Reduction of radiation-related anxiety promoted wellbeing after the 2011 disaster: 'Fukushima Health Management Survey'

Thoughts, perceptions and concerns of coastal residents regarding the discharge of tritium-containing treated water from the Fukushima Daiichi Nuclear Power Plant into the Pacific Ocean

BACKGROUND

As a part of the decontamination process after the Fukushima Daiichi Nuclear Power Plant accident of 2011, 1.32 million tonnes of tritium-containing water will be discharged from the power plant into the Pacific Ocean. Although radiobiological impacts of the treated water discharge on the public and the environment were reported to be minimal, Tomioka and Okuma locals expressed unease regarding the long-term recovery of their towns, which are economically dependent on the agricultural, fishery, and tourism sectors. This study presents thoughts, perceptions and concerns of Tomioka and Okuma locals regarding the discharge of FDNPP-treated water containing tritium into the Pacific Ocean to facilitate a more inclusive decision-making process that respects local stakeholder interests.

METHODS

Conducted from November to December 2022, surveys were mailed to current residents and evacuees aged 20 years or older registered with the town councils.

RESULTS

Out of 1268 included responses, 71.5% were from those > 65 years. 65.6% were unemployed, 76.2% routinely visited hospitals, and 85.5% did not live with children. 61% did not want to return to Okuma/Tomioka. Anxiety about radiation-related health effects (38.7%), consuming food produced in Okuma/Tomioka (48.0%) and genetic effects (45.3%) were low. >50% reported poor physical and mental health. 40% were acceptive, 31.4% were unsure, and 29.7% objected to the discharge plans. Multinomial regression analysis revealed that, compared to acceptive responders, those who objected were more likely to be female, unemployed, and have anxiety about radiation-related genetic effects and poor mental health. Unsure responders were similarly more likely to be female, anxious about radiation-related genetic effects and have poor mental health.

CONCLUSION

The poor mental health of the locals, connected to high levels of risk perception and anxiety about the loss of economic opportunities related to the discharge plans, must be addressed. The 30-year discharge process could handicap local industries and hamper post-disaster socioeconomic recovery due to the circulation of false rumours among consumers. These results highlight the need to actively involve residents in the towns' recovery process to address local concerns. The focus should be on the judicious combination of transparent science with the human aspect of recovery and narratives highlighting dialogues between local stakeholders and experts to enable the locals and the general public to make informed decisions about their protection and future.

Subjective Wellbeing and Related Factors of Older Adults Nine and a Half Years after the Great East Japan Earthquake: A Cross-Sectional Study in the Coastal Area of Soma City

This study examined older adults’ subjective wellbeing and related factors in the coastal area of Soma City nine and a half years after the Great East Japan Earthquake (GEJE). Data were collected from 65- to 84-year-old residents and 1297 participants via a questionnaire from October to November 2020. The participants were divided into two groups: housing complexes and non-housing complexes. The dependent variable was subjective wellbeing assessed via Lawton’s Philadelphia Geriatric Center Morale Scale (PGCMS). Using multivariate regression analysis, the factors most strongly related to a low PGCMS score for both groups were poor health conditions, difficulties resting while asleep, poor financial wellbeing, inability to chew certain foods, and fear of solitary death. The GEJE experience was further distinguished in the housing complex group by the loss of an important non-family individual; for the other group, important factors were female gender, junior high school education level or lower, limited social networks, and deterioration of a family member’s health. Older adults’ subjective wellbeing in Soma City was low after nine and a half years following the GEJE. For disaster victims and their families in both groups, it is crucial to implement measures such as long-term, continuous physical and mental health support.

Long-Term, Community-based Approach for Affected People Having Problems With Mental Health and Lifestyle Issues After the 2011 Fukushima Disaster: the Fukushima Health Management Survey

A Mental Health and Lifestyle Survey (MHLS) has been conducted yearly as part of the Fukushima Health Management Survey since 2012, in order to monitor different health issues related to long-term evacuation of affected people after the 2011 Fukushima disaster. This survey is a mail-based one of nearly 210,000 affected people living in the evacuation zone at the time of the disaster. Another purpose of the MHLS is to provide efficient interventions by telephone based on the results of the survey. Significant findings contributing to understanding of non-radiological health effects caused by long-term evacuation were obtained from the MHLS, directly connecting to telephone-based interventions for over 3,000 respondents per year. In this article, the mental health outcomes of the MHLS, including depressive symptoms and posttraumatic responses, are reviewed, and the usefulness of telephone-based interventions is discussed. The evidence showed that, despite improvement of core mental health outcomes, the prevalence of respondents at high risk of some psychiatric problems remained high compared to that among the general population in Japan. In particular, several mental health consequences of respondents staying outside of Fukushima Prefecture were higher than those staying inside Fukushima. Along with further efforts to increase the response rate, we need to continue and modify the MHLS to meet the requirements of the affected people and communities.

Trajectory and factors of radiation risk perception of students aged 10-12 years at the time of the Fukushima Daiichi Nuclear Power Station accident

Various studies have investigated radiation risk perceptions after the accident at the Fukushima Daiichi Nuclear Power Station. However, student surveys are limited. This study aimed to investigate the perception of radiation risk among students aged 18-20 years who were in the 5th and 6th grades of elementary school at the time of the accident. We surveyed students in the Fukushima Prefecture and outside the prefecture. Out of all the data, 59% of the respondents were living in the Fukushima Prefecture at the time of the accident and 41% outside the prefecture. Trajectory analysis showed that changes in anxiety levels over time since 2011 could be divided into five classes: (a) the anxiety was the highest, and this tendency persisted. (b) High at the beginning, but decreased more quickly than class 1. (c) High at the beginning, but it diminished quickly. (d) Not high, but did not diminish easily in later years. (e) Low from the beginning, and persisted. Multinomial logistic analysis showed that among students living outside the prefecture at the time of the accident, a significantly higher proportion was in groups 4 and 5 than in group 2. A significant proportion of boys were present in groups 3, 4 and 5. A significant proportion of students whose current educational institutions were inside the prefecture were present in group 3. The level of anxiety was associated with the academic course, but not with subjective knowledge of radiation. In contrast, in the qualitative analysis of the free text, 31% considered 'knowledge about radiation' as the reason for the reduction in anxiety level. At the time of the investigation, most young people were not anxious about radiation. However, approximately 20% still had strong anxiety. We established that continuous risk communication is necessary. Furthermore, that stabilization and support related to life in general is important.

Social and Mental Health Impact of Nuclear Disaster in Survivors: A Narrative Review

This narrative review synthesizes the literature on the psychological consequences of the Three Mile Island nuclear accident of 1979, the Chernobyl nuclear disaster of 1986, and the Fukushima nuclear disaster of 2011. A search was conducted on OVID for studies in English from 1966 to 2020. Fifty-nine studies were included. Living through a nuclear disaster is associated with higher levels of PTSD, depression, and anxiety. Decontamination workers, those living in closest proximity to the reactor, and evacuees experience higher rates of mental health problems after a nuclear disaster. Those with greater psychological resilience and social supports experience lower rates of psychological distress. Individual-level interventions, such as mindfulness training, behavioral activation, and cognitive reappraisal training, have shown modest benefits on improving psychological wellbeing. At the population level, many of the measures in place aimed at reducing exposure to radiation actually increase individuals’ anxiety. Technology-based supports have been studied in other types of natural disasters and it may be beneficial to look at mobile-based interventions for future nuclear disasters.

Mental Health Consequences of the Three Mile Island, Chernobyl, and Fukushima Nuclear Disasters: A Scoping Review

Many individuals who were affected by the Great East Japan earthquake and tsunami and the subsequent Fukushima Daiichi Nuclear Power Plant accident continue to face a challenging recovery. We reviewed the long-term mental health consequences of three major nuclear power plant accidents: the Three Mile Island (TMI, 1979), Chernobyl (1986), and Fukushima (2011) nuclear disasters. We examined the relevant prospective cohort studies and before-and-after studies that covered more than two timepoints, searching four databases (PubMed, Ichushi, PsyArticles, and PTSDPub). We identified a total of 35 studies: TMI, n = 11; Chernobyl, n = 6; and Fukushima, n = 18. The smaller numbers of early-phase studies (within 6 months) of the Chernobyl and Fukushima disasters may also indicate the chaotic situation at those timepoints, as large-scale interviews were conducted in the early phase after the TMI disaster. Although the patterns of effects on mental health outcomes were diverse, more than half of the participants in the studies we evaluated were categorized into low or under-threshold symptom groups in all three disasters. Across the three disasters, the radiation exposure level estimated by the proximity and stigma were the common risk factors for mental health outcomes. Our findings will contribute to a comprehensive understanding of the impact of the worst nuclear accidents in history on the affected individuals' mental health, and our results illustrate the longitudinal consequences of such disasters.

Measuring Online Wellbeing: A Scoping Review of Subjective Wellbeing Measures

With the increasing importance of the internet to our everyday lives, questions are rightly being asked about how its' use affects our wellbeing. It is important to be able to effectively measure the effects of the online context, as it allows us to assess the impact of specific online contexts on wellbeing that may not apply to offline wellbeing. This paper describes a scoping review of English language, peer-reviewed articles published in MEDLINE, EMBASE, and PsychInfo between 1st January 2015 and 31st December 2019 to identify what measures are used to assess subjective wellbeing and in particular to identify any measures used in the online context. Two hundred forty studies were identified; 160 studies were removed by abstract screening, and 17 studies were removed by full-text screening, leaving 63 included studies. Fifty-six subjective wellbeing scales were identified with 18 excluded and 38 included for further analysis. Only one study was identified researching online wellbeing, and no specific online wellbeing scale was found. Therefore, common features of the existing scales, such as the number and type of questions, are compared to offer recommendations for building an online wellbeing scale. Such a scale is recommended to be between 3 and 20 questions, using mainly 5-point Likert or Likert-like scales to measure at least positive and negative affect, and ideally life satisfaction, and to use mainly subjective evaluation. Further research is needed to establish how these findings for the offline world effectively translate into an online measure of wellbeing.

Analysis of direction of association between radiation risk perception and relocation using a random-intercept and cross lagged panel model: The Fukushima Health Management Survey

In the aftermath of a nuclear disaster, a person's radiation risk perception can harm their sociopsychological health. Although there are reports of an association between radiation risk perception and relocation, the direction of this association has not been clarified yet. In this study, we used a random-intercept and cross lagged panel model (RI-CLPM) to investigate the association and its direction between radiation risk perception and the prefectural-level relocation (i.e., inside/outside of Fukushima Prefecture). We did this by using five waves of longitudinal surveys between 2011 fiscal year and 2015 fiscal year among the people affected by the Fukushima disaster in 2011. We included 90,567 participants aged ≥15 years during the time of the disaster who responded to the questionnaire at least once. RI-CLPM was applied to examine the reciprocal relationship between radiation risk perception and locations. We used two radiation risk perception indicators (i.e., genetic effect and delayed effect) and two handling methods on missing data (i.e., listwise deletion and full information maximum likelihood estimation) as sensitive analyses. The effects of radiation risk perception on relocation were found to be negligibly small. Living inside Fukushima Prefecture reduced radiation risk perception irrespective of the difference of indicators or methods, highlighting that radiation risk perception did not dominantly govern whether people were living inside Fukushima Prefecture, but that the locations also affected radiation risk perception. This was the first study to reveal the direction of the association between radiation risk perception and relocation in the aftermath of nuclear disasters.

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Directionality between radiation risk perception and relocation is ambiguous.

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We analyzed the bidirectionality after the Fukushima disaster in Japan.

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The effects of radiation risk perception on relocation are negligibly small.

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Living inside Fukushima Prefecture reduces radiation risk perception.

Modeling reconstruction-related behavior and evaluation of influences of major information sources

Reconstruction has progressed steadily since the 2011 TEPCO's Fukushima Daiichi Nuclear Power Station accident. However, some people still hesitate to eat foods from Fukushima or to travel there, and there are concerns about the health risks of radiation. We investigated the relationships among reconstruction-related behavior, risk perception, types of information, and information sources, in order to consider appropriate measures for providing information and promoting reconstruction-related behavior a number of years after the accident. We conducted an online questionnaire survey (n = 1000) of Tokyo residents. First, a factor analysis was conducted on knowledge associated with radiation. Two factors were extracted; namely, "physical knowledge" and "health/social knowledge." We conducted structural equation modeling to construct a model of "knowledge," "radiation risk perception," and "intention concerning reconstruction-related behavior." "Intention concerning reconstruction-related behavior" decreased with "radiation risk perception" and increased with "health/social knowledge." In addition, "health/social knowledge" negatively affected "radiation risk perception;" this effect was not large, but it was significant. Second, respondents were clarified by information sources using a cluster analysis. Clusters that included respondents who got information from public relations materials issued by municipalities and websites of administrative agencies had a higher factor score for "health/social knowledge" than other clusters. The cluster of respondents who did not get any particular knowledge had the lowest factor score, which was significant, and also had a low "perception of reconstruction."

Risk perceptions regarding radiation exposure among Japanese schoolteachers living around the Sendai Nuclear Power Plant after the Fukushima accident

In response to the Fukushima Daiichi nuclear power plant disaster, the Nuclear Regulation Authority of Japan issued the new “Nuclear Emergency Response Guideline.” However, there is a perception that scientific information about the health impact of radiation exposure has not been adequately shared among the local government staffs, including schoolteachers. We contacted schoolteachers at all 120 schools within the Urgent Protective Action Planning Zone of the Sendai Nuclear Power Plant, Kagoshima prefecture, in 2017. We invited them to take part in a written survey to clarify their concerns and risk perceptions regarding the effects of radiation exposure on health. Five hundred and fifty schoolteachers’ replies were included in the analysis. The results revealed that 355 schoolteachers had concerns about the health effects of radiation exposure due to working within the Urgent Protective Action Planning Zone. A logistic regression analysis revealed that sex (OR = 2.26, 95% CI: 1.49–3.45, p < 0.001), age (OR = 3.39, 95% CI: 2.10–5.47, p < 0.001), reluctance to undergo a radiological examination at a hospital (OR = 1.91, 95% CI: 1.23–2.88, p = 0.004), place of work (OR = 2.18, 95% CI: 1.46–3.27, p < 0.001), and anxiety about having to address questions about radiation from students (OR = 4.66, 95% CI: 2.83–7.67, p < 0.001) were independently associated with schoolteachers’ concerns about the health effects of radiation exposure due to working in the area around the nuclear power plant. Therefore, it is important to respond to these concerns in order to establish a meaningful education program for school children on radiation and its health effects.