Misari Oe

Three-year trend survey of psychological distress, post-traumatic stress, and problem drinking among residents in the evacuation zone after the Fukushima Daiichi Nuclear Power Plant accident [The Fukushima Health Management Survey].

Prolonged periods of instability in terms of living environment can lead to a serious increase in mental health issues among disaster‐affected individuals. The aim of this study was to assess long‐term trends in mental health among adult residents in a nuclear‐disaster‐affected area.

Culture-sensitive psychotraumatology

Background Although there is some evidence of the posttraumatic stress disorder (PTSD) constructs cross cultural validity, trauma-related disorders may vary across cultures, and the same may be true for treatments that address such conditions. Experienced therapists tailor psychotherapy to each patients particular situation, to the nature of the patients psychopathology, to the stage of therapy, and so on. In addition, culture-sensitive psychotherapists try to understand how culture enhances the meaning of their patients life history, the cultural components of their illness and help-seeking behaviors, as well as their expectations with regard to treatment. We cannot take for granted that all treatment-seeking trauma survivors speak our language or share our cultural values. Therefore, we need to increase our cultural competencies. Methods The authors of this article are clinicians and/or researchers from across the globe, working with trauma survivors in various settings. Each author focused on one or more specific cultural aspects of working with trauma survivors and highlighted the following aspects. Results As a result of culture-specific individual and collective meanings linked to trauma and trauma-related disorders survivors may be exposed to (self-)stigma in the aftermath of trauma. Patients who are reluctant to talk about their traumatic experiences may instead be willing to write or use other ways of accessing the painful memories such as drawing. In other cultures, community and family cohesion are crucial elements of recovery. While awareness of culture-specific aspects is important, we also need to beware of premature cultural stereotyping. When disseminating empirically supported psychotherapies for PTSD across cultures, a number of additional challenges need to be taken into account: many low and middle income countries have very limited resources available and suffer from a poor health infrastructure. Conclusions In summary, culture-sensitive psychotraumatology means assuming an empathic and non-judgmental attitude, trying to understand each individuals cultural background. Highlights of the article Cultural sensitivity is required to successfully treat trauma survivors. Empirically supported treatments may need to be modified depending on the patient’s cultural background. In addition to talking, patients may write or use other ways of accessing the traumatic memories such as painting, dancing, or singing. In low and middle income countries, dissemination of evidence-based treatments is frequently impeded by limited resources and poor health infrastructure. Beware of cultural stereotyping!

The Great East Japan Earthquake: Tsunami and Nuclear Disaster

The Great East Japan Earthquake, which occurred in 2011, was the worst complex disaster in human history that brought serious and multidimensional psychosocial effects on many people in Japan. First, the tsunami struck the coastal area of the Tohoku region and subsequently resulted in the explosion of the Fukushima Daiichi Nuclear Power Plant. In this chapter, these two tragic events and their psychosocial consequences are described. We especially focused on the nuclear disaster in Fukushima because of its long-term and serious effects on people living in or out of Fukushima Prefecture and the worldwide concern it brought. Also, in order to more deeply understand the current complicated situation in Fukushima, we reviewed three major nuclear accidents, including one which occurred in Japan. The various psychosocial reactions associated with the nuclear disaster in Fukushima can be summarized within five main issues: posttraumatic stress response, chronic anxiety and guilt, ambiguous loss, separated families and communities, and stigma. We offer recommendations for effective intervention to mitigate adversities, including mothers’ anxieties and guilt feelings, the stigma against the Fukushima people, and exhaustion and burnout of the local staff.

Mental Health Consequences and Social Issues After the Fukushima Disaster

The Great East Japan Earthquake and subsequent nuclear power plant accident caused multidimensional and long-term effects on the mental health condition of people living in Fukushima. In this article, focusing on the influence of the nuclear disaster, we present an overview of studies regarding the psychosocial consequences of people in Fukushima. Studies revealed that the experiences of the explosions at the plant as well as the tsunami are deeply embedded in their memory, leading to posttraumatic responses. Chronic physical diseases, worries about livelihood, lost jobs, lost social ties, and concerns about compensation were also associated with posttraumatic responses. Furthermore, the radioactive fallout brought chronic anxiety regarding physical risks of radiation exposure to people, especially young mothers. People often have different opinions about the radiation risk and their own future plans, resulting in a reduction in the resilience that communities and families had before the disaster. In addition, such weakened community resilience may produce a significant increase in disaster-related suicide in Fukushima. Specific social issues, such as “radiation stigma” among the public and self-stigma among evacuees, that are never seen with other natural disasters also increased in Fukushima.

Predictors of severe psychological distress trajectory after nuclear disaster: evidence from the Fukushima Health Management Survey

Objectives The Fukushima Daiichi Nuclear Power Plant accident, which occurred after the Great East Japan Earthquake and Tsunami in March 2011, may have a considerable long-term impact on the lives of area residents. The aims of this study were to determine the trajectories of psychological distress using 3-year consecutive data, and to find predictive factors of severe distress that may also prove useful for public health intervention. Methods Data were obtained on 12 371 residents who were registered in the municipalities categorised as complete evacuation areas for 3 years after the disaster and who completed an assessment in each of the 3 years. Results Using group-based trajectory modelling, we identified four trajectory patterns distinguished by the levels of psychological distress, which gradually improved over time in all trajectories. Subjective sleep insufficiency, problem drinking, poor social support and perception of radiation risk 3 years after the accident were associated with the severity of psychological distress, according to the multivariate analysis. Conclusions The identified factors may be useful for community-based mental healthcare over the long term following a nuclear disaster.

Disaster Behavioral Health: Psychological Effects of the Fukushima Nuclear Power Plant Accident

We reviewed studies regarding the mental health problems of the people who were directly affected by the past three severe nuclear accidents: the Three Mile Island accident, the Chernobyl accident, and the Tokaimura accident. These events brought us many lessons on complicated and long-term sociopsychological effects of the people who met with a nuclear accident. The Fukushima nuclear power plant accident also caused multidimensional behavioral problems of the residents in Fukushima. The various sociopsychological reactions among the Fukushima people can be summarized within five main issues: posttraumatic stress response, chronic anxiety and guilt, ambiguous loss, separated families and communities, and stigma. We should provide the effective intervention to mitigate mothers’ anxieties and guilty feelings, dispel the stigma against the Fukushima people, and prevent exhaustion or burnout of the local staff.

Startle reactivity in the long-term after severe accidental injury: preliminary data.

An exaggerated startle response is one of the core hyperarousal symptoms of posttraumatic stress disorder (PTSD). Heightened startle eye-blink magnitude and reduced habituation of this response in PTSD patients have been reported in several studies. However, it is unclear whether this is an enduring characteristic of individuals vulnerable for PTSD or to which degree trauma-exposed individuals who do not develop PTSD also show exaggerated startle. Thirteen accident survivors with remitted PTSD, 12 trauma controls, and 16 non-trauma controls were examined. Four measures of startle reactivity were analyzed in response to 15 bursts of white noise (95 dB, 50 ms): eye-blink magnitude, eye-blink onset latency, skin conductance response, and heart rate response. The eye-blink reflex was measured over the left musculus orbicularis oculi. Reactivity and habituation were analyzed using linear mixed models. Remitted PTSD subjects did not differ from non-trauma controls regarding any of the startle reactivity or habituation measures. Unexpectedly, trauma controls showed larger eye-blink magnitude than non-trauma controls. These results suggest that the exaggerated startle response disappears after remission from PTSD. Further, they suggest that psychologically resilient trauma survivors might show a PTSD-like pattern of exaggerated physiological startle even many years after a traumatic event.

Diagnostic interview study of the prevalence of depression among public employees engaged in long‐term relief work in Fukushima

The Great East Japan Earthquake and in particular, the Fukushima Daiichi Nuclear Power Plant accident, have had a serious psychological impact on not only residents, but also relief workers in Fukushima. Although public employees work in highly stressful situations and play a very important role in long‐term relief, their psychiatric features have yet to be clarified. The two aims of this study were to identify the current prevalence rate of depression and post‐traumatic stress disorder among public employees working in the disaster area using diagnostic interviews, and to speculate on the psychosocial factors affecting their mental condition.

Does trait anxiety influence effects of oxytocin on eye-blink startle reactivity? A randomized, double-blind, placebo-controlled crossover study

Background Previous research has demonstrated that the neuropeptide oxytocin modulates social behaviors and reduces anxiety. However, effects of oxytocin on startle reactivity, a well-validated measure of defense system activation related to fear and anxiety, have been inconsistent. Here we investigated the influence of oxytocin on startle reactivity with particular focus on the role of trait anxiety. Methods Forty-four healthy male participants attended two experimental sessions. They received intranasal oxytocin (24 IU) in one session and placebo in the other. Startle probes were presented in combination with pictures of social and non-social content. Eye-blink startle magnitude was measured by electromyography over the musculus orbicularis oculi in response to 95 dB noise bursts. Participants were assigned to groups of high vs. low trait anxiety based on their scores on the trait form of the Spielberger State-Trait Anxiety Inventory (STAI). Results A significant interaction effect of oxytocin with STAI confirmed that trait anxiety moderated the effect of oxytocin on startle reactivity. Post-hoc tests indicated that for participants with elevated trait anxiety, oxytocin increased startle magnitude, particularly when watching non-social pictures, while this was not the case for participants with low trait anxiety. Conclusion Results indicate that effects of oxytocin on defense system activation depend on individual differences in trait anxiety. Trait anxiety may be an important moderator variable that should be considered in human studies on oxytocin effects.

Changes of Posttraumatic Stress Responses in Evacuated Residents and Their Related Factors: A 3-Year Follow-up Study From the Fukushima Health Management Survey

The longitudinal posttraumatic stress responses and resilient factors after the Fukushima Daiichi Nuclear Power Plant are yet unknown. Here we attempted to quantify the patterns of the course of posttraumatic stress disorder (PTSD) symptoms and we explored the factors associated with psychological recovery. The subjects were 12 371 residents in the municipalities categorized as the forced evacuated area. We categorized the subjects’ PTSD symptoms into 4 groups: Chronic, Resistant, Recovered, and Non-recovered. We applied a logistic regression to clarify the factors related to psychological recovery. We observed that laughter showed significant odds ratio in the Recovered group and the Resistant group. Meanwhile, elderly residents and those with poor living circumstances showed significant odds ratios for the Recovered group and the Resistant group. Laughter in daily life was associated with the psychological health in the evacuation area.