printing company in Tokyo for 4,320 hours a year including night work (equivalent of nearly six months, thus half a year) and died from a stroke at the age of 58. His widow received workers' compensation 14 years after her husband's death. Ms. D, a 22-year-old nurse, died from a heart attack after 34 hours of continuous duty five times a month. As well as physical pressure, mental stress from the workplace can cause karoshi. People who die by suicide due to mental stress are called karōjisatsu (). The ILO also lists some causes of overwork or occupational stress that include the following: All-night, late-night or holiday work, both long and excessive hours. During the long-term economic recession after the collapse of the bubble economy in the 1980s and 1990s, many companies reduced the number of employees. The total amount of work, however, did not decrease, forcing each employee to work harder. Stress accumulated due to frustration at not being able to achieve the goals set by the company. Even in economic recession, companies tended to demand excessive sales efforts from their employees and require them to achieve better results. This increased the psychological burden placed on the employees at work. Forced resignation, dismissal, and bullying. For example, employees who worked for a company for many years and saw themselves as loyal to the company were suddenly asked to resign because of the need for staff cutbacks. Suffering of middle management. They were often in a position to lay off workers and torn between implementing a corporate restructuring policy and protecting their staff. Karoshi Hotline In a 1988 report published by the Karoshi Hotline Network, the majority of the clients who consulted were not workers, but the wives of the workers who had either died because of karoshi or were at high risk of doing so. This indicated that those who were stressed out by work either did not realize the cause was overwork or were under social pressure to not express it explicitly or to seek help. The Karoshi Hotline received the highest number of calls when it was first established in 1988. From 1988 to 1990, there were a total number of 1806 calls received. From 1990 to 2007, the number of calls received per year decreased, but still maintained an average of 400 calls per year. Effects on society Suicide can be induced by overwork-related stress or