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

Housing damage and forgetfulness following the 2024 Noto Peninsula earthquake, Japan

On January 1, 2024, a major earthquake struck Japan's Noto Peninsula. From 2021 to 2023, we conducted a baseline survey. Four months after the disaster, we conducted a follow-up survey to investigate the relationship between house damage and forgetfulness in older adults without dementia. A total of 923 individuals were included. Among the respondents, 32.2% and 33.8% reported as suffered major house damages and increased forgetfulness, respectively. Multivariate analysis revealed major house damage was significantly associated with self-reported forgetfulness, which are partly mediated through sleep disturbance and sedentary behavior in the cognitively unimpaired and mild cognitive impairment groups, respectively.

Resilience Factors Affecting Long-Term Trajectories of Depressive Symptoms in the Aftermath of the Great East Japan Earthquake and Tsunami Among Older Adults

OBJECTIVES

We examined long-term trajectories of depressive symptoms among older adults following exposure to the 2011 Great East Japan Earthquake and Tsunami. We further characterized the pre- and post-disaster social relationship factors that predicted membership in each trajectory group.

METHODS

Data from 4 time points (including pre-disaster data) were used to analyze the depression trajectories of 2,033 survivors through a group-based trajectory model. Multinomial logistic analysis was used to investigate the social relationship factors (i.e., social interactions with neighbors, social support, social participation, and social cohesion) that predicted membership to each trajectory group.

RESULTS

Five distinct trajectories of depressive symptoms were identified; stably not depressed (12.4%), increased after the disaster (14.2%), decreased after the disaster (8.8%), persistent mild depressive symptoms (28.1%), and persistent severe depressive symptoms (36.5%). Compared to those who were stably not depressed, those who experienced an increase in symptoms were more likely to experience housing damage and not to participate in social activities. Compared to those who were stably mildly depressed, those who experienced a decrease in symptoms had higher pre-disaster social interactions with neighbors as well as higher post-disaster social support. Adults with persistent severe symptoms were physically, psychologically, and socially vulnerable preceding the disaster.

DISCUSSION

The study revealed the heterogeneity of older adults experiencing depressive symptoms in the wake of major disaster. Those who experienced increased symptoms after the disaster showed a chronic rather than temporary rise, while those with pre-disaster depressive symptoms showed sustained symptoms regardless of disaster-related trauma.

Shattered ground, shaken minds: Mental health consequences of earthquakes

Despite growing recognition of the importance of mental health status for the achievement of the global development goals, substantial challenges persist in addressing this issue in both developed and developing countries. The literature has pointed to a variety of conditions as triggers for mental health problems, including exposure to unexpected natural disasters. Contributing to the literature, our study quantifies the mental health consequences of the devastating 2006 Yogyakarta earthquake in Indonesia. We combine the Modified Mercalli Intensity from the United States Geological Survey with individual-level data from the Indonesia Family Life Survey to assess the impacts on municipalities with varying earthquake intensities. Employing a difference-in-differences approach, we identify a significant and persistent deterioration in the mental health condition for individuals in municipalities with stronger earthquake severity. To explore the mechanisms underlying this impact, we analyze the roles of family casualties, physical health declines, and socio-economic disruptions, identifying family loss and worsened physical health as particularly influential factors driving the observed mental health outcomes.

The prevalence and risk factors for post-traumatic stress disorder, depression and anxiety among older survivors post-earthquake: A systematic review and meta-analysis

BACKGROUND

The occurrence of PTSD, depression, and anxiety is notably high among older adults following an earthquake. This research aimed to assess the prevalence and determinants of mental health conditions among older survivors after an earthquake.

METHODS

The review was conducted in accordance with the PRISMA process. A comprehensive search was conducted across various databases including PubMed, EMBASE, Web of Science, Scopus, CINAHL, Cochrane Library, SinoMed, China National Knowledge Infrastructure (CNKI), the VIP Database for Chinese Technical Periodicals, and the Wan Fang Database for Chinese Periodicals for studies reporting on the prevalence of PTSD, depression, and anxiety among older survivors post-earthquake. Each database was searched from inception to August 1, 2023 each database, and updated the search on October 1, 2024. The random effects model was employed to conduct meta-analysis, and the I2 index was taken into account to evaluate heterogeneity among studies. A narrative synthesis was performed to identify the risk factors associated with these mental health conditions.

RESULTS

A total of 33 studies were analyzed in this meta-analysis, mainly from China, Japan, Nepal, and Mexico. The prevalence rates of PTSD, depression, and anxiety among older earthquake survivors were found to be 19.3 % (95 % CI [16.0-22.6 %]; I2 = 99.486 %, P = 0.000), 23.5 % (95 % CI [13.9-33.1 %]; I2 = 99.901 %, P = 0.000) and 10.9 % (95 % CI [6.7-15.1 %]; I2 = 99.287 %, P = 0.000), respectively. The identified major risk factors were categorized into four dimensions, including demographic variables (e.g., older age, chronic illness), pre-disaster mitigation variables (e.g., lack of insurance), responding in disaster variables (e.g., being injured, property damage) and post-disaster relief variables (e.g., inadequate psychological care, low levels of social/family support).

LIMITATIONS

The optimal cut-off for different screening tools may be sensitive to changes in the prevalence of older survivors post-earthquake. Furthermore, due to the heterogeneity of the studies, a narrative synthesis of risk factors was conducted.

CONCLUSIONS

The findings of this review may increase the awareness of the burden and risk factors associated with PTSD, depression, and anxiety in older survivors post-earthquake. It serves as a reference for the government in formulating recovery policies focusing on interventions, such as financial allocation, psychological treatment, and insurance claims. These policies aim to mitigate the long-term psychological effects on older survivors and ultimately lower the prevalence of mental health conditions.

Long-Term Trajectories of Cognitive Disability Among Older Adults Following a Major Disaster

Importance

Older adults are at high risk for cognitive impairments following natural disasters, but the persistence of such effects is not well understood.

Objective

To track older adults' postdisaster cognitive disability trajectories over a decade and examine associations of cognitive disability with disaster damage exposure.

Design, Setting, and Participants

This prospective cohort study used predisaster baseline surveys conducted in August 2010 and 4 follow-ups approximately every 3 years until November 10, 2022. Invitations were mailed at baseline to all citizens 65 years or older in Iwanuma City, Japan, a coastal municipality significantly impacted by the 2011 Great East Japan Earthquake and Tsunami. A total of 1988 respondents who were cognitively independent (ie, without cognitive disability) before the disaster completed the 4 postdisaster cognitive assessments.

Exposures

Experiences of residential damage, worsening financial conditions, loss of loved ones, and disruption in health care services. A composite score quantified these experiences, with higher scores indicating greater overall damage.

Main Outcomes and Measures

Cognitive disability level was assessed using a standardized in-home evaluation under a national long-term care insurance scheme. Trained investigators evaluated participants' activities of daily living, cognitive function, and presence of mental and/or behavioral disorders. Latent class growth analyses (LCGA) identified distinct cognitive disability trajectories. Primary outcomes consisted of inclusion in these trajectories.

Results

The analytic sample consisted of 1988 participants who were cognitively independent at baseline, with a mean (SD) age of 72.4 (5.4) years, of whom 1159 (58.3%) were female. LCGA identified 3 cognitive disability trajectories: high and gradual deterioration (277 [13.9%]; high levels of cognitive disability with increasing impairment over time), low and progressive deterioration (541 [27.2%]; low levels of cognitive disability with accelerated decline in cognitive function over time), and low and stable (1170 [58.9%]; low levels of cognitive disability that remained stable). In multinomial regression analyses with the low and stable trajectory serving as the reference, housing damage (adjusted odds ratio [AOR], 2.52; 95% CI, 1.26-5.04), worsening financial conditions (AOR, 1.83; 95% CI, 1.15-2.90), and disruption in health care services (AOR, 1.76; 95% CI, 1.03-2.99) were associated with high and gradual deterioration. Worsening financial conditions (AOR, 1.38; 95% CI, 1.01-1.90) and higher composite damage scores (AOR, 1.16; 95% CI, 1.01-1.34) were associated with low and progressive deterioration. These associations no longer remained after adjusting for postdisaster depressive symptoms.

Conclusions and Relevance

In this cohort study of older adults who survived the 2011 Great East Japan Earthquake and Tsunami, disaster-related exposures were associated with worse long-term cognitive disability trajectories. These findings could inform tailored interventions to preserve cognitive function in older disaster survivors.

Associations between leisure time, non-leisure time physical activity, and kidney function in Japanese adults: a cross-sectional study

BACKGROUND

Chronic kidney disease (CKD) contributes to decreased life expectancy. We examined the association between leisure-time physical activity (LTPA), non-leisure-time physical activity (non-LTPA) and kidney function.

METHODS

This was a cross-sectional study including 32 162 community-dwelling adults aged ≥ 20 years from the Tohoku Medical MegaBank community-based cohort study. Kidney function was evaluated using cystatin C-based estimated glomerular filtration rate (eGFR) as well as self-reported LTPA and non-LTPA. CKD was defined as either eGFR decline (≤ 60 mL/min/1.73 m2) or presence of albuminuria (albumin-creatinine ≥ 30 mg/g). The association between domain-specific physical activity and kidney function, and CKD prevalence was examined using multivariable-adjusted ordinary least squares and modified Poisson models.

RESULTS

The mean eGFR was 98.1 (± 13.2) mL/min/1.73 m2. 3 185 (9.9%) participants were classified as having CKD. The mean LTPA and non-LTPA levels were 2.9 (± 4.2) and 16.6 (± 14.2) METs-hour/day, respectively. For LTPA, in the adjusted model, the quartile groups with higher levels had a higher kidney function (β, 0.36; 95% confidence intervals [CI], [0.06, 0.66]; p = 0.019 for the 2nd quartile, β, 0.82; 95% CI, [0.51, 1.14]; p < 0.001 for the 3rd quartile, and β, 1.16; 95% CI, [0.83, 1.49]; p < 0.001 for the 4th quartile), whereas there were no apparent associations for prevalence of CKD. For non-LTPA, 4th quartile was associated with decreased eGFR (β, -0.42; 95% CI, [-0.72, -0.11]; p = 0.007) and higher prevalence of CKD prevalence (Prevalence ratio, 1.12; 95% CI, [1.02, 1.24]; p = 0.022). These associations with kidney function remained consistent in the subgroup analyses divided by demographic and biological variables.

CONCLUSIONS

We observed a positive association between higher LTPA levels and better kidney function, but not association with CKD prevalence. In contrast, higher non-LTPA was negatively associated with both kidney function and CKD prevalence. These findings suggest that promoting LTPA is beneficial for kidney function.

Challenges and Coping Strategies of Older Adults in the Aftermath of Kahramanmaraş Earthquake in Türkiye: A Qualitative Research

The aim of this study was to explore the post-earthquake experiences, difficulties, and coping strategies of older adults who experienced the Kahramanmaraş earthquakes that occurred in Türkiye in 2023. This research was designed as a qualitative descriptive study. The study was conducted with 21 (13 female and 8 male) older adults and the mean age of the participants was 70.2 (in the range of 65-85). In line with the data obtained from the participants, "Fulfilling Basic Needs of Older Adults, Emotional Turmoil in Later Life, Healthcare Disparities in Aging, Adaptive Response of Older Adults" themes and sub-themes related to the theme were formed. Both physical and socio-emotional challenges, as well as coping strategies and support systems that older adults face in the aftermath of earthquakes, demonstrate unique characteristics for this demographic group. Therefore, it is recommended to plan programs by considering these differences while planning intervention programs before, during, and after the disaster.

Mental health of nursing students regarding the Moroccan earthquake: A cross-sectional study

OBJECTIVE

In addition to the economic and social impact, mental health issues are one of health needs during natural disaster such as earthquake. Thus, surveillance for mental health variables is crucial for public health planning. Nursing students as professional students may be particularly vulnerable to adverse mental health effects after an earthquake because of their potential role in emergency response and the challenges associated with providing medical care in crisis conditions. The aim of this research was to assess the mental health of students after six months of the Moroccan earthquake and associated factors.

METHOD

A cross-sectional survey of student nurses was conducted on March 2024; six months after the Moroccan earthquake in front to 261 students using class sampling method. Three validated psychometric measures, Post-Traumatic Stress Disorder (PCL-C), Depression, Anxiety and Stress Scale (DASS-21), and The Connor-Davidson Resilience Scale (CD-RISC) were used to assess the nursing student mental health after Moroccan earthquake.

RESULTS

Anxiety, Depression, Stress and abnormal post-traumatic stress rank was present respectively in 44.8%, 37.1%, 7.7%, 61.3% of participants. However, a minority of students obtained the high resilience score (13.8%). The results showed that the DAS scale correlated negatively with age (p = 0.034). Furthermore, the female gender, 3rd grade students (as final year for the nursing diploma) and those who had lost a family member in the natural disaster obtained higher medians with a significant difference in the DAS scale score (p < 0.05). The post-traumatic stress scale was only affected by material damage (p = 0.044). However, the high level of scores resilience obtained significantly for students living with their families. In contrast, no association between the mental health of nursing students and attending the phenomenon or living near earthquake foci.

CONCLUSION

This study has demonstrated the crucial need to train healthcare providers in emotion management in the event of a natural disaster, and to launch a priori initiatives, particularly with regard to the mental health of students in health universities, in order to prepare them psychologically for any intervention in the case of an alert.

Associations between housing and psychological damage by earthquake and modifiable risk factors for dementia in general older adults: Tohoku Medical Megabank community-based cohort study

AIM

To evaluate the association between housing and psychological damage caused by the Great East Japan Earthquake (GEJE) and modifiable risk factors (MRFs) of dementia for general population of older adults.

METHODS

This cross-sectional study enrolled 29 039 community-dwelling older adults (mean age 69.1 ± 2.9 years, 55.5% women). We evaluated disaster-related damage (by complete or not complete housing damage) and psychological damage (by post-traumatic stress reaction [PTSR]) after the GEJE using a self-report questionnaire. MRFs encompassed the presence of depression, social isolation, physical inactivity, smoking, and diabetes. We examined the association between disaster-related damage and MRFs using ordinary least squares and modified Poisson regression models adjusted for sociodemographic and health status variables.

RESULTS

Complete housing damage and PTSR were identified in 2704 (10.0%) and 855 (3.2%) individuals, respectively. The number of MRFs was significantly larger for the individuals with complete housing damage (β = 0.23; 95% confidence interval [CI]: 0.19-0.27) and PTSR (β = 0.60; 95% CI: 0.53-0.67). Prevalence ratios (PRs) for depression and physical inactivity were higher in individuals with complete housing damage. The PRs for all domains of the MRFs were significantly higher in individuals with PTSR.

CONCLUSIONS

Housing and psychological damage caused by the GEJE were associated with an increased risk factor of dementia. To attenuate the risk of dementia, especially among older victims who have experienced housing and psychological damage after a disaster, multidimensional support across various aspects of MRFs is required. Geriatr Gerontol Int 2024; 24: 509-516.

Do Adverse Childhood Experiences Modify the Association Between Disaster-Related Trauma and Cognitive Disability?

Identifying subpopulations that are particularly vulnerable to long-term adverse health consequences of disaster-related trauma is needed. We examined whether adverse childhood experiences (ACEs) potentiate the association between disaster-related trauma and subsequent cognitive disability among older adult disaster survivors. Data were from a prospective cohort study of older adults who survived the 2011 Great East Japan Earthquake. The baseline survey pre-dated the disaster by 7 months. We included participants who completed follow-up surveys (2013 and 2016) and did not have a cognitive disability before the disaster (n = 602). Disaster-related traumas (i.e., home loss, loss of friends or pets) and ACEs were retrospectively assessed in 2013. Cognitive disability levels in 2016 were objectively assessed. After adjusting for pre-disaster characteristics using a machine learning-based estimation approach, home loss (0.19, 95% confidence interval (CI): 0.09, 0.28) was, on average, associated with greater cognitive disability. Among individuals with ACEs, home loss was associated with even higher cognitive disability levels (0.64, 95% CI: 0.24, 1.03). Losses of friends (0.18, 95% CI: 0.05, 0.32) and pets (0.13, 95% CI: 0.02, 0.25) were associated with higher cognitive disability levels only among those with ACEs. Our findings suggest that individuals with a history of ACEs may be particularly vulnerable to adverse health consequences related to disasters.

Evaluation of the relationship between the fear of COVID-19 and mental status of female employees during the COVID-19 pandemic

BACKGROUND

The stress due to the COVID-19 pandemic has influenced the physical, mental, and social well-being of humans worldwide.

OBJECTIVE

To evaluate the relationship between the fear of COVID-19 and mental state of female employees during the COVID-19 pandemic.

METHODS

A cross-sectional study was conducted involving 726 participants. Data was collected using the Personal Information Form, fear of COVID-19 scale, and brief symptom inventory.

RESULTS

The fear experienced by women during the social isolation and quarantine period was associated with depression, anxiety, somatization, obsessive-compulsive disorder, interpersonal sensitivity, hostility, phobic anxiety and paranoid experiences.

CONCLUSION

Women, young people, the elderly and single individuals were most likely affected psychologically during the pandemic. Thus, interventions and psychological evaluations are recommended at an early stage to minimize this effect. Such interventions must be implemented considering the strategic planning and coordination of risk groups.

Driving the determinants of older people's mental health in the context of urban resilience: a scoping review

BACKGROUND

Population aging is a pervasive phenomenon occurring rapidly worldwide, while sustainable development goals are considered the mental health among older adults.

METHODS

To investigate the factors affecting mental health, we conducted a scoping review of the 47 papers published between 2015 and 2022 to explore various dimensions affecting older adults' mental health.

RESULTS

Our finding mirrors four dimensions of creating healthy and sustainable environments for older adults: person, place, processes, and resilience-related health in the living environment. The person dimension includes individual characteristics, attitudes and behaviors, and health status. The place dimension is divided into five categories: land use, access, physical form, public open spaces, and housing, while the process consists of the social, cultural, and economic environments. Resilience-related health dimension emphasizes the impact of natural and man-made disasters on older people's mental health.

DISCUSSION

These findings can provide policymakers insights into developing community-based environmental intervention strategies to promote mental health among older adults and support healthy and active aging.

Do disasters exacerbate socioeconomic inequalities in health among older people?

Disasters can exacerbate socioeconomic health disparities because of differential exposure (e.g., socioeconomically disadvantaged groups are more likely to be exposed to disaster-related trauma) and differential vulnerability (disadvantaged groups are more likely to suffer health consequences of exposure to trauma). We sought to test whether health disparities among older adults widened in the area which was directly affected by the 2011 Great East Japan Earthquake & Tsunami compared to areas which largely escaped tsunami damage. We used data from a cohort of community-dwelling older adults who were directly affected by the 2011 disaster (the Iwanuma Study) and municipalities that were not directly affected (the JAGES parent cohort excluding Iwanuma city). The Iwanuma Study gathered pre-disaster information from participants in 2010 (seven months before the disaster) as well as post-disaster information in 2013, 2016 and 2019 (2.5, 5.5 and 8.5 years after the disaster). Our outcomes were depressive symptoms (GDS) and instrumental activities of daily living (IADL). We examined the pre- versus post-disaster trends in socioeconomic health disparities using the slope index and relative index of inequality. We then conducted a difference-in-difference analysis comparing the pre/post disaster change in health disparities in the "exposed" city (Iwanuma) compared to "control" cities. We found clear pre-disaster socioeconomic inequalities in both GDS and IADL in both the exposed and control cities. However, the magnitude of these inequalities did not change after the disaster on either the absolute or relative scales. The 2011 disaster in northeastern Japan did not exacerbate pre-existing patterns of health inequalities in the older population.

Longitudinal changes in depressive symptoms associated with social isolation after the Great East Japan Earthquake in Iwate Prefecture: findings from the TMM CommCohort study

BACKGROUND

Whether past disaster experiences affect the association between changes in social isolation and depressive symptoms is largely unknown. This study examined the association between changes in social isolation and depressive symptoms among survivors who experienced earthquake damage in the aftermath of the Great East Japan Earthquake (GEJE).

METHODS

We analyzed longitudinal data from 10,314 participants who responded to self-report questionnaires on the Lubben Social Network Scale-6 (LSNS-6) and the Center for Epidemiological Studies-Depressive Scale (CES-D) in both the baseline survey (FY2013 to FY2015) and follow-up survey (FY2017 to FY2019) after the GEJE. According to changes in the presence of social isolation (< 12 of LSNS-6) at two time points, participants were categorized into four groups: "not socially isolated," "improved socially isolated," "newly socially isolated," and "continuously socially isolated." At the follow-up survey, a CES-D score of ≥ 16 indicates the presence of depressive symptoms. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using the logistic regression analysis to examine the influence of the change in social isolation over four years on depressive symptoms.

RESULTS

Participants who were newly socially isolated had a significantly higher prevalence of depressive symptoms than those who were not socially isolated (AOR = 1.89, 95% CI = 1.61 - 2.23). In addition, AORs were highest for those who were continuously socially isolated and had experienced house damage (AOR = 2.17, 95% CI = 1.73 - 2.72) and those who were newly socially isolated and had not experienced the death of family members due to the GEJE (AOR = 1.88, 95%CI = 1.60 - 2.22).

CONCLUSION

Our longitudinal findings suggest that being newly or continuously socially isolated is associated with a risk of depressive symptoms, not only among those who had experienced house damage or the death of a family member, but also those who had not, in the disaster-affected area. Our study underlines the clinical importance of social isolation after a large-scale natural disaster and draws attention to the need for appropriate prevention measures.

Seismic activity and development of mood disorders: Findings from the 2016 Kyungju earthquake

BACKGROUND

An earthquake with a moment magnitude of 5.8 occurred in Kyungju on 12 September 2016. Although the earthquake was the largest seismic activity in Korean history, there were no direct casualties from the event. This study evaluated whether a moderate-level earthquake is related to acute development of mood disorders in earthquake-exposed residents.

MATERIAL AND METHODS

The healthcare information of residents (n = 865,263) living in Kyungju and control cities (Gimpo, Jeonju, Gimhae, and Pohang) over a 10-year period (from 2010 to 2019) was gathered from the national health insurance database. Difference-in-difference analysis was used to compare the daily incidence of mood disorders (manic episode; bipolar affective disorder; depressive episode; recurrent depressive disorder) 20 weeks before (reference: -20 to -11 weeks, period 1: -10 to -1 weeks) and after (period 2: 0-9 weeks, period 3: 10-19 weeks) the earthquake. Subregional analyses based on the distance to the epicenter and stratification analyses by sex, age, and income were conducted.

RESULTS

The weekly average incidence rate (/100,000 persons) of mood disorders in Kyungju residents increased from 27.0 (-20 to -11 weeks) and 28.3 (-10 to -1 weeks) persons before the earthquake, to 38.1 persons (0 to 9 weeks) after the earthquake. A significant increase in the risk of developing mood disorders was observed in Kyungju residents during the 0 to 9 weeks after the earthquake when compared to the control cities [relative risk (95 % confidence intervals): vs. Gimpo, 1.40 (1.05, 1.88); vs. Jeonju, 1.45 (1.14, 1.84); vs. Gimhae, 1.48 (1.14, 1.93)]. The increase was more prominent in women, low-income individuals, and those living closer to the epicenter.

CONCLUSION

Moderate-level earthquakes without direct casualties may cause mood disorders in residents living in affected areas. Mental health aid programs should be provided to earthquake victims even if the earthquake has caused limited life and property loss.

Heterogenous effects of the Great East Japan earthquake on prosociality of people depending on their age

This study investigates the instability of prosociality in the real world by looking at the age-specific non-linear relationship between disaster exposure and prosocial behavior. We employed unique microdata from two communities in Japan that were hit by the Great East Japan Earthquake and Tsunami disaster in 2011. Exploiting exogenous variations in disaster exposure, we find age-specific heterogeneous effects of disaster exposure on prosocial behavior captured by the behavior of sending New Year's cards as well as attitudinal survey questions. Among the older groups, disaster damages undermine prosociality, whereas the younger groups show reinforced prosocial behaviors. These findings can be explained consistently by combining two possible determinants of prosocial behavior: pure or impure altruism and self-enforcements in repeated interactions at workplaces. Age information can help disentangle these two elements at least partially.

Uncovering Heterogeneous Associations Between Disaster-Related Trauma and Subsequent Functional Limitations: A Machine-Learning Approach

This study examined heterogeneity in the association between disaster-related home loss and functional limitations of older adults, and identified characteristics of vulnerable subpopulations. Data were from a prospective cohort study of Japanese older survivors of the 2011 Japan Earthquake. Complete home loss was objectively assessed. Outcomes in 2013 (n = 3,350) and 2016 (n = 2,664) included certified physical disability levels, self-reported activities of daily living, and instrumental activities of daily living. We estimated population average associations between home loss and functional limitations via targeted maximum likelihood estimation with SuperLearning and its heterogeneity via the generalized random forest algorithm. We adjusted for 55 characteristics of survivors from the baseline survey conducted 7 months before the disaster. While home loss was consistently associated with increased functional limitations on average, there was evidence of effect heterogeneity for all outcomes. Comparing the most and least vulnerable groups, the most vulnerable group tended to be older, not married, living alone, and not working, with preexisting health problems before the disaster. Individuals who were less educated but had higher income also appeared vulnerable for some outcomes. Our inductive approach for effect heterogeneity using machine learning algorithm uncovered large and complex heterogeneity in postdisaster functional limitations among Japanese older survivors.

The Suicidal Ideation of Disaster Victims: A Nationwide Cross-Sectional Study

Purpose

Various natural and human made disasters occur worldwide. This study aimed to identify the factors affecting suicidal ideation in victims of disasters such as typhoons, heavy rainfall, fires, and earthquakes.

Methods

Data were obtained from a long-term survey on life changes among disaster victims conducted in 2019 by the National Disaster Management Research Institute. The study included 2234 victims of natural and social disasters occurring in Korea between 2012 and 2018. Suicidal ideation was assessed using the Korean version of the Composite International Diagnostic Interview developed by the World Health Organization. The participants' demographic characteristics, disaster-related characteristics, physical characteristics, psychological characteristics, and social characteristics were analyzed as the influencing factors. The data were analyzed using the chi-square test, t-test, and logistic regression.

Results

Of the 2234 subjects in this study, 32 were disaster victims who had experienced suicidal ideation, accounting for 1.4%. The results showed that the factors affecting suicidal ideation included disaster-related injury/disease, depression, and social support. The odds ratio of suicidal ideation was higher when there was injury/disease (OR=1.89, 95% CI=0.07-0.48), with higher depression levels (OR=1.31, 95% CI=1.18-1.47) and with lower social support (OR=0.94, 95% CI=0.90-0.99).

Conclusion

This study identifies the significant influencing factors of suicidal ideation in disaster victims, which were as follows: disaster-related injury or disease, depression, and social support. Our study's findings would contribute to screening high-risk groups of suicidal ideation and developing effective support, interventions, and suicide prevention programs for disaster victims. Furthermore, to prevent suicide and promote the healthy recovery of disaster victims, mental health care services aimed at suicide prevention should be reinforced and the victims should be provided with psychological support and treatment without financial burden.

Aging and Neuropsychiatric Disease: A General Overview of Prevalence and Trends

The increasing trend of life-expectancy is becoming a significant demographic, societal and economic challenge. Currently, global number of people above sixty years of age is 900 million, while United Nations expect this number to rise to over 1.4 billion in 2030 and over 2.5 billion by 2050. Concordant to this trend, numerous physiological changes are associated with aging and brain-related ones are associated with neuropsychiatric diseases. The main goal of this chapter is to identify the most important neuropsychiatric diseases to assess in older patients to help to promote health and prevent diseases and complications associated with chronic illness, as these changes are progressive and require important psychological and setting-related social adjustments. Findings identify several health-aspects highly present in elderly: stroke, white matter lesions, dementia rise with age, changes in levels of neurotransmitters and hormones, depression as well as the bereavement following loss of the loved one, and the most common neurodegenerative disease—Alzheimer’s disease and Parkinson’s. In conclusion, studying the aging process should include all developmental, circumstantial, and individual aspects of aging. This offers opportunities to improve the health of elderly by using a wide range of skills and knowledge. Thus, further studies are necessary to elucidate what can be done do to improve the aging process and health of elderly in the future.

The course, trajectories and predictors of depression 23 years after the 1988 Spitak earthquake in Armenia: A prospective cohort study

There is a scarcity of long-term studies of depression after natural disasters. This prospective epidemiologic study evaluated the course of depression and factors associated with it among survivors 23-years post-earthquake. A geographically stratified subsample of 725 adults exposed to the Spitak earthquake was assessed for depression using DSM-III-R criteria in 1991 and 2012. Additionally, an adapted CES-D-16 scale was used to assess depressive symptoms in 2012. A fitted multi-nominal logistic regression model identified predictors of different trajectories of depression. For the whole group, the rate of clinical depression dropped from 51.5% in 1991 to 31.7% in 2012. Earthquake intensity and experiencing strong fear at baseline were strongly associated with chronic (depressed at both assessments, 18.1%) and recovered (depressed only in 1991, 33.5%) depression trajectories compared with the healthy group, with odds ratios (OR) over 4.0 and 3.0, respectively. Predictors distinguishing chronic depression included earthquake-related nuclear-family deaths (OR=3.79), chronic illnesses at baseline (OR=1.24), and social support (OR=0.91). Predictors of the late-onset trajectory (depressed only in 2012, 13.5% of the cohort) included post-earthquake trauma (OR=1.42), socioeconomic status (OR=0.45), and social support (OR=0.86). The factors associated with the different trajectories of depression provide guidance for planning more effective mental health interventions after disasters.

Long-Term Associations between Disaster-Related Home Loss and Health and Well-Being of Older Survivors: Nine Years after the 2011 Great East Japan Earthquake and Tsunami

BACKGROUND

Little research has examined associations between disaster-related home loss and multiple domains of health and well-being, with extended long-term follow-up and comprehensive adjustment for pre-disaster characteristics of survivors.

OBJECTIVES

We examined the longitudinal associations between disaster-induced home loss and 34 indicators of health and well-being, assessed ∼ 9 y post-disaster.

METHODS

We used data from a preexisting cohort study of Japanese older adults in an area directly impacted by the 2011 Japan Earthquake (n = 3,350 and n = 2,028 , depending on the outcomes). The study was initiated in 2010, and disaster-related home loss status was measured in 2013 retrospectively. The 34 outcomes were assessed in 2020 and covered dimensions of physical health, mental health, health behaviors/sleep, social well-being, cognitive social capital, subjective well-being, and prosocial/altruistic behaviors. We estimated the associations between disaster-related home loss and the outcomes, using targeted maximum likelihood estimation and SuperLearner. We adjusted for pre-disaster characteristics from the wave conducted 7 months before the disaster (i.e., 2010), including prior outcome values that were available.

RESULTS

After Bonferroni correction for multiple testing, we found that home loss (vs. no home loss) was associated with increased posttraumatic stress symptoms (standardized difference = 0.50 ; 95% CI: 0.35, 0.65), increased daily sleepiness (0.38; 95% CI: 0.21, 0.54), lower trust in the community (- 0.36 ; 95% CI: - 0.53 , - 0.18 ), lower community attachment (- 0.60 ; 95% CI: - 0.75 , - 0.45 ), and lower prosociality (- 0.39 ; 95% CI: - 0.55 , - 0.24 ). We found modest evidence for the associations with increased depressive symptoms, increased hopelessness, more chronic conditions, higher body mass index, lower perceived mutual help in the community, and decreased happiness. There was little evidence for associations with the remaining 23 outcomes.

DISCUSSION

Home loss due to a disaster may have long-lasting adverse impacts on the cognitive social capital, mental health, and prosociality of older adult survivors. https://doi.org/10.1289/EHP10903.

Big Five Personality Traits, Social Networks, and Depression Among Older Adults in Japan: A Multiple Mediation Analysis

This study examines the mediating effect of social network size on depression among older adults in Japan in association with the Big Five personality traits: extraversion, agreeableness, conscientiousness, neuroticism, and openness. Cross-sectional data were obtained from 739 older adults (Mean age = 75.13, SD = 6.86) residing in Tokyo. Multiple mediation analyses estimated total, indirect, and direct effects between personality and depression. Extraversion was associated with the number of kin and friend networks and agreeableness with the number of kin networks. Moreover, these social networks partially mediated the effects of extraversion and agreeableness on depression. The findings show that personality traits such as extraversion and agreeableness are associated with social network size, which contributes to better mental health in old age.

Uncovering heterogeneous associations of disaster-related traumatic experiences with subsequent mental health problems: A machine learning approach

AIM

Understanding the differential mental health effects of traumatic experiences is important to identify particularly vulnerable subpopulations. We examined the heterogeneous associations between disaster-related traumatic experiences and postdisaster mental health, using a novel machine learning-based causal inference approach.

METHODS

Data were from a prospective cohort study of Japanese older adults in an area severely affected by the 2011 Great East Japan Earthquake. The baseline survey was conducted 7 months before the disaster and the 2 follow-up surveys were conducted 2.5 and 5.5 years after (n = 1150 to n = 1644 depending on the exposure-outcome combinations). As disaster-related traumatic experiences, we assessed complete home loss and loss of loved ones. Using the generalized random forest algorithm, we estimated conditional average treatment effects (CATEs) of the disaster damages on postdisaster mental health outcomes to examine the heterogeneous associations by 51 predisaster characteristics of the individuals.

RESULTS

We found that, even when there was no population average association between disaster-related trauma and subsequent mental health outcomes, some subgroups experienced severe impacts. We also identified and compared characteristics of the most and least vulnerable groups (ie, top versus bottom deciles of the estimated CATEs). While there were some unique patterns specific to each exposure-outcome combination, the most vulnerable group tended to be from lower socioeconomic backgrounds with preexisting depressive symptoms for many exposure-outcome combinations.

CONCLUSIONS

We found considerable heterogeneity in the association between disaster-related traumatic experiences and subsequent mental health problems.

Can parkland mitigate mental health burden imposed by the COVID-19? A national study in China

The worldwide coronavirus disease 2019 (COVID-19) pandemic has seriously affected not only physical health but also mental wellbeing (i.e mental stress and suicide intention) of numerous urban inhabitants across the globe. While many studies have elucidated urban parkland enhances and mental wellbeing of urban residents, the potential for parkland to mitigate mental health burden imposed by the COVID-19 has received no attention. This nationwide study systematically explored the association between parkland, the COVID-19 pandemic situation and mental wellbeing from 296 cities in China. The study innovatively used big data from Baidu Search Engine to assess city-level mental wellbeing, thereby enabling comparisons among cities. The results show that the provision of parkland is positively associated with mental wellbeing during the COVID-19 epidemic. For COVID-19-related indicators, the geographical distance to Wuhan city, work resumption rate, and travel intensity within the city are also positively associated with mental wellbeing, while the number of COVID-19 infections and the proportion of migrants from Hubei Province for each city are negatively associated with mental wellbeing. Last, the most important finding is that parkland reduces the negative effect of COVID-19 on mental wellbeing during the COVID-19 epidemic. To achieve the goal of promoting mental wellbeing through urban planning and design during the future pandemics, policymakers and planners are advised to provide more well-maintained and accessible parkland and encourage residents to use them with proper precautions.

Heterogeneity in cognitive disability after a major disaster: A natural experiment study

Cognitive disability following traumatic experiences of disaster has been documented; however, little is known about heterogeneity in the association across individuals. In this natural experiment study of approximately 3000 Japanese older adults in an area directly affected by the 2011 Great East Japan Earthquake, the baseline survey was established 7 months before the 2011 earthquake. To inductively identify heterogeneity in postdisaster cognitive disability by predisaster characteristics, we applied a machine learning–based causal inference approach—generalized random forest. We identified strong evidence for heterogeneity in the association between home loss and cognitive disability objectively assessed 2.5 and 5.5 years after the 2011 earthquake. The subgroups with the strongest disaster-dementia associations tended to be from low socioeconomic backgrounds and have predisaster health problems. The study demonstrated that some subpopulations are particularly prone to experience cognitive disability after disasters, which could be overlooked in studies assessing population average associations only.

Causal Inference in Studying the Long-Term Health Effects of Disasters: Challenges and Potential Solutions

Two frequently encountered but underrecognized challenges for causal inference in studying the long-term health effects of disasters among survivors include 1) time-varying effects of disasters on a time-to-event outcome and 2) selection bias due to selective attrition. In this paper, we review approaches for overcoming these challenges and demonstrate application of the approaches to a real-world longitudinal data set of older adults who were directly affected by the 2011 Great East Japan Earthquake and Tsunami (n = 4,857). To illustrate the problem of time-varying effects of disasters, we examined the association between degree of damage due to the tsunami and all-cause mortality. We compared results from Cox regression analysis assuming proportional hazards with those derived using adjusted parametric survival curves allowing for time-varying hazard ratios. To illustrate the problem of selection bias, we examined the association between proximity to the coast (a proxy for housing damage from the tsunami) and depressive symptoms. We corrected for selection bias due to attrition in the 2 postdisaster follow-up surveys (conducted in 2013 and 2016) using multivariable adjustment, inverse probability of censoring weighting, and survivor average causal effect estimation. Our results demonstrate that analytical approaches which ignore time-varying effects on mortality and selection bias due to selective attrition may underestimate the long-term health effects of disasters.

Coastal exposure and residents' mental health in the affected areas by the 2011 Great East Japan Earthquake and Tsunami

No previous study has ever explored the association between coastal exposure and the mental health of residents in a post-disaster context. Therefore, we aimed to confirm whether there was an association between sea visibility and coastal proximity and the mental health of coastal residents a devastating tsunami. We targeted 15 coastal municipalities located in the Miyagi Prefecture, and obtained data from a community-based cohort study. The baseline survey was initiated 2 years after the 2011 Great East Japan Earthquake and Tsunami and the secondary survey was initiated 6 years after the disaster. We applied multilevel mixed-effects models to the longitudinal data. Our outcome measure was the Kessler Psychological Distress Scale (K6) score. We assessed the data collected from 2,327 respondents on both surveys as of April 2018 for this ongoing cohort study. We found that neither sea visibility nor coastal proximity was significantly associated with the recovery of mental health after the disaster. However, we found a distinctive trend of mental health recovery in people who lived alone with a sea view, indicating that visibility of the sea had a negative effect on their mental health immediately after the GEJET, but that the negative effect was subsequently eliminated.

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.

Effects of peri-traumatic stress experienced during Hurricane Sandy on functional limitation trajectories for older men and women

BACKGROUND AND METHODS

Although the short-term effects of disasters on the physical health of mid-life and older people have been documented, little is understood about the long-term effects that disasters have on the physical health of these people. Based on the environmental docility hypothesis and research regarding gender effects on functional limitations and disaster, our analyses examined the effects of peri-traumatic stress experienced during Hurricane Sandy using longitudinal data from 5688 people aged 50 and older collected over six waves (2006-2019).

RESULTS

We found that functional limitations follow three trajectories, with people in each group having a significant linear increase over time and all but the highest functioning people also having a significant quadratic effect, indicating that the linear increase peaked post-Hurricane and then slowed in later waves.

CONCLUSION

Consistent with the environmental docility hypothesis, peri-traumatic stress had its greatest impact on people with more functional limitations before the hurricane. Men experiencing peri-traumatic stress during Hurricane Sandy were more likely to experience an increase in functional limitations than women. These findings, which identify people most likely to experience long-term health effects following a disaster, can be used to inform health policies before, during, and after disaster strikes.

The Short-Term Psychological Impact of the COVID-19 Pandemic in Psychiatric Patients: Evidence for Differential Emotion and Symptom Trajectories in Belgium

The spread of COVID-19 and the implementation of various containment strategies across the world have seriously disrupted people's everyday life, and it is especially uncertain what the psychological impact of this pandemic will be for vulnerable individuals, such as psychiatric (ex-)patients. Governments fear that this virus outbreak may prelude a major mental health crisis, and psychiatrists launch critical calls to flatten an upcoming mental ill-health surge. Here, we aim to add nuance to the idea that we are heading towards a mental health pandemic and that psychiatric populations will unavoidably (re)develop psychopathology. Despite being subjected to the same challenges posed by COVID-19, we argue that people with a history of psychiatric illness will psychologically deal with this adversity in different ways. To showcase the short-term differential impact of COVID-19 on patients' mental health, we present the day-to-day emotion and symptom trajectories of different psychiatric patients that took part in an experience sampling study before, during, and after the start of the first wave of the COVID-19 pandemic in March 2020 and associated lockdown measures in Belgium. Piecewise regression models show that not all patients' psychological well-being is affected to a similar degree. As such, we argue that emphasizing human resilience, also among the more vulnerable in society, may be opportune in these unsettling times.

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.

Persistent mental health impacts of disaster. Five-year follow-up after the 2011 great east Japan earthquake and tsunami: Iwanuma Study

Few studies have tracked the long-term mental health outcomes following major disaster. We sought to document the trajectories of depressive symptoms and post-traumatic stress symptoms (PTSS) in the aftermath of the 2011 Great East Japan earthquake and tsunami. A cohort of community-dwelling older adults were followed for 5.5 years after the disaster at 3 waves (2010, 2013 and 2016). Depressive symptoms were measured by the Geriatric Depression Scale Short Form, while PTSS was assessed by the Screening Questionnaire for Disaster Mental Health. We examined the trajectories of mental illness symptoms based on the probabilities of persistence, recovery, and delayed onset. Among people without pre-disaster depressive symptoms, 13.6% had developed depressive symptoms 2.5 years after the disaster. Of these, half of those had recovered and half had persisted at the 5.5 year follow-up. 11.1% of survivors reported post-traumatic stress symptoms in 2013; of these, 58% recovered by 2016, while 4.8% experienced delayed onset. Job loss was associated with persistent PTSS (OR 2.03; 95%CI 1.01-4.12) while a drop in subjective economic status predicted delayed onset of PTSS (OR 2.13; 1.34-3.39). However, disaster-related experiences were unrelated to the trajectory of depressive symptoms at 5.5 years. The probabilities of remission (58%) and delayed onset (5%) of PTSS are consistent with prior disaster research. The experience of job loss and drop in subjective economic status appeared to exert a lingering influence on the persistence or delayed onset of PTSS. Depressive symptoms after the disaster had remitted in roughly half of the survivors after 5.5 years.

Six-year follow-up study of residential displacement and health outcomes following the 2011 Japan Earthquake and Tsunami

Studies examining the long-term health consequences of residential displacement following large-scale disasters remain sparse. Following the 2011 Japan Earthquake and Tsunami, victims who lost their homes were resettled by two primary means: 1) group relocation to public housing or 2) individual relocation, in which victims moved into public housing by lottery or arranged for their own accommodation. Little is known about how the specific method of residential relocation affects survivors' health. We examined the association between residential relocation and long-term changes in mental and physical well-being. Our baseline assessment predated the disaster by 7 mo. Two follow-up surveys were conducted ∼2.5 y and 5.5 y after the disaster to ascertain the long-term association between housing arrangement and health status. Group relocation was associated with increased body mass index and depressive symptoms at 2.5-y follow-up but was no longer significantly associated with these outcomes at 5.5-y follow-up. Individual relocation at each follow-up survey was associated with lower instrumental activities of daily living as well as higher risk of cognitive impairment. Our findings underscore the potential complexity of long-term outcomes associated with residential displacement, indicating both positive and negative impacts on mental versus physical dimensions of health.

Multilevel Social Mechanisms of Post-Disaster Depression

This exploratory study empirically shows how community social capital is related to post-disaster depression, whereas most disaster mental health research has focused on posttraumatic stress disorder. We tested the validity of earlier found multilevel social and individual mechanisms of posttraumatic stress for symptoms of post-disaster depression. We used data (n = 231) from a community study after a flood in Morpeth (2008), a rural town in northern England. At the salutary community level, our multilevel analyses showed that, in communities with high social capital, individuals employ less individual social support and coping effort, which protects individuals from developing symptoms of depression. Yet, on the ‘dark’ individual level of our model, we found that perceiving the disaster as less traumatic after a year was related to more feelings of depression in contrast to previous findings for posttraumatic stress. Our explanation of this finding is that, when the appraisal of the disaster as threatening fades into the background, individuals may perceive the full scope of the disaster aftermath and start to feel depressed. We also found that more social support is related to more depression. Although depressed people may attract or receive more social support, this social support can paradoxically become disabling by reinforcing a sense of dependence, thereby undermining self-esteem and leading to feelings of helplessness. Our results imply that to curb post-disaster depression, boosting community level social capital may be an important starting point for building resilience. At the same time, interventionists need to identify risk groups for whom the stressful experience becomes less intrusive and who experience the burden of dependency on an unequal relationship with ones’ social inner circle.

On the Direct and Indirect Effects of the Great East Japan Earthquake on Self Rated Health through Social Connections: Mediation Analysis

The Great East Japan Earthquake created health hazards for many people. Using Panel Data gathered in Iwanuma city, Japan, at two points in time (in 2010 before the quake, and in 2013 after the quake), we found that the high degree of housing damage negatively affected victims' self rated health (SRH) (direct effect), and decreased the levels of their social connections, which in turn also had a harmful effect on their SRH (indirect effect). We also found that although the direct impacts of earthquakes disappear relatively quickly, the harmful indirect effects associated with a decrease in social connections are slower to dissipate. We conducted a first-difference two-step GMM estimation to consider the possible problem of endogeneity. The results support the above conclusion, and show that in the short-term, the indirect impacts of the earthquake accounted for 55% of all the impacts experienced.

Depressive symptoms in the aftermath of major disaster: Empirical test of the social support deterioration model using natural experiment

INTRODUCTION

We examined the extent to which the post-disaster deterioration of social support and social capital mediates the associations between disaster-related experiences and depressive symptoms among survivors to test the social support deterioration model.

METHODS

We used unique natural experiment data (n = 3567) stemming from the 2011 Great East Japan Earthquake. The follow-up survey was conducted 2.5 years after the disaster. We examined associations between changes in depressive symptoms, disaster-related experiences (loss of loved ones, changes in household income, loss of job, drop in subjective economic status, and home loss), and post-disaster deterioration of four different types of social support (i.e., kin emotional, kin instrumental, non-kin emotional, and non-kin instrumental support), as well as two dimensions of individual-level social capital (i.e., informal socializing and social cohesion). We then performed causal mediation analysis.

RESULTS

We found that there was deterioration of social support and social capital among individuals with disaster-related experiences. We also found associations between deterioration of social support/capital and worsening of depressive symptoms for specific categories of disaster experiences (i.e., drop in subjective economic status, loss of job, and home loss). However, causal mediation analysis showed little evidence of mediation by post-disaster deterioration of social support/capital. There was some evidence to suggest exposure-mediator interaction such that the association between social support/capital deterioration and depressive symptoms was weaker among those with disaster experiences.

DISCUSSION

The social support deterioration model was not empirically supported among older-adult disaster survivors of the 2011 Great East Japan Earthquake, after accounting for exposure-mediator interactions.

Type of Disaster Exposure Affects Functional Limitations of Older People 6 Years Later

BACKGROUND

Natural disasters, including earthquakes, tsunamis, tornadoes, and hurricanes, are traumatic events that simultaneously affect the lives of many people. Although much is known about the effects that natural disasters have on mental health, little is known about how natural disasters affect physical health. These analyses add to the literature by examining the ways in which four types of disaster exposure (geographic, peri-traumatic stress, personal and property loss, and poststorm hardship) experienced by older people during and after Hurricane Sandy affected functional limitations.

METHODS

We analyzed five waves of data from the ORANJ BOWL panel ("Ongoing Research on Aging in New Jersey: Bettering Opportunities for Wellness in Life") using multilevel mixed-effects models.

RESULTS

We found that although peri-traumatic stress and poststorm hardship each had independent effects on functional limitations, the effects of peri-traumatic stress dominated and were evident 6 years after the hurricane. Geographic exposure and personal/property loss were not associated with functional limitations.

CONCLUSIONS

These findings add important information to what is known about older people who experience a natural disaster and suggest opportunities for intervention. Finding that an individual's emotional response during the disaster plays an important role in the development of functional limitations suggests that reduction of exposure to traumatic stress during a storm (ie, evacuation from a storm area) may be important for older people. Likewise, interventions immediately after a disaster that target older people who experience high levels of peri-traumatic distress may be needed in order to alleviate functional limitations before they develop.

Mediation of the relationship between home loss and worsened cardiometabolic profiles of older disaster survivors by post-disaster relocation: A natural experiment from the Great East Japan earthquake and tsunami

The underlying mechanism for deterioration in cardiometabolic health after major natural disasters is unknown. We leveraged natural experiment data stemming from the 2011 Great East Japan Earthquake and Tsunami (n = 1165) to examine whether specific types of post-disaster accommodations explain the association between disaster-related property damage and objectively measured cardiometabolic profiles of older disaster survivors. Causal mediation analysis showed that relocation to trailer-style temporary shelters largely mediated the associations between home loss and unhealthy changes in anthropometric measures (72.6% of 0.65 kg/m² for body mass index and 62.3% of 3.89 cm for waist circumference), but it did not mediate the associations with serum lipid measures. This study demonstrates that there are outcome-specific pathways linking disaster damage and health of survivors.

Prevalence of and Risk Factors for Depression Among Older Persons 6 Months After the Lushan Earthquake in China: A Cross-Sectional Survey

BACKGROUND

Older persons are particularly vulnerable to the impact of earthquakes and are more likely to suffer from depression.

OBJECTIVES

We aimed to estimate the prevalence of depression, to compare the prevalence between disaster-affected and non-disaster affected areas, and to explore additional risk factors for depression 6 months after the Lushan earthquake.

DESIGN

A cross-sectional study was conducted.

SETTING

A magnitude 7.0 earthquake occurred in Lushan County, Ya'an Prefecture, Sichuan Province, on April 20, 2013. In total, 196 people were killed, and 11,470 were injured over 5 days.

PARTICIPANTS

A multistage cluster sampling strategy was used. A total of 1,509 older persons (aged 60 or older) participated.

METHODS

The Geriatric Depression Scale-15, the University of California Los Angeles Loneliness scale, the Activities of Daily Living Scale, the Social Support Rating Scale, and the Family Apgar Index scale were used to evaluate symptoms of depression, loneliness, dependence with respect to activities of daily living, perceived social support, and family function, respectively. A generalized linear regression model and multiple logistic regression analysis were employed to identify risk factors for depression.

RESULTS

Using a cutoff score of 8, the prevalence of depression was 29.16% in the hardest-hit disaster area, 29.06% in the hard-hit disaster area, 31.61% in the moderately-hit disaster area, 17.94% in the remote non-disaster area, and 12.28% in the neighboring non-disaster area. The prevalence was significantly higher in the disaster areas than in the non-disaster areas. Risk factors for depression included an educational level of elementary school or lower, a greater number of chronic illnesses, feelings of loneliness, limitations in activities of daily living, family dysfunction, and low levels of social support.

CONCLUSION

Depression was highly prevalent in elderly survivors and was significantly more prevalent in disaster areas than in non-disaster areas. Psychological interventions and care should focus on older survivors.

Causal effect of deteriorating socioeconomic circumstances on new-onset arthritis and the moderating role of access to medical care: A natural experiment from the 2011 great east Japan earthquake and tsunami

Socioeconomic disadvantage is a risk factor for arthritis, but its causal relationship remains unclear. This study examined the causal relationship between socioeconomic circumstances and new-onset arthritis by taking advantage of the "natural experiment" that resulted from the Great East Japan Earthquake and Tsunami. The baseline survey was conducted in August 2010, 7 months before the disaster. Self-reported questionnaires were mailed to all eligible residents of Iwanuma City in Miyagi Prefecture. The earthquake and tsunami occurred on March 11, 2011. The follow-up survey was conducted in October 2013, as well as the gathering of information about disaster damage (housing damage and subjective deterioration of economic circumstances) and health-related information. We used a two-stage least squares instrumental variable model to analyze 2360 survivors who did not have arthrosis at baseline, of whom 95 (4.0%) developed arthritis over the 2.5-year follow-up period. We used the linear probability model for the estimations. Our results revealed that both the subjective deterioration of economic circumstances and housing damage were associated with the development of arthritis (95% confidence interval [CI], 0.08 [0.03-0.12] and 0.02 [0.01-0.04], respectively). In addition, we also found that the disruption of access to orthopedics was associated with the development of arthritis. Our findings added robust evidence of the causal relationship between worsening economic circumstances and the development of arthritis. Our study emphasized the importance of recovery as well as the establishment of the post-disaster orthopedic medical system in the aftermath of a disaster.

Long-term Trends in Mental Health Disorders After the 2011 Great East Japan Earthquake and Tsunami

IMPORTANCE

Posttraumatic stress symptoms (PTSS) and depressive symptoms are common among survivors of a major disaster, yet few longitudinal studies have documented their long-term persistence at the community level.

OBJECTIVE

To examine the trajectories of PTSS and depressive symptoms for as long as 5.5 years after the 2011 Great East Japan earthquake and tsunami.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used data from 2781 participants in 3 waves of the Iwanuma Study (2010, 2013, and 2016), a cohort of community-dwelling older adults (≥65 years in August 2010) in Iwanuma, Japan, who were directly affected by the 2011 disaster. The baseline assessment of mental health predated the disaster by 7 months, and survivors were followed up for 5.5 years after the disaster. Data analysis was performed from October 2019 to February 2020.

EXPOSURES

The March 11, 2011, Great East Japan earthquake and tsunami.

MAIN OUTCOMES AND MEASURES

PTSS were measured by 9 questions on the Screening Questionnaire for Disaster Mental Health, while depressive symptoms were measured by 15 items on the Geriatric Depression Scale short form.

RESULTS

The analytic samples for trajectories of PTSS and depressive symptoms included 2275 and 1735 respondents, respectively. In the study population at baseline, there were slightly more women (1262 of 2275 [55.5%] and 882 of 1735 [50.8%]), and most participants were aged 65 to 74 years (1533 [67.4%] and 1224 [70.5%]) and married (1664 [76.2%] and 1319 [77.7%]). Overall, there was a 13.6% (95% CI, 11.7%-15.6%) incidence of depression among individuals who did not have depression before the disaster, while a further 11.1% (95% CI, 9.8%-12.4%) reported PTSS after the disaster. By 5.5 years of follow-up, approximately half of the survivors with new depressive symptoms in 2013 (85 of 168 [50.6%]) and PTSS (147 of 253 [58.1%]) had recovered. The prevalence of depression in the community remained remarkably stable (between 504 participants [29.0%] and 506 participants [29.2%]) comparing predisaster and postdisaster data.

CONCLUSIONS AND RELEVANCE

In this study, mental illness symptoms persisted for more than 5 years among half of disaster survivors, but the community-wide prevalence of depression remained stable, suggesting that the community itself was resilient.

Changes in smoking behavior among victims after the great East Japan earthquake and tsunami

Background

In areas affected by the tsunami of the great East Japan Earthquake, smoking behavior may have deteriorated due to high stress and drastic changes in living environment. Surveys were conducted to reveal changes in smoking behaviors among victims.

Methods

A population-based random-sample home-visit interview survey of victims in Iwate and Miyagi Prefectures affected by the tsunami disaster was conducted in 2012 (n = 1978), while a population-based nationwide survey was conducted in 2013 (n = 1082). A panel survey in 2014 was conducted with respondents of the 2012 survey (n = 930). Multiple logistic regression analysis was performed to reveal factors related to smoking status after the disaster.

Results

There was high smoking prevalence of both sexes in the tsunami disaster area (current smoking rate in coastal area, 50.0% for male, 21.4% for female; inland area, 34.7% for male, 7.6% for female). Low prevalence of male quitters was observed (quitter rate in coastal area, 20.8% for male, 8.0% for female; inland area, 23.4% for male, 5.5% for female). The prevalence of nicotine-dependent people assessed by FTND (Fagerström Test for Nicotine Dependence) in the coastal area was also higher than in the inland area or other areas of Japan. Smoking behavior among victims worsened after the disaster and did not improve 3 years from the disaster. Post-disaster factors related to smoking were living in coastal area, complete destruction of house, and living in temporary housing.

Conclusions

Smoking prevalence and the level of nicotine dependence of tsunami victims were still high even 3 years after the disaster. It is important to emphasize measures for smoking control in the disaster areas for an extended time period.

Disaster Resilience in Aging Populations: Lessons from the 2011 Great East Japan Earthquake & Tsunami

Recovery after major disaster poses a unique set of challenges for the older population, including disruption of medical care for pre-existing conditions, functional limitations that impede recovery, and social isolation following involuntary resettlement. In this review, we summarize the lessons about disaster resilience that have been learned (so far) from a unique ongoing field study based in a community that was affected by the 2011 earthquake and tsunami in Japan. In the Iwanuma Study, baseline information about the health status and living conditions of older residents was collected seven months before the disaster. A follow-up survey was conducted 2.5 years after the disaster, allowing us investigate the risk and protective factors for a range of disaster-related health sequelae, including mental illness and cognitive disability. A consistent finding to emerge from our studies is the critical role of social connections (the "social capital" of a community) in protecting against the deleterious after-effects of psychological trauma and involuntary resettlement following the disaster. In contrast to the emphasis on investing in material infrastructure to prepare for disasters, a review of our studies suggests that repairing (or at least preserving) the social fabric of people's lives is a crucial ingredient in disaster resilience.

Neighborhood Ties Reduced Depressive Symptoms in Older Disaster Survivors: Iwanuma Study, a Natural Experiment

Objective: As most studies relating to mental health and disasters have employed cross-sectional or follow-up assessments about psychological health with post-disaster information, the association between changes in social ties and mental health remains unclear. We examined the relationship between the changes in survivor neighborhood ties and depressive symptoms before and after a natural disaster. Methods: Participants were 3567 individuals aged ≥65 years living in Iwanuma city who had responded to questionnaires by the Japan Gerontological Evaluation Study both predating the 2011 Great East Japan Earthquake and Tsunami, and 2.5 years afterward. Changes in the depressive symptoms were assessed using the geriatric depression scale (GDS) at the baseline and follow-up survey. Changes in the neighborhood ties were assessed by asking the participants about their interactions with people in their neighborhood. Possible confounders were adjusted in a linear regression model. Results: Among the 3111 participants in this analysis, 1073 (34.5%) had increased GDS score after the disaster. There were 336 (10.8%) individuals who had neighborhood ties before the disaster, but had no ties afterward; their mean GDS score increased from 2.93 points in 2010 to 3.19 points in 2013. Among those who had not had ties before and after the disaster the mean GDS score remained almost stable, from 2.19 points in 2010 to 2.12 points in 2013. The participants with post-disaster ties were significantly less likely to have an increased GDS score compared with those who had not had ties before and after the disaster (β = −0.39; 95% confidence interval: −0.72, −0.06). Conclusions: Increased neighborhood ties after the disaster reduced the risk of depressive symptoms even when survivors suffered disaster damages. The study reinforces the importance of social capital in disaster recovery and suggests to local governments and local communities that fostering horizontal, neighborhood ties may improve disaster preparedness and mental health resilience.

Pre-disaster social support is protective for onset of post-disaster depression: Prospective study from the Great East Japan Earthquake & Tsunami

We examined whether pre-disaster social support functions as a disaster preparedness resource to mitigate post-disaster depressive symptoms among older survivors of the 2011 Great East Japan earthquake and tsunami. The participants were 3,567 individuals aged ≥65 years living in Iwanuma city who completed a baseline survey as part of the nationwide Japan Gerontological Evaluation Study seven months before the disaster. A follow-up survey was administered approximately 2.5 years after the disaster. The analysis included a total of 2,293 participants, and social support (giving and receiving emotional & instrumental help) before the disaster was measured using four items. Depressive symptoms were assessed using the GDS with a cut-off score of 4/5 (not depressed/depressed). We discovered that participants who gave and received emotional and instrumental support before the disaster were significantly less likely to develop depressive symptoms after the disaster compared to those without support (ARR = 0.70; 95% CI: 0.56–0.88). The risk of the onset of depressive symptoms was 1.34 (95% CI: 1.03–1.74) among those who experienced disaster damages but had also given and received social support, and 1.70 (95% CI: 1.03–2.76) among those who experienced damages but lacked support. Strengthening social aid may help cultivate psychological resilience to disasters.

Mental Health Effects in Primary Care Patients 18 Months After a Major Wildfire in Fort McMurray: Risk Increased by Social Demographic Issues, Clinical Antecedents, and Degree of Fire Exposure

Objectives: To assess prevalence of likely posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) in patients attending the only out-of-hours primary care clinic in Fort McMurray some 18 months following a major fire. Methods: A quantitative cross-sectional survey was used to collect data through self-administered paper-based questionnaires to determine likely PTSD, MDD, and GAD using the PTSD Checklists for Diagnostic and Statistical Manual (DSM) 5, Patient Health Questionnaire (PHQ) 9, and GAD-7, respectively, from residents of Fort McMurray who were impacted by the wildfires. This was carried out eighteen (18) months after a major wildfire, which required the rapid evacuation of the entire city population (approximately 90,000 individuals). Results: We achieved a response rate of 48% and results from the 290 respondents showed the 1 month prevalence rate for likely PTSD was 13.6%, likely MDD was 24.8%, and likely GAD was 18.0%. Compared to self-reported prevalence rates before the wildfire (0%, 15.2%, and 14.5% respectively), these were increased for all diagnoses. After controlling for other factors in a logistic regression model, there were statistically significant associations between individuals who had likely PTSD, MDD, and GAD diagnoses and multiple socio-demographic, clinical, and exposure-related variables as follows: PTSD: History of anxiety disorder and received counselling had odds ratios (ORs) of 5.80 and 7.14, respectively. MDD: Age, witnessed the burning of homes, history of depressive disorder, and receiving low level support from friends and family had ORs of 2.08, 2.29, 4.63, and 2.5, respectively. GAD: Fearful for their lives or the lives of friends/family, history of depressive disorder, and history of anxiety disorder had ORs of 3.52, 3.04, and 2.68, respectively. There were also associations between individuals with a likely psychiatric diagnosis and those who also had likely alcohol or drug abuse/dependence. Conclusion: Our study suggests there are high prevalence rates for mental health and addiction conditions in patients attending the out-of-hours clinic 18 months after the wildfires, with significant associations between multiple variables and likely PTSD, MDD, and GAD. Further studies are needed to explore the impact of population-based mental health interventions on the long-term mental health effects of the wildfires.

Temporal Transitions in Patterns of Posttraumatic Stress Disorder and Depression Among Adolescents Following the Wenchuan Earthquake

Posttramatic stress disorder (PTSD) and depression are persistent disorders with heterogeneous comorbidity. Cross-sectional design limitations have prevented previous studies from examining symptom pattern transitions, which limits the understanding on the change of mental health over time since trauma. This study examined transition patterns of PTSD and depression comorbidity and assessed the role of personality. PTSD, depression, and personality scales were used to assess 619 adolescents 1 year after the Wenchuan earthquake and then to longitudinally assess 332 adolescents 2 years post-earthquake. Data were analyzed using latent transition analysis and logistic regression. Four PTSD and depression comorbidity patterns were identified at both times: moderate comorbidity, high comorbidity, no symptoms, and depression. Patterns of PTSD and depression changed in 23.4% of adolescents: 4.4% and 7.1% transitioned from no symptoms to depression and from depression to moderate comorbidity, respectively; 7.5% transitioned from moderate comorbidity to depression. Extraversion and conscientiousness were more likely and openness was less likely to be associated with moderate comorbidity symptoms transitioned to depression symptoms. These findings indicated that patterns of PTSD and depression in adolescents are heterogeneous and show temporal change.

Predictors of persistent sleep problems among older disaster survivors: a natural experiment from the 2011 Great East Japan earthquake and tsunami

Study Objectives

To examine prospectively the associations of disaster experiences and social support with sleep problems in older adults.

Methods

Data came from a natural experiment caused by the 2011 Great East Japan earthquake and tsunami. Participants in an ongoing prospective cohort (3547 Japanese individuals aged 65 years or older) were inadvertently exposed to the disaster due to their residential location (Iwanuma city) after the 2010 baseline survey. We conducted a follow-up survey in 2013 to inquire about disaster-related experiences and short sleep duration, sleep insufficiency, poor sleep quality, insomnia symptoms, and sleep medication use. Poisson regression models adjusted for baseline socio-demographic and lifestyle covariates.

Results

Financial hardship predicted increased risks of short sleep duration (relative risk [RR] = 1.40; 95% confidence interval [CI] [1.03, 1.90]), sleep insufficiency (RR = 1.29; 95% CI [1.01, 1.66]), poor sleep quality (RR = 1.47; 95% CI [1.26, 1.70]), and insomnia symptoms (RR = 1.13; 95% CI [1.01, 1.28]). Home destruction predicted sleep medication use while health care disruption predicted poor sleep quality. Loss of close relatives or friends did not predict any sustained sleep problems. Additionally, having instrumental support reduced risks of all sleep problems while having emotional support reduced risk of poor sleep quality.

Conclusions

Approximately 2.5 years after the disaster, older survivors' sleep problems were more durably linked to material aspects of disaster damage than to loss of loved ones. Findings could inform targeted recovery efforts for groups with greatest need to promote older survivors' sleep health and overall well-being.

Adverse childhood experiences, exposure to a natural disaster and posttraumatic stress disorder among survivors of the 2011 Great East Japan earthquake and tsunami

AIMS

To investigate whether adverse childhood experiences (ACEs) modify the impact of exposure to a natural disaster (the 2011 Great East Japan earthquake and tsunami) on the occurrence of posttraumatic stress disorder (PTSD) among older people.

METHODS

Data were collected as part of the Japan Gerontological Evaluation Study (JAGES), which is an on-going epidemiological survey investigating social determinants of health among older people across Japan. Information on PTSD symptoms based on the Screening Questionnaire for Disaster Mental Health, traumatic exposure to the earthquake (i.e., house damage and loss of relatives/friends during the earthquake/tsunami) and ACEs was obtained from 580 participants aged 65 or older living in Iwanuma City, Miyagi Prefecture, which suffered severe damage as a result of the earthquake and the subsequent tsunami in March 2011. Associations were examined using Poisson regression analysis with a robust variance estimator after adjusting for covariates.

RESULTS

The prevalence of PTSD was 9.7% in this population; compared to those with no traumatic experience, the prevalence of PTSD was approximately two times higher among those who experienced the loss of close friends/relatives (PR = 1.84, 95% CI = 1.11-3.03, p = 0.018), or whose house was damaged (PR = 2.15, 95% CI = 1.07-4.34, p = 0.032). ACE was not significantly associated with PTSD. Stratified analyses by the presence of ACE showed that damage due to the earthquake/tsunami was associated with PTSD only among those without ACEs; more specifically, among non-ACE respondents the PR of PTSD associated with house damage was 6.67 (95% CI = 1.66-26.80), while for the loss of a relative or a close friend it was 3.56 (95% CI = 1.18-10.75). In contrast, no statistically significant associations were observed among those with ACEs.

CONCLUSION

Following the Great East Japan earthquake/tsunami in 2011 a higher risk of developing PTSD symptoms was observed in 2013 especially among older individuals without ACEs. This suggests that ACEs might affect how individuals respond to subsequent traumatic events later in life.