Mental health care and East Japan Great Earthquake

Addressing challenges in children's mental health in disaster-affected areas in Japan and the Philippines - highlights of the training program by the National Center for Global Health and Medicine

Background and purpose

Natural disasters such as earthquakes, typhoons, floods, and volcanic eruptions frequently occur in Republic of Philippines and mental health care for children affected by these natural disasters is a major public health concern. Aiming to train health professionals on children’s mental health, to conduct a situational analysis to identify the local needs and resources for children’s mental health, and to propose a mental health program for children that can be transferred from Japan to the Philippines, the National Center for Global Health and Medicine (NCGM) conducted a training program for children’s mental health in disaster-affected areas in Japan and the Philippines in June, October, and December, 2017. The training was organized by NCGM for the Program for International Promotion of Japan’s Healthcare Technologies and Services funded by Ministry of Health, Labour, & Welfare, Japan in relation to the Memorandum of Understanding in the Field of Healthcare between NCGM in Japan and University of the Philippines Manila, College of Public Health.

Key highlights

The training program consisted of classroom trainings, site visits, and round table discussions in Japan and the Philippines. The classroom trainings and site visits focused on two points: the experiences of individuals and families who survived the Great East Japan Earthquake (GEJE) in 2011 and super typhoon Haiyan in 2013 and the program and activities, especially on mental health, of various government and non-government organizations in helping the affected families and communities. The round table discussion, on the other hand, was conducted to identify challenges related to children’s mental health in disaster-affected areas and to develop recommendations to address these challenges.

The major recommendations for the Philippines were to give equal emphasis to physical and psychosocial preparedness and to develop a comprehensive program to care for carers. In Japan, public health and mental health should be integrated in the Disaster Medical Service. Experts from both countries should also generate evidence on the effectiveness of interventions in reducing mental health stigma and collaborate with school personnel and communities in order to learn more about psychosocial preparedness. Finally, mental health must be mainstreamed in programs not only in Japan but also in other countries.

Implications

The training program enabled key stakeholders to describe the current situation of mental health in Japan and the Philippines, to identify mental health challenges common to disaster-affected areas in both countries, and to propose short- and long-term plans and recommendations. The training program is expected to address the mental health needs of children in disaster-affected areas through a responsive community-based support network. The training participants agreed to form a network and build partnerships toward the common goal of mainstreaming community-based support for children’s mental health in disaster-affected areas in Japan and the Philippines.

Suicide Rates in Evacuation Areas After the Fukushima Daiichi Nuclear Disaster

Abstract.Background: Associations between nuclear disasters and suicide have been examined to a limited extent. Aim: To clarify the suicide rates in evacuation areas after the nuclear disaster in Fukushima, which occurred in March 2011. Method: This descriptive study used monthly data from vital statistics between March 2009 and December 2015. Suicide rates in areas to which evacuation orders had been issued, requiring across-the-board, compulsory evacuation of residents from the entire or part of municipalities, were obtained and compared with the national average. Results: Male suicide rates in evacuation areas increased significantly immediately after the disaster, and then began to increase again 4 years after the disaster. Female suicide rates declined slightly during the first year and then increased significantly over the subsequent 3-year period. Moreover, male rates in areas where evacuation orders were issued for the total area declined over the course of approximately 2 years, but then began to increase thereafter. Analysis by age revealed postdisaster male rates in evacuation areas decreased for those aged 50–69 years and increased for those aged ≤ 29 years and ≥ 70 years. Limitations: The number of suicides among females and the female population in the evacuation area was small. Conclusion: Our findings suggest the need to keep in mind that, when providing post-disaster mental health services, suicide rates can eventually increase even if they initially decrease.

The Relationship between Starting to Drink and Psychological Distress, Sleep Disturbance after the Great East Japan Earthquake and Nuclear Disaster: The Fukushima Health Management Survey

This longitudinal study aimed to investigate the prevalence of newly-started drinkers and their continuing drinking behaviors after the Great East Japan earthquake. Moreover, the relationships between newly-started drinking and psychological factor, disaster-related experience, and perceived radiation risk were examined. We used data from 37,687 pre-disaster non-drinkers who participated in the 2012 and 2013 surveys conducted in Fukushima. We defined newly-started drinkers as those who did not drink before the disaster but who began drinking after the disaster, based on information collected retrospectively. In 2012, 9.6% of non-drinkers began drinking, of which the prevalence of heavy drinkers was 18.4%. The prevalence of continued drinking among newly-started drinkers in 2013 was 53.8%. Logistic regression analyses revealed post-disaster newly-started drinking was significantly associated with being male, less than 65 years old, sleep dissatisfaction and psychological distress (Kessler 6 ≤ 13) when this model was adjusted for disaster-related experience and perceived radiation risk. Moreover, psychological distress and heavy drinking were significant risk factors for continued drinking among newly-started drinkers. Newly-started drinkers might use alcohol to cope with disaster-related stress. Thus, they may be targeted for disaster-related health services. Moreover, early intervention should encourage responsible drinking, since post-disaster heavy drinkers were likely to continue heavy drinking.

Noncommunicable Diseases After the Great East Japan Earthquake: Systematic Review, 2011-2016

OBJECTIVE

Noncommunicable diseases (NCDs), including mental disorders, have become major threats to human health worldwide. People with NCDs are particularly vulnerable to disasters. We systematically reviewed reports describing studies of NCDs at the time of the Great East Japan Earthquake (GEJE) to clarify the circumstances of people with NCDs and to build strong measures to support them.

METHODS

Relevant articles published from March 2011 through December 2016 were collected by searching the PubMed database (National Library of Medicine). We specifically examined reports describing NCDs and including the key words "East Japan Earthquake." NCDs included every disease type aside from injury and infectious disease.

RESULTS

We collected 160 relevant articles, 41 of which described NCDs that existed in residents before the GEJE. Articles describing respiratory diseases and mental illnesses were found most frequently. Interruption of regular treatment was the most frequent problem, followed by lack of surveillance capacity. We found 101 reports describing NCDs that had developed after the GEJE, of which 60% were related to mental health issues.

CONCLUSIONS

NCDs pose major health issues after large-scale disasters. Establishment of strong countermeasures against interruption of treatment and surveillance systems to ascertain medical needs for NCDs are necessary to prepare for future disasters. (Disaster Med Public Health Preparedness. 2018; 12: 396-407).

Practical Report on Long-term Disaster Mental Health Services Following the Great East Japan Earthquake: Psychological and Social Background of Evacuees in Sendai City in the Mid- to Long-term Post-disaster Period

OBJECTIVE

The Great East Japan Earthquake, which occurred on March 11, 2011, caused unprecedented damage. To address evacuees' psychosocial issues, our disaster mental health team provided psychosocial support in the form of careful listening and providing information for reconstruction.

METHODS

To summarize evacuees' psychosocial issues, we reviewed records of our daily activities and analyzed factors related to continuation or termination of support. Terminated support was defined as the resolution or improvement of psychological issues relative to the time of initial support.

RESULTS

Based on logistic regression analysis, living in prefabricated temporary housing (odds ratio [OR]: 0.37; 95% confidence interval [CI]: 0.19-0.72), a high number of improved stress symptoms (0.81; 95% CI: 0.67-0.99), and higher support frequency (0.84; 95% CI: 0.78-0.90) were significantly associated with a lower likelihood of continuing support. Conversely, economic and resettlement issues (2.75; 95% CI: 1.63-4.64) and high numbers of stress symptoms (1.24; 95% CI: 1.06-1.45) were strongly and significantly associated with continuing support, particularly in the mid- to long-term phase following the earthquake (ie, after August 1, 2011). No significant association was found between support status and alcohol problems or disaster-related experiences (eg, loss of family or housing).

CONCLUSION

Our findings highlight the need to be aware of evacuees' social issues such as resettlement in the mid- to long-term post-disaster phase. (Disaster Med Public Health Preparedness. 2017;11:439-450).

Post-traumatic growth of children affected by the Great East Japan Earthquake and their attitudes to memorial services and media coverage

AIMS

Post-traumatic growth (PTG) refers to positive changes that result from coping with a major life crisis or a traumatic event. Factors influencing PTG in youth have not been well characterized but could have a great impact on overall maturation.

METHODS

Fourth to ninth graders (n = 3337) attending elementary or junior high schools located in a district severely damaged by the Great East Japan Earthquake completed a questionnaire, including the revised Posttraumatic Growth Inventory for Children (PTGI-C-R) along with the Post Traumatic Stress Symptoms for Children 15 items (PTSSC-15), 31 months after the event. Experience of the disaster, prior traumatic experiences, and attitudes toward memories of the disaster (rumination) were scored by their caregivers and teachers, and effects of these factors on PTG were evaluated.

RESULTS

There were no significant associations between PTGI-C-R and sex or experiences of the disaster. However, PTGI-C-R was negatively correlated with age (r = -0.132, P < 0.001). There was significant but very weak negative correlation between PTGI-C-R and PTSSC-15 among the children (r = -0.096, P < 0.001). PTGI-C-R was significantly associated with positive attitudes to memorial services (P < 0.001) and media coverage (P < 0.05).

CONCLUSION

Positive attitudes to deliberate rumination may facilitate PTG in children following natural disasters.

Delayed increase in male suicide rates in tsunami disaster-stricken areas following the great east japan earthquake: a three-year follow-up study in Miyagi Prefecture

Devastating natural disasters and their aftermath are known to cause psychological distress. However, little information is available regarding suicide rates following tsunami disasters that destroy regional social services and networks. The aim of the present study was to determine whether the tsunami disaster following the Great East Japan Earthquake in March 2011 has influenced suicide rates. The study period was from March 2009 to February 2014. Tsunami disaster-stricken areas were defined as the 16 municipalities facing the Pacific Ocean in Miyagi Prefecture. Inland areas were defined as other municipalities in Miyagi that were damaged by the earthquake. Suicide rates in the tsunami disaster-stricken areas were compared to national averages, using a time-series analysis and the Poisson distribution test. In tsunami disaster-stricken areas, male suicide rates were significantly lower than the national average during the initial post-disaster period and began to increase after two years. Likewise, male suicide rates in the inland areas decreased for seven months, and then increased to exceed the national average. In contrast, female post-disaster suicide rates did not change in both areas compared to the national average. Importantly, the male suicide rates in the inland areas started to increase earlier compared to the tsunami-stricken areas, which may reflect the relative deficiency of mental healthcare services in the inland areas. Considering the present status that many survivors from the tsunami disaster still live in temporary housing and face various challenges to rebuild their lives, we should continue intensive, long-term mental healthcare services in the tsunami-stricken areas.

Trauma signature analysis of the great East Japan disaster: guidance for psychological consequences

OBJECTIVES

On March 11, 2011, Japan experienced the largest earthquake in its history. The undersea earthquake launched a tsunami that inundated much of Japan's eastern coastline and damaged nuclear power plants, precipitating multiple reactor meltdowns. We examined open-source disaster situation reports, news accounts, and disaster-monitoring websites to gather event-specific data to conduct a trauma signature analysis of the event.

METHODS

The trauma signature analysis included a review of disaster situation reports; the construction of a hazard profile for the earthquake, tsunami, and radiation threats; enumeration of disaster stressors by disaster phase; identification of salient evidence-based psychological risk factors; summation of the trauma signature based on exposure to hazards, loss, and change; and review of the mental health and psychosocial support responses in relation to the analysis.

RESULTS

Exposure to this triple-hazard event resulted in extensive damage, significant loss of life, and massive population displacement. Many citizens were exposed to multiple hazards. The extremity of these exposures was partially mitigated by Japan's timely, expert-coordinated, and unified activation of an evidence-based mental health response.

CONCLUSIONS

The eastern Japan disaster was notable for its unique constellation of compounding exposures. Examination of the trauma signature of this event provided insights and guidance regarding optimal mental health and psychosocial responses. Japan orchestrated a model response that reinforced community resilience.

Changes in suicide rates in disaster-stricken areas following the Great East Japan Earthquake and their effect on economic factors: an ecological study

OBJECTIVE

Devastating disasters may increase suicide rates due to mental distress. Previous domestic studies have reported decreased suicide rates among men following disasters. Few reports are available regarding factors associated with disasters, making it difficult to discuss how these events affect suicide rates. This study aimed to observe changes in suicide rates in disaster-stricken and neighboring areas following the Great East Japan Earthquake, and examine associations between suicide rates and economic factors.

METHODS

Monthly suicide rates were observed from March 2009 to February 2013, during which time the earthquake occurred on March, 2011. Data were included from disaster-stricken (Iwate, Miyagi, and Fukushima Prefectures) and neighboring (control: Aomori, Akita, and Yamagata Prefectures) areas. The association between changes in suicide rates and economic variables was evaluated based on the number of bankruptcy cases and ratio of effective job offers.

RESULTS

In disaster-stricken areas, post-disaster male suicide rates decreased during the 24 months following the earthquake. This trend differed relative to control areas. Female suicide rates increased during the first seven months. Multiple regression analysis showed that bankruptcy cases (β = 0.386, p = 0.038) and ratio of effective job offers (β = -0.445, p = 0.018) were only significantly associated with male post-disaster suicide rates in control areas.

CONCLUSION

Post-disaster suicide rates differed by gender following the earthquake. Our findings suggest that considering gender differences might be important for developing future post-disaster suicide prevention measures. This ecological study revealed that increasing effective job offers and decreasing bankruptcy cases can affect protectively male suicide rates in control areas.

Posttraumatic symptoms in elementary and junior high school children after the 2011 Japan earthquake and tsunami: symptom severity and recovery vary by age and sex

OBJECTIVES

To measure psychiatric symptoms exhibited by children in Ishinomaki City, Japan, an area severely damaged by the 2011 earthquake and tsunami, at 8 and 20 months post-tsunami to investigate differences in symptom severity and recovery rate by age, sex, and degree of trauma experienced.

STUDY DESIGN

Prospective data were collected from children in elementary school (5th and 6th grades) and junior high school (8th and 9th grades). Students completed the Post-Traumatic Stress Symptoms for Children-15 (PTSSC-15) survey. Trauma severity was scored according to experiences of bereavement, home damage, and evacuation. In total, 3795 PTSSC-15 surveys were analyzed, yielding total scores, post-traumatic stress disorder (PTSD) factor subscores, and depression factor subscores, which were analyzed according to grade group, sex, and degree of trauma (trauma dose).

RESULTS

In the elementary school children, mean total PTSSC-15 score, PTSD factor score, and depression factor score were significantly improved at 20 months post-tsunami compared with 8 months (P < .0001 for all), whereas there were no significant improvements in the junior high school children. In females of the older group, the depression factor score at 20 months post-tsunami was significantly higher than at 8 months (P < .01).

CONCLUSIONS

Elementary school and junior high school children living near the epicenter of the 2011 Japan earthquake and tsunami exhibited marked differences in PTSD and depressive symptoms. The mental health status of elementary school children improved, whereas that of junior high school children did not.

Diabetes care: After the Great East Japan Earthquake

The Great East Japan Earthquake and subsequent tsunami destroyed large parts of Japan's Tohoku district. Special efforts were made regarding the prompt distribution of medical supplies, including insulin, for diabetic patients. However, many diabetic patients in the shelters lost their blood glucose control as a result of the unfavorable living environment. The high‐calorie food provided led to severe postprandial hyperglycemia. Furthermore, mental stress can aggravate diabetic control and these patients require special mental care. We have a few suggestions to propose in preparation for future disasters based on the experience gained from our shelter visits during this disaster. First, people in the affected areas had no way of accessing such information in the early days after the disaster. Therefore, we should consider the practical means of distributing important information in various situations. Second, guidelines and manuals for both diabetic patients and healthcare providers need to be created for the various situations that occur in the event of a natural disaster. We already have a few, but situations vary and several guidelines are required to cover different conditions. Manuals for the prescription of antidiabetic agents will be useful, especially for doctors who are not specialized in diabetes. Third, patients should be educated beforehand as to what to do and what to be prepared for in the case of a disaster; each of the various situations that might be encountered should be covered. Lectures about these issues might be included in educational classes for diabetic patients organized by each medical institution.

The Great East Japan Earthquake: Experiences and Suggestions for Survivors with Diabetes (perspective)

The Great East Japan Earthquake and the subsequent tsunami that occurred in the afternoon of March 11, 2011, destroyed large parts of Japan’s Tohoku district. Owing to the unfavorable living environment, many diabetic patients in the refuges lost control of their blood glucose levels, and in addition, the high-calorie food provided led to severe postprandial hyperglycemia. We recommend that diabetic patients keep personal stocks of medical supplies and the medication that they require daily, as well as records of their medication. We also recommend the creation of basic guidelines to facilitate the practical prescription of medication for diabetic patients under various conditions that may arise in the aftermath of a natural disaster.