Teachers and medical staff are among the professions most at risk of overwork, raising concerns about serious health issues — and even death — a government white paper on combating karōshi (death from overwork) showed Tuesday.

In a government survey cited in the white paper, teachers and officials at elementary, middle and high schools nationwide are working more than 11 hours per day on average. Senior staff such as vice principals were found to have worked particularly long hours, with a daily average of about 12.5 hours.

This means they worked 4.5 extra hours per day, or 90 hours per month — well over the 80-hour monthly overtime threshold that often sees the risk of death from overwork rise.

In the survey, which drew responses from some 35,000 schoolteachers and officials, 80.7 percent said they have grappled with stress or concerns related to work. In a response to a multiple-choice question, 43.4 percent cited long working hours as the cause of their distress.

Among other reasons, 40.2 percent identified personal relationships at work, while 38.3 percent pointed to dealing with parents. Extracurricular activity duties were also cited as causing stress, including among 42.0 percent of junior high teachers and 36.2 percent of high school teachers.

The white paper was released Tuesday as part of a 2014 law intended to bolster steps to prevent karōshi.

Calling for the need to address overwork and stress, the paper listed teachers, medical staff, drivers, workers in the information technology sector and restaurant workers as five professional categories that require attention due to their particularly grueling working hours.

Asked about measures needed to rein in overtime work, 78.5 percent of the teachers and school officials polled called for an increase in staff. This was followed by 54.4 percent who said a review of school events was needed, 43.1 percent who said better communication among teachers was necessary and 38.8 percent who voiced a need for shorter school meeting hours.

The white paper also touched on the need to conduct stress tests to make workers better aware of their conditions and help create a more positive working environment.

The paper also looked into doctors and nurses who were awarded workers’ compensation.

Many nurses developed psychological disorders due to verbal and physical abuse by patients or because of suicides they had witnessed.

According to the paper, 52 cases, most involving nurses in their 30s or younger, were recognized as work-related illnesses and were awarded workers’ compensation. A majority of cases occurred during nighttime working hours, from midnight to 8 a.m.

The paper called for the establishment of a system to report ill treatment and abuse at work and to offer mental health support for victims.

For the cases concerning doctors, most were awarded compensation due to long working hours.

The white paper cited a survey of about 9,400 medical personnel in which paperwork was identified by the largest number of doctors and nurses as the reason they needed to work extra hours.

The government is aiming to slash the proportion of employees working more than 60 hours per week to a maximum of 5 percent by 2020. In 2017, the figure stood at 7.7 percent, unchanged from the previous year.