Diagnostic interview study of the prevalence of depression among public employees engaged in long-term relief work in Fukushima

Public Works Employees and Posttruamatic Stress Disorder: an At-Risk Population

Although not widely known, public works employees in the United States were designated as emergency providers during critical incidents in 2003 and have provided these public works services, when activated. These public works employees may be either employees of a specific government entity or, more recently, privately contracted employees who provide similar services for a government entity. First responders working critical incidents are at risk for psychological trauma and posttraumatic stress disorder (PTSD). It is less clear, however, whether government/contracted public works employees working the same critical incidents are subject to the same risk of onset. This paper reviewed 24 empirical studies assessing this possible association from 1980 to 2020. These studies included 94,302 government/contracted employees. Psychological trauma/PTSD was reported in all 24 manuscripts assessing PTSD. Three of these studies additionally reporting serious somatic health problems. Public works employees are at risk for onset and this is a worldwide issue. Study findings and treatment implications are presented.

Symposium on disaster-related deaths after the Fukushima Daiichi Nuclear Power Plant accident

Disaster deaths can be classified into direct and indirect deaths. Direct deaths are those caused by the direct physical effects of disasters, such as earthquakes, tsunamis, and radiation exposure. Indirect deaths are those caused by secondary health effects such as emergency evacuation, relocation, evacuation environment, disruption of health care delivery services, and psychosocial effects. In addition, in Japan, the term disaster-related deaths refers to indirect deaths in accordance with the disaster condolence payments system, which provides relief for bereaved families. On 11 March 2011, the Great East Japan Earthquake exposed several issues related to disaster-related deaths in Japan. Therefore, on 1 February 2022, a symposium on disaster-related deaths hosted by this study was held on the website. The symposium discussed the issues and challenges associated with disaster-related deaths for future disaster preparedness. The authors introduced the concept of 'shaking' at the symposium by defining 'shaking' as 'the repeated changes in the social and living environment that worsen health conditions, regardless of the disaster'. It was also pointed out that vulnerable populations are more likely to experience more pronounced health effects. This generalised concept of 'shaking' associated with disaster-related deaths suggests that it is important to anticipate disasters before they occur to take specific preventive measures, targeted at vulnerable populations. This study found that disaster-related deaths in Japan create several problems in terms of future radiation disaster preparedness and medical countermeasures. In the future, there will be a need to examine the relevance of the issues of disaster-related deaths identified as a result of this symposium for future radiation disaster preparedness.

Occupational Difficulties of Disaster-Affected Local Government Employees in the Long-Term Recovery Phase after the Fukushima Nuclear Accident: A Cross-Sectional Study Using Modeling Analysis

Local government officials play a central role in post-disaster community reconstruction. However, few studies have reported on the actual difficulties during a complex disaster involving a nuclear accident. A self-rated questionnaire survey was administered to a total of 583 public employees in four municipalities around the Fukushima Daiichi Nuclear Power Station. The relationship between universal occupational factors and radiation disaster-specific factors on job satisfaction and intention to leave the job due to radiation anxiety was evaluated using structural equation modeling. The results showed that interpersonal problems (β = −0.246) and service years (β = −0.127) were related to job satisfaction, whereas radiation-specific factors were not related to job satisfaction, and only to the intention to leave work due to radiation anxiety. A sense of coherence was associated with job satisfaction (β = 0.373) and intention to leave work due to radiation anxiety (β = −0.182), and it served as a moderator of the universal occupational factors and the radiation disaster-specific factors. Therefore, it is suggested that outcomes could be improved through increased stress coping capacity by providing support for relationships and radiation risk communication to public employees during the disaster recovery period.

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 for survivors of the 2011 Fukushima nuclear disaster: a systematic review. Part 2: emotional and behavioral consequences

To compile the findings of studies assessing emotional and behavioral changes in the survivors of the 2011 Fukushima nuclear disaster, we performed a systematic review in August 2019 using four literature databases (PubMed, PsycINFO, Psychology and Behavioral Sciences Collection, and ICHUSHI). Peer-reviewed manuscripts, either in English or Japanese, were included in the searches. Sixty-one studies were retrieved for the review. Of these, 41 studies (67.2%) assessed emotional consequences, 28 studies (45.9%) evaluated behavioral consequences, and 8 studies (13.1%) evaluated both emotional and behavioral outcomes. The main research topic in emotional change was radiation exposure-associated risk perception, as reported in 15 studies. This risk perception included immediate health effects (eg, acute radiation syndrome) as well as future health effects (eg, future cancer and genetic effects). Lowered subjective well-being was reported in eight studies. Six studies reported perceived discrimination/stigmatization in the disaster survivors. The most critical behavioral change was an increase in suicides compared with residents in the whole of Japan or affected by the earthquake and tsunami, but not by the nuclear disaster. Increased rate of alcohol and tobacco use was reported, although the effect on one's health was inconsistent. As a conclusion, the Fukushima nuclear disaster survivors suffered issues in risk perception, well-being, stigmatization, and alcohol/tobacco use in the first 8 years after the disaster. The present study is important in order to better understand the emotional and behavioral responses to future nuclear/radiological disasters as well as other "invisible" disasters, such as chemical and biological public health crises.

Mental health consequences for survivors of the 2011 Fukushima nuclear disaster: a systematic review. Part 1: psychological consequences

To integrate scholastic literature regarding the prevalence and characteristics of the psychological consequences faced by survivors of the 2011 Fukushima earthquake/tsunami/nuclear disaster, we conducted a systematic review of survivor studies concerning the Fukushima disaster. In August 2019, four literature databases (PubMed, PsycINFO, Psychology and Behavioral Sciences Collection, and ICHUSHI) were used in the literature search. Peer-reviewed manuscripts reporting psychological consequences, either in English or Japanese, were selected. A total of 79 studies were selected for the review. Twenty-four studies (30.4%) were conducted as part of the Fukushima Health Management Survey-large-scale cohort study recruiting the residents of the entire Fukushima prefecture. Study outcomes were primarily nonspecific psychological distress, depressive symptoms, post-traumatic stress symptoms, and anxiety symptoms. The rates of high-risk individuals determined by the studies varied significantly owing to methodological differences. Nevertheless, these rates were mostly high (nonspecific psychological distress, 8.3%-65.1%; depressive symptoms, 12%-52.0%; and post-traumatic stress symptoms, 10.5%-62.6%). Many studies focused on vulnerable populations such as children, mothers of young children, evacuees, and nuclear power plant workers. However, few studies reported on the intervention methods used or their effect on the survivors. As a conclusion, high rates of individuals with psychological conditions, as well as a wide range of mental conditions, were reported among the Fukushima nuclear disaster survivors in the first 8 years after the disaster. These findings demonstrate the substantial impact of this compound disaster, especially in the context of a nuclear catastrophe.

Trajectories for Post-traumatic Stress Disorder Symptoms Among Local Disaster Recovery Workers Following the Great East Japan Earthquake: Group-based Trajectory Modeling

BACKGROUND

As many local municipality and medical workers were involved in disaster recovery duties following the Great East Japan Earthquake (GEJE) on March 11, 2011, the aim of this work was to elucidate the distinct trajectories for post-traumatic stress disorder (PTSD) symptoms and associated factors among these personnel. They confronted a diverse range of stressors both as survivors and as relief workers; however, little is known about their longitudinal PTSD symptoms.

METHODS

The participants were 745 local municipality and hospital medical workers [average age: 43.6 ± 9.5 years, range: 20 - 66 years; 306 (59%) women] involved in disaster recovery duties following the GEJE. PTSD symptoms were measured using the Japanese version of the PTSD Checklist Specific Version (PCL-S) at four time points: 14, 30, 43, and 54 months after the GEJE. Using group-based trajectory modeling, distinct trajectories were elucidated.

RESULTS

We identified five distinct PTSD symptoms profiles: resistance (n = 467, 62.7%), subsyndromal (n = 181, 24.3%), recovery (n = 47, 6.3%), fluctuating (n = 26, 3.5%), and chronic (n = 24, 3.2%). The trajectories differed according to the post-disaster working conditions and personal disaster experiences.

LIMITATIONS

Potential selection bias resulting from the limited number of participants who completed all waves. The survey was conducted in one region of the disaster area.

CONCLUSIONS

The majority of participants remained stable, with a relatively small group classified as chronic and fluctuating. Our results highlight the importance of improved working conditions and sustained monitoring of workers responding to natural disasters.

Factors related to the fatigue of relief workers in areas affected by the Great East Japan Earthquake: survey results 2.5 years after the disaster

Background

After the Great East Japan Earthquake (March 11, 2011), the fatigue of relief workers became a major problem in affected areas. In the present study, we conducted a questionnaire survey 2.5 years post-disaster identifying factors related to the fatigue of relief workers.

Methods

This survey was cross-sectional and participants (N = 119) were relief workers living in affected areas. We used a self-administered questionnaire which included participants’ current problems, sources of strong feeling of loss, psychological distress and compassion fatigue. Based on answers (Yes/No) to the fatigue item, we created 2 groups; a Fatigue-group and a Non-fatigue group. We employed bivariate analysis on items with significant differences between the two groups and entered them into a multivariable logistic regression model.

Results

Fifty-seven (48%) reported that they were “very tired” and were assigned to the Fatigue group. The total score of the 6-item Kessler Psychological Distress Scale (K6) and each subscale score (burnout, secondary trauma, and compassion satisfaction) of the Professional Quality of Life measure (Pro-QOL) in the Fatigue group were significantly higher than those in the Non-fatigue group. There were significant differences between the two groups for 11 items relating to current problems and sources of strong feelings of loss, and the following items were extracted as factors related to the fatigue of relief workers: loss of trust in others (adjusted OR, 10.03: 95%CI, 2.30–43.79), no confidence to continue work (adjusted OR, 6.27: 95%CI, 1.72–22.83), loss of important person(s) (adjusted OR, 5.58: 95%CI, 2.05–15.19), and sleep disturbance (adjusted OR, 5.14: 95%CI, 1.93–13.67).

Conclusion

Many relief workers who reported fatigue had experienced various losses and current problems. Adequate consideration and care systems for local relief workers with fatigue should be given for a long-period after a disaster and it is important for the workers themselves to continue accepting support from others and maintaining self-care habits.

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).

Mental Health Consequences and Social Issues After the Fukushima Disaster

The Great East Japan Earthquake and subsequent nuclear power plant accident caused multidimensional and long-term effects on the mental health condition of people living in Fukushima. In this article, focusing on the influence of the nuclear disaster, we present an overview of studies regarding the psychosocial consequences of people in Fukushima. Studies revealed that the experiences of the explosions at the plant as well as the tsunami are deeply embedded in their memory, leading to posttraumatic responses. Chronic physical diseases, worries about livelihood, lost jobs, lost social ties, and concerns about compensation were also associated with posttraumatic responses. Furthermore, the radioactive fallout brought chronic anxiety regarding physical risks of radiation exposure to people, especially young mothers. People often have different opinions about the radiation risk and their own future plans, resulting in a reduction in the resilience that communities and families had before the disaster. In addition, such weakened community resilience may produce a significant increase in disaster-related suicide in Fukushima. Specific social issues, such as "radiation stigma" among the public and self-stigma among evacuees, that are never seen with other natural disasters also increased in Fukushima.