Kotaro Otsuka

Mental health and related factors after the Great East Japan Earthquake and tsunami

Mental health is one of the most important issues facing disaster survivors. The purpose of this study is to determine the prevalence and correlates of mental health problems in survivors of the Great East Japan Earthquake and Tsunami at 6–11 months after the disaster. The questionnaire and notification were sent to the survivors in three municipalities in the Tohoku area of the Northern part of Honshu, Japan’s largest island, between September 2011 and February 2012. Questionnaires were sent to 12,772, 11,411, and 18,648 residents in the Yamada, Otsuchi, and Rikuzentakata municipalities, respectively. Residents were asked to bring the completed questionnaires to their health check-ups. A total of 11,124 or (26.0%) of them underwent health check-ups, and 10,198 were enrolled. We excluded 179 for whom a K6 score was missing and two who were both 17 years of age, which left 10,025 study participants (3,934 male and 6,091 female, mean age 61.0 years). K6 was used to measure mental health problems. The respondents were classified into moderate (5–12 of K6) and serious mental health problems (13+). A total of 42.6% of the respondents had moderate or serious mental health problems. Multivariate analysis showed that women were significantly associated with mental health problems. Other variables associated with mental health problems were: younger male, health complaints, severe economic status, relocations, and lack of a social network. An interaction effect of sex and economic status on severe mental health problems was statistically significant. Our findings suggest that mental health problems were prevalent in survivors of the Great East Japan Earthquake and Tsunami. For men and women, health complaints, severe economic status, relocations, and lack of social network may be important risk factors of poor mental health. For men, interventions focusing on economic support may be particularly useful in reducing mental health problems after the disaster.

Monoamine neurons in the human brain stem: anatomy, magnetic resonance imaging findings, and clinical implications.

By using high-resolution, conventional, and neuromelanin-sensitive magnetic resonance imaging techniques, we reviewed the normal anatomy of the nuclei consisting of monoamine neurons such as dopaminergic, noradrenergic, and serotoninergic neurons and noted the changes in these nuclei that occur in some degenerative and psychiatric disorders. Multimodal MR images can directly or indirectly help in identifying the substantia nigra, locus ceruleus, and raphe nuclei that contain monoamine neurons. Neuromelanin-sensitive magnetic resonance imaging can detect signal alterations in the substantia nigra pars compacta and/or locus ceruleus that occur in Parkinsons disease and psychiatric disorders such as depression and schizophrenia. This technique seems to be promising for the noninvasive evaluation of the pathological or functional changes in the monoamine system that occur in degenerative and psychiatric disorders.

Use of Neuromelanin-Sensitive MRI to Distinguish Schizophrenic and Depressive Patients and Healthy Individuals Based on Signal Alterations in the Substantia Nigra and Locus Ceruleus

BACKGROUND We investigated alterations in the substantia nigra pars compacta (SNc) and locus ceruleus (LC) in schizophrenic and depressive patients by using a neuromelanin-sensitive magnetic resonance imaging (MRI) technique that enables direct visualization of these nuclei and examined whether this technique could distinguish between these disorders and healthy subjects. METHODS Using a neuromelanin-sensitive T1-weighted MRI technique, we examined 20 schizophrenia patients, 18 depressive patients, and 34 healthy control subjects. The signal intensities of the areas corresponding to the SNc and LC were measured, and the contrast ratios (CR) to the adjacent white matter were calculated. RESULTS The CR of the SNc was significantly higher in schizophrenic patients (22.6 +/- 5.6) than in depressive patients (19.2 +/- 4.7) and healthy control subjects (19.6 +/- 3.8), whereas the CR of the LC in depressive patients (7.7 +/- 2.4) was significantly lower than that in healthy control subjects (11.0 +/- 3.9) and schizophrenic patients (10.0 +/- 3.1). Further, the difference in the CR between the SNc and LC was significantly greater in schizophrenic patients (12.6 +/- 6.7) than in control subjects (8.6 +/- 4.1). CONCLUSIONS Neuromelanin-sensitive MRI enables visualization of alterations in the SNc and LC that are observed in schizophrenia and depression.

Pathway to psychiatric care in Japan: A multicenter observational study.

BackgroundThis study examines pathways to psychiatric care in Japan using the same method as the collaborative study carried out in 1991 under the auspices of the World Health Organization.MethodsThirteen psychiatric facilities in Japan were involved. Of the 228 patients who contacted psychiatric facilities with any psychiatric illness, eighty four visiting psychiatric facilities for the first time were enrolled. Pathways to psychiatric care, delays from the onset of illness to treatment prior to reaching psychiatrists were surveyed.ResultsThirty three patients (39.4%) directly accessed mental health professionals, 32 patients (38.1%) reached them via general hospital, and 13 patients (15.5%) via private practitioners. The patients who consulted mental health professionals as their first carers took a longer time before consulting psychiatrists than the patients who consulted non-mental health professionals as their first carers. The patients who presented somatic symptoms as their main problem experienced longer delay from the onset of illness to psychiatric care than the patients who complained about depressive or anxiety symptoms. Prior to the visit to mental health professionals, patients were rarely informed about their diagnosis and did not receive appropriate treatments from their physicians. Private practitioners were more likely to prescribe psychotropics than physicians in general hospitals, but were less likely to inform their patients of their diagnosis.ConclusionThis first pathway to psychiatric care study in Japan demonstrated that referral pathway in Japan heavily relies on medical resources. The study indicates possible fields and gives indications, underlining the importance of improving skills and knowledge that will facilitate the recognition of psychiatric disorders presenting with somatic and depressive symptoms in the general health care system and by private practitioners.

The impact of inpatient suicide on psychiatric nurses and their need for support

BackgroundThe nurses working in psychiatric hospitals and wards are prone to encounter completed suicides. The research was conducted to examine post-suicide stress in nurses and the availability of suicide-related mental health care services and education.MethodsExperiences with inpatient suicide were investigated using an anonymous, self-reported questionnaire, which was, along with the Impact of Event Scale-Revised, administered to 531 psychiatric nurses.ResultsThe rate of nurses who had encountered patient suicide was 55.0%. The mean Impact of Event Scale-Revised (IES-R) score was 11.4. The proportion of respondents at a high risk (≥ 25 on the 88-point IES-R score) for post-traumatic stress disorder (PTSD) was 13.7%. However, only 15.8% of respondents indicated that they had access to post-suicide mental health care programmes. The survey also revealed a low rate of nurses who reported attending in-hospital seminars on suicide prevention or mental health care for nurses (26.4% and 12.8%, respectively).ConclusionsThese results indicated that nurses exposed to inpatient suicide suffer significant mental distress. However, the low availability of systematic post-suicide mental health care programmes for such nurses and the lack of suicide-related education initiatives and mental health care for nurses are problematic. The situation is likely related to the fact that there are no formal systems in place for identifying and evaluating the psychological effects of patient suicide in nurses and to the pressures stemming from the public perception of nurses as suppliers rather than recipients of health care.

A community intervention trial of multimodal suicide prevention program in Japan: A Novel multimodal Community Intervention program to prevent suicide and suicide attempt in Japan, NOCOMIT-J

BackgroundTo respond to the rapid surge in the incidence of suicide in Japan, which appears to be an ongoing trend, the Japanese Multimodal Intervention Trials for Suicide Prevention (J-MISP) have launched a multimodal community-based suicide prevention program, NOCOMIT-J. The primary aim of this study is to examine whether NOCOMIT-J is effective in reducing suicidal behavior in the community.Methods/DesignThis study is a community intervention trial involving seven intervention regions with accompanying control regions, all with populations of statistically sufficient size. The program focuses on building social support networks in the public health system for suicide prevention and mental health promotion, intending to reinforce human relationships in the community. The intervention program components includes a primary prevention measures of awareness campaign for the public and key personnel, secondary prevention measures for screening of, and assisting, high-risk individuals, after-care for individuals bereaved by suicide, and other measures. The intervention started in July 2006, and will continue for 3.5 years. Participants are Japanese and foreign residents living in the intervention and control regions (a total of population of 2,120,000 individuals).DiscussionThe present study is designed to evaluate the effectiveness of the community-based suicide prevention program in the seven participating areas.Trial registrationUMIN Clinical Trials Registry (UMIN-CTR) UMIN000000460.

Reduced signal of locus ceruleus in depression in quantitative neuromelanin magnetic resonance imaging.

We used a neuromelanin-magnetic resonance imaging technique to investigate abnormalities in the locus ceruleus in depression. We examined 20 patients with major depression and 43 age-matched controls using a 3 T scanner with a neuromelanin-sensitive sequence. The signal intensities of the areas corresponding to the rostral, middle, and caudal portions of the locus ceruleus were measured, and the contrast ratio relative to the adjacent pontine tegmentum was calculated. In controls, the contrast ratio in the middle portion was higher than in the rostral and caudal areas. In patients, contrast ratios in the rostral and middle portions were significantly decreased in comparison with controls, suggesting dysfunction of the ascending noradrenergic system. Neuromelanin-magnetic resonance imaging can be used to visualize abnormalities in the locus ceruleus of depressive patients.

Assertive case management versus enhanced usual care for people with mental health problems who had attempted suicide and were admitted to hospital emergency departments in Japan (ACTION-J): a multicentre, randomised controlled trial

BACKGROUND Non-fatal suicide attempt is the most important risk factor for later suicide. Emergency department visits for attempted suicide are increasingly recognised as opportunities for intervention. However, no strong evidence exists that any intervention is effective at preventing repeated suicide attempts. We aimed to investigate whether assertive case management can reduce repetition of suicide attempts in people with mental health problems who had attempted suicide and were admitted to emergency departments. METHODS In this multicentre, randomised controlled trial in 17 hospital emergency departments in Japan, we randomly assigned people aged 20 years and older with mental health problems who had attempted suicide to receive either assertive case management (based on psychiatric diagnoses, social risks, and needs of the patients) or enhanced usual care (control), using an internet-based randomisation system. Interventions were provided until the end of the follow-up period (ie, at least 18 months and up to 5 years). Outcome assessors were masked to group allocation, but patients and case managers who provided the interventions were not. The primary outcome was the incidence of first recurrent suicidal behaviour (attempted suicide or completed suicide); secondary outcomes included completed suicide and all-cause mortality. This study is registered at ClinicalTrials.gov (NCT00736918) and UMIN-CTR (C000000444). FINDINGS Between July 1, 2006, and Dec 31, 2009, 914 eligible participants were randomly assigned, 460 to the assertive case management group and 456 to the enhanced usual care group. We noted no significant difference in incidence of first recurrent suicidal behaviour between the assertive case management group and the enhanced usual care group over the full study period (log-rank p=0·258). Because the proportional hazards assumption did not hold, we did ad-hoc analyses for cumulative incidence of the primary outcome at months 1, 3, 6, 12, and 18 after randomisation, adjusting for multiplicity with the Bonferroni method. Assertive case management significantly reduced the incidence of first recurrent suicidal behaviour up to the 6-month timepoint (6-month risk ratio 0·50, 95% CI 0·32-0·80; p=0·003), but not at the later timepoints. Prespecified subgroup analyses showed that the intervention had a greater effect in women (up to 18 months), and in participants younger than 40 years and those with a history of previous suicide attempts (up to 6 months). We did not identify any differences between the intervention and control groups for completed suicide (27 [6%] of 460 vs 30 [7%] of 454, log-rank p=0·660) or all-cause mortality (46 [10%] of 460 vs 42 [9%] of 454, log-rank p=0·698). INTERPRETATION Our results suggest that assertive case management is feasible in real-world clinical settings. Although it was not effective at reducing the incidence of repetition of suicide attempts in the long term, the results of our ad-hoc analyses suggested that it was effective for up to 6 months. This finding should be investigated in future research. FUNDING The Ministry of Health, Labour, and Welfare of Japan.

Effectiveness of a Multimodal Community Intervention Program to Prevent Suicide and Suicide Attempts: A Quasi-Experimental Study

Background Multilevel and multimodal interventions have been suggested for suicide prevention. However, few studies have reported the outcomes of such interventions for suicidal behaviours. Methods We examined the effectiveness of a community-based multimodal intervention for suicide prevention in rural areas with high suicide rates, compared with a parallel prevention-as-usual control group, covering a total of 631,133 persons. The effectiveness was also examined in highly populated areas near metropolitan cities (1,319,972 persons). The intervention started in July 2006, and continued for 3.5 years. The primary outcome was the incidence of composite outcome, consisting of completed suicides and suicide attempts requiring admission to an emergency ward for critical care. We compared the rate ratios (RRs) of the outcomes adjusted by sex, age group, region, period and interaction terms. Analyses were performed on an intention-to-treat basis and stratified by sex and age groups. Findings In the rural areas, the overall median adherence of the intervention was significantly higher. The RR of the composite outcome in the intervention group decreased 7% compared with that of the control group. Subgroup analyses demonstrated heterogeneous effects among subpopulations: the RR of the composite outcome in the intervention group was significantly lower in males (RR = 0.77, 95% CI 0.59–0.998, p = 0.0485) and the RR of suicide attempts was significantly lower in males (RR = 0.39, 95% CI 0.22–0.68, p = 0.001) and the elderly (RR = 0.35, 95% CI 0.17–0.71, p = 0.004). The intervention had no effect on the RR of the composite outcome in the highly populated areas. Interpretation Our findings suggest that this community-based multimodal intervention for suicide prevention could be implemented in rural areas, but not in highly populated areas. The effectiveness of the intervention was shown for males and for the elderly in rural areas. Trial Registration ClinicalTrials.gov NCT00737165 UMIN Clinical Trials Registry UMIN000000460

Docosahexaenoic Acid Promotes Axon Outgrowth by Translational Regulation of Tau and Collapsin Response Mediator Protein 2 Expression

n-3 PUFAs are essential for neuronal development and brain function. However, the molecular mechanisms underlying their biological effects remain unclear. Here we examined the mechanistic action of docosahexaenoic acid (DHA), the most abundant n-3 polyunsaturated fatty acids in the brain. We found that DHA treatment of cortical neurons resulted in enhanced axon outgrowth that was due to increased axon elongation rates. DHA-mediated axon outgrowth was accompanied by the translational up-regulation of Tau and collapsin response mediator protein 2 (CRMP2), two important axon-related proteins, and the activation of Akt and p70 S6 kinase. Consistent with these findings, rapamycin, a potent inhibitor of mammalian target of rapamycin (mTOR), prevented DHA-mediated axon outgrowth and up-regulation of Tau and CRMP2. In addition, DHA-dependent activation of the Akt-mTOR-S6K pathway enhanced 5′-terminal oligopyrimidine tract-dependent translation of Tau and CRMP2. Therefore, our results revealed an important role for the Akt-mTOR-S6K pathway in DHA-mediated neuronal development.