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

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

Disaster Resilience Reduces Radiation-Related Anxiety Among Affected People 10 Years After the Fukushima Daiichi Nuclear Power Plant Accident.

This study examined whether disaster resilience affects the recovery of mental health states and mitigates psychosocial anxiety 10 years later the Fukushima Daiichi nuclear power plant accident. The survey was conducted in Fukushima's evacuation-directed and non-evacuation-directed areas in January 2020. The 695 participants responded to a questionnaire including items on radiation-related anxiety regarding the Fukushima Daiichi accident, an action-oriented approach as a resilience factor, psychological distress, and demographic information. The structural equation modeling showed that the action-oriented approach also eased radiation-related anxiety by mediating with improving mental health states. Moreover, a multi-group model analysis was conducted for evacuation-directed and non-directed areas. In the evacuation-directed area, we found stronger associations among resilience, mental health states, and radiation-related anxiety, and a direct effect of resilience factors on radiation risk anxiety. These findings emphasize the importance of resilience in post-disaster contexts, at least for a decade, where mental health deteriorates and various psychosocial issues become more complex.

The Usefulness of Brief Telephonic Intervention After a Nuclear Crisis: Long-Term Community-Based Support for Fukushima Evacuees.

The Fukushima Daiichi Nuclear Power Station accident in 2011 produced over 100000 evacuees. In order to deal with an increased need of mental health care, brief, transdiagnostic Telephonic Interventions (TI) have been provided for those at risk of different mental health problems identified based on results of the Mental Health and Lifestyle Survey (MHLS). This study aimed to examine usefulness of TI with focusing on evacuees' subjective estimation assessed in individual follow-up interviews. The sample comprised 484 persons who had been evacuated from 13 municipalities in Fukushima Prefecture to 8 safer regions in and out of Fukushima. We conducted semi-structured interviews for participants receiving TI (intervention group) and those not receiving TI despite being identified as high risk (non-intervention group). The intervention group was older, had a higher proportion of self-reported mental illness, and higher unemployment compared with the non-intervention group. The satisfaction proportion of those who underwent TI was as high as 74.6%. Satisfaction was significantly associated with advance knowledge of TI availability (OR = 3.00, 95% CI: 1.59-5.64), and advice on health-related practices (OR = 2.15, 95% CI: 1.12-4.13). Thus, TI is considered to be feasible and useful for public health management practices in major disasters.

Vulnerability of Evacuees Having No One to Consult after the Fukushima Nuclear Disaster: The Fukushima Health Management Survey.

After the accident at the Fukushima nuclear power plant in 2011, caused by the Great East Japan Earthquake, some evacuees had no one to consult despite many local care providers offering assistance. This study identified the characteristics of individuals who did not receive consultations and the relevant determinants, and proposed the available measures to address this issue. Altogether, 32,699 participants aged 16 years or older and residing in the disaster area at Fukushima were surveyed. Those with no one to consult showed a significantly higher prevalence of psychological distress (16.2%, p < 0.001) and drinking problems (21.5%, p < 0.001). Multivariate analysis revealed that these behaviors were associated with the middle age group (i.e., 40-64 years old) (odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.16-1.46), men (OR = 2.46; 95% CI, 2.27-2.66), bad financial circumstances (OR = 2.11; 95% CI, 1.96-2.27), and living alone (OR = 1.53; 95% CI, 1.39-1.68). This research verifies that people with such characteristics were more likely to be isolated and vulnerable to psychiatric problems, such as depression. We suggest that it is integral for local care providers to recognize those who have no one to consult and provide targeted support.

Trajectories of peer relationship problems and emotional symptoms in children 5 years after a nuclear disaster: Fukushima Health Management Survey.

The Fukushima Daiichi Nuclear Power Station (NPS) accident, which occurred in March 2011, is having long-term effects on children. About 3 years after the accident, we identified three patterns of peer relationship problems and four patterns of emotional symptoms using group-based trajectory modeling. As a result, we reported that different factors might be related to very severe trajectories of peer relationship problems and emotional symptoms. In this study, we used five waves of data from fiscal year (FY) 2011 to FY2015 from the Mental Health and Lifestyle Survey, a detailed survey of the Fukushima Health Management Survey started in FY2011. We analyzed 7013 residents within the government-designated evacuation zone (aged 6-12 years old as of 11 March 2011) with responses to all items of psychological distress in at least one wave from FY2011 and FY2015. We planned this study to describe the trajectories of peer relationship problems and emotional symptoms in children and to examine potential risks and protective factors over the 5 years following the NPS accident. We identified four patterns of peer relationship problems and five patterns of emotional symptoms using latent class growth analysis. For peer relationship problems, male sex, experiencing the NPS explosion and lack of exercise habits were associated with the severe trajectory group. For emotional symptoms, experiencing the NPS explosion, experiencing the tsunami disaster and lack of exercise habits were associated with the severe trajectory group. Exercise habits are very important for the mental health of evacuees after a nuclear disaster.

Associations of the COVID-19 pandemic with the economic status and mental health of people affected by the Fukushima disaster using the difference-in-differences method: The Fukushima Health Management Survey.

Although the coronavirus disease 2019 (COVID-19) pandemic and relevant preventive measures can affect the economic status and mental health of the public, their effect remains unraveled owing to a limited number of surveys conducted before and during the COVID-19 pandemic. We investigated the association of COVID-19 and relevant measures with multivariate outcomes among people affected by the Fukushima disaster in 2011 using the difference-in-differences (DID) method. We then analyzed the associations between sociodemographic factors and outcomes. We assessed psychological distress, problem drinking, insomnia state, unemployment, household economic decline, and interpersonal problems using three questionnaire surveys administered in 2018, 2019, and 2020. Participants were grouped according to three time periods by dates of voluntary stay-at-home requests (February 26) and the declaration of emergency (April 16) in Japan. The years 2020 and 2019 were regarded as the treatment group and control group, respectively, after confirming that no DIDs were found between 2018 and 2019. We performed regression analyses to identify the risk factors for outcomes. The DIDs were significant for household economic decline after the declaration of emergency, whereas problem drinking significantly improved. No significant DIDs were observed for other mental health outcomes including psychological distress and insomnia state. Absence of counselors was positively and significantly associated with all outcomes in 2020. Overall, people affected by the Fukushima disaster experienced more economic damage after the declaration of emergency during the COVID-19 pandemic but their mental health status did not reduce. Identifying people who have no counselors and providing them with support are emergent requirements to prevent a subsequent mental health decline.

Resilience Factors Contributing to Mental Health Among People Affected by the Fukushima Disaster: Development of Fukushima Resilience Scale.

Aim: The aims of the present study were to develop and validate a psychological resilience scale reflecting the specificity of the Fukushima disaster, and to examine the effects of this scale on mental health. Methods: The Fukushima Resilience Scale was developed based on data obtained from semi-structured interviews with seven people who had lived in the affected area of Fukushima Prefecture at the time of the disaster. The reliability and validity of the scale were then examined in cross-sectional studies conducted on 500 evacuees through an epidemiological mail survey. To examine the effects of the scale and disaster-related factors on the general mental health status of the respondents, a logistic regression analysis was performed using the six-item Kessler psychological distress scale. Results: The newly developed scale consisted of a four-factor structure: "coping with stigma-related issues," "sharing experiences of the disaster," "action-oriented approach," and "sense of support." Internal consistency coefficients ranged from 0.66 to 0.79. The multivariable logistic regression analysis showed that the only significant association was between "action-oriented approach" (odds ratio = 1.26) and respondents with a K6 score <5 points. Conclusion: The reliability and concurrent validity of the new developed scale in residents of the evacuation area of Fukushima Prefecture were acceptable. A significant association was found between "action-oriented approach" and good mental health among the evacuees, which suggests that this may improve resilience among people affected by the Fukushima disaster.

Mental Health Recovery of Evacuees and Residents from the Fukushima Daiichi Nuclear Power Plant Accident after Seven Years-Contribution of Social Network and a Desirable Lifestyle.

The 2011 Fukushima nuclear accident resulted in the exposure to radiation and evacuation, which has created psychological distress among the Fukushima residents. With the provision of multi-faceted support and the progress of the reconstruction, their mental health has appeared to show signs of recovery. However, there have been few studies investigating their recovery. To clarify the related factors associated with mental health recovery, a cross-sectional questionnaire survey was conducted. Subjects whose answers were associated with Resilience, Recovery, and Remitting patterns of mental health status were categorized in the Recovery group, while those associated with Delayed/Chronic dysfunction were placed in the Non-recovered group. In a multivariable logistic regression analysis, disaster-related unemployment (odds ratio (OR): 0.80, 95% CI (confidence interval): 0.65⁻0.99) and economic hardship (OR: 0.80, 95% CI: 0.65⁻0.98) were associated with the hindrance of recovery. In contrast, overall good health (OR: 1.47, 95% CI: 1.20⁻1.80), regular physical activity (OR: 1.23, 95% CI: 1.01⁻1.50), social interaction with friends (OR: 1.25, 95% CI: 1.00⁻1.55), and established social roles (OR: 1.44, 95% CI: 1.14⁻1.82) were associated with the promotion of recovery. In conclusion, our study showed a positive association between mental health recovery and a desirable lifestyle and social network, particularly with social roles. Thus, the provision of active social roles can promote recovery related to a disaster as with multi-faceted support.