Naoko Horikoshi

Experiences of Municipal Public Health Nurses Following Japan's Earthquake, Tsunami, and Nuclear Disaster

OBJECTIVE The purpose of this study was to explore the experiences of municipal public health nurses in the wake of the March 2011 massive earthquake and tsunami and resulting nuclear accident in Fukushima, Japan, from the time of the disaster until December 2013. DESIGN AND SAMPLE Thirty-two public health nurses working in three cities in Fukushima prefecture were divided into four focus groups and took part in interviews, which were analyzed using a qualitative descriptive method. RESULTS Two major themes were extracted: (1) experiences of difficulties and dilemmas, and (2) professional challenges and the meaning of excellence as a public health nurse. Subjects recounted their experiences based on the timeline of events. The process of overcoming various dilemmas--between prescribed roles and actual needs on the ground, being both civil servants and private citizens with families, and having to be publicly accountable while lacking adequate information--caused participants to reexamine the meaning of excellence in the practice of public health. CONCLUSION The strenuous and complex demands of extended disaster management caused subjects to grow professionally. Helping them process their emotions should also help these nurses give focus to their posttraumatic growth, and strengthen their sense of professionalism.

Diagnostic accuracy of Japanese posttraumatic stress measures after a complex disaster: The Fukushima Health Management Survey

The Posttraumatic Stress Disorder (PTSD) Checklist (PCL) has been widely used among traumatized populations to screen people with PTSD; however, the Japanese version of the PCL has yet to be validated. We examined the diagnostic accuracy of the Japanese version PCL‐Specific (PCL‐S) and the abbreviated versions of the PCL‐S among the evacuees of the Fukushima Daiichi Nuclear Power Plant accident.

Residence-related factors and psychological distress among evacuees after the Fukushima Daiichi nuclear power plant accident: a cross-sectional study

BackgroundRelocation following a disaster can impact the psychological well-being of evacuees. This study investigated the associations between residence-related factors and psychological distress among evacuees living in temporary housing after the Fukushima Daiichi Nuclear Power Plant accident.MethodsData from 525 participants living in temporary housing were collected. Associations between residence-related factors (frequent relocation, dissatisfaction with the residence, and plan to move to permanent housing) and psychological distress were measured. The psychological distress of evacuees was measured using the Japanese version of the 6-item Kessler scale (K6). We used a cut-off score of five to identify cases with psychological distress, the basis of Kessler’s 6 items for psychological distress.ResultsMultivariate logistic regression analysis (n = 418) showed that frequent relocation (OR = 2.05, 95% CI: 1.14–3.66, p = 0.016) and dissatisfaction with the residence (OR = 2.48, 95% CI: 1.60–3.83, p < 0.001) was significantly associated with psychological distress. After stratifying by gender, dissatisfaction with the residence was associated with psychological distress, and a plan to move to permanent housing was significantly associated with psychological distress in women (OR = 1.93, 95% CI: 1.03–3.63, p = 0.041).ConclusionsFrequent relocation and dissatisfaction with the residence were associated with psychological distress among evacuees following the Fukushima nuclear disaster. Evacuees should be provided with comfortable living spaces, and steps should be taken to reduce repeated relocation of evacuees. Thus, particular attention should be paid to women with a plan to move to permanent housing within this context.

The effect of a behavioral activation program on improving mental and physical health complaints associated with radiation stress among mothers in Fukushima: a randomized controlled trial

BackgroundMothers living with small children in Fukushima prefecture may experience radiation anxiety and related symptoms after the Fukushima Dai’ich Nuclear Power Plant Accident. A behavioral activation (BA) program was developed to improve their psychosomatic symptoms. The purpose of this randomized controlled trial was to examine the effectiveness of a BA program for improving psychological distress and physical symptoms among mothers with preschool children in Fukushima-prefecture 3 years after the Fukushima Daiichi Nuclear Power Plant accident.MethodsParticipants were recruited from mothers living with a preschool child(ren) in Fukushima city and surrounding areas though a newspaper advertisement, posters, and flyers. Participants allocated to the intervention group received a newly developed group-based BA program, which consisted of two 90- min lessons with a 1-week interval. Psychological distress and physical symptoms as a primary outcome, and radiation anxiety and positive well-being (liveliness and life satisfaction) as a secondary outcome, were measured at baseline, 1- and 3-month follow-ups.ResultsParticipants were randomly allocated to either an intervention or a control group (18 and 19, respectively). The BA program showed a marginally significant intervention effect on psychological distress (p = 0.051) and physical symptoms (p = 0.07) at 1-month follow-up, while the effect became smaller at 3-month follow-up. The effect sizes at 1-month were medium to large (-0.72 and -0.56, respectively). There was a significant intervention effect on increasing liveliness at 3-month follow-up (p = 0.02); and there were marginally significant effects on life satisfaction at 1- and 3-month follow-ups (both p = 0.09).ConclusionsThis BA program may be effective for improving psychological distress, physical symptoms, and well-being, at least for a short duration, among mothers with preschool children after the nuclear power plant accident in Fukushima, while a further large-scale study is needed.Trial registrationThe UMIN Clinical Trials Registry (UMIN-CTR; ID = UMIN000014081). Registered 27 May 2014.

Environmental radiation level, radiation anxiety, and psychological distress of non-evacuee residents in Fukushima five years after the Great East Japan Earthquake: Multilevel analyses

The present study aimed to clarify the associations among radiation exposure or psychological exposure to the Fukushima nuclear power plant accident (i.e., fear/anxiety immediately after the accident), current radiation anxiety, and psychological distress among non-evacuee community residents in Fukushima five years after the Great East Japan Earthquake, which occurred in March 2011. A questionnaire survey was administered to a random sample of non-evacuee community residents from 49 municipalities of Fukushima prefecture from February to April 2016, and data from 1684 respondents (34.4%) were analyzed. Environmental radiation levels at the time of the accident were ascertained from survey meter data, while environmental radiation levels at the time of the survey were ascertained from monitoring post data. In the questionnaire, immediate fear/anxiety after the accident, current radiation anxiety, and psychological distress were measured using a single-item question, a 7-item scale, and K6, respectively. Multilevel linear or logistic regression models were applied to analyze the determinants of radiation anxiety and psychological distress. The findings showed that environmental radiation levels at the time of the survey were more strongly associated with radiation anxiety than radiation levels immediately after the accident. Disaster-related experiences, such as direct damage, disaster-related family stress, and fear/anxiety after the accident, and demographic characteristics (e.g., younger age, being married, low socioeconomic status) were significantly associated with radiation anxiety. Environmental radiation levels at the time of the accident or survey were not significantly associated with psychological distress. Radiation anxiety largely mediated the association between fear/anxiety after the accident and psychological distress. In addition to environmental radiation levels, respondents’ radiation anxiety was affected by multiple factors, such as disaster-related experiences and demographic characteristics. Radiation levels were not associated with psychological distress in non-evacuee community residents. Rather, fear/anxiety after the nuclear power plant accident may be a determinant of psychological distress, mediated by radiation anxiety.

The characteristics of non-respondents and respondents of a mental health survey among evacuees in a disaster: The Fukushima Health Management Survey

The Fukushima Medical University conducted a mental health care program for evacuees after the Fukushima Daiichi nuclear power plant accident. However, the mental health status of non-respondents has not been considered for surveys using questionnaires. Therefore, the aim of this study was to clarify the characteristics of non-respondents and respondents. The target population of the survey (FY2011-2013) is people living in the nationally designated evacuation zone of Fukushima prefecture. Among these, the participants were 967 people (20 years or older). We examined factors that affected the difference between the groups of participants (i.e., non-respondents and respondents) using multivariate logistic regression analysis. Employment was higher in non-respondents (p=0.022) and they were also more socially isolated (p=0.047) when compared to respondents; non-respondents had a higher proportional risk of psychological distress compared to respondents (p<0.033). The results of the multivariate logistic regression analysis showed that, within the participants there was a significant association between employment status (OR=1.99, 95% confidence interval [CI]:1.12-3.51) and psychological distress (OR=2.17, 95% CI:1.01-4.66). We found that non-respondents had a significantly higher proportion of psychological distress compared to the respondents. Although the non-respondents were the high-risk group, it is not possible to grasp the complexity of the situation by simply using questionnaire surveys. Therefore, in the future it is necessary to direct our efforts towards the mental health of non-respondents and respondents alike.

Association between psychological distress and dietary intake among evacuees after the Great East Japan Earthquake in a cross-sectional study: the Fukushima Health Management Survey

Objective Psychological distress is generally associated with poor dietary intake, but this has never been investigated among residents after a major disaster. We attempted to reveal the associations between dietary intake and non-specific mental health distress as well as traumatic symptoms among evacuees after the Great East Japan Earthquake of 2011. Methods In this cross-sectional analysis of 63 047 evacuees (27 901 men, 35 146 women) who responded to The Fukushima Health Management Survey in 2012, non-specific mental health distress was assessed using the Kessler-6 (K6) scale, while traumatic symptoms were evaluated using the Post-traumatic Stress Disorder (PTSD) Checklist—Stressor-Specific Version (PCL-S). The outcome was ‘low frequency’—meaning a daily consumption in the 25th centile or less according to the food frequency questionnaire (FFQ)—of 19 targeted food items. Logistic regression analysis was used to estimate ORs and 95% CIs adjusted for demographic, lifestyle-related and disaster-related factors. Results Of the participants, 14.7% suffered non-specific mental health distress, and 21.2% exhibited traumatic symptoms. Multivariable adjusted logistic regression analysis showed that the former were likely to have a low intake frequency of certain foods, such as rice and bread, fish, meat, vegetables or fruit (non-juice), soya bean products, milk, and yogurt or lactobacillus drinks; the latter were also likely to have a low intake frequency of certain foods, including rice and bread, fish, meat, vegetables (non-juice), milk and yogurt or lactobacillus drinks, but conversely consumed vegetable and fruit juices more often. These associations between dietary intake and non-specific mental health distress, as well as traumatic symptoms, were predominantly observed in women. Conclusions Psychological distress after the Great East Japan Earthquake among evacuees was associated with a low intake frequency of certain foods, and the association was predominantly observed in women.

Associations of disaster-related and psychosocial factors with changes in smoking status after a disaster: a cross-sectional survey after the Great East Japan Earthquake

Objective Few studies have comprehensively examined changes in smoking status and related factors after a disaster. We examined these factors among residents of an evacuation area in Fukushima after the Great East Japan Earthquake. Methods The study participants included 58 755 men and women aged ≥20 years who participated in the Fukushima Health Management Survey in 2012 after the disaster. Smoking status was classified as either current smokers or current non-smokers before and after the disaster. The participants were divided into the following groups: (1) non-smokers both before and after the disaster, (2) non-smokers before and smokers after the disaster, (3) smokers before and non-smokers after the disaster and (4) smokers both before and after the disaster. The adjusted prevalence ratios and 95% CIs of changes in smoking status for demographic, disaster-related and psychosocial factors were tested using logistic regression analysis that was stratified by smoking status before the disaster. Results Among the 44 729 participants, who were non-smokers before the disaster, 634 (1.4%) began smoking after the disaster. Among the 14 025 smokers before the disaster, 1564 (11.1%) quit smoking after the disaster, and the proportion of smokers in the evacuation area consequently decreased from 21.2% to 19.6%. In the multivariable model, factors significantly associated with beginning smoking included being a male, being younger, having a lower education, staying in a rental house/apartment, house being damaged, having experienced a tsunami, change jobs and the presence of traumatic symptoms and non-specific psychological distress. On the contrary, factors associated with quitting smoking included being a female, being older, having a higher education and having a stable income. Conclusion The proportion of smokers slightly decreased among residents in the evacuation area. The changes in smoking statuses were associated with disaster-associated psychosocial factors, particularly changes in living conditions, having experienced a tsunami, change jobs and developing post-traumatic stress disorder.

Effects of socioeconomic factors on cardiovascular-related symptoms among residents in Fukushima after the Great East Japan Earthquake: a cross-sectional study using data from the Fukushima Health Management Survey

Objective To investigate the association between socioeconomic factors and the exacerbation of cardiovascular symptoms among evacuees after the Great East Japan Earthquake. Methods A sample of 73 433 individuals was included in the Fukushima Health Management Survey. Self-report questionnaires were used to determine the influence of socioeconomic factors including living arrangements, loss of employment and decreased income on the exacerbation of headache, dizziness, palpitations and shortness of breath. Odds ratios (ORs) and 95% CIs of the effect of socioeconomic factors were estimated for each symptom using multiple logistic regression analyses. Results Exacerbation of headaches was reported by 1893 individuals, dizziness by 1229, palpitations by 1085 and shortness of breath by 626 individuals. Evacuation accommodation was associated with all of these symptoms. Compared with participants living in their own home (OR=1.00), individuals living in relatives’ homes had increased probability of experiencing exacerbation of headache (1.58; 95% CI 1.19 to 2.09) and dizziness (1.42; 95% CI 1.02 to 1.98); those living in rental housing or apartments experienced exacerbation of headache (1.54; 95% CI 1.32 to 1.80), dizziness (1.45; 95% CI 1.20 to 1.75), palpitations (1.25; 95% CI 1.03 to 1.51) and shortness of breath (1.76; 95% CI 1.35 to 2.28); participants living in evacuation shelters experienced exacerbation of headache (1.80; 95% CI 1.09 to 2.96); and refugees living in temporary housing also experienced exacerbation of headache (1.42; 95% CI 1.15 to 1.72), dizziness (1.40; 95% CI 1.09 to 1.79) and shortness of breath (1.49; 95% CI 1.07 to 2.08). Compared with the evacuees who retained their jobs, unemployed individuals showed increased probability of exacerbation of headache (1.28, 95% CI 1.12 to 1.46), dizziness (1.26, 95% CI 1.07 to 1.48) and palpitations (1.21, 95% CI 1.01 to 1.45). Decreased income was associated with exacerbation of headache (1.39, 95% CI 1.22 to 1.60). Conclusion After the earthquake, living in non-home conditions was more likely to result in exacerbated cardiovascular symptoms among evacuees. Loss of employment was another risk factor related to exacerbated headache and dizziness.