Dealing with Community Mental Health post the Fukushima disaster: lessons learnt for the COVID-19 pandemic

Disasters and kidney care: pitfalls and solutions

Patients with kidney disease, especially those with kidney failure, are particularly susceptible to the adverse effects of disasters because their survival depends on functional infrastructure, advanced technology, the availability of specific drugs and well-trained medical personnel. The risk of poor outcomes across the entire spectrum of patients with kidney diseases (acute kidney injury, chronic kidney disease and kidney failure on dialysis or with a functioning transplant) increases as a result of disaster-related logistical challenges. Patients who are displaced face even more complex problems owing to additional threats that arise during travel and after reaching their new location. Overall, risks may be mitigated by pre-disaster preparedness and training. Emergency kidney disaster responses depend on the type and severity of the disaster and include medical and/or surgical treatment of injuries, treatment of mental health conditions, appropriate diet and logistical interventions. After a disaster, patients should be evaluated for problems that were not detected during the event, including those that may have developed as a result of the disaster. A retrospective review of the disaster response is vital to prevent future mistakes. Important ethical concerns include fair distribution of limited resources and limiting harm. Patients with kidney disease, their care-givers, health-care providers and authorities should be trained to respond to the medical and logistical problems that occur during disasters to improve outcomes.

Evaluation of physical and psychological status of health care workers infected with COVID-19 during a hospital outbreak in Japan

PURPOSE

COVID-19 causes physical and psychological impacts on health care workers (HCWs), especially when it occurs during an outbreak. As there are few reports on outcomes of HCWs infected with COVID-19 during a hospital outbreak, we investigated the physical and psychological impacts on HCWs infected with COVID-19 during an outbreak in our hospital.

METHODS

During the outbreak in our hospital, 231 people were infected with COVID-19 including patients, HCWs and their families. Among them, 83 HCWs were enrolled in this study. Current quality of life (QOL) was assessed with the EuroQol-visual analogue scales (EQ-VAS), and motivation to keep on working was evaluated by a 10-point analogue scale. Physiological recovery rates including return to work (RTW) period were also analyzed.

RESULTS

One nurse quit work due to anxiety regarding re-infection with COVID-19. The median period to RTW from the diagnosis was 14.0 (12.0-17.0) days. Motivation to keep on working was slightly reduced, and the EQ-VAS was 75.0 (65.0-83.6). There were no significant differences in QOL and motivation between male and female HCWs, nurses and other HCWs, treatment and non-treatment group, and supplemental and non-supplemental oxygen group. The most frequent persistent symptoms at 1,3 and 6 months after infection were anosmia followed by fatigue.

CONCLUSION

Although QOL and motivation to keep on working were slightly reduced, only one HCW quit work. No severe persistent symptoms were observed, and the RTW period was relatively short.

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

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

Mitigating COVID-19 Risk and Vaccine Hesitancy Among Underserved African American and Latinx Individuals with Mental Illness Through Mental Health Therapist-Facilitated Discussions

Background

Underserved ethnic minorities with psychiatric disorders are at an increased risk of COVID-19. This study aims to examine the effectiveness of one-to-one counseling on COVID-19 vaccination and vaccination readiness among underserved African American and Latinx individuals with mental illnesses and adult caregivers of children with mental illness.

Methods

Through an academic-community partnered collaboration, a multidisciplinary and culturally sensitive training on COVID-19 was co-developed and delivered to 68 therapists from January to March 2021. Mental health clients and their caregivers were recruited to participate in pre- and post-intervention surveys to evaluate the impact of the intervention on their perceptions of COVID-19 public health guidelines, testing, and vaccination. Mental health therapists delivered four lessons of the COVID-19 educational intervention with 254 clients from March to June 2021, when vaccine availability was widely available. Of those clients, we collected 180 baseline and 115 follow-up surveys. The main outcome was the uptake in COVID-19 vaccine.

Results

There was a positive shift in participant vaccine acceptance and receptivity. Pre-intervention survey shows that only 56% of adult clients and 48% of caregivers had indicated a likelihood of getting the vaccine for themselves at baseline. Post-intervention documented that more than 57% of each group had been vaccinated, with another 11–15% of the unvaccinated individuals reporting that they were somewhat or very likely to get the vaccine.

Conclusion

This study demonstrated that multidisciplinary academic-community and theoretical-based educational intervention delivered by mental health therapists is an effective strategy in increasing COVID-19 vaccine acceptance and reducing the negative impact and disruption that COVID-19 caused in the daily life of mental health patients and caregivers.

Practical Report of Disaster-Related Mental Health Interventions Following the Great East Japan Earthquake during the COVID-19 Pandemic: Potential for Suicide Prevention

Background: This practical report aims to publicize the ongoing disaster-related mental health interventions following the Great East Japan Earthquake during the COVID-19 pandemic. Methods: Disaster-related mental health interventions consisted of: (1) screening high-risk evacuees with high psychological distress (Kessler 6 score ≥ 13) or binge drinking; and (2) visiting selected high-risk individuals and providing them counseling through outreach in evacuee housing. These activity records were compiled from existing material in the Sendai City Office; therefore, no new interviews or questionnaire surveys were conducted. Results: During the COVID-19 pandemic, we introduced telephone counseling and shortened the time of support as a result of the restrictions. Counselors addressed issues of “loneliness” or “isolation” among evacuees, who had little connection with society due to the pandemic. Moreover, the procedure for obtaining COVID-19 special financial aid was explained to evacuees in financial difficulty. During this period, the suicide rates in the affected area did not increase significantly as compared to the national average. Conclusions: Our report may be instructive in terms of preventing suicide during the pandemic using high-risk approaches and counselors trained in disaster-related mental health interventions.

Depression, anxiety, and stress symptoms in pregnant women before and during the COVID-19 pandemic

OBJECTIVE

This study evaluates depression, anxiety, and stress symptoms in pregnant women before and during COVID-19 pandemic and analyzes their risk factors.

METHODS

This was a cross-sectional analyses included pregnant women with depression, anxiety, and stress levels evaluated both in the Novel Coronavirus-Pregnancy Cohort study (NCP) and the Healthy Baby Cohort study (HBC). NCP was conducted during COVID-19 pandemic, while HBC was performed before the pandemic. Multiple logistic regressions were employed to evaluate the associations between COVID-19 pandemic and other co-variables and maternal mental health.

RESULTS

NCP and HBC studies respectively included 531 and 2352 participants. Depression rates differed significantly between the two studies (p < 0.05). The mild and moderate-to-severe depression rates in NCP study were 25.8% and 10.36%, respectively, and 19.94% and 0.55% in HBC study. The stress rate of participants was higher in HBC study (69.39%) than in NCP study (60.45%) (p < 0.05). COVID-19 pandemic was correlated with higher depression but lower stress risks (p < 0.05) in pregnant women, with OR and 95% CI as 1.68 (1.16, 2.44) and 0.42 (0.29, 0.61), respectively. Pregnant women with pre-pregnancy obesity and high educational levels might have lower risks for depression, anxiety, and stress than those with normal weight and low educational levels.

CONCLUSIONS

Depression among pregnant women was impacted by the pandemic. Apart from COVID-19 pandemic impact, pre-pregnant weight status and educational level might also influence depression, anxiety and stress statuses in pregnant women.

The ongoing activities of livelihood support counselors following nuclear disaster under the COVID-19 restrictions: A preliminary survey

Background

This preliminary study aims to understand the state of support provided in the evacuation areas of the 2011 Fukushima nuclear disaster, during the novel coronavirus 2019 (COVID-19) restriction.

Methods

A self-administered survey was conducted with 18 livelihood support counselors from two Social Welfare Councils in November 2020. We investigated the number of consultations since the COVID-19 pandemic and the impact of telephonic consultation as opposed to in-person consultations through visits to counselees’ homes.

Results

Counselors have been continued offering supports to their counselees even under the COVID-19 restrictions, in fact, fifty percent of counselors have increased the consultations. Although some counselors had a sense of unease or concern about telephonic consultation due to the inability to see their non-verbal expressions, there were some advantages of telephonic consultation, in that the counselors were able to have longer sessions and listen more attentively to severe issues.

Conclusions

Notably, livelihood support counselors in this study have increased the number of consultations while utilization telephonic consultations, despite the adverse conditions created by the COVID-19 restriction. Moreover, certain advantages of telephonic consultation instead of in-person consultation have been identified. It may be an effective support method avoiding in-person contacts, that also considers infection-prevention measures.

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Counselors coped with evacuees’ mental health issues following the Fukushima nuclear accident.

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Counselors continued to support evacuees even during the COVID-19 restrictions.

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Counselors provided telephonic consultations as an infection-prevention measure.

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Some counselors felt uneasy about telephonic instead of in-person consultation.

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Telephonic consultation had more advantages, such as longer sessions and attentive listening.

Mental Health Consequences of the Three Mile Island, Chernobyl, and Fukushima Nuclear Disasters: A Scoping Review

Many individuals who were affected by the Great East Japan earthquake and tsunami and the subsequent Fukushima Daiichi Nuclear Power Plant accident continue to face a challenging recovery. We reviewed the long-term mental health consequences of three major nuclear power plant accidents: the Three Mile Island (TMI, 1979), Chernobyl (1986), and Fukushima (2011) nuclear disasters. We examined the relevant prospective cohort studies and before-and-after studies that covered more than two timepoints, searching four databases (PubMed, Ichushi, PsyArticles, and PTSDPub). We identified a total of 35 studies: TMI, n = 11; Chernobyl, n = 6; and Fukushima, n = 18. The smaller numbers of early-phase studies (within 6 months) of the Chernobyl and Fukushima disasters may also indicate the chaotic situation at those timepoints, as large-scale interviews were conducted in the early phase after the TMI disaster. Although the patterns of effects on mental health outcomes were diverse, more than half of the participants in the studies we evaluated were categorized into low or under-threshold symptom groups in all three disasters. Across the three disasters, the radiation exposure level estimated by the proximity and stigma were the common risk factors for mental health outcomes. Our findings will contribute to a comprehensive understanding of the impact of the worst nuclear accidents in history on the affected individuals' mental health, and our results illustrate the longitudinal consequences of such disasters.

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

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

Exacerbation of Subthreshold PTSD Symptoms in a Great East Japan Earthquake Survivor in the Context of the COVID-19 Pandemic

Background

In 2011, the people of Fukushima, Japan, experienced the Great East Japan Earthquake (GEJE), a complex disaster of earthquake, tsunami, and nuclear accident. Its residents are experiencing a second global disaster, a COVID-19 pandemic in 2020.

Objective

In this article, we aimed at discussing the effects of subthreshold PTSD in a previous disaster on an exacerbation of PTSD symptoms in another disaster.

Method

We present a case of subthreshold PTSD in the context of a nuclear accident and exacerbation of symptoms due to the COVID-19 pandemic.

Results

Exacerbation of subthreshold PTSD symptoms was likely due to the reemergence of an urgent atmosphere similar to the previously experienced traumatic event.

Conclusions

PTSD may occur not only in those who experience the actual life-threatening like ICU admission but in those who experience the atmospheric change of society. This case demonstrated the characteristics of subthreshold PTSD caused by two disasters that shared a similar sense of insecurity, the scale of impact on the society, invisibility of the threat, restricted movement, and authoritative conflicts. These commonalities led to a recurrence and exacerbation of initial symptoms. This finding should be shared with those involved in the care system for victims' mental health suffering from a large-scale disaster, and we need further research about the issue.