Severe Psychological Distress of Evacuees in Evacuation Zone Caused by the Fukushima Daiichi Nuclear Power Plant Accident: The Fukushima Health Management Survey

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Abstract

Background

Following the Great East Japan Earthquake on March 11, 2011, the nuclear disaster at the Fukushima Daiichi Nuclear Power Plant has continued to affect the mental health status of residents in the evacuation zone. To examine the mental health status of evacuee after the nuclear accident, we conducted the Mental Health and Lifestyle Survey as part of the ongoing Fukushima Health Management Survey.

Methods

We measured mental health status using the Kessler 6-item psychological distress scale (K6) in a total of 73,569 (response rate: 40.7%) evacuees aged 15 and over who lived in the evacuation zone in Fukushima Prefecture. We then dichotomized responders using a 12/13 cutoff on the K6, and compared the proportion of K6 scores ≥13 and ≤12 in each risk factor including demographic information, socioeconomic variables, and disaster-related variables. We also performed bivariate analyses between mental health status and possible risk factors using the chi-square test. Furthermore, we performed multivariate regression analysis using modified Poisson regression models.

Results

The median K6 score was 5 (interquartile range: 1–10). The number of psychological distress was 8,717 (14.6%). We found that significant differences in the prevalence of psychological distress by almost all survey items, including disaster-related risk factors, most of which were also associated with increased Prevalence ratios (PRs). Additionally, we found that psychological distress in each evacuation zone was significantly positively associated with the radiation levels in their environment ( r = 0.768, p = 0.002).

Conclusion

The earthquake, tsunami and subsequent nuclear accident likely caused severe psychological distress among residents in the evacuation zone in Fukushima Prefecture. The close association between psychological distress and the radiation levels shows that the nuclear accident seriously influenced the mental health of the residents, which might be exacerbated by increased risk perception. To provide prompt and appropriate support, continued psychosocial intervention for evacuees is strongly recommended.

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Most cited references 18

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Trends in mental illness and suicidality after Hurricane Katrina.

R C Kessler, S Galea, M J Gruber … (2008)

A representative sample of 815 pre-hurricane residents of the areas affected by Hurricane Katrina was interviewed 5-8 months after the hurricane and again 1 year later as the Hurricane Katrina Community Advisory Group (CAG). The follow-up survey was carried out to study patterns-correlates of recovery from hurricane-related post-traumatic stress disorder (PTSD), broader anxiety-mood disorders and suicidality. The Trauma Screening Questionnaire screening scale of PTSD and the K6 screening scale of anxiety-mood disorders were used to generate DSM-IV prevalence estimates. Contrary to results in other disaster studies, where post-disaster mental disorder typically decreases with time, prevalence increased significantly in the CAG for PTSD (20.9 vs 14.9% at baseline), serious mental illness (SMI; 14.0 vs 10.9%), suicidal ideation (6.4 vs 2.8%) and suicide plans (2.5 vs 1.0%). The increases in PTSD-SMI were confined to respondents not from the New Orleans Metropolitan Area, while the increases in suicidal ideation-plans occurred both in the New Orleans sub-sample and in the remainder of the sample. Unresolved hurricane-related stresses accounted for large proportions of the inter-temporal increases in SMI (89.2%), PTSD (31.9%) and suicidality (61.6%). Differential hurricane-related stress did not explain the significantly higher increases among respondents from areas other than New Orleans, though, as this stress was both higher initially and decreased less among respondents from the New Orleans Metropolitan Area than from other areas affected by the hurricane. Outcomes were only weakly related to socio-demographic variables, meaning that high prevalence of hurricane-related mental illness remains widely distributed in the population nearly 2 years after the hurricane.

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A 25 year retrospective review of the psychological consequences of the Chernobyl accident.

E.J. Bromet, J.M. Havenaar, L.T. Guey (2011)

The Chernobyl Forum Report from the 20th anniversary of the Chernobyl nuclear power plant disaster concluded that mental health effects were the most significant public health consequence of the accident. This paper provides an updated review of research on the psychological impact of the accident during the 25 year period since the catastrophe began. First responders and clean-up workers had the greatest exposure to radiation. Recent studies show that their rates of depression and post-traumatic stress disorder remain elevated two decades later. Very young children and those in utero who lived near the plant when it exploded or in severely contaminated areas have been the subject of considerable research, but the findings are inconsistent. Recent studies of prenatally exposed children conducted in Kiev, Norway and Finland point to specific neuropsychological and psychological impairments associated with radiation exposure, whereas other studies found no significant cognitive or mental health effects in exposed children grown up. General population studies report increased rates of poor self-rated health as well as clinical and subclinical depression, anxiety, and post-traumatic stress disorder. Mothers of young children exposed to the disaster remain a high-risk group for these conditions, primarily due to lingering worries about the adverse health effects on their families. Thus, long-term mental health consequences continue to be a concern. The unmet need for mental health care in affected regions remains an important public health challenge 25 years later. Future research is needed that combines physical and mental health outcome measures to complete the clinical picture. Copyright © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

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Mental Health and Related Factors after the Great East Japan Earthquake and Tsunami

Yukari Yokoyama, Kotaro Otsuka, Norito Kawakami … (2014)

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.

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Author and article information

Contributors

Tapio Mappes: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 8 July 2016

Publication date Collection: 2016

Volume: 11

Issue: 7

Electronic Location Identifier: e0158821

Affiliations

[1 ]Department of Neuropsychiatry, School of Medicine, Fukushima Medical University, Fukushima, Japan

[2 ]Department of Adult Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan

[3 ]Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan

[4 ]Department of Public Health, School of Medicine, Fukushima Medical University, Fukushima, Japan

[5 ]Department of Disaster Psychiatry, School of Medicine, Fukushima Medical University, Fukushima, Japan

[6 ]Department of Psychiatry, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan

[7 ]Department of Radiation Health Management, School of Medicine, Fukushima Medical University, Fukushima, Japan

University of Jyväskylä, FINLAND

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: YK SY HY MM SN AO MA. Performed the experiments: YK YS TS. Analyzed the data: YK TS HM. Wrote the paper: YK.

¶ Membership of the Mental Health Group of the Fukushima Health Management Survey is provided in the Acknowledgments.

* E-mail: kunii@ 123456fmu.ac.jp

Article

Publisher ID: PONE-D-15-35587

DOI: 10.1371/journal.pone.0158821

PMC ID: 4938533

PubMed ID: 27391446

SO-VID: 7eed88b6-7805-414e-b727-ab013be154d1

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 21 August 2015

Date accepted : 22 June 2016

Page count

Figures: 2, Tables: 3, Pages: 15

Funding

Funded by: Health Fund for Children and Adults Affected by the Nuclear Incident

Award Recipient : Masafumi Abe

This study was supported by the national “Health Fund for Children and Adults Affected by the Nuclear Incident.”

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Data Availability All relevant data are within the paper and its Supporting Information files.

Severe Psychological Distress of Evacuees in Evacuation Zone Caused by the Fukushima Daiichi Nuclear Power Plant Accident: The Fukushima Health Management Survey

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Most cited references 18

Trends in mental illness and suicidality after Hurricane Katrina.

A 25 year retrospective review of the psychological consequences of the Chernobyl accident.

Mental Health and Related Factors after the Great East Japan Earthquake and Tsunami

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