Long-Term Impact of Parental Post-Traumatic Stress Disorder Symptoms on Mental Health of Their Offspring After the Great East Japan Earthquake.

Longitudinal studies of the long-term psychological impact of the Great East Japan Earthquake (GEJE) on parents and their children have been limited. The current study aimed to monitor parents' post-traumatic stress disorder (PTSD) symptoms and behavioral problems among their children over time and to analyze their long-term associations among the survivors of the GEJE. We used data from the GEJE Follow-up for Children study, which recruited 4- to 6-year-old children and those children's parents immediately after the GEJE in March 2011, with ongoing follow-up. Children's total, internalizing, and externalizing behavioral problems were assessed using the Child Behavior Checklist (CBCL), and parental probable PTSD was assessed using the Impact of Event Scale-R (IES-R), in 2012 (baseline) and 2014 (follow-up). Parental PTSD symptoms and children's behavioral problems declined slightly over time, and both showed a significant correlation between the surveys (r = 0.55-0.77, P < 0.001). The association between parental PTSD symptoms and children's behavioral problems was investigated using multivariate logistic regression analysis adjusting for baseline children's behavioral problems and other potential confounders. Cross-sectionally, while no significant association was detected in 2012, all types of children's behavioral problems exhibited significant positive associations with parental PTSD symptoms in multiple logistic regression analysis adjusted odds ratio (AOR) = 3.03, 3.30, and 5.34 for total, internalizing, and externalizing behavior problems, respectively. Maternal educational attainment level (higher than high school education) showed a significant negative association with children's total and externalizing behavioral problems (AOR = 0.30 and 0.13, respectively) in 2014. Longitudinally, parental PTSD symptoms in 2012 showed a significant association with children's internalizing behavioral problems in 2014 after adjusting for children's behavioral problems in 2012 and parental PTSD symptoms in 2014 (AOR = 4.62). These results suggest that the effect of the GEJE on parental PTSD symptoms and children's behavioral problems was long-term, lasting for at least 3 years. These possibilities should be carefully considered in mental health support for parents and their offspring in areas affected by the GEJE.

Impact of Parenting Style on Clinically Significant Behavioral Problems Among Children Aged 4-11 Years Old After Disaster: A Follow-Up Study of the Great East Japan Earthquake.

Objective: The purpose of this study was to investigate the influence of parenting style on children's behavior problems after the Great East Japan Earthquake in 2011. Methods: Participants were children exposed to the 2011 disaster at preschool age (n = 163). Data were collected from August 2012 to March 2013, and from July 2014 to March 2015 (2 and 4 years, respectively, after the earthquake), thus participants were aged 4-11 years when assessed. Parenting style was assessed by caregivers using the Alabama Parenting Questionnaire (APQ), which measures parental involvement, positive parenting, poor monitoring/supervision, inconsistent discipline, and corporal punishment in the second year after the disaster. Behavior problems were assessed by caregivers using the Child Behavior Checklist (CBCL), which identifies internalizing, externalizing, and total problems in the second and fourth year after the disaster. Results: The results show that corporal punishment in the second year after the disaster had negative influence on CBCL internalizing score (coefficient: 0.78, 95%CI: 0.12-1.45, p = 0.023), externalizing score (coefficient: 0.74, 95%CI: 0.09-1.39, p = 0.025), and total score in the fourth year after the disaster (coefficient: 0.85, 95%CI: 0.16-1.55, p = 0.016), after adjusted for children's age, sex, the number of trauma experiences, maternal education, the number of siblings, temporally housing experience, and CBCL each scores in the second year after the disaster. Other parenting style did not affect children's behavioral problems. Conclusion: The result suggests that inadequate rearing after a natural disaster had negative impact on the behavior problems of the affected children in 4 years later of the disaster. Specifically, corporal punishment had negative influence on children's behavior problems.

Disaster-related trauma and blood pressure among young children: a follow-up study after Great East Japan earthquake.

The 11 March 2011 earthquake and tsunami in Japan resulted in ~19,000 lost lives and the displacement of nearly a quarter million people owing to extensive property damage and evacuation from the nuclear meltdown in Fukushima. We sought to prospectively examine whether exposure to disaster-related trauma affected blood pressure levels among young children. We sampled children in three affected prefectures (Miyagi, Fukushima, Iwate) and one unaffected prefecture (Mie). The participants (mean age 6.6 years) and their caregivers answered a baseline survey (N = 320) and a follow-up survey 4 years after the earthquake (N = 227, follow-up rate 71%). Disaster-related trauma was assessed at the baseline, and blood pressure measurements were taken at the follow-up. We converted blood pressure data into age/sex/height-specific z-scores. In linear regression models, we controlled for body mass index, income, age, sex, and housing situation (living in the same house as before the disaster, in a shelter, or in a new house). The number of traumatic experiences was related to diastolic blood pressure in a dose-dependent manner but was not related to systolic blood pressure. Children reporting four or more traumatic experiences had marginally significant elevated diastolic blood pressure (ß = 0.43, p = 0.059). Among specific types of disaster trauma, witnessing a fire was significantly related to higher diastolic blood pressure (ß = 0.60, p = 0.009). In conclusion, disaster-related trauma was associated with higher diastolic blood pressure among young children 4 years after the traumatic events.

Suicide risk among young children after the Great East Japan Earthquake: A follow-up study.

On 11 March 2011, the Great East Japan Earthquake and subsequent tsunami hit East Japan. We aim to investigate the impact of trauma experiences related to the earthquake on suicide risk among young children, stratified by child sex. Participants at baseline were children who were exposed to the 2011 disaster at preschool age (affected area, n=198; unaffected area, n=82, total n=280). From July 2013 to May 2014, suicide risk was assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) in a follow-up interview conducted by a child psychiatrist or psychologist (N=210, follow-up rate: 75%). Among young girls in the affected area, 12 out of 65 (18.5%) showed suicidal ideation, which is significantly higher than girls in the unaffected area (4.7%, p for chi-square=0.036). In the multivariate model adjusted for potential confounders and mediators, the odds ratio for 4 or more trauma experiences related to the earthquake was 5.74 (95% confidence interval: 0.83-39.6, p=0.076) compared to no trauma experience related to the earthquake. Among young boys, trauma exposure was not associated with suicidal ideation. Our findings showed that young girls who experienced earthquake-related trauma at preschool age had a higher suicidal ideation 3 years after the earthquake.

Symptoms of Post-Traumatic Stress Disorder Among Young Children 2 Years After the Great East Japan Earthquake.

OBJECTIVE: The aim of this study was to investigate the prevalence of post-traumatic stress disorder (PTSD) and its association with each traumatic experience among 5- to 8-year-old children 2 years after the Great East Japan Earthquake. METHOD: Children ages 5-8 years who were in selected preschool classes on March 11, 2011, in 3 prefectures affected by the earthquake and 1 prefecture that was unaffected, participated in the study (N=280). PTSD symptoms were assessed through questionnaires completed by caregivers and interviews by psychiatrists or psychologists conducted between September 2012 and May 2013 (ie, 1.5-2 years after the earthquake). RESULTS: Among children who experienced the earthquake, 33.8% exhibited PTSD symptoms. Of the different traumatic experiences, experiencing the earthquake and the loss of distant relatives or friends were independently associated with PTSD symptoms; prevalence ratios: 6.88 (95% confidence interval [CI]: 2.06-23.0) and 2.48 (95% CI: 1.21-5.08), respectively. CONCLUSION: Approximately 1 in 3 young children in the affected communities exhibited PTSD symptoms, even 2 years after the Great East Japan Earthquake. These data may be useful for preventing PTSD symptoms after natural disasters and suggest the importance of providing appropriate mental health services for children. (Disaster Med Public Health Preparedness. 2017;11:207-215).

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

AIMS: Post-traumatic growth (PTG) refers to positive changes that result from coping with a major life crisis or a traumatic event. Factors influencing PTG in youth have not been well characterized but could have a great impact on overall maturation. METHODS: Fourth to ninth graders (n = 3337) attending elementary or junior high schools located in a district severely damaged by the Great East Japan Earthquake completed a questionnaire, including the revised Posttraumatic Growth Inventory for Children (PTGI-C-R) along with the Post Traumatic Stress Symptoms for Children 15 items (PTSSC-15), 31 months after the event. Experience of the disaster, prior traumatic experiences, and attitudes toward memories of the disaster (rumination) were scored by their caregivers and teachers, and effects of these factors on PTG were evaluated. RESULTS: There were no significant associations between PTGI-C-R and sex or experiences of the disaster. However, PTGI-C-R was negatively correlated with age (r = -0.132, P < 0.001). There was significant but very weak negative correlation between PTGI-C-R and PTSSC-15 among the children (r = -0.096, P < 0.001). PTGI-C-R was significantly associated with positive attitudes to memorial services (P < 0.001) and media coverage (P < 0.05). CONCLUSION: Positive attitudes to deliberate rumination may facilitate PTG in children following natural disasters.

Lessons learned from the Great East Japan Earthquake: The need for disaster preparedness in the area of disaster mental health for children.

The Great East Japan Earthquake on March 11, 2011 brought unprecedented challenges to individuals, families, and communities of the Tohoku region in Japan. Children are especially vulnerable to the postdisaster risk factors that impact their ability to heal. The destruction of the infrastructure by the disasters made it more challenging to reach out to children in an area where the stigma against mental illness is persistent. The authors share their experiences, what they heard from patients, and their reflections on lessons learned. The authors recommend the development of a coordinated mental health response system in preparation for the next disaster.

Clinically significant behavior problems among young children 2 years after the Great East Japan Earthquake.

BACKGROUND: On March 11, 2011, a massive undersea earthquake and tsunami struck East Japan. Few studies have investigated the impact of exposure to a natural disaster on preschool children. We investigated the association of trauma experiences during the Great East Japan Earthquake on clinically significant behavior problems among preschool children 2 years after the earthquake. METHOD: Participants were children who were exposed to the 2011 disaster at preschool age (affected area, n = 178; unaffected area, n = 82). Data were collected from September 2012 to June 2013 (around 2 years after the earthquake), thus participants were aged 5 to 8 years when assessed. Severe trauma exposures related to the earthquake (e.g., loss of family members) were assessed by interview, and trauma events in the physical environment related to the earthquake (e.g. housing damage), and other trauma exposure before the earthquake, were assessed by questionnaire. Behavior problems were assessed by caregivers using the Child Behavior Checklist (CBCL), which encompasses internalizing, externalizing, and total problems. Children who exceeded clinical cut-off of the CBCL were defined as having clinically significant behavior problems. RESULTS: Rates of internalizing, externalizing, and total problems in the affected area were 27.7%, 21.2%, and 25.9%, respectively. The rate ratio suggests that children who lost distant relatives or friends were 2.36 times more likely to have internalizing behavior problems (47.6% vs. 20.2%, 95% CI: 1.10-5.07). Other trauma experiences before the earthquake also showed significant positive association with internalizing, externalizing, and total behavior problems, which were not observed in the unaffected area. CONCLUSIONS: One in four children still had behavior problems even 2 years after the Great East Japan Earthquake. Children who had other trauma experiences before the earthquake were more likely to have behavior problems. These data will be useful for developing future interventions in child mental health after a natural disaster.