Predictors of depressive symptoms following the Great East Japan earthquake: A prospective study

Impact of major earthquakes on Parkinson's disease

In April of 2016, major earthquakes occurred in Kumamoto, Japan. There is limited information on how major earthquakes affect patients with Parkinson's disease (PD). This study investigates the effect of major earthquakes on patients with PD. The participants were outpatients with PD from hospitals located in areas heavily damaged by the earthquakes. We performed an anonymous survey at nine medical institutions to investigate the condition of these patients during the month following the earthquakes. We collected questionnaires from 335 patients with PD. The mean age was 72.6, and the mean disease duration was 7.4 years. Regarding physical conditions, 29.3% of the patients worsened, 1.5% improved, and 68.1% had no change. The mental health of 35.2% of the patients worsened, 2.4% improved, and 57.9% had no change. The most frequently exacerbated neurologic symptoms included bradykinesia (56.1%), gait disturbance (51.0%), freezing of gait (40.8%), extension of "off" time (38.8%), and constipation (38.8%). The worsening mental conditions included fear of an aftershock (77.1%), anxiety (49.2%), insomnia (47.5%), melancholy feelings (45.8%), and fatigability (38.1%). Patients forced to evacuate reported significantly more physical and mental health symptoms (p < 0.01). The influences of major earthquakes on patients with PD were identified. After major earthquakes, we should consider the care required for patients' physical and mental health especially for those who experienced evacuation.

Long-term effects of disaster on depressive symptoms: Type of exposure matters

RATIONALE

Natural disasters have the potential to change the lives of older people, yet most studies rely on small convenience samples, few include assessments of people prior to the disaster, and only a handful examine the effects of different types of exposure.

OBJECTIVE

Our analyses add new knowledge to the literature by examining the ways in which four types of exposure (i.e., geographic, peri-traumatic stress, personal and property loss, and post-storm hardship) affect depressive symptoms experienced by older people over a five-year period.

METHOD

We analyzed four waves of data from the ORANJ BOWL panel using multilevel mixed effects models.

RESULTS

We found that although each type of exposure had an independent effect on depressive symptoms, the effects of peri-traumatic stress were dominant.

CONCLUSIONS

As nearly 20% of people in the United States will experience a natural disaster during the course of their lives, it is critical to understand how disaster exposure can influence mental health because each type of exposure demands a different response. Finding that an individual's emotional response during the disaster plays an important role in the development of depressive symptoms suggests that reduction of exposure to traumatic stress during a storm (i.e., evacuation from a storm area) is important for older people. Likewise, immediate interventions following a disaster that target people experiencing high levels of peri-traumatic distress may be particularly effective and that failing to attend to these people may miss a critical opportunity and result in years of suffering.

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.

Does the Type of Temporary Housing Make a Difference in Social Participation and Health for Evacuees of the Great East Japan Earthquake and Tsunami? A Cross-Sectional Study

Background

Although the majority of survivors of the huge Great East Japan Earthquake and Tsunami evacuated to two types of temporary housings, prefabricated housing and rented housing, health effects of these different environments were unclear. We examined whether prevalent social participation in prefabricated housing brought larger health benefits than in rented housing using the largest health survey data of the disaster survivors.

Methods

This cross-sectional study used a 2012 survey by the Miyagi Prefectural Government, in which almost all of evacuees were targeted (response rate: 61.6%). Self-rated health (SRH) and psychological distress measured via K6 score were the dependent variables, and social participation was the independent variable. Odds ratios of the social participation on health variables were estimated using logistic regression models. To assess the contribution of social participation, the population attributable fraction (PAF) was estimated.

Results

The participants lived in prefabricated and rented housing numbered 19,726 and 28,270, respectively. Participants in prefabricated housing had poorer SRH and K6 than those in rented housing. The proportions of participants engaging in social participation of prefabricated and rented housing were 38.2% and 15.4%, respectively. The absence of social participation was significantly associated with poor SRH and K6 among participants in both housing types. The PAFs of social participation with good SRH were 39.5% in prefabricated housing and 14.4% in rented housing. For K6, the PAFs were 47.1% and 19.5% in prefabricated and rented housing, respectively.

Conclusion

Compared to the residents in rented housing, residents in prefabricated housing had more frequent opportunities for social participation, which was associated with larger health benefits.

Lack of access to medical care during Hurricane Sandy and mental health symptoms

Destruction caused by natural disasters compromises medical providers' and hospitals' abilities to administer care. Hurricane Sandy was particularly devastating, resulting in massive disruptions of medical care in the region. This study aimed to determine whether a lack of access to medical care during Hurricane Sandy was associated with posttraumatic stress disorder (PTSD) symptoms and other mental health/substance abuse outcomes. A secondary aim was to examine whether having a chronic illness moderates those associations. Self-reported medical access and mental health symptomatology were obtained from New York City and Long Island residents (n = 1669) following Hurricane Sandy under the Leaders in Gathering Hope Together project (10/23/2013–2/25/2015) and Project Restoration (6/5/2014–8/9/2016). Multivariable logistic regressions were utilized to determine the relationship between lack of access to medical care and mental health outcomes. Of the 1669 participants, 994 (59.57%) were female, 866 (51.89%) were white, and the mean age was 46.22 (SD = 19.2) years old. Those without access to medical care had significantly higher odds of showing symptoms of PTSD (AOR = 2.71, CI = [1.77–4.16]), as well as depression (AOR = 1.94, CI = [1.29–2.92]) and anxiety (AOR = 1.61, CI = [1.08–2.39]) compared to those with access. Lack of access to care was associated with a 2.12 point increase in perceived stress scale score (SE = 0.63). The interaction between having a chronic illness and lack of access to medical care was not significantly associated with any outcomes. The findings emphasize the importance of making medical care more accessible to patients, both chronically and acutely ill, during natural disasters to benefit their physical as well as their mental health.

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Individuals without access to medical care had asignificantly higher odds of showing symptoms of mental health difficulties.

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Chronic illness did not moderate the relationship between a lack of access to care and mental health outcomes.

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Access to medical care during natural disasters may benefit the mental health of survivors with and without chronic illness.</span>

Pre-disaster PTSD as a moderator of the relationship between natural disaster and suicidal ideation over time

BACKGROUND

Natural disasters are associated with a variety of negative health consequences, including enhanced suicide risk. Factors that moderate the relationship between disaster exposure and enhanced suicide risk are unknown. The aim of the current study was to determine whether pre-disaster PTSD moderates the association between change over time in thoughts of death, suicidal ideation (SI), suicide plans, and suicide attempts (SA) from pre- to post-disaster.

METHODS

Participants (n = 2832) were recruited from Chile as part of the larger PREDICT study and completed a measure of lifetime PTSD and panic disorder at baseline and a lifetime death/suicide measure at baseline in 2003 and again 6, 12, and 24 months later (i.e. "pre-disaster"). One year following a major earthquake and tsunami in 2010 (i.e., "post-disaster"), participants completed another death/suicide measure.

RESULTS

Both those with and without pre-disaster PTSD experienced significant increases in SI from pre- to post-disaster. However, pre-disaster PTSD was associated with significantly accelerated increases in thoughts of death and SI from pre-to post-disaster. At nearly all time-points, pre-disaster PTSD was associated with higher thoughts of death and SI, suicide planning, and SA. In contrast, panic disorder did not moderate the association between time and changes in SI.

LIMITATIONS

There was a long time-gap between pre-disaster and post-disaster, with limited data about what occurred during this time.

CONCLUSION

Pre-disaster PTSD is an important predictor of increased SI following a natural disaster, and groups with pre-disaster PTSD should be prioritized for receipt of mental health resources following a natural disaster.

Changes in pulmonary function of residents in Sanriku Seacoast following the tsunami disaster from the Great East Japan Earthquake

BACKGROUND

Residents in the district struck by the Great East Japan Earthquake Tsunami (GEJET) suffered from adverse living conditions and various pulmonary diseases.

OBJECTIVES

To evaluate the influence of GEJET, we performed serial assessment of pulmonary function of approximately 10,000 residents in the district struck by GEJET.

METHODS

Using a spirometer, we assessed the pulmonary function of approximately 10,000 residents older than 18 years in the Sanriku seacoast, which was struck by the tsunami. Measurements were performed in 2011 and 2012.

RESULTS

We compared FVC (forced vital capacity) % pred. and FEV1 (forced expiratory volume in 1second) % pred. of subjects between 2011 and 2012, by serial spirometry. Of the 7053 subjects studied, including 2611 men and 4442 women, FVC% pred. and FEV1% pred. were significantly higher in 2012 than in 2011. Physical indices including height, body weight and the body mass index (BMI) did not change significantly during this period. Smoking prevalence changed significantly between 2010, 2011, and 2012. Both FVC% pred. and FEV1% pred. of subjects who had quit smoking increased significantly on spirometry carried out in 2012, compared with those in 2011.

CONCLUSIONS

The pulmonary function expressed as FVC% pred. and FEV1% pred. were significantly higher in 2012 than in 2011 among the subjects studied. The changes in the smoking status may be one of the reasons for the increase in values observed. However, other undetermined factors during recovery from a disaster might have resulted in improved pulmonary function.

Does Type of Residential Housing Matter for Depressive Symptoms in the Aftermath of a Disaster? Insights From the Great East Japan Earthquake and Tsunami

The 2011 Great East Japan Earthquake and Tsunami resulted in widespread property destruction and over 250,000 displaced residents. We sought to examine whether the type of housing arrangement available to the affected victims was associated with a differential incidence of depressive symptoms. In this prospective cohort study, which comprised participants aged ≥65 years from Iwanuma as a part of the Japan Gerontological Evaluation Study, we had information about the residents' mental health both before the disaster in 2010 and 2.5 years afterward. The Geriatric Depression Scale was used. Type of accommodation after the disaster was divided into 5 categories: no move, prefabricated housing (temporary housing), existing private accommodations (temporary apartment), newly established housing, and other. Poisson regression analysis was adopted, with and without multiple imputation. Among the 2,242 participants, 16.2% reported depressive symptoms at follow-up. The adjusted rate ratio for depressive symptoms among persons moving into prefabricated housing, compared with those who did not, was 2.07 (95% confidence interval: 1.45, 2.94). Moving into existing private accommodations or other types of accommodations was not associated with depression. The relationship between living environment and long-term mental health should be considered for disaster recovery planning.

Association between sleep disturbance and new-onset subjective knee pain in Great East Japan Earthquake survivors: A prospective cohort study in the Miyagi prefecture

BACKGROUND

The Great East Japan Earthquake (GEJE) and Tsunami devastated the northeastern coast of Japan on March 11, 2011. This study aimed to determine whether sociopsychological factors, such as sleep disturbance and psychological distress, influenced new-onset subjective knee pain in survivors during the post-disaster phase of the GEJE.

METHODS

From November 2012 to February 2013 (2 years after the GEJE) and from November 2013 to February 2014 (3 years after the GEJE), survivors (≥18 years) completed self-reported questionnaires. A total of 1470 survivors responded to the questionnaires and were included in this study. New-onset subjective knee pain was defined as knee pain by encircled response absent at 2 years but present at 3 years after the GEJE. Two years after the GEJE, ≥10/24 points on the Kessler Psychological Distress Scale, and ≥6/24 points on the Athens Insomnia Scale defined the presence of psychological distress and sleep disturbance, respectively. Multiple logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of the association between new-onset subjective knee pain and psychological distress or sleep disturbance.

RESULTS

Among the participants, 10.9% (160/1470) reported experiencing new-onset subjective knee pain. Sleep disturbance was significantly associated with new-onset subjective knee pain (OR, 1.57, 95% CI, 1.08-2.29, P = 0.017); however, psychological distress was not (OR, 1.07, 95% CI, 0.65-1.78, P = 0.80).

CONCLUSIONS

This is the first study to indicate an association between sleep disturbance and new-onset subjective knee pain among survivors of the GEJE. 247/300.

Risk of mortality during and after the 2011 Great East Japan Earthquake and Tsunami among older coastal residents

The Japan Gerontological Evaluation Study is a nationwide cohort study of individuals aged 65 years and older established in July 2010. Seven months later, one of the study field sites was directly in the line of the 2011 Great East Japan Earthquake and Tsunami. Despite the 1-hour warning interval between the earthquake and tsunami, many coastal residents lost their lives. We analyzed the risk of all-cause mortality on the day of the disaster as well as in the 38-month interval after the disaster. Among 860 participants, 33 (3.8%) died directly because of the tsunami and an additional 95 people died during the 38-month follow-up period. Individuals with depressive symptoms had elevated risk of mortality on the day of the disaster (odds ratio = 3.90 [95% CI: 1.13, 13.47]). More socially connected people also suffered increased risk of mortality, although these estimates were not statistically significant. In contrast, after the disaster, frequent social interactions reverted back to predicting improved survival (hazard ratio = 0.46 (95% CI: 0.26, 0.82)). Depressive symptoms and stronger social connectedness were associated with increased risk of mortality on the day of the disaster. After the disaster, social interactions were linked to improved survival.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Determinants and Predictors of Grief Severity and Persistence: The Rotterdam Study

OBJECTIVE

We aimed to explore correlates and predictors of bereavement severity and persistence (triggered by "loss of a loved one"; referent group partner loss) in the Rotterdam cohort.

METHOD

We used linear regression to examine factors associated with grief severity using a cross-sectional analysis and logistic regression to determine prospective associations.

RESULTS

Cross-sectionaly, females, child-lost, higher depressive symptoms, lower education, and difficulties in daily activities were independently associated with a higher bereavement severity. Prospectively (6 years; response rate 71%), the baseline value of the grief severity was the single predictor significantly associated with grief persistence.

DISCUSSION

Our results suggest that only grief severity is independently associated with grief persistence. Further studies are needed to confirm our findings.

Are Lowered Socioeconomic Circumstances Causally Related to Tooth Loss? A Natural Experiment Involving the 2011 Great East Japan Earthquake

Oral health status is correlated with socioeconomic status. However, the causal nature of the relationship is not established. Here we describe a natural experiment involving deteriorating socioeconomic circumstances following exposure to the 2011 Great East Japan Earthquake and Tsunami. We investigated the relationship between subjective economic deterioration and housing damage due to the disaster and tooth loss in a cohort of community-dwelling residents (n = 3,039), from whom we obtained information about socioeconomic status and health status in 2010 (i.e., predating the disaster). A follow-up survey was performed in 2013 (postdisaster), and 82.1% of the 4,380 eligible survivors responded. We estimated the impact of subjective economic deterioration and housing damage due to the disaster on tooth loss by fitting an instrumental variable probit model. Subjective economic deterioration and housing damage due to the disaster were significantly associated with 8.1% and 1.7% increases in the probability of tooth loss (probit coefficients were 0.469 (95% confidence interval: 0.065, 0.872) and 0.103 (95% confidence interval: 0.011, 0.196), respectively). In this natural experiment, we confirmed the causal relationship between deteriorating socioeconomic circumstances and tooth loss.

Perspectives acquired through long-term epidemiological studies on the Great East Japan Earthquake

The Great East Japan Earthquake (GEJE) and subsequent tsunamis that occurred in 2011 caused extensive and severe structural damage and interrupted numerous research activities; however, the majority of such activities have been revived, and further public health researches and activities have started to follow the population affected by the disaster. In this mini-review, we overview our recent activities regarding epidemiologic studies in Miyagi Prefecture, the region most affected by the GEJE. Through our study processes, we were able to identify the particular characteristics of vulnerable populations, and provide ideas that may help save lives and reduce the amount of damage caused by a future disaster. Long-term follow-up and care of survivors is essential in affected areas, and health professionals should pay particular attention to various diseases, e.g., cardiovascular complications and mental disorders. Furthermore, building up resilience and social relationships in the community is beneficial to survivors. Ongoing cohort studies conducted before disasters can help minimize biases regarding the survivors’ pre-disaster information, and emerging cohort studies after disasters can find potential helpful novel indices. To identify characteristics of vulnerable populations, save lives, and reduce the amount of damage caused by a future disaster, constant research that is consistently improved by new data needs to be performed.

Reducing depressive symptoms after the Great East Japan Earthquake in older survivors through group exercise participation and regular walking: a prospective observational study

OBJECTIVES

Survivors of the 2011 Great East Japan Earthquake have an increased risk of depressive symptoms. We sought to examine whether participation in group exercise and regular walking could mitigate the worsening of depressive symptoms among older survivors.

DESIGN

Prospective observational study.

SETTING

Our baseline survey was conducted in August 2010, ∼7 months prior to the Great East Japan Earthquake and tsunami, among people aged 65 or older residing in Iwanuma City, Japan, which suffered significant damage in the disaster. A 3-year follow-up survey was conducted in 2013.

PARTICIPANTS

3567 older survivors responded to the questionnaires predisaster and postdisaster.

PRIMARY OUTCOME MEASURES

Change in depressive symptoms was assessed using the 15-item Geriatric Depression Scale (GDS).

RESULTS

From predisaster to postdisaster, the mean change in GDS score increased by 0.1 point (95% CI -0.003 to 0.207). During the same interval, the frequency of group exercise participation and daily walking time also increased by 1.9 days/year and 1.3 min/day, respectively. After adjusting for all covariates, including personal experiences of disaster, we found that increases in the frequency of group exercise participation (B=-0.139, β=-0.049, p=0.003) and daily walking time (B=-0.087, β=-0.034, p=0.054) were associated with lower GDS scores. Interactions between housing damage and changes in group exercise participation (B=0.103, β=0.034, p=0.063) and changes in walking habit (B=0.095, β=0.033, p=0.070) were marginally significant, meaning that the protective effects tended to be attenuated among survivors reporting more extensive housing damage.

CONCLUSIONS

Participation in group exercises or regular walking may mitigate the worsening of depressive symptoms among older survivors who have experienced natural disaster.

Predictors of decline in IADL functioning among older survivors following the Great East Japan earthquake: A prospective study

INTRODUCTION

We described associations between the type of disaster experience and change in instrumental activities of daily living among older adult survivors before-after a terrible disaster.

METHODS

The study took advantage of a "natural experiment" afforded by the Japan Gerontological Evaluation Study (JAGES), a nationwide cohort study established in 2010, seven months prior to the earthquake and tsunami. A follow-up survey was conducted in 2013. This study was conducted in Iwanuma, which was directly struck by tsunami. Our sample comprised community-dwelling aged survivors in Iwanuma who responded to questions about personal circumstances and functional status both before and after the disaster (N = 3547). Personal experiences of earthquake and tsunami damage was used as an exposure variable. The outcome was changes in self-reported 13-item instrumental activities of daily living (IADL), which was assessed both before and after the disaster.

RESULTS

Among the participants, 931 reported losing family member(s) to the disaster, while a further 549 reported losing friend(s). More than half of the participants reported any damage to their houses while approximately 1 in 8 lost their car(s). The multivariable OLS regression revealed that complete house loss and disruption of internal medicine were associated with significantly worse IADL: -0.67 points (95%CI: -0.99, -0.34) for entirely destroyed homes; -0.40 points (95% CI: -0.71, -0.092) for disruption of internal medicine. By contrast, loss of family/friends/pets/cars and disruption to the other medical service were not associated with decline in IADL.

CONCLUSION

Complete house loss and disruption of access to internal medicine after a disaster were associated with significant adverse impact on decline in physical and cognitive functions 2.5 years after the disaster, while loss of family/friends was not.

Social Factors Associated With Psychological Distress and Health Problems Among Elderly Members of a Disaster-Affected Population: Subgroup Analysis of a 1-Year Post-disaster Survey in Ishinomaki Area, Japan

OBJECTIVE

We aimed to investigate the influence of social factors, especially social support, on psychological distress and the prevalence of health problems (HPs) among victims living in their homes 14 to 21 months after the Great East Japan Earthquake and tsunami.

METHODS

A subgroup analysis was performed for elderly participants of a cross-sectional household survey in Ishinomaki area, Japan. The prevalence of psychological HPs was assessed by using a psychological distress questionnaire (K6) and by recording the number of subjective HPs. Perceived social support was assessed in 3 dimensions: informational, emotional, and instrumental support. Univariate and multivariate logistic regression models were used to examine the association between social factors and psychological health.

RESULTS

An elderly subgroup with 879 participants was used for analyses. Psychological distress (K6 score≥9) was observed in 6.8% of the participants aged 65 to 74 years and in 8.0% of those aged ≥75 years. Receiving a long-term care service was associated with having HPs, and discontinuation of attendance at a hospital as an outpatient was associated with psychological distress. Receiving emotional support was associated with lower psychological distress and not having HPs.

CONCLUSIONS

Emotional support was found to be an important factor for promoting health among elderly disaster victims. (Disaster Med Public Health Preparedness. 2017;11:64-71).