resigned due to mental health issues reached 13.5%, rising steadily from 10.0% over the past decade (MHLW, 2024). In an era where approximately 1 in 15 people will experience depression in their lifetime (MHLW), re-leave is not an edge case — it is a management risk that can arise in any workplace.
Re-Leave Risk Assessment Checklist
The more of the following that apply, the higher the risk of re-leave:
- No written workload adjustment plan (return-to-work support plan) exists for the returning employee
- No regular check-in interview schedule has been set in advance
- Post-return follow-up depends on a single individual (e.g., the direct supervisor)
- The attending physician's "fit to return" is interpreted as "able to work as before"
- No occupational physician is available, and external consultation resources (e.g., Chiisanpo) are not known
Data and Evidence
Re-Leave Rates
| Indicator | Figure | Source |
|---|---|---|
| Re-leave rate within 5 years among depression leave-takers | 47.1% | (MHLW, 2017) |
| Re-leave experience rate among those who returned to work or changed jobs | 53.7% | (Leverages, 2025) |
| Re-leave rate at new employers (after job change) | Approx. 40%+ | (Leverages, 2025) |
| Re-leave within less than 1 year after return | More than half | (Leverages, 2025) |
| Re-leave/job loss rate approx. 1 year after rework program | Approx. 20% | (Oki & Igarashi, 2013) |
Leave and Resignation Due to Mental Health Issues
| Indicator | Figure | Source |
|---|---|---|
| Percentage of establishments with employees who took leave or resigned | 13.5% | (MHLW, 2024) |
| Percentage with employees on leave for 1+ consecutive months | 10.4% | (MHLW, 2024) |
| Percentage with employees who resigned | 6.4% | (MHLW, 2024) |
| Percentage of workers on leave for 1+ consecutive months (as share of all workers) | 0.6% | (MHLW, 2024) |
| Percentage of workers who resigned (as share of all workers) | 0.2% | (MHLW, 2024) |
| 10-year trend (establishments with leave/resignation) | 10.0% → 13.5% | (MHLW, 2024) |
By Establishment Size: Percentage with Employees on Leave or Who Resigned Due to Mental Health Issues
| Establishment Size | Percentage | Source |
|---|---|---|
| 1,000+ employees | 91.2% | (MHLW, 2024) |
| 500–999 employees | 87.2% | (MHLW, 2024) |
| 300–499 employees | 74.1% | (MHLW, 2024) |
| 100–299 employees | 55.3% | (MHLW, 2024) |
| 50–99 employees | 28.2% | (MHLW, 2024) |
| 30–49 employees | 16.0% | (MHLW, 2024) |
| 10–29 employees | 7.5% | (MHLW, 2024) |
Corporate Return-to-Work Support: Implementation Status
| Indicator | Figure | Source |
|---|---|---|
| Establishments with a formal return-to-work support program (overall) | 25.1% | (MHLW, 2024) |
| Same (1,000+ employees) | 78.4% | (MHLW, 2024) |
| Same (10–29 employees) | 21.3% | (MHLW, 2024) |
| In-house consultation framework in place | 45.0% | (MHLW, 2024) |
| Stress check implementation | 65.0% | (MHLW, 2024) |
| Listed companies with a leave-of-absence system | 98.3% | (NIVR, 2019) |
Triggers for Taking Leave
| Trigger | Percentage | Source |
|---|---|---|
| Workplace interpersonal relationships | 24.3% | (Leverages, 2025) |
| Workplace harassment | 22.8% | (Leverages, 2025) |
| Excessive workload | 22.5% | (Leverages, 2025) |
Duration of Leave
| Category | Overall | Workers in their 20s | Source |
|---|---|---|---|
| Most common duration | 1 year or more (34.7%) | 1–3 months (43.2%) | (Leverages, 2025) |
| Trend | — | Shorter for younger workers; longer with increasing age | (Leverages, 2025) |
Post-Leave Resignation and Employment Status Changes
| Indicator | Figure | Source |
|---|---|---|
| Resigned after returning from leave (overall) | Approx. 50% | (Leverages, 2025) |
| Resigned after returning from leave (workers in their 20s) | Over 70% | (Leverages, 2025) |
| Continued as full-time employee after return/job change | 86.9% | (Leverages, 2025) |
| Changed to contract/part-time employment | Over 10% | (Leverages, 2025) |
| Obtained a mental health welfare certificate (精神障害者保健福祉手帳) | Approx. 30% | (Leverages, 2025) |
| Considering obtaining the certificate | Approx. 20% | (Leverages, 2025) |
Return-to-Work Rates (Survey of Listed Companies)
| Indicator | Figure | Source |
|---|---|---|
| Companies where all leave-takers returned | 11.3% | (NIVR, 2019) |
| Companies where 70–80% returned (most common) | 24.1% | (NIVR, 2019) |
| Companies with zero returns | 6.5% | (NIVR, 2019) |
Employer Measures for Employees on Leave
| Measure | Implementation Rate | Source |
|---|---|---|
| Requiring submission of a medical certificate | 90.8% | (NIVR, 2019) |
| Utilizing external resources | 33.9% | (NIVR, 2019) |
Employer Measures at Return and Post-Return (Survey of 457 Listed Companies)
| Measure | Implementation Rate | Source |
|---|---|---|
| Restricting or prohibiting overtime and weekend work | 67.6% | (NIVR, 2019) |
| Shortened working hours | 61.9% | (NIVR, 2019) |
| Regular check-in interviews | 60.2% | (NIVR, 2019) |
| Adjusting work content based on the individual's condition | 53.0% | (NIVR, 2019) |
Return-to-Work Decision Criteria (386 Listed Companies Responding)
| Criteria Category | Examples |
|---|---|
| Intent to return | Worker has expressed intent to return (formal request submitted) |
| Daily rhythm | Stable sleep-wake cycle and daily routine |
| Motivation and cognitive recovery | Motivation for return, reflection on leave triggers, relapse prevention plan |
| Trial commute | Able to commute safely and independently during regular hours |
| Trial attendance | Able to sustain shortened work hours, then full scheduled hours |
| Medical assessment | Attending physician's clearance, occupational physician's determination |
| Other | Family support situation, workplace readiness, return-to-work plan completion |
Source: (NIVR, 2019). 97.2% of companies set conditions for return-to-work decisions, and most combine two or more criteria categories.
Return-to-Work Decision Criteria — Standard Benchmarks
The worker demonstrates sufficient motivation; can commute safely and independently during regular hours; can sustain attendance on scheduled days and hours; can perform required tasks; fatigue sufficiently recovers by the next day; attention and concentration required for work have recovered (MHLW, 2009).
Examples of Work Accommodations
Shortened working hours, assignment to light or routine tasks, prohibition of overtime and night shifts, travel restrictions, shift work restrictions, restrictions on hazardous work / driving / elevated work / customer-facing / complaint-handling duties, restrictions on or application of flextime, consideration regarding transfers (MHLW, 2009).
MHLW Five-Step Return-to-Work Support Framework
| Step | Content |
|---|---|
| Step 1 | Commencement of sick leave and care during leave |
| Step 2 | Attending physician's determination that return to work is possible |
| Step 3 | Decision on return-to-work eligibility and development of a return-to-work support plan |
| Step 4 | Final return-to-work decision |
| Step 5 | Post-return follow-up |
Source: (MHLW, 2009). In establishments with fewer than 50 employees, the health promotion officer (衛生推進者) or safety and health promotion officer (安全衛生推進者) serves as the responsible contact.
Three Forms of Trial Attendance Programs
| Form | Description |
|---|---|
| Simulated attendance (模擬出勤) | Performing light mock tasks at a day-care program or similar setting |
| Commute training (通勤訓練) | Practicing the commute from home to the vicinity of the workplace |
| Trial attendance (試し出勤) | Attending the actual workplace on a trial basis for a set period |
Source: (MHLW, 2009). Trial attendance is not a statutory requirement — companies can design and implement it at their discretion. When adopted, the program should be formalized with internal rules before use (JOHAS, 2019).
Post-Return Follow-Up: Case Example
In a case study from the MHLW guidelines, a male sales professional in his 30s was permitted one hour of overtime per day starting from the third month after return, progressing to full regular duties over six months. The follow-up structure consisted of monthly interviews with the occupational physician and occupational health nurse, biweekly check-ins with the occupational health nurse, and weekly interviews with the direct supervisor (MHLW, 2009).
Key Principles for Developing a Return-to-Work Support Program
- The standard for return is "acceptance in a state that is not a full return" (JOHAS, 2019)
- Ensure that excessive burden does not fall on colleagues and supervisors (JOHAS, 2019)
- Support for the worker's family (understanding, cooperation, necessary information sharing) is also important (JOHAS, 2019)
- If changes to employment terms or contracts are anticipated, formalize the rules in advance through employment regulations (JOHAS, 2019)
- In principle, the worker should return to their original, familiar workplace. However, when the condition was triggered by a transfer or similar change, reassignment may be preferable (MHLW, 2009)
Effectiveness of Regular Check-In Interviews
In surveys of returning workers, regular contact, status checks, and consultations were rated as "helpful," and prior research has demonstrated their effectiveness in preventing re-leave and facilitating workplace readjustment (NIVR, 2019).
Regular interviews help alleviate employee anxiety, enable objective self-assessment, and support early problem resolution. Prior research has confirmed their effectiveness in preventing re-leave and supporting workplace readjustment (NIVR, 2019).
Cognitive and Behavioral Characteristics Leading to Re-Leave (Qualitative Study of 8 Depression Re-Leave Cases)
| Category | Characteristic | Specific Manifestations |
|---|---|---|
| Cognitive | Attachment to an idealized self-image | Strong sense of responsibility to meet expectations, high ideals as a professional, intense comparison tendency with extreme self-deprecation |
| Cognitive | Searching for a convincing narrative | Attributing failures to oneself, holding strong conviction that depression will recur |
| Behavioral | Overloading with work | Increasing overtime and take-home work, reducing break time, working alone |
| Behavioral | Enduring in silence | Not speaking up, putting on a facade of being fine |
| Behavioral | Rumination | Repeatedly dwelling on past failures, future anxieties, and negative self-perceptions |
Source: (Nitta et al., 2024). The patterns unique to re-leave cases — as opposed to first-time leave — are "intense comparison tendency with extreme self-deprecation" and "rumination." For re-leave prevention, it is considered important to (1) ensure the worker receives objective and accurate feedback in the workplace, and (2) develop coping strategies for rumination.
Individual and Environmental Factors Associated with Re-Leave
| Factor | Finding | Source |
|---|---|---|
| Family relationships | Workers who successfully returned tended to rate their family relationships positively | (Hori et al., 2013) |
| Marital/living status | Unmarried individuals and those living alone had shorter intervals before re-leave | (Nakagawa & Ihara, 2016) |
| Externalization tendency | Workers who tend to attribute blame externally had shorter intervals before re-leave | (Nakagawa & Ihara, 2016) |
| Interpersonal conflict | Re-leave cases showed significantly higher interpersonal conflict stress in the workplace compared to first-time leave cases | (Nakamura, 2015) |
Resources for Small and Medium Enterprises
| Resource | Description | Target | Cost |
|---|---|---|---|
| Regional Occupational Health Center (地域産業保健センター / Chiisanpo) | Occupational health services | Establishments with fewer than 50 employees | Free |
| Occupational Health Promotion Center (産業保健総合支援センター) | Mental health promotion staff provide on-site support | All establishments | Free |
| Kokoro no Mimi e-Learning | "Understanding Return-to-Work Support in 15 Minutes" | All establishments | Free |
| ELECTRIC DOC. | Return-to-work support manual, checklists, daily activity logs | SMEs without an occupational physician | Free (PDF) |
Sources: (Kokoro no Mimi / MHLW), (JOHAS, 2019), (ELECTRIC DOC.). Information about external support services may not be reaching SMEs without specialist staff sufficiently, and further awareness-raising is needed (NIVR, 2019).
Analysis and Implications
Technical keywords: psychological safety, cognitive distortion, emotional exhaustion, rumination, comparison tendency, learned helplessness, duty of care, tertiary prevention, presenteeism, desensitization to pain, over-adaptation
Axis A: Mechanism Analysis — Why Re-Leave Occurs
The Gap Between "Fit to Return" and "Fit for Full Duty"
When an attending physician issues a "fit to return" (復職可能) determination, it is based on recovery at the daily-living level. It does not necessarily mean the worker has recovered the job performance capacities the workplace requires — sustained attention, tolerance for interpersonal stress, ability to handle unexpected tasks (MHLW, 2009). If the organization fails to recognize this gap, it implicitly expects the returning worker to perform at their previous level from day one, and the worker pushes themselves to meet that expectation. This is the entry point to re-leave.
From 30 years of organizational experience, this gap is less a matter of "not knowing" and more often a case of "looking the other way." The team has been covering for a six-month vacancy. The pressure to get a full contributor back — even among well-meaning managers — is difficult to resist. The problem is not individual judgment; it is the absence of a system that guarantees a phased return.
Cognitive and Behavioral Patterns Unique to Re-Leave Cases
What Nitta et al. (2024) revealed is a set of cognitive and behavioral patterns common to those who go on to take re-leave. Most notably, "intense comparison tendency with extreme self-deprecation" and "rumination" are characteristics found specifically in re-leave cases but not among first-time leave-takers.
The cognitions "I should be able to work like before" and "I'm burdening everyone" translate directly into behaviors: overloading with work and enduring in silence — putting on a facade of being fine. These behaviors, in turn, form a vicious cycle through their impact on emotions and physical health.
What is often overlooked is that this "facade of being fine" is sometimes not consciously recognized even by the individual. Speaking from the experience of having looked back on 200 hours of monthly overtime as "not that hard at the time," people become desensitized to their own pain. The state of being unable to recognize one's own overexertion manifests as checking "no issues" on a self-assessment form. When you ask "How are things going?" in a check-in interview and receive "I'm fine," the reliability of that answer cannot be taken at face value. Interview design must incorporate measures to account for this desensitization.
Interpersonal Conflict and the Workplace Environment
Re-leave cases show significantly higher interpersonal conflict stress in the workplace compared to first-time leave-takers (Nakamura, 2015). This aligns with data showing that "workplace interpersonal relationships (24.3%)" and "harassment (22.8%)" rank among the top triggers for leave (Leverages, 2025). When the worker returns to their original workplace, the interpersonal dynamics that contributed to the initial leave may remain unresolved. The MHLW guidelines state that "return to the original, familiar workplace is the principle," while noting the caveat that "when the condition was triggered by a transfer or similar change, reassignment may be preferable" — a qualification that can be understood as addressing this interpersonal conflict risk.
The Cascading Nature of Recurrence
Depression becomes more likely to recur, more severe, and more debilitating with each episode (Nitta et al., 2024). Re-leave is not simply a repeat of "taking leave again" — it represents a progression of the condition. The finding that approximately 20% of rework program participants experienced re-leave or job loss within about one year (Oki & Igarashi, 2013) demonstrates that re-leave risk persists even after specialized return-to-work programs. Responding to this pattern with "let's wait and see" is nothing more than deferring the problem.
Axis B: Institutional and Environmental Analysis — The Systemic Context
The Gap in Institutional Readiness
Only 25.1% of establishments overall have developed a return-to-work support program, dropping to 21.3% among those with 10–29 employees (MHLW, 2024). By contrast, 78.4% of establishments with 1,000+ employees have one in place. This more than threefold gap means that return-to-work support in SMEs depends on individual judgment rather than institutional systems.
Without a system, HR staff and managers must rely on their own discretion to determine "how much accommodation is appropriate" and "when to transition back to full duties." When a judgment call goes wrong, that staff member falls into self-blame — itself a mental health risk for the individual responsible.
The common assertion is that "SMEs can't do return-to-work support because they don't have an occupational physician." The reality on the ground is somewhat different. Mental health promotion staff at Occupational Health Promotion Centers (産業保健総合支援センター) visit workplaces and provide free assistance in developing programs. Regional Occupational Health Centers (Chiisanpo) offer free occupational health services to establishments with fewer than 50 employees. ELECTRIC DOC. publishes a free return-to-work support manual designed specifically for SMEs without an occupational physician. More than the absence of systems, the fact that these resources are not widely known is the greater barrier.
Practical Implications of the Duty of Care
The duty of care (安全配慮義務, Article 5 of the Labour Contracts Act) requires employers to ensure the safety and health of workers. Phased workload adjustment and regular check-in interviews for returning employees are concrete expressions of this obligation. Without formalization, "what accommodation is required" becomes ambiguous, creating the risk of being judged as having failed in the duty of care.
Developing a return-to-work support program is also a means of making duty-of-care compliance visible and documented. Implementing and documenting Step 3 of the MHLW guidelines (development of a return-to-work support plan) serves both to reduce legal risk and to deliver effective return-to-work support.
The Current State and Challenges of External Resource Utilization
The NIVR survey found that approximately one-third (33.9%) of listed companies utilize external resources (NIVR, 2019). These include rework support through Regional Centres for Persons with Disabilities (地域障害者職業センター), medical institution rework programs, and EAP (Employee Assistance Programs). However, information about available support has not reached SMEs sufficiently.
In return-to-work decisions, 97.2% of listed companies set formal conditions, and most combine two or more criteria categories — covering intent to return, stable daily rhythm, trial attendance completion, and medical assessment (NIVR, 2019). Scaling down this multi-perspective decision-making framework for adoption by SMEs is entirely feasible.
Axis C: Impact Analysis — What Happens When Re-Leave Is Not Prevented
Impact on Organizations
Approximately 50% of workers resign after returning from leave, rising to over 70% among those in their 20s (Leverages, 2025). Even among those who do return, over 10% transition to contract or part-time employment, indicating that leave has lasting effects on career trajectory. For companies, the cycle of leave → re-leave → resignation means not only lost recruitment and training investment, but also the need to redistribute work and the increased burden on colleagues — a decline in organizational productivity overall.
Ripple Effects on Colleagues
Both the MHLW guidelines and the JOHAS program development guide explicitly state that "care should be taken to ensure that excessive burden does not fall on colleagues and supervisors." This underscores that return-to-work support is not solely the returning employee's issue. Team members who have covered for a colleague's absence for six months are at risk of secondary mental health deterioration. Those doing the supporting are themselves running on reserves.
Where Individual and Environmental Factors Intersect
Re-leave risk sits at the intersection of individual and environmental factors. Workers with positive family relationships are less likely to take re-leave (Hori et al., 2013), while unmarried individuals and those living alone have shorter intervals before re-leave (Nakagawa & Ihara, 2016). These individual factors are not areas where companies can intervene directly, but including "home support situation" as a check-in item during interviews can inform decisions about providing more intensive follow-up for higher-risk individuals.
Recommended Actions
Phase 1: Initial Response (From Return-to-Work Decision to Return Date)
- Consolidate the return-to-work support plan into a single document: Include the return date, work content, working hours, interview schedule, and accommodation requirements. Share with the returning employee, their supervisor, and HR. This corresponds to Step 3 in the MHLW guidelines. Mental health promotion staff at Occupational Health Promotion Centers provide free assistance in developing the plan.
- Clarify what the attending physician's "fit to return" means: Distinguish between recovery at the daily-living level and recovery of job performance capacity. Based on the physician's written assessment, obtain advice from an occupational physician or external body to determine the appropriate workload level.
- Schedule check-in interviews on the calendar from day one: The approach should be "interviews on set dates," not "come talk to us if things get bad."
Phase 2: Post-Return Follow-Up (Return to 6 Months)
- Phased workload adjustment: Weeks 1–2: half-day / light duties. Weeks 3–4: 6-hour days / no overtime. Months 2–3: full-time hours (no overtime, workload at 70–80%). Months 3–6: transition to regular duties.
- Adjust check-in frequency over time: Months 1–3: one formal interview per month + weekly brief check-ins by the supervisor. Stabilization period (months 3–6): once every two months. After transition to regular duties: once every three months.
- Use specific prompts in check-in interviews: (1) Sleep (morning wakefulness, difficulty falling asleep), (2) Perceived workload (whether fatigue carries over to the next day), (3) Workplace relationships, (4) General physical condition, (5) Daily rhythm (wake-up time, eating habits).
- Monitor the team as a whole: Be mindful of the burden on colleagues supporting the returning employee. Review workload distribution and attend to the mental health of the wider team in parallel.
Role-Specific Action Steps
| Role | Primary Responsibility | Specific Actions |
|---|---|---|
| **Business Owner** | Setting policy and institutionalizing support | Communicate the company's return-to-work support policy internally. Consider implementing a trial attendance program. Use the free on-site support available from Occupational Health Promotion Centers. |
| **HR Staff** | Planning and progress management | Serve as the liaison with the attending physician. Develop the return-to-work support plan and maintain interview records. Incorporate stress check results for a multidimensional view. The NIVR survey found that approximately one-third of companies use external resources. |
| **Manager** | Day-to-day observation and communication | Conduct brief weekly interviews. Balance workload adjustments with overall team capacity. |
| **Colleague** | Maintaining a natural working relationship | Focus on treating the returning colleague normally rather than giving special treatment. Also pay attention to your own stress and workload. |
Sample Phrases for Consultations
- HR → Attending Physician: "Could you share your perspective on the appropriate workload after return? We are planning a phased approach to gradually increase responsibilities."
- Manager → Returning Employee: "You seem a little tired lately — could we find a time to talk about your workload?"
Resource Guide
Public Consultation Services
| Service | Contact | Hours |
|---|---|---|
| **Kokoro no Mimi Telephone Counseling** (MHLW) | 0120-565-455 | Weekdays 17:00–22:00, Weekends 10:00–16:00 |
| **Yorisoi Hotline** | 0120-279-338 | 24 hours |
| **Occupational Health Promotion Center** (産業保健総合支援センター) | 47 locations nationwide (one per prefecture) | Free on-site workplace support |
| **Regional Occupational Health Center (Chiisanpo)** (地域産業保健センター) | Approx. 350 locations nationwide | Free occupational health services for establishments with fewer than 50 employees |
Free Tools
- Kokoro no Mimi e-Learning: "Understanding Return-to-Work Support in 15 Minutes"
- ELECTRIC DOC. Return-to-Work Support Manual, Checklists, and Daily Activity Logs (free PDF download)
Conclusion
Re-leave is not something that "might happen" — it is a risk that should be anticipated and planned for. The 47–54% re-leave rate must be understood not as a matter of individual willpower or recovery, but as a function of the post-return work environment and organizational support systems.
Phased workload adjustment, regular check-in interviews to capture changes in condition, and early detection of warning signs: embedding these three practices as institutional systems — rather than leaving them to individual judgment — is what determines the effectiveness of re-leave prevention. Even SMEs without an occupational physician can take the most effective first step by utilizing the free on-site support from Occupational Health Promotion Centers to develop a return-to-work support program.
Frequently Asked Questions (FAQ)
Q: What is the re-leave rate after return to work?
Ministry of Health, Labour and Welfare research data shows that 47.1% of workers who took leave for depression return to leave within five years (MHLW, 2017). A 2025 survey by Leverages found that 53.7% of those who returned to work or changed jobs experienced re-leave, with more than half taking re-leave within less than one year.
Q: Can SMEs without an occupational physician still provide return-to-work support?
Yes. Regional Occupational Health Centers (Chiisanpo) provide free occupational health services to establishments with fewer than 50 employees. Mental health promotion staff at Occupational Health Promotion Centers also visit workplaces to assist in developing return-to-work support programs at no cost. The ELECTRIC DOC. return-to-work support manual is designed specifically for establishments without an occupational physician and is available for free download.
Q: Does the attending physician's "fit to return" mean "able to work as before"?
No. The attending physician's "fit to return" determination is typically based on recovery at the daily-living level and does not necessarily indicate that job performance capacity has been restored (MHLW, 2009). Phased workload adjustment is essential after return, and the MHLW guidelines envision a timeline of approximately six months before transition to regular duties.
Q: What should be covered in post-return check-in interviews?
Rather than the abstract question "How are you doing?", use specific prompts: (1) Sleep (morning wakefulness, difficulty falling asleep), (2) Perceived workload (whether fatigue carries over to the next day), (3) Workplace relationships, (4) General physical condition, (5) Daily rhythm (wake-up time, eating habits). Because re-leave cases tend to "put on a facade of being fine" (Nitta et al., 2024), the interview design should not rely solely on self-report.
Q: What are the warning signs of re-leave?
Observable warning signs include: increased tardiness or early departures, skipping lunch or spending more time alone, increased errors or declining concentration, flat facial expressions, lower voice tone, sudden weight changes, sharp increases in overtime (indicative of work overloading), and repeated responses of "I'm fine" (indicative of suppression). While each may seem minor individually, multiple signs appearing together warrant attention.
Sources and References
Government Publications
- Ministry of Health, Labour and Welfare (2009), "Guide for Supporting the Return to Work of Workers Who Have Taken Leave Due to Mental Health Issues (Revised Edition)." https://www.mhlw.go.jp/content/000561013.pdf
- Ministry of Health, Labour and Welfare (2024), "Results of the FY2023 Survey on Industrial Safety and Health (Workplace Conditions)." https://www.mhlw.go.jp/toukei/list/dl/r05-46-50_gaikyo.pdf
- Ministry of Health, Labour and Welfare (2017), FY2016 Occupational Injury and Illness Clinical Research Project (Survey on re-leave rates among depression leave-takers).
- Japan Organization of Occupational Health and Safety [JOHAS] (2019), "Return-to-Work Support Program (Rationale and Framework for Development)." https://www.johas.go.jp/Portals/0/pdf/johoteikyo/return_program.pdf
- Kokoro no Mimi, Ministry of Health, Labour and Welfare, "Return-to-Work Support Resources (For Employers and Supervisors)." https://kokoro.mhlw.go.jp/return/return-employer/
Survey Reports
- National Institute of Vocational Rehabilitation [NIVR] (2019), "Research on the Status of Return-to-Work Support (Research Report No. 156)." https://www.nivr.jeed.go.jp/research/advance/yomitoku_2019-11-004.html
- Leverages, Inc. (2025), "After Mental Health Leave, 70% of Workers in Their 20s Resign; Re-Leave After Job Change Also Prevalent." https://leverages.jp/news/2025/0901/5212/
Academic Papers
- Nitta, M., Nemoto, T., & Okada, K. (2024). "Cognitive and Behavioral Characteristics of Individuals with Depression Who Took Re-Leave After Returning to Work." Journal of Japan Academy of Nursing Science, 44, 702-711. https://www.jstage.jst.go.jp/article/jans/44/0/44_44702/_html/-char/ja
- Oki & Igarashi (2013). Report on post-return outcomes of rework program participants.
- Hori et al. (2013). Study on family relationships in successful return-to-work cases.
- Nakagawa & Ihara (2016). Study on factors associated with time to re-leave.
- Nakamura (2015). Study on interpersonal conflict stress among re-leave cases.
Practical Tools
- ELECTRIC DOC., "Return-to-Work Support Manual for Workers with Mental Health Issues." https://electricdoc.net/fukushoku
Related Content & Author
Related Article
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Author Profile
Kazuhiko Ehara
Occupational Counselor (certified by the Japan Industrial Counselors Association). Director, Kazuna Research Institute. After approximately 25 years in corporate life, became independent in 2018. Combines logical thinking from a career as an IT engineer with practical expertise cultivated in EAP (Employee Assistance Program) counseling to support mental health initiatives in small and medium enterprises. Having personally experienced 200–250 hours of monthly overtime in his twenties — and later recognizing his own desensitization to that pain — he continues to share the message: "It's okay to stop." Grounded in SFBT (Solution-Focused Brief Therapy), he provides Brief Coaching to walk alongside companies and their workers.