Psychosomatics 48:6, November-December 2007 http://psy.psychiatryonline.org 517 A Comparison of Psychiatric Consultation–Liaison Services Between Hospitals in the United States and Japan YASUHIRO KISHI, M.D., WILLIAM H. MELLER, M.D. MASASHI KATO, M.D., STEVEN THURBER,PH.D. SUSAN E. SWIGART, M.D., TORU OKUYAMA, M.D. KATSUNAKA MIKAMI, M.D., ROGER G. KATHOL, M.D. TAKASHI HOSAKA, M.D., TAKAYUKI AOKI, M.D. The authors investigated psychiatric consultation in two hospitals, one in the United States, the other in Japan. They examined similarities and differences, and drew inferences on possible cross-cultural values and/or temporary cultural conditions. As compared with the Japanese con- sultation patients, the Americans had more mood disorders, including anxiety and chemical- dependency problems, in respective diagnostic classifications. Patients in the United States also showed more acute as well as more serious chronic conditions. These differences may relate to disorder base-rates in the respective countries. In general, psychosocial problems emerged as as- cendant in Japan, as compared with chemical-dependency difficulties among American patients. The results are discussed in terms of current conditions in Japan that affect the mental health professions, together with attempts by Japanese clinicians to protect collective mores by ascrib- ing causation for disorders to the individual, rather than the societal conditions often invoked in the United States. (Psychosomatics 2007; 48:517–522) Received December 26, 2005; revised July 8, 2006; accepted July 13, 2006. From the Dept. of Psychiatry, Univ. of Minnesota; the Dept. of Psychiatry, Tokai University; the Dept. of Psychiatry, Saitama Medical Center, Saitama Medical School; the Dept. of Psychiatry, Saitama Psy- chiatric Center; the Dept. of Psychiatry, Nagoya City University; and the Dept. of Psychology, Woodland Centers. Send correspondence and reprint requests to Dr. Yasuhiro Kishi, Dept. of Psychiatry, Saitama Medical Cen- ter, 1981 Tsujido-machi, Kamoda, Kawagoe Saitama, 350-8550, Japan. e-mail (Dr. Thurber): steven_thurber@yahoo.com  2007 The Academy of Psychosomatic Medicine T he aim of this study is to explore possible similarities and differences between two hospital consultation ser- vices, one in a major American city in Minnesota (catch- ment area: 3 million), the other in the central part of Kan- agawa, Japan (catchment area: 1 million). Heretofore, investigations of consultation–liaison services have in- volved comparisons between the United States and coun- tries in Europe. It was reasoned that the notable differences between the United States and Japan in areas such as cul- tural, healthcare systems, and political structures might be reflected in the nature of the patients referred for psychi- atric consultation. METHOD The participants included patients consecutively referred to the psychiatric consultation–liaison service of Fairview University Medical Center at the University of Minnesota (from January 1, 2001 through December 31, 2001) and the Psychiatric Service of Tokai University Hospital, Kan- agawa, Japan. The Japanese referrals occurred from July 1, 2003 through June 30, 2004. This period was selected because of a major change in the Japanese system, from “fee-for-service” to a “lump-sum” payment system with