{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T17:52:02Z","timestamp":1776102722093,"version":"3.50.1"},"reference-count":15,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"unspecified","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,31]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Cognitive behavioural therapy (CBT) is recommended as a first-line treatment for depression and anxiety disorders, but its utilisation under Japan\u2019s national health insurance remains poorly understood. This study aimed to describe CBT utilisation patterns, quantify regional disparities across prefectures and analyse temporal trends from fiscal year (FY)2015 to FY2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This was a nationwide repeated cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Japan\u2019s National Database of Health Insurance Claims and Specific Health Checkups Open Data (NDB Open Data), FY2015\u20132023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>All patients who received insurance-covered CBT in FY2023, with a longitudinal comparison across FY2015\u20132023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The primary outcomes were annual CBT claims and patient counts. The secondary outcomes included prefecture-level distribution, population-adjusted utilisation rates per 100\u2009000 population, distribution by sex and age, monthly trends and temporal changes over 9 years. Regional variation in physician-delivered CBT was assessed using the coefficient of variation (CV) and extremal quotient (EQ).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In FY2023, the total CBT claims numbered 38\u2009045 with 8299 patients, representing only 0.14% of an estimated 6.03\u2009million psychiatric patients. Physician-delivered CBT accounted for 99.6% (37 886 claims), whereas nurse-delivered CBT introduced in 2016 remained at 0.4% (159 claims). 13 of the 47 prefectures (27.7%) had zero or fewer than 10 claims. The population-adjusted physician-delivered CBT claims ranged from 370.96 per 100\u2009000 in Okayama to 0.99 per 100\u2009000 in Kumamoto, yielding an EQ of 375-fold. The CV among the 34 prefectures with measurable physician-delivered CBT was 174.8%. Despite indication expansions in 2016 and 2018, claims decreased by 9.9% from 42\u2009216 in FY2015 to 38\u2009045 in FY2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Insurance-covered CBT in Japan remains severely underused, with significant regional disparities. Incremental policy measures, including indication expansions and nurse-delivered CBT, have failed to improve access. Fundamental system reforms, potentially including dedicated psychological therapy services, are needed to ensure equitable access to evidence-based psychological treatments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-115722","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:50:21Z","timestamp":1776099021000},"page":"e115722","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Regional disparities in insurance-covered cognitive behavioural therapy in Japan: a nationwide cross-sectional study using National Database Open Data, 2015\u20132023"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3862-110X","authenticated-orcid":false,"given":"Takayuki","family":"Fujii","sequence":"first","affiliation":[{"name":"Department of Nursing, Faculty of Nursing, Yasuda Women\u2019s University, Hiroshima, Hiroshima Prefecture, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3962-6211","authenticated-orcid":false,"given":"Yuji","family":"Nogami","sequence":"additional","affiliation":[{"name":"Student Counseling Office, Nakamura Gakuen University, Fukuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2999-4744","authenticated-orcid":false,"given":"Taiga","family":"Seo","sequence":"additional","affiliation":[{"name":"Akihabara Labor and Social Security Attorney Corporation, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"key":"2026041309501378000_16.4.e115722.1","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1002\/wps.21069","article-title":"Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta-analysis including 409 trials with 52,702 patients","volume":"22","author":"Cuijpers","year":"2023","journal-title":"World Psychiatry"},{"key":"2026041309501378000_16.4.e115722.2","unstructured":"National Institute for Health and Care Excellence . Depression in adults: treatment and management, nice guideline [ng222]. London: NICE; 2022. Available: https:\/\/www.nice.org.uk\/guidance\/ng222"},{"key":"2026041309501378000_16.4.e115722.3","unstructured":"Ministry of Health, Labour and Welfare . FY2016 revision of medical fee schedule [in Japanese]. Tokyo: MHLW; 2016. Available: https:\/\/www.mhlw.go.jp\/stf\/seisakunitsuite\/bunya\/0000106421.html"},{"key":"2026041309501378000_16.4.e115722.4","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-033365","article-title":"How was cognitive behavioural therapy for mood disorder implemented in Japan? A retrospective observational study using the nationwide claims database from FY2010 to FY2015","volume":"10","author":"Hayashi","year":"2020","journal-title":"BMJ Open"},{"key":"2026041309501378000_16.4.e115722.5","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1111\/pcn.13294","article-title":"Has the 2016 expansion of mental disorders covered under national health insurance increased the use of cognitive behavioral therapy in Japan? An analysis of the National Open Data Base","volume":"75","author":"Haraguchi","year":"2021","journal-title":"Psychiatry Clin Neurosci"},{"key":"2026041309501378000_16.4.e115722.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement","volume":"12","author":"Benchimol","year":"2015","journal-title":"PLoS Med"},{"key":"2026041309501378000_16.4.e115722.7","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(07)61602-x"},{"key":"2026041309501378000_16.4.e115722.8","doi-asserted-by":"crossref","first-page":"28","DOI":"10.37737\/ace.1.2_28","article-title":"Real World Data in Japan: Chapter I NDB","volume":"1","author":"Yasunaga","year":"2019","journal-title":"Ann Clin Epidemiol"},{"key":"2026041309501378000_16.4.e115722.9","unstructured":"Ministry of Health, Labour and Welfar . NDB open data [in Japanese]. Tokyo: MHLW; 2025. Available: https:\/\/www.mhlw.go.jp\/stf\/seisakunitsuite\/bunya\/0000177182.html"},{"key":"2026041309501378000_16.4.e115722.10","unstructured":"Statistics Bureau of Japan . Population estimates (as of october 1, 2023) [in japanese]. Tokyo: Statistics Bureau, 2024. Available: https:\/\/www.stat.go.jp\/data\/jinsui\/2023np\/index.html"},{"key":"2026041309501378000_16.4.e115722.11","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2288-11-172","article-title":"Shared component modelling as an alternative to assess geographical variations in medical practice: gender inequalities in hospital admissions for chronic diseases","volume":"11","author":"Ib\u00e1\u00f1ez-Beroiz","year":"2011","journal-title":"BMC Med Res Methodol"},{"key":"2026041309501378000_16.4.e115722.12","unstructured":"Ministry of Health, Labour and Welfare . Summary of patient survey 2023 [in japanese]. Tokyo: MHLW; 2024. Available: https:\/\/www.mhlw.go.jp\/toukei\/saikin\/hw\/kanja\/23\/index.html"},{"key":"2026041309501378000_16.4.e115722.13","unstructured":"NHS England . London: NHS Digital; NHS Talking Therapies, for anxiety and depression: Annual reports 2023\u201324, 2024. Available: https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/nhs-talking-therapies-for-anxiety-and-depression-annual-reports\/2023-24"},{"key":"2026041309501378000_16.4.e115722.14","unstructured":"Takahashi F , Takegawa S , Okumura Y , et al . Survey on the implementation of cognitive behavioral therapy at psychiatric clinics in Japan [in Japanese], Available: http:\/\/ftakalab.jp\/wordpress\/wp-content\/uploads\/2011\/08\/japancbtclinic_report.pdf"},{"key":"2026041309501378000_16.4.e115722.15","doi-asserted-by":"publisher","DOI":"10.1080\/16506073.2017.1401115"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-115722","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:50:25Z","timestamp":1776099025000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-115722"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":15,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,13]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bmjopen-2025-115722"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-115722","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}