Mental health and related factors after the Great East Japan earthquake and tsunami

Changes in physical activity during the year after the Great East Japan Earthquake and future frailty in older survivors

AIM

This study examines whether changes in physical activity (PA) during the first year after the Great East Japan Earthquake and Tsunami (2011-2012) contributed to preventing the onset of future frailty among older survivors of the disaster.

METHODS

This study tracked 2561 physically active Japanese survivors aged ≥ 65 years (43.6% men; mean age 72.9 years) who had completed self-administered questionnaires in 2011 and 2012. PA levels for participants were classified into four categories based on ≥23 and <23 metabolic equivalent hours/week in 2011 and 2012: "consistently low," "decreasing," "increasing," and "consistently high." Frailty was defined as a Kihon Checklist score ≥ 5, which is used in the long-term care insurance system in Japan. Hazard ratios were calculated for the onset of frailty using a Cox proportional hazards model that fitted the proportional sub-distribution hazards regression model with weights for competing risks of death.

RESULTS

From 2012 to 2018, 283 men and 490 women developed frailty. Men with consistently high or increasing PA during the first year after the disaster had a lower risk of frailty. Furthermore, even increasing PA by walking for just 30 min/day prevented future frailty in men; however, this association between a change in PA and the decreased risk of frailty was not observed in women.

CONCLUSIONS

Older men who remained physically active or resumed PA at an early stage and at a low intensity, even after being physically inactive owing to the disaster, were able to prevent future frailty. Geriatr Gerontol Int 2024; 24: 563-570.

Long-term mental health and resilience of the first responders in Japanese ground self-defense forces engaging body recovery after the great east Japan earthquake

Handling human remains is extremely difficult and stressful task, and it can contribute to the development of stress-related mental health problems. To prevent disaster from the development of mental disorders in first responders, it will be important to elucidate factors sustaining psychological well-being following the events requiring handling of human remains. Japanese Ground Self-Defense Forces (JGSDF) first responders (n = 146), involved in human remains recovery after the Great East Japan Earthquake (GEJE) participated. We examined the psychological resilience (S-H Resilience Test), depressive symptoms (SDS), and psychological distress (GHQ-28) 6 years after GEJE, in three groups; Group A: no contact no view of human remains, B: view only of human remains, and C: direct handling of human remains. S-H Resilience test evaluated the 3 subclasses of resilience; Social Support, Self Efficacy, Sociality. One-way ANOVA revealed the significant difference in resilience scores between Group B and C without any differences in depressive symptoms or psychological distress among the 3 groups. Multiple regression analyses revealed that depressive symptoms and resilience were associated with psychological distress in all participants. Path analyses showed that whereas one subtype of resilience indirectly reduced psychological distress through lower depressive symptoms in Group A (Social Support) and Group B (Sociality), both subtypes of resilience indirectly reduced psychological distress by lowering depressive symptoms in Group C. These findings suggest that exposure to higher stressful situation may decrease the psychological resilience based on the S-H Resilience test, and two subtypes of resilience may be necessary to sustain the psychological well-being.

Associations Between Lifestyle Factors and Constipation Among Survivors After the Great East Japan Earthquake: A 9-year Follow-up Study

BACKGROUND

Disaster survivors experience deterioration in lifestyles and an increase in constipation. After the Great East Japan Earthquake in 2011, some survivors were evacuated for a long term, even after moving to temporary housing and public reconstruction housing. However, annual changes in constipation and the association between lifestyles and constipation among the survivors are still unknown.

METHODS

Overall, 9,234 survivors aged 18 years or older participated in this 9-year follow-up survey after the disaster. Information about the prevalence of constipation and lifestyle factors (diet, physical activity, and mental health) was collected using a self-reported questionnaire. Their dietary intake was categorized into the following two dietary patterns: prudent (fish and shellfish, soybean products, vegetables, fruits, and dairy products) and meat (meat and eggs). Odds ratios for constipation according to lifestyle factors were calculated using a generalized linear mixed model.

RESULTS

In women, the prevalence of constipation was the highest at baseline (8.7%) and remained around 5% afterward. In both men and women, older age, poor mental health, and poor physical activity were significantly associated with higher odds ratios of constipation. Moreover, a lower frequency of meals and a lower prudent dietary score were significantly associated with women's constipation.

CONCLUSION

The prevalence of constipation was the highest at baseline and remained around 5% in women. Lifestyle factors, such as poor mental health, physical inactivity, and low frequency of meals were associated with constipation. Our findings suggest continuous support for the survivors with constipation for medium- to long-term after disasters.

Development and validation of the Earthquake Obsession Scale

Earthquakes are natural disasters that are very destructive and whose timing is unknown. These disasters can have a very negative effect on people's mental health, and their effects can last for many years. This study examined the psychometric properties of a scale to measure earthquake obsession. Data were collected from adults living in different provinces of Türkiye (N = 732), who completed the new scale, Doomscrolling Scale, Death Distress Scale, and Mental Well-Being Scale. The Earthquake Obsession Scale (EOS) had a two-factor structure, good internal consistency reliability, and convergent and discriminant validity. Correlational analysis revealed that earthquake obsession was positively associated with doomscrolling and death anxiety, and negatively associated with well-being. Mediation analysis indicated that doomscrolling and death distress mediated the relationship between earthquake obsession and well-being. The results emphasized the potential of earthquake obsession to affect daily life negatively and revealed its relationship with psychological variables.

The Impact of Moderate Earthquakes on Antidepressant Prescriptions in Ulsan, South Korea: A Controlled Interrupted Time Series Analysis

BACKGROUND

In 2016, two consecutive moderate magnitude earthquakes occurred in Ulsan, South Korea. Therefore, we aimed to investigate the impact of earthquakes on the mental health of residents in Ulsan.

METHODS

We used data from the 2015-2017 Korean Health Insurance Review & Assessment Service National Patient Sample. We conducted an interrupted time series analysis using location-based controls. Changes in the number of antidepressants, benzodiazepines, and zolpidem prescriptions in Ulsan were compared to controls. Overall changes in weekly prescriptions 1 year after the first earthquake, compared to a non-earthquake scenario, were estimated.

RESULTS

In antidepressant prescriptions, the increase in trend after an earthquake was significantly higher than controls. However, the changes in benzodiazepines and zolpidem prescribing were not significant. Overall, the impact of the earthquake on weekly antidepressant prescriptions at 1 year was estimated as a 1.32 (95% CI, 1.18-1.56) rate ratio compared to the non-earthquake scenario. This corresponded to an increase of 1,989.7 (95% CI, 1,202.1-3,063.0) in the number of prescriptions. Among subgroups, the increase was highest among males aged 20-39 years.

CONCLUSION

The moderate earthquake in Ulsan was associated with an increase in antidepressant prescriptions. The increase in the male group aged 20-39 was the highest. The impact may vary according to the context of the population.

Psychological distress is affected by fear of COVID-19 via lifestyle disruption and leisure restriction among older adults in Japan: a cross-sectional study

Introduction

Engaging in social activities is an essential component of a healthy lifestyle for community-dwelling older adults. Critically, as with past disasters, there is concern about the effects of long-term activity restrictions due to the coronavirus disease 2019 (COVID-19) pandemic on health of older adults. However, the precise associations between fear of COVID-19, lifestyle satisfaction, leisure activities, and psychological distress are unclear.

Objective

The purpose of this study was to comprehensively determine the associations between fear of COVID-19, lifestyle satisfaction, leisure engagement, and psychological distress among community-dwelling older adults in the context of the ongoing COVID-19 pandemic.

Materials and methods

A questionnaire survey administered by mail was conducted from October 1 to October 15, 2021. The questionnaire included the Fear of COVID-19 Scale, the Lifestyle Satisfaction Scale, the Leisure Activity Scale for Contemporary Older Adults, and the Kessler Psychological Distress Scale-6. Based on previous studies, we developed a hypothetical model for the association between fear of COVID-19, lifestyle satisfaction, leisure engagement, and psychological distress and performed structural equation modeling to assess the relationships between these variables.

Results

Participants included 301 Japanese citizens (23.6% male, 76.4% female), with a mean age of 76.7 ± 4.58 years. Goodness-of-fit from structural equation modeling was generally good. Analysis of standardized coefficients revealed a significant positive relationship between fear of COVID-19 and psychological distress (β = 0.33, p < 0.001) and lifestyle satisfaction and leisure activities (β = 0.35, p < 0.001). We further observed a significant negative relationship between fear of COVID-19 and lifestyle satisfaction (β = -0.23, p < 0.001) and between leisure activities and psychological distress (β = -0.33, p < 0.001).

Conclusion

Fear of COVID-19 is significantly associated with psychological distress, both directly and via its effects on lifestyle satisfaction and leisure activities. That is, not only did fear of COVID-19 directly impact psychological distress of participants, it also affected psychological distress through lifestyle disruption and leisure restriction. This results may be used to better understand how a national emergency that substantially restricts daily life, such as COVID-19 or an earthquake disaster, can affect the psychological health and wellbeing of older, community-dwelling adults.

Does disaster-related relocation impact mental health via changes in group participation among older adults? Causal mediation analysis of a pre-post disaster study of the 2016 Kumamoto earthquake

BACKGROUND

Disaster-related relocation is associated with depression and post-traumatic stress disorder, especially in older adults. Disaster-related relocation often deprives survivors of opportunities for social group participation, potentially deteriorating their mental health. On the contrary, the relocation could also be an opportunity for optimizing social relationships, ending/reducing unwanted participation. This study examined the potential mediation effects of changing participation for the link of disaster-related relocation to mental health.

METHODS

We analyzed a pre-post disaster dataset of functionally independent older adults from the Japan Gerontological Evaluation Study. Following the 2013 survey, a follow-up survey was conducted seven months after the 2016 Kumamoto earthquake (n = 828).

RESULTS

The causal mediation analyses indicated that compared to no relocation, the relative risk for experiencing major depressive episodes among those relocating to temporary housing was 3.79 [95% confidence interval: 1.70-6.64] (natural direct effect). By contrast, the relative risk for those renewing (either ceased or started) group participation was 0.60 [95% CI: 0.34-0.94] (natural indirect effect).

CONCLUSIONS

Optimization of social ties according to a renewal of group participation status might have protected older adults in temporary housing against depression.

Depression, Stress and the Mediating Role of Intimate Partner Violence (IPV) Among Israeli Women of Childbearing Age in the Shadow of the COVID-19 Pandemic

Dealing with the outbreak of the new coronavirus has generated unprecedented challenges around the world, including in Israel. Women of childbearing age may be forced to live under particularly difficult circumstances during the pandemic. The current study among Israeli women of childbearing age has three main objectives related to the specific period of the COVID-19 pandemic: to study the prevalence and predictors of intimate partner violence (IPV); to investigate the prevalence and predictors of depression; to examine whether IPV mediates the association between general stress, fear of COVID-19 and depression as an outcome. In a cross-sectional study, 722 married women, Jewish and Arab residents of Israel, were recruited to answer an online self-completion questionnaire during the first wave of the COVID-19 pandemic. The questionnaire included an assessment of their degree of general stress and depression, fear of COVID-19, experiences of IPV and demographic variables. The results of the current study show that a high percentage of women reported IPV (with Muslim women reporting higher IPV than Jewish women), perceived stress (PSS), perceived COVID-19 stress and depression. The findings also show that IPV and its three dimensions mediate the relationship between COVID-19 stress and depression, such that higher stress was related to higher IPV, raising the odds for depression. Moreover, the total scores for IPV and emotional violence were found to mediate the relationship between stress and depression. That is, domestic violence explains part of the association between stress and depression during the COVID-19 pandemic. Indeed, the current pandemic has resulted in an increase in IPV and depression, and especially in the specific stress associated with the disease itself. Based on the findings of the current study, preventing violence will reduce stress-related depression. The Muslim population, and especially those who are more religious, is in particular need of intervention.

Psychological Distress in Responders and Nonresponders in a 5-year Follow-up Health Survey: The RIAS Study

BACKGROUND

People with poor health or mental conditions are generally unwilling to participate in the health examinations, and no studies have directly examined the relationship of psychological distress among disaster survivors with participation status to date. The present study thus examined psychosocial differences according to the respondent status in a 5-year follow-up survey among participants in the prospective health surveys on survivors of the Great East Japan Earthquake and Tsunami Disaster study in Iwate Prefecture, Japan.

METHODS

We analyzed data from 10,203 Japanese survivors aged ≥18 years (mean age, 65.6 years; 38.0% men) and who underwent health examinations at baseline in 2011. Participants were classified into responders and nonresponders according to their 2015 health examination participation status. Psychological distress was evaluated using the Kessler 6 scale and categorized as none, mild, and severe. Multinominal logistic regression was used to examine the risk of psychological distress in relation to participation status.

RESULTS

In the 2015 survey, 6,334 of 6,492 responders and 1,686 of 3,356 nonresponders were analyzed. The most common reasons for nonparticipation in the survey were participated in other health examinations, examined at a hospital, and did not have time to participate. Nonresponse in males was associated only with mild psychological stress, whereas nonresponse in females was associated with mild and severe psychological distress.

CONCLUSION

Nonresponders in the follow-up survey had a higher risk of psychological distress than responders. Continuous monitoring of the health of nonresponders and responders may help to prevent future health deterioration.

Association between Dietary Diversity and Sociopsychological Factors and the Onset of Dyslipidemia after the Great East Japan Earthquake: Fukushima Health Management Survey

This study aimed to clarify the relationship between the onset of low-density lipoprotein hypercholesterolemia (hyper-LDLemia), high-density lipoprotein hypocholesterolemia (hypo-HDLemia), and hyper-triglyceridemia (hyper-TGemia) and lifestyle/socio-psychological factors among Fukushima evacuation area residents after the Great East Japan Earthquake. Participants included 11,274 non-hyper-LDLemia, 16,581 non-hypo-HDLemia, and 12,653 non-hyper-TGemia cases in the Fiscal Year (FY) 2011. In FY2011, these participants underwent a health checkup and responded to a mental health and lifestyle survey. The onset of each disease was followed through FY2017. The evacuation experience was positively associated with the risk of hyper-LDLemia, hypo-HDLemia, or hyper-TGemia. Conversely, the middle high dietary diversity score was negatively associated with the onset of hyper-TGemia. Moreover, low sleep satisfaction was positively associated with hypo-HDLemia and hyper-TGemia. The "almost never" exercise habit was positively associated with hypo-HDLemia. Current smoking and audible nuclear power plant explosions were positively associated with the risk of hyper-TGemia. Drinking habits exhibited a negative association with the onset of hyper-LDLemia, hypo-HDLemia, and hyper-TGemia. The results of this study indicate the need for continuous improvement in lifestyle, as well as efforts to eliminate the impact of disasters to prevent the onset of dyslipidemia among disaster evacuees.

Mental Health Impacts of Tornadoes: A Systematic Review

Tornadoes are one of the most prevalent natural hazards in the United States, yet they have been underrepresented in the disaster mental health comprehensive literature. In the current study, we systematically reviewed available scientific evidence within published research journals on tornadoes and mental health from 1994 to 2021. The electronic search strategy identified 384 potentially relevant articles. Of the 384 articles, 29 articles met the inclusion criteria, representing 27,534 participants. Four broad areas were identified: (i) Mental health impacts of tornadoes; (ii) Risk factors; (iii) Protective factors; and (iv) Mental health interventions. Overall, results showed adverse mental health symptoms (e.g., post-traumatic stress disorder, depression, anxiety) in both adult and pediatric populations. A number of risk factors were found to contribute to negative mental health, including demographics, tornado exposure, post-tornado stressors, and prior exposure to trauma. Protective factors found to contribute to positive outcomes included having access to physical, social, and psychological resources. Together, these findings can serve as an important resource for future mental health services in communities experiencing tornadoes.

Suicide and Suicide Prevention Activities Following the Great East Japan Earthquake 2011: A Literature Review

BACKGROUND

Since the Great East Japan Earthquake (GEJE), numerous studies have been conducted, but no comprehensive review study has been carried out. Thus, this literature review aimed to examine how the GEJE might affect suicide and suicidal behaviors from a long-term perspective.

METHODS

For the literature review, a search of electronic databases was carried out to find articles written in English and in Japanese that were related to suicide and its risk factors, as well as suicide prevention activities following the GEJE. Thirty-two articles were then selected for the review.

RESULTS

There were several findings, as follows: (1) gender differences in suicide rates in the affected area: nationwide, the suicide rates in men showed a delayed increase, whereas suicide rates in women increased temporarily immediately after the GEJE; (2) the suicide rates increased again in the recovery phase; (3) the background of the suicides was linked to both disaster-related experiences, and indirect reasons pertaining to the GEJE; and (4) intensive intervention combined with a high-risk and community-focused approach could prevent suicides following the disaster.

CONCLUSIONS

Although further accumulation of knowledge about suicide and suicide prevention is essential, these findings can contribute to response, recovery, and preparedness in relation to future disasters.

Lessons learned from psychosocial support and mental health surveys during the 10 years since the Great East Japan Earthquake: Establishing evidence-based disaster psychiatry

Post-disaster mental health and psychosocial support have drawn attention in Japan after the 1995 Great Hanshin-Awaji Earthquake, with mental health care centers for the affected communities being organized. After the catastrophe, a reconstruction budget was allocated to organize mental health care centers to provide psychosocial support for communities affected by the 2007 Chūetsu offshore earthquake, the 2011 Great East Japan Earthquake, and the 2016 Kumamoto Earthquake. There were several major improvements in post-disaster mental health measures after the Great East Japan Earthquake. The Disaster Psychiatric Assistance Team system was organized after the earthquake to orchestrate disaster response related to the psychiatric health system and mental health of the affected communities. Special mental health care efforts were drawn to the communities affected by the nuclear power plant accident through Chemical, Biological, Radiological, Nuclear, and high yield Explosives, being succeeded by measures against the coronavirus pandemic. As another new movement after the Great East Japan Earthquake, the number of surveys involving communities affected by disasters has soared. More than 10 times the number of scientific publications were made in English during the decade following the Great East Japan Earthquake, compared with the previous decades. In this review, we examined the results and issues acquired in the 10 years since the Great East Japan Earthquake, proposing evidence-based disaster psychiatry as the direction of future mental health measures related to emergency preparedness and response.

Long-Term Mental Health Support after Natural Hazard Events: A Report from an Online Survey among Experts in Japan

This paper aims to provide preliminary evidence on the degree of consensus on the approach to long-term mental health and psychosocial support after a natural hazard event. We conducted an online survey among mental health experts in Japan. The questionnaire was divided into five categories: (A) terminology setting definition of “long-term”, (B) priority in activity for long-term mental health support, (C) system and preparedness for better support, (D) transition from acute support to long-term support, and (E) actions to improve preparedness for future disasters. Invitations to participate in the survey were sent by e-mail in November 2017 to mental health experts in Japan, who had participated in workshops related to disaster mental health or trauma care organized by the National Institute of Mental Health over the last 15 years. Out of 1385 experts who received the invitation, a total of 305 participants responded to the survey. Participants were for the most part in agreement regarding focuses and required preparedness and actions for long-term support. There was still low consensus especially on defining the timeframe “long-term”. The acute phase and long-term phase were identified as being different in dimension rather than category. Although caution is necessary around the representativeness of these findings, they will provide important scientific evidence for the development of future plans for a qualitative improvement in long-term mental health support.

Impact of Natural Disasters on Mental Health: A Cross-Sectional Study Based on the 2014 China Family Panel Survey

Mental health problems are a leading cause of disability in both developed and developing countries, and the consequences of mental health disorders for individuals, families, and society as a whole could be severe and costly. To supplement relevant research and provide insightful policy suggestions to families, government and societies, this study investigates the nexus between natural disasters and mental health for middle-aged and older adults in rural China. Based on data of 8721 observations from the 2014 China Family Panel Studies, we estimate the effects of natural disasters on mental health using ordinary least squares and propensity score matching. Our findings suggest that natural disasters have a significant negative effect on middle-aged and older adults' mental health in the case of rural China. This effect is heterogeneous depending on individuals' education level and their agricultural production status. Finally, individuals' happiness and life satisfaction are shown to be the potential mechanism through which the effect of natural disasters on mental health operates.

Brumadinho Health Project: methodological aspects and epidemiological profile of participants in the cohort baseline

ABSTRACT: Objective: To present the methodological aspects of the Brumadinho Health Project and to describe the epidemiological profile of participants in the baseline cohort. Methods: Prospective, population-based cohort study in a representative sample of residents (aged 12 and over) of Brumadinho, Minas Gerais, after a mining tailings dam failure. Information for the baseline was collected in 2021, two years after the mining tailings dam collapsed, including sociodemographic, health and service use aspects, among others. Prevalence estimates of health outcomes were described in Brumadinho, as well as in the Metropolitan Region of Belo Horizonte and Minas Gerais, using data from the 2019 National Health Survey. All analyses were performed in the software Stata 17.0, considering the sampling weights and design effect. Results: 3,080 (86.4%) residents participated in the study, most of them being females (56.7%) and with a mean age of 46.1 years. The diseases more frequently reported were arterial hypertension (30.1%), high cholesterol (23.1%) and depression (22.5%), similarly to what was observed in the Metropolitan Region of Belo Horizonte and Minas Gerais, although the prevalence in Brumadinho was higher. At least one medical appointment and one hospitalization occurred in 75.2% and 9.4% of residents in the past year, respectively. Conclusion: It is important to monitor health, physical and mental conditions of residents after the occurrence of a disaster of this magnitude. This information can contribute with risk management of these processes, not only in the affected municipality, but also in other areas where populations are at risk of major disasters.

Analysis of Factors That Influenced the Mental Health Status of Public Health Workers During the COVID-19 Epidemic Based on Bayesian Networks: A Cross-Sectional Study

Background: Public health workers are essential to responding to the coronavirus disease 2019 (COVID-19) epidemic, but research on anxiety and stress among public health workers during the epidemic is limited. This study aimed to evaluate related factors affecting mental health among public health workers during the epidemic. Methods: Between February 19 and 25, 2020, an online, cross-sectional study was conducted among public health workers in a city in China. Mental health status was assessed using the Chinese versions of the Generalized Anxiety Disorder-7 (GAD-7) scale and Patient Health Questionnaire-9 (PHQ-9), both with a cutoff score of 5. Work-related variables, workloads and sacrifices, and personal perceptions were also assessed. Results: The prevalence of anxiety and depression were 49.2% and 45.7%, respectively, among public health workers. Three risk factors and one protective factor, namely, overcommitment (OR = 1.10∼1.20, p < 0.001), perceived troubles at work (OR = 1.14∼1.18, p < 0.001), perceived tension (OR = 1.11, p < 0.001) and the capability to persist for more than 1 month at the current work intensity (OR = 0.41∼0.42, p < 0.001) were found to be independently associated with anxiety and depression in the multivariable logistic regression analyses after propensity score matching. But the Bayesian networks analysis found that the last three factors directly affect anxiety and depression. Conclusion: Psychological responses to COVID-19 were dramatic among public health workers during the severe phase of the outbreak. To minimize the impact of the epidemic, working conditions should be improved, and easily accessible psychological support services should be implemented.

The association between psychological distress and risk of incident functional disability in elderly survivors after the Great East Japan Earthquake: The mediating effect of lifestyle and bodily pain

BACKGROUND

We previously reported that psychological distress was associated with an increased risk of functional disability. However, the mechanism of the association remains unclear. Our aim was to estimate the mediating effect of lifestyle and bodily pain on the association among elderly survivors after the Great East Japan Earthquake.

METHODS

The study population comprised 1037 residents aged ≥ 65 years. The baseline surveys (exposure and mediators) were conducted in 2011. We classified participants into three categories according to their Kessler 6 score (low: 0-9, moderate: 10-12, and high: 13-24) and defined functional disability as certification for long-term care insurance in Japan. The Cox proportional hazards model was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident functional disability according to Kessler 6 categories and explored the mediating effects of lifestyle and bodily pain on the association.

RESULTS

During approximately 8 years of follow-up, we documented 271 incident cases of functional disability. Compared with those in the low distress group, the multivariate adjusted HR for incident functional disability was 1.95 (95% CI 1.21-3.13) for those in the high distress group. Time spent walking, going out, and bodily pain significantly mediated the association between psychological distress and incident functional disability by 10.2%, 10.5%, and 10.3% for the high distress group, respectively.

LIMITATIONS

We did not consider unmeasured confounders and use of appropriate medication.

CONCLUSIONS

The evaluation and treatment of bodily pain as well as promotion of active lifestyle would be important for preventing disability among disaster survivors.

Health Impact and Risk Factors Affecting South and Southeast Asian Women Following Natural Disasters: A Systematic Review

(1) Background: Following natural disasters, women have a higher prevalence of adverse physical and mental health outcomes. Given that the South and Southeast Asia regions are highly disaster prone, a review was undertaken to identify the potential health impact and key risk factors affecting women after disasters in the countries located in South and Southeast Asia regions. (2) Methods: A systematic literature search of four databases yielded 16 studies meeting the inclusion criteria. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidance, between July 2008 and March 2021. (3) Results: The majority of studies reported women's negative/poor mental health, identifying a significant association of socio-demographics, during disaster exposure, post-disaster, and pre-existing risk factors. The six most-cited influences on women's mental health found in the reviewed literature were being female, adult age group, having no formal education, poverty or low economic status, poor physical health/physical injuries, and death of family members. Women's health during the post-disaster period was generally reported as poor among all the countries of the South and Southeast Asia regions. (4) Conclusions: Appropriate social support and the availability of free healthcare access for women are warranted in disaster-affected areas. This review offers a valuable contribution to the knowledge of women's health complications/challenges and associated risk factors related to disasters, essential for the development of strategies to help reduce this burden in the future. Further research is required on natural disasters to identify ways to reduce women's health impacts after natural disasters, especially in the context of low-income and lower-middle-income countries.

The differences of poor SRH among municipalities in Iwate after the Great East Japan Earthquake

The health of communities has been observed to recover at differential rates in the wake of disasters. In the present study, the 5-year trends in poor self-rated health (SRH) in three municipalities of Iwate Prefecture following the 2011 Great East Japan Earthquake and Tsunami were compared. Annual surveys were conducted from 2011 to 2015 in three municipalities (Otsuchi, Rikuzentakata, and Yamada) that were heavily damaged by the tsunami. We tracked the prevalence of poor SRH in 10,052 participants (mean age, 61.0 years; 39.0% men). Trends in the prevalence of poor SRH were analyzed using generalized linear mixed effect models with control for covariates. Immediately after the disaster (2011), all three municipalities reported similar prevalences of poor SRH (around 15%). Among people under the age of 65 years, there was a gradual improvement in health for residents of Rikuzentakata and Yamada, but the prevalence of poor SRH remained persistently high in Otsuchi. Among people over the age of 65 years, the prevalence of poor SRH remained constant in Rikuzentakata and Yamada but increased over a 5-year follow-up period in Otsuchi. The delayed health recovery in Otsuchi may be due to the characteristics of the local health system. Examination of the variations in health recovery may provide clues about the sources of disaster resilience.

Disasters and the Disablement Process framework: an analysis of the great east Japan earthquake and tsunami of 2011

This study used the Disablement Process framework to examine how exposure to the great east Japan earthquake and tsunami on 11 March 2011 was related to elders' experiences of disability-that is, 'a gap between personal capability and environmental demand' (Verbrugge and Jette, 1994, p. 1). Data were derived from two waves (2009 and 2013) of the Nihon University Japanese Longitudinal Study of Aging, involving a representative sample of citizens aged 65 or more. Logistic regression was employed to model how the disaster was associated with the prevalence and incidence of disability. A significant relationship was documented between the two. Those impacted by the event exhibited greater odds of reporting a disability in 2013 and developing one between 2009 and 2013. Disasters destroy social infrastructure and disrupt daily life, widening the lacuna between the environment and personal resources. Given the increasing number of disasters, more policy attention should be directed to reducing their adverse consequences for health.

Association between Psychosocial Factors and Oral Symptoms among Residents in Fukushima after the Great East Japan Earthquake: A Cross-Sectional Study from the Fukushima Health Management Survey

Oral health is closely related to subjective general health and systemic diseases. This cross-sectional study aimed to identify the factors related to oral symptoms and their worsening in relation to psychosocial factors after the Great East Japan Earthquake. In this study, 64,186 residents aged 15–101 years old, who experienced the earthquake on 11 March 2011, were surveyed regarding their oral symptoms; psychological factors, such as post-traumatic reactions and psychological distress; and social factors such as evacuation, work change, and loss of a close person; history of systemic diseases; and lifestyle. Binomial logistic regression analysis was used to calculate odds ratios, and 95% confidence intervals were established for each factor associated with prevalent and exacerbated oral symptoms. The proportions of participants with prevalent and exacerbated oral symptoms were 10.3% and 1.6%, respectively. The multivariate odds ratios and 95% CI of psychosocial factors associated with exacerbated oral symptoms were as follows: post-traumatic stress disorder symptoms, 2.24 (1.64–3.06); work changes, 1.88 (1.34–2.65); history of dyslipidemia, 1.74 (1.27–2.39); and subjective current poor health condition, 2.73 (2.00–3.75). Psychological factors, social factors, and physical factors were associated with both prevalent and exacerbated oral symptoms.

Association between the social isolation and depressive symptoms after the great East Japan earthquake: findings from the baseline survey of the TMM CommCohort study

BACKGROUND

Social isolation and mental health issues have become a severe problem in disaster areas in the Great East Japan Earthquake. This study examined whether the combination of the house damage and social isolation or the combination of the death of family members and social isolation is associated with depressive symptoms among survivors using the baseline study data of the Tohoku Medical Megabank Project Community-Based Cohort Study (TMM CommCohort Study).

METHODS

We used cross-sectional data from a baseline survey of 48,958 participants (18,423 males, 30,535 females; aged 60.1 ± 11.2 years) to examine the association between social isolation measured by the Lubben social network scale 6 (LSNS-6) and depressive symptoms measured by the Center for Epidemiological Studies-Depressive Scale (CES-D). The presence of social isolation and depressive symptoms was defined by an LSNS-6 score of < 12 and a CES-D score of ≥16, respectively. We performed a logistic regression analysis to determine the multivariable-adjusted odds ratio (95% confidence interval) [AOR (95% CI)] for depressive symptoms according to sex in the social isolation in comparison to without social isolation, and the associations of the combination of the house damage or the death of family members and social isolation and depressive symptoms.

RESULTS

Social isolation was significantly associated with depressive symptoms (males: OR = 1.87; 95% CI = 1.72-2.04, females: OR = 2.13; 95% CI = 2.00-2.26). Both males and females respondents with severe house damage and social isolation had a greater risk of depressive symptoms in comparison to those with an undamaged house and without social isolation (males: OR = 3.40; 95% CI = 2.73-4.24, females: OR = 2.92; 95% CI = 2.46-3.46). The risk of depressive symptoms was also higher in both males and females respondents with the death of family members and social isolation in comparison to those without the death of family members and without social isolation (males: OR = 2.18; 95% CI = 1.90-2.50, females: OR = 2.60; 95% CI = 2.35-2.88).

CONCLUSION

The findings suggested that a combination of social isolation and severe house damage and the death of family members caused by a large-scale natural disaster was associated with a higher risk of depressive symptoms although the interaction was not statistically significant.

Depression and Elevated Inflammation Among Chinese Older Adults: Eight Years After the 2003 SARS Epidemic

BACKGROUND AND OBJECTIVES

This study examined associations between exposure to the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic and Chinese older adults' depression and inflammation 8 years after the crisis. Further, this study investigated the buffering effects of perceived social support and social participation.

RESEARCH DESIGN AND METHODS

Data were drawn from the 2011 China Health and Retirement Longitudinal Survey, including N = 4,341 Chinese adults aged 60 years and older. For the survey, local officials identified whether the 2003 SARS outbreak was one of the major disasters in the history of their communities. Depression was assessed by the Center for Epidemiological Studies-Depression scale and inflammation was measured by C-reactive protein (CRP) collected from participants via venous blood draws.

RESULTS

Results from multilevel logistic regression models revealed that Chinese older adults living in communities exposed to SARS were more likely to have elevated CRP compared to those not living in such communities. Moreover, community SARS exposure was associated with greater risks of depression for Chinese older adults who had no perceived social support. Among Chinese older adults who had low levels of social participation, community SARS exposure was more strongly related to elevated CRP.

DISCUSSION AND IMPLICATIONS

Findings suggest community-level exposure to the SARS epidemic had enduring consequences for Chinese older adults' health. However, active social participation and supportive social ties provided important resources that may buffer against negative effects of exposure to the SARS epidemic.

Association between the prevalence of hypertension and dairy consumption by housing type among survivors of the Great East Japan Earthquake

Survivors of the Great East Japan Earthquake in 2011 had higher risks of cardiovascular diseases and hypertension, particularly residents of heavy flooding areas and evacuees. Thus far, the association between the prevalence of hypertension and dairy consumption remains unknown among these evacuees. We investigated this association by housing type after the Great East Japan Earthquake. In this cross-sectional study, we conducted a baseline survey among 9569 survivors of the earthquake, aged ≥18 years, between September 2011 and February 2012. Hypertension was defined as a systolic/diastolic blood pressure ≥140/90 mmHg or as persons undergoing treatment for high blood pressure. The frequency of dairy consumption was determined using a questionnaire. Participants living in prefabricated housing and emergency shelters were regarded as residents of temporary housing. Hypertension was prevalent among 43.8% and 44.7% of the participants in temporary and non-temporary housing, respectively. A logistic regression analysis of the prevalence of hypertension by daily dairy consumption showed that the magnitude of multivariable-adjusted odds ratios differed according to housing type (odds ratio, 0.64; 95% confidence interval, 0.51-0.80 in temporary housing; odds ratio, 0.85; 95% confidence interval, 0.73-0.995 in non-temporary housing; P for interaction = 0.0501). These associations were consistent across subgroups according to sex, age, behavioral factors, obesity, disorders of lipid metabolism, and economic status. A higher frequency of dairy consumption was associated with a lower prevalence of hypertension among community-dwelling survivors of earthquakes and tsunamis, particularly those living in temporary housing. Therefore, dietary therapy involving dairy consumption could help prevent hypertension among evacuees.

Five-year blood pressure trajectories of survivors of the tsunami following the Great East Japan Earthquake in Iwate

Whether tsunami survivors who suffered substantial damage experienced increases in blood pressure (BP) immediately after the disaster and in the medium to long term is unclear. We divided tsunami survivors into groups, those who relocated (substantial damage) and those who did not (little damage) and compared the BP trajectories between the groups over the first 5 years after the disaster. Of the 42,831 residents, 3914 were assessed from 2010 to 2015. Subgroup analysis was performed among the 2037 subjects with no information on antihypertensive medications between 2010 and 2015 (no antihypertensive medication group). The BP trajectories in the relocation and no relocation groups were compared using linear mixed models. The multivariate-adjusted mean systolic BP (SBP) values for all subjects significantly decreased after the disaster in both the group who relocated (2010: 130.6 mmHg, 2015: 124.8 mmHg) and the group who did not relocate (2010: 130.7 mmHg, 2015: 126.7 mmHg). The interaction between relocation and time points on SBP was significant (P = 0.017). In the no antihypertensive medication group, the SBP values in the subgroup who relocated were significantly lower in the second, third, and fifth years after the disaster than those in the subgroup who did not relocate. It was concluded that the SBP values of survivors of the tsunami caused by Great East Japan Earthquake decreased in the medium to long term after the disaster, and the group who relocated had a larger decrease in SBP than the group who did not relocate.

Telomere shortening as a stress-related biomarker in children exposed to maternal chronic stress in utero measured 7 years after the Great East Japan Earthquake

Seven years after the Great East Japan Earthquake, we investigated telomeres as a potential biomarker of maternal chronic stress in children according to the timing of exposure to the disaster. The subjects were children aged 5-9 years living in Rikuzentakata, Japan. Relative telomere length (rTL) was measured with PCR in saliva samples. The partial regression coefficient of the rTL was significantly shorter in the group of children conceived after the disaster than in the children who were in utero on the day of the disaster. Telomere length should be investigated as a biomarker for assessing disaster-related trauma in future studies.

Association between high psychological distress and poor oral health-related quality of life (OHQoL) in Japanese community-dwelling people: the Nagasaki Islands Study

Background

We investigated the association between psychological distress and oral health status/oral health-related quality of life (OHQoL) in Japanese community-dwelling people.

Methods

We conducted a cross-sectional study using data from the Nagasaki Islands Study. A total of 1183 (455 men and 728 women) has been analyzed in this study. Psychological distress was measured using the Kessler Psychological Distress Scale (K6). Oral health status was measured by dental examination. The OHQoL was measured using the General Oral Health Assessment Index (GOHAI). We defined the total score of ≥5 points on the K6 as high psychological distress (high-K6 group).

Results

The multiple linear regression analysis to identify the GOHAI showed that gender, K6, the total number of teeth, the number of dental caries, and visiting a dental clinic within the past 6 months significantly associated with the GOHAI. Among all of these variables, high-K6 (≥ 5) was a substantial contributing factor of the GOHAI (β = − 0.23, 95% Cl − 2.31 to −1.41, p < 0.0001).

Conclusions

It is likely that the individual with high psychological distress was strongly related to poor OHQoL even in the general population.

Increase in Body Weight Following Residential Displacement: 5-year Follow-up After the 2011 Great East Japan Earthquake and Tsunami

BACKGROUND

Previous studies have linked residential displacement as a result of the 2011 East Japan Earthquake to increases in body weight. However, no study has examined longer-term trajectories of body weight among displaced survivors. We compared body weight change between survivors relocated to temporary housing (TH) group versus other types of accommodation for up to 5 years after the Great East Japan Earthquake.

METHODS

Longitudinal follow-up was conducted from 2011 to 2015 in a cohort of 9,909 residents of 42,831. We compared trends in body weight in the TH group (n = 3,169) and the non-TH group (n = 6,740) using a mixed linear regression model stratified by sex (mean age, 61.0 years old; male, 38.9%).

RESULTS

In age-adjusted analysis, the body weight in the 2011 survey was not significantly different between two groups for either sex. In men, the TH group significantly increased body weight compared to the non-TH group since 2012. In women, body weight sharply increased in the TH group while body weight did not change in the non-TH group during survey time points. The interaction of living conditions and survey years was statistically significant in both sexes (men; F-value, 6.958; P < 0.001: women; F-value, 19.127; P < 0.001).

CONCLUSION

Survivors relocated to temporary housing had an increased risk of weight gain. The weight gain in this group is a potential risk factor for metabolic syndrome in the post-disaster period.

Fragile heroes. The psychological impact of the COVID-19 pandemic on health-care workers in Italy

This survey-based study aimed to explore the mental health status and psychological care needs of 933 health-care workers in Italy during the COVID-19 outbreak. Sociodemographic data, exposure to COVID-19, perception of psychological care needs, depression, anxiety, somatization, and post-traumatic symptoms were concurrently assessed. The majority of the sample (71%) suffered from somatization and 55% of distress. Female care workers experienced higher levels of anxiety (d = 0.50) and somatization symptoms (d = 0.82) and stated they needed psychological care more than men (p < .001). Younger participants (aged <40 years-old) reported higher levels of somatization, depression, anxiety, and post-traumatic symptoms (effects size range from d = 0.22 to d = 0.31). Working in a high infected area (red-zones) and directly with COVID-19 patients (front-line) affected the psychological health of participants to a smaller degree. Health-care workers who lost one of their patients reported higher levels of depression (d = 0.22), anxiety (d = 0.19), post-traumatic symptoms (d = 0.30), and psychological care needs than those who did not have the same experience (p < .01). Health-care workers who perceived the need for psychological support scored above the clinical alarming level (cut-off scores) in all the psychological scales, ranging from 76% to 88%. Psychological distress (p < .01), anxiety (p < .05), depression (p < .05), and being women (p < .01) contribute to explain the need for psychological care and accounted for 32% of the variance in this sample. These findings point out the importance to consider the psychological impact of COVID-19 on Italian health-care workers and strongly suggest establishing psychological support services for providing adequate professional care.

Occurrence of Cerebrovascular Diseases Decreased after the Great East Japan Earthquake and Tsunami of 2011

Background

A temporary increase in the occurrence of cerebrovascular diseases (CVDs) after the Great East Japan Earthquake and Tsunami of 2011 was reported; however, no studies have been conducted to investigate long-term effects. We assessed the long-term impact of the disaster on the incidence of CVDs.

Methods

Incidence data for CVDs from 2008 to 2017 were acquired from the population-based Stroke Registry with an inventory survey of Iwate Prefecture, Japan. Part of the coastal area in Iwate Prefecture was mildly flooded and the other part was severely flooded. Age-adjusted incidence rates of CVDs (according to the Japanese standard population) were calculated for each area. The relative risk (RR) of incidence based on the years before the disaster (2008–2010), adjusted by stratified age groups, was calculated for the year of the disaster (2011), and the years after the disaster (2012–2017) in each area.

Results

The age-adjusted incidence rates gradually decreased in all areas, with the exception of a temporary increase among men who lived on the coast the year the disaster occurred. The adjusted RR in the disaster year were not significant in any area and those of the postdisaster years were 0.91 (95% CI 0.87–0.96) for all inland men, 0.93 (0.89–0.97) for all inland women, 0.85 (0.78–0.93) for all coastal men, 0.87 (0.81–0.94) for all coastal women, 0.88 (0.80–0.98) for men at mildly flooded coast, 0.82 (0.75–0.89) for women at mildly flooded coast, 0.79 (0.68–0.91) for men at severely flooded coast, and 0.98 (0.86–1.11) for women at severely flooded coast.

Conclusions

The occurrence of CVDs in the flooded coastal areas did not increase in the year of the Great East Japan Earthquake and Tsunami; furthermore, it decreased for men according to the severity of flood damage in the subsequent years; this can be attributed to supportive activities for the tsunami victims and the migration of the population.

Effect of temporary housing on incidence of diabetes mellitus in survivors of a tsunami-stricken area in 2011 Japan disaster: a serial cross-sectional RIAS study

The association between incidence of diabetes mellitus (DM) and living conditions has not been studied after natural disasters. We compared the incidence of DM between individuals living in temporary housing (TH) and those living in other types of accommodation (non-TH) five years after the 2011 Great East Japan Earthquake. Longitudinal follow-up was conducted from 2011 to 2015 in a cohort of 7,491 residents of coastal communities in Iwate Prefecture directly impacted by the 2011 disaster (mean age, 61.6 years; men, 36.0%). We calculated the odds ratio of new onset of DM in the TH group (n = 2,372) compared with the non-TH group (n = 5,119) using discrete-time logit models stratified by sex and age classes (64 years or younger and older than 65 years). The TH group showed a significantly higher odds ratio (OR) for DM in men aged 64 years or younger (OR [95% confidence interval (CI)], 1.71 [1.03–2.85]; P-value = 0.040). In women, living conditions were not significantly associated DM. Survivors relocated to TH appeared to be at an increased risk of new onset DM.

Increased incidence of metabolic syndrome among older survivors relocated to temporary housing after the 2011 Great East Japan earthquake & tsunami

Background

Beyond the immediate toll of injuries and deaths, major disasters are often associated with long-term increased risks of chronic disease. We sought to investigate the incidence of metabolic syndrome (MetS) among survivors of the 2011 Great East Japan Earthquake and tsunami.

Methods

Subjects aged ≥18 years from the tsunami-stricken area participated in a prospective cohort study of disaster survivors (the RIAS Study) from 2011 to 2015. After excluding subjects who were previously diagnosed with MetS, we observed the cumulative incidence of MetS across four annual examinations among 7318 subjects (mean age, 59.8 years; 43.5% men). We defined MetS using the International Diabetes Foundation criteria.

Results

The 4-year cumulative incidence of MetS was 18.0% in the overall sample. The incidence was significantly higher among older women survivors relocated to prefabricated temporary housing (40.9%, 95% confidence interval, 36.4-44.6), and other types of housing (36.2%, 95% CI: 32.3-40.6) compared to those who were not relocated (34.1%, 95% CI: 30.9-37.4). An increase in incidence of MetS was not observed for older men, or younger survivors aged ≤64 years.

Conclusion

Relocation to prefabricated temporary housing was a risk factor for increased incidence of MetS in older women.

Social trust predicts sleep disorder at 6 years after the Great East Japan earthquake: data from a prospective cohort study

Background

The physical and psychological health impacts on victims of the Great East Japan Earthquake (GEJE) have lasted for a long time. Some cross-sectional studies have reported a relationship between social networks and/or social support and mental health among victims. Previous studies were cross-sectional observations at one time point after a disaster, it remains unclear whether the lack of social trust soon after the GEJE predicts long-term mental health outcomes among the victims. The objective of the present study was to examine prospectively the association between social trust soon after the GEJE and trends in sleep disorders up to 6 years after the GEJE.

Methods

We conducted a health survey on residents living in two areas affected by the GEJE. We analyzed data from 1293 adults (aged ≥18 years) who had participated in an initial health survey. The participants responded to a self-administrated questionnaire composed of items on health condition, mental health, including sleep disorders (based on the Athens Insomnia Scale [AIS]), and social trust. We classified the participants into two categories (high or low) based on the level of social trust at the first health survey. A linear mixed model was used to estimate trends in AIS scores in relation to social trust at the first health survey.

Results

The AIS scores of participants in the low social trust group were significantly higher than those in the high social trust group throughout the 6 years after the GEJE (P < 0.01). After adjusting for some covariates, the AIS score estimate for the participants who had low social trust was 1.30 point higher than those for the participants who had high social trust.

Conclusion

Social trust at 3 to 5 months after the GEJE predicted AIS scores at 6 years after the GEJE among victims. This finding suggests that it may be possible to identify people who have a lower potential for mental resilience from disaster damage over the long term. Further, health interventions for this high-risk group could help promote resilience after a disaster.

Relationship between household composition and intergenerational post-disaster mental health in two-parent families: Evidence from Japan

BACKGROUND

Previous literature has neglected the effect of household composition on mental health, especially in the context of post-disaster recovery.

METHODS

Open access data from the 2015 Social Survey on Living and Disaster Recovery (SSLDR) in Japan are used. A total of 689 respondents (346 from Fukushima and 343 from Sendai) made up of people living in two-parent families are examined in the current study. Pearson's Chi-square Test and ANOVA are applied to assess the differences between four groups: Fukushima parent generation, Fukushima child generation, Sendai parent generation, and Sendai child generation. The method of multiple linear regression is used to explore the association factors of intergenerational mental health in two city sites, respectively.

RESULTS

Fukushima child generation tended to have the worst mental health status. In two city sites, the child generation tended to have a less degree of neighborhood connectedness than those in the parent generation. Variables of household composition, daily worries, and gender have significant associations with mental health in either two cities or one of them.

LIMITATIONS

The 2015 SSLDR datasets were collected by means of investigation through a series of questionnaires. Errors may exist if the respondents did not honestly or fully report their household composition. And there is some complexity in some attempted analysis models that is not fully included in the imputation model.

CONCLUSION

Household composition has significant association with intergenerational mental health in the context of post-disaster recovery. Our results highlight the need to look for appropriate and targeted supporting mechanisms.

Post-traumatic positive and negative psychological changes experienced by child and adolescent earthquake survivors in remote rural western China: a cross-sectional study six years after the Yushu earthquake

Background: Yushu, Qinghai province is located in remote Tibetan plateau in Western China, struck by a disastrous earthquake in 2010. The study aimed to find out the positive and negative psychological changes and related risk factors of children and adolescents who had experienced Yushu earthquake, 6 years after it occurred. Methods: A cross-sectional research was adopted in the capital of Yushu Autonomous Prefecture in August 2016. The short form of the Changes in Outlook Questionnaire (CiOQ-S) was used, which is a 10-item self-report instrument consists of two subscales. A total of 591 valid questionnaires completed by local junior students were finally included in our study. Results: The mean scores of the positive and negative psychological changes were 19.28 and 13.08, respectively. The factors associated with positive psychological changes included high level of education, male gender, and uninjured in the earthquake. The factors associated with negative psychological changes included living in a pasture instead of downtown, injured during the earthquake, and not receiving psychological counselling. Conclusions: The current analysis tries to investigate the long-term psychological effects of earthquakes among children and adolescents, which aims to improve the psychological health status for child and adolescent survivors of similar events.

Cervical cancer screening rates before and after the Great East Japan Earthquake in the Miyagi Prefecture, Japan

After disasters, issues pertaining to women’s health such as irregular periods and bleeding are well surveyed. However, the management of women’s health, especially changes in the rate of health checkups, has not been investigated. In the present study, we focused on the change in the cervical cancer screening rates (CCS-Rs) before and after the Great East Japan Earthquake in Miyagi Prefecture, Japan. The earthquake had a magnitude of 9.0, a profound disaster. We examined the CCS-R from 2009 to 2016 in 45 areas of the Miyagi Prefecture. Screening was completed using mobile vans. In the 4 areas impacted by the tsunami after the earthquake, a marked decrease in the CCS-R was observed in 2011 when the earthquake took place (more than a 3% decrease compared with that in the previous year). The CCS-Rs in these 4 regions remained lower in 2016 than in the previous year. In 2009–2016 except for 2014, CCS-Rs in coastal areas (9 areas) were significantly lower than those in the non-coastal areas (36 areas). A delay in seeking healthcare, also known as “patient’s delay,” is considered as one of the problems of cancer treatment in affected areas. It is possible that a decrease in the CCS-R may lead to low detection of advanced stages of cancer. Therefore, the establishment of a comprehensive medical system including medical screening after a disaster is important for the management of women’s health.

Prevalence and risk factors of post-traumatic stress disorder among elderly survivors six months after the 2008 Wenchuan earthquake in China

BACKGROUND

Several studies indicate that older age is a risk factor for probable post-traumatic stress disorder (PTSD). However, evidence on the prevalence and risk factors for elderly disaster survivors is limited.

METHODS

Multi-stage stratified sampling was applied in this cross-sectional study. The Revised Version of the Impact of Event Scale (IES-R) was used to evaluate symptoms of PTSD. Chi-squared test was used for univariable analysis of prevalence of probable PTSD by possible determinants. Multivariable logistic regression analysis was utilized to further explore risk factors for PTSD.

RESULTS

427 elderly survivors age 60 or older participated. The prevalence of probable PTSD was 40.5, 36.3, and 21.5% according to a cut off score of the IES-R of 33, 35, and 2 points on average across items, respectively. In multivariable logistic regression, elderly survivors with a higher number of diagnosed chronic illnesses were more likely to be screened positive for PTSD and those with a greater number of family members living in the same home were less likely to be classified as having probable PTSD for all cut off scores. Elderly survivors with improved economic status and those with primary school or lower education were more often estimated to have probable PTSD with a cut off score of 35 and 2 points on average.

CONCLUSIONS

Elderly survivors in a high impact area following a major earthquake are at high risk for developing PTSD. Those who live alone and report pre-existing chronic illness are particularly vulnerable.

Women's health-related vulnerabilities in natural disasters: a systematic review protocol

INTRODUCTION

There is a paucity of evidence identifying both the physical and psychological health risks and underlying causes of women's health-related vulnerabilities related to natural disasters. Therefore, this systematic review will be conducted to determine the impact of natural disasters on women's health from a global perspective.

METHODS AND ANALYSIS

Five electronic databases of health research, including ProQuest, ProQuest Health and Medicine, PubMed, PsycINFO and CINAHL, will be searched to retrieve relevant literature where Medical Subject Headings terms and keywords will be used depending on the search method of each database. Google Scholar will also be searched for preliminary information on the topic and to check for further evidence that may have been missed. Inclusion and exclusion criteria will be developed and refined by the research team. We will restrict our search for empirical full-text articles published in the English language peer-reviewed journals between July 2008 and June 2018 to ensure contemporary evidence is retrieved. Two authors will participate in each step in the process, including title, abstract and full-text screening against inclusion criteria, data extraction and quality appraisal. The quality of selected studies will be assessed using the Mixed Method Appraisal Tool. Data synthesis will follow a sequential explanatory approach. Finally, the quantitative and qualitative findings will be merged under themes and described using a narrative approach.

ETHICS AND DISSEMINATION

Formal ethical approval is not required as primary data will not be collected. The results will be published in an international peer-reviewed journal and presented at national and international conferences.

PROSPERO REGISTRATION NUMBER

CRD42019123809.

Circulating microRNAs (miR-126, miR-197, and miR-223) are associated with chronic kidney disease among elderly survivors of the Great East Japan Earthquake

Background

A recent study has reported that incidence of chronic kidney disease (CKD) is higher in evacuees, but the molecular mechanism still remains unclear. One plausible hypothesis is a change in vascular function following to psychological distress. In order to assess molecular mechanisms underlying this association, we examined whether cardiovascular disease (CVD)-associated miRNAs (miR-126, miR-197, and miR-223) were associated with CKD among Japanese elderly survivors after an earthquake.

Methods

We analyzed 1385 individuals (670 men and 715 women) who participated in a post-disaster health check-up after the Great East Japan Earthquake, which occurred in 2011. The check-up involved collection of information about lifestyle, clinical history, the degree of housing damage, and baseline measurement of the estimated glomerular filtration rate. Expression levels of miRNAs were determined using real-time polymerase chain reaction. Estimated glomerular filtration rate (eGFR) was calculated using sex, age, and serum creatinine. CKD was defined as eGFR < 60 ml/min/1.73m². The multivariable regression analyses were performed to examine the associations between CVD-associated miRNAs and CKD after adjusting potential confounders.

Results

Mean age (standard deviation) of participants with normal kidney function and CKD was 62.7 (10.6) and 71.9 (8.1) years, respectively. Expression levels of these miRNAs in participants with CKD were significantly lower than normal kidney function (all p < 0.001). Even after adjusting for lifestyle, clinical profiles, and psychological distress, significant associations between three miRNAs and CKD still remained. A significant linear association between the cumulative score of these miRNAs and CKD was found (p = 0.04).

Conclusions

This cross-sectional study suggested that CVD-associated miRNAs were an important factor of CKD in an elderly Japanese population after earthquake. Future studies need to examine this association in longitudinal dataset.

Musculoskeletal pain and new-onset poor physical function in elderly survivors of a natural disaster: a longitudinal study after the great East Japan earthquake

Background

Functional disability is a significant problem after natural disasters. Musculoskeletal pain is reported to increase after disasters, which can cause functional disability among survivors. However, the effects of musculoskeletal pain on functional decline after natural disasters are unclear. The present study aimed to examine the association between musculoskeletal pain and new-onset poor physical function among elderly survivors after the Great East Japan Earthquake.

Methods

A longitudinal study was conducted on survivors aged ≥65 years at three and 4 years after the Great East Japan Earthquake. A total of 747 persons were included in this study. Physical function was assessed using the Kihon Checklist. New-onset poor physical function was defined as low physical function not present at 3 years but present at 4 years after the disaster. Knee, hand or foot, low back, shoulder, and neck pain was assessed using a self-reported questionnaire and was defined as musculoskeletal pain. Musculoskeletal pain at 3 years after the disaster was categorized according to the number of pain regions (0, 1, ≥ 2). Multiple logistic regression analyses were performed to calculate the odds ratio (OR) and 95% confidence interval (95% CI) for new-onset poor physical function due to musculoskeletal pain.

Results

The incidence of new-onset poor physical function was 14.9%. New-onset poor physical function was significantly associated with musculoskeletal pain. Compared with “0” musculoskeletal pain region, the adjusted ORs (95% CI) were 1.39 (0.75–2.58) and 2.69 (1.52–4.77) in “1” and “≥ 2” musculoskeletal pain regions, respectively (p for trend = 0.003).

Conclusions

Musculoskeletal pain is associated with new-onset poor physical function among elderly survivors after the Great East Japan Earthquake. Monitoring musculoskeletal pain is important to prevent physical function decline after natural disasters.

Did kindergarteners who experienced the Great East Japan earthquake as infants develop traumatic symptoms? Series of questionnaire-based cross-sectional surveys: A concise and informative title: traumatic symptoms of kindergarteners who experienced disasters as infants

BACKGROUND

The Great East Japan Earthquake (GEJE) and tsunami of March 11, 2011 left behind many survivors, including children. This study aimed to assess changes in traumatic symptoms with time among kindergarteners who experienced GEJE as infants and to discuss the relationship between these symptoms and the disaster experience.

METHODS

The 15-item Post-Traumatic Stress Symptoms for Children (PTSSC-15) questionnaire were distributed to the parents of kindergarteners (children aged 4-5 years) at 8, 20, 30, and 42 months after GEJE. Questionnaires regarding environmental damage conditions affecting the children were distributed to teachers 8 months after the tsunami.

RESULTS

The number of kindergarteners was 262, 255, 236, and 202 at 8, 20, 30, and 42 months after the disaster. The PTSSC-15 total score was not different between kindergartners with and without environmental damage conditions. After 8 and 20 months, the PTSSC-15 total score of children who usually ate breakfast was significantly higher than that of children who did not. Moreover, after 30 and 42 months, the PTSSC-15 total score of kindergarteners who usually ate breakfast was not significantly higher than that of kindergarteners who did not.

CONCLUSIONS

The traumatic symptoms of kindergarteners were not related to disaster experiences.

Living in the Restoration Public Housing after the Great East Japan Earthquake Correlates with Lower Subjective Well-Being of Older Adults

We aimed to (1) describe the subjective well-being (SWB) of older residents in Fukushima Prefecture seven years and seven months after the Great East Japan Earthquake (GEJE) and examine the effect of relocation to the restoration public housing (RPH) on SWB, social capital, and health indicators; and (2) investigate the association between social capital and SWB. Questionnaires were administered to collect data of both RPH and non-RPH residents (≥65 years). Respondents' SWB was collected via the Japanese version of the World Health Organization Five Well-Being Index. Additionally, residents' social capital (trust, reciprocity, and participation), physical activity level, social network, functional health, history of chronic disease, and demographic data were collected. We analyzed 101 responses (valid response rate: approximately 34%) from RPH and 158 (53%) from non-RPH residents. SWB was lower in RPH compared to non-RPH residents but not statistically significant. Older RPH residents may demonstrate lower social capital and health indicators after the GEJE. Mistrust was found to be positively associated with low SWB in RPH residents. Future studies should examine the effectiveness of support for enhancing the trust of older RPH residents regarding, for example, the involvement of scientists-including medical professionals-in risk communications in promoting SWB.

Medium-Term Effects of a Train Derailment on the Physical and Psychological Health of Men

In July 2013, the derailment of a train caused the death of 47 people and the destruction of Lac-Mégantic's downtown area (Canada). Three years after this event, a population survey was conducted among a representative sample of 800 adults, including 282 men. Several significant differences were observed among respondents of a survey based on their level of exposure to this tragedy, including their physical (changes in physical health) and psychological health (post-traumatic stress disorder, mood and anxiety disorders, psychological distress, signs of depression, consultation of social workers and psychologists) as well as their use of prescribed (anxiolytics and antidepressants) and nonprescribed drugs. Such results can be explained by the nature, magnitude, and cause of the event.

The Current Health and Wellbeing of the Survivors of the Rana Plaza Building Collapse in Bangladesh: A Qualitative Study

This study aims to identify the ongoing physical and psychological health vulnerabilities of the readymade garment (RMG) factory workers involved in the Rana Plaza building collapse in 2013, along with their experiences within the current socioeconomic and political contexts of Bangladesh. Seventeen Rana Plaza survivors participated in unstructured, face-to-face, in-depth interviews. Interviews were thematically analyzed using Haddon’s matrix to examine pre-event, event, and post-event injury experiences. The collapse of the Rana Plaza building resulted in significant physical and emotional trauma for those who survived the event. The majority of the participants were forced to attend work on the day of the collapse. Participants reported physical health complaints related to bone injuries/fractures and amputation, severe headache, kidney problems, and functional difficulties. In addition to the reported physical health issues, the participants revealed psychological health issues including trauma, depression and suicidal ideation, sleep disorders, anxiety, and sudden anger. Participants described barriers to their potential for re-employment in the RMG sector and outlined their limited access to free healthcare for follow-up treatment. Those who survived the collapse of the Rana Plaza building continue to experience significant adverse physical and emotional outcomes related to the disaster. Yet, they have little recourse to ensure the availability of adequate health care and rehabilitation. Given the international reliance on the Bangladeshi RMG industry, continued pressure to ensure care is provided for these survivors, and to reduce the risk of future disasters, is necessary.

Alcohol consumption behaviours in the immediate aftermath of earthquakes: time series study

OBJECTIVES

Earthquakes are a distressing natural phenomenon that can disrupt normal health-related behaviours. The aim of this study was to investigate changes in alcohol consumption behaviours in the immediate aftermath of mild to moderate earthquakes.

SETTING

This retrospective cohort study was conducted at a large academic hospital in Tokyo, Japan from April 2004 to March 2017.

PARTICIPANTS

We included all adult patients presenting with acute alcohol intoxication in the emergency room.

PRIMARY AND SECONDARY OUTCOME MEASURES

Our outcome was the number of such patients per 24 hours period comparing days with and without earthquake activity. We mainly focused on mild to moderate earthquakes (Shindo scale of less than 3). We conducted a simple generalised autoregressive conditional heteroscedasticity (GARCH) analysis, followed by a multivariate GARCH, including year-fixed effects and secular changes in alcohol taxation. Subanalyses were conducted by gender and age group.

RESULTS

During the study period, 706 earthquakes were observed with a median Shindo scale of 2 (IQR: 1). During this period, 6395 patients were admitted with acute ethanol intoxication; the mean age was 42.6 (SD: 16.9) years and 4592 (71.8%) patients were male. In univariate analyses, the occurrence of daytime earthquakes was marginally inversely related to the number of acutely intoxicated patients (β coefficient: -0.19, 95% CI -0.40 to 0.01). This finding remained similar in multivariate analyses after adjustment for covariates. In analyses stratified by gender, the inverse association between daytime earthquakes and alcohol intoxication was only observed among men (p<0.03 for males and p=0.99 for females). In subanalyses by age, older people were less likely to be admitted to the hospital due to acute alcohol intoxication on days with daytime earthquakes (p=0.11), but this was not the case for younger people (p=0.36).

CONCLUSION

On days when a mild to moderate daytime earthquake occurred, the number of patients with acute alcohol intoxication was lower compared with days without earthquakes. Even milder forms of potentially catastrophic events appear to influence social behaviour; mild to moderate earthquake activity is associated with the avoidance of excessive alcohol consumption.