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The nuclear accident that accompanied the Great East Japan Earthquake of 11 March, 2011, was also an information disaster. A serious problem that arose after the accident and persisted for a long time was the damage caused by harmful rumors (DCBHR). In 2016, a cross-sectional questionnaire survey on health and information was conducted in Fukushima. The eligible population of this survey was 2000 Fukushima residents, which included those in the evacuated areas. We received 861 responses. Data were analyzed using the responses to the question about perceived DCBHR as the objective variable and the sources of information residents trusted and the media they used as explanatory variables. A multiple logistic regression analysis revealed that those who trusted government ministries and local commercial TV were significantly associated with no effect. In contrast, those who used Internet sites and blogs were significantly associated with a negative effect. This study underlines the pivotal importance of media and information, literacy, and education and discusses how these should be improved to avoid DCBHR in the future. Furthermore, accurate information should be made available to all sections of the population to diminish DCBHR.

Objectives　Posttraumatic growth (PTG) refers to a positive psychological transformation experienced as a result of struggling with a major life crisis or traumatic event. In recent times, PTG has been used as a form of psychological support for those who have experienced trauma. In this study, we classified the free descriptions of PTG in Fukushima residents who experienced the Great East Japan Earthquake (GEJE). We examined the relationship between basic characteristics and PTG clusters, and between "recovery from radiation anxiety" and PTG clusters.Methods　A mail survey was conducted in August 2016 among 2,000 Fukushima residents, aged 20-79 years. We asked the participants for a free description of the specific content of their PTG. We also asked about their age, gender, and education, as well as about radiation anxiety immediately after the GEJE and at the time of the survey. Participants were divided into the following groups: "no anxiety," "recovered from anxiety," and "unrecovered from anxiety". The PTG free descriptions were classified into eight categories, including five dimensions based on the Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996) ("relating to others," "new possibilities," "personal strength," "spiritual change," and "appreciation of life") and three categories created according to Nishino et al. (2013) ("increased awareness of disaster prevention," "renewed recognition of nuclear-related issues," and "critical examination of information from authorities").Results　Of the 916 collected responses, data from 786 responses with no missing values were analyzed. Among women and young people, the proportion of those who answered "relating to others" and "appreciation of life" was high. For those with higher education, the proportion of those who answered "relating to others," "renewed recognition of nuclear issues," "critical examination of information from authorities," "personal strength," "spiritual change," and "appreciation of life" was high. In the "recovered from anxiety" group, the proportion of those who answered "renewed recognition of nuclear issues" was high.Conclusion　In assessing PTG, women and young people were more likely to report that they felt closely connected to family or friends, as well as to the community, and that they were grateful for their daily lives. Those with higher education tended to recognize that they have come to critically examine information provided by the national government, electric power companies, and national newspapers; they felt mental strength and growth after the earthquake. Those who recovered from radiation anxiety were more likely to report forming a heightened awareness of issues relating to nuclear power plants and energy.

The Fukushima Daiichi Nuclear Power Station accident in 2011 produced over 100000 evacuees. In order to deal with an increased need of mental health care, brief, transdiagnostic Telephonic Interventions (TI) have been provided for those at risk of different mental health problems identified based on results of the Mental Health and Lifestyle Survey (MHLS). This study aimed to examine usefulness of TI with focusing on evacuees' subjective estimation assessed in individual follow-up interviews. The sample comprised 484 persons who had been evacuated from 13 municipalities in Fukushima Prefecture to 8 safer regions in and out of Fukushima. We conducted semi-structured interviews for participants receiving TI (intervention group) and those not receiving TI despite being identified as high risk (non-intervention group). The intervention group was older, had a higher proportion of self-reported mental illness, and higher unemployment compared with the non-intervention group. The satisfaction proportion of those who underwent TI was as high as 74.6%. Satisfaction was significantly associated with advance knowledge of TI availability (OR = 3.00, 95% CI: 1.59-5.64), and advice on health-related practices (OR = 2.15, 95% CI: 1.12-4.13). Thus, TI is considered to be feasible and useful for public health management practices in major disasters.

We examined the differences in the posttraumatic growth (PTG) free descriptions from clusters of Fukushima residents (evacuation and non-evacuation zones) who experienced the Great East Japan Earthquake, and the relationship between "recovery from radiation anxiety" and the PTG-free description classification in these regions. A mail survey was conducted in August 2016 among Fukushima residents aged 20-79 years for free descriptions of their PTG. Participants were then divided into the "no anxiety," "recovered from anxiety," and "unrecovered from anxiety" groups based on their "recovery from radiation anxiety." Data from 786 responses were analyzed. The PTG-free descriptions were classified into eight categories. Among those who lived in the evacuation zone versus those in the non-evacuation zone, "relating to others" (non-evacuation zone: 11.9% vs. evacuation zone: 18.4%) and "appreciation of life" (non-evacuation zone: 2.7% vs. evacuation zone: 9.8%) were significantly higher, and "increased awareness of disaster prevention" (non-evacuation zone: 20.4% vs. evacuation zone: 8.0%) was significantly lower. In the evacuation zone, "renewed recognition of nuclear issues" was significantly lower than the expected value in the no anxiety group (3.1%) and significantly higher than the expected value in the recovered group (22.9%). Further studies are needed to build support measures and potentially aid in preparing for future disasters.

Objectives　Nine years after the accident at the TEPCO Fukushima Daiichi Nuclear Power Plant in March 2011, anxiety about the effects of radiation on future generations persists. We considered the possibility that information from mass media sources and the Internet might influence this anxiety. Thus, this study examined the relationship between information sources and anxiety; based on the results, we consider the necessary measures to reduce this anxiety.Methods　We conducted a mail-based survey by distributing an anonymous self-administered questionnaire to 2,000 Fukushima Prefecture residents aged 20 to 79. We randomly selected 500 residents from Aizu, Nakadori, Hamadori, and the evacuation areas, and compared the data obtained from Hamadori and the evacuation areas. The objective variable was anxiety about the effects (of radiation) on future generations, while the explanatory variables were trusted sources and media the respondents used to get information on radiation. Other variables assessed included health status and knowledge of radiation. We conducted univariate analysis of combined data to assess the relationship between anxiety and the questionnaire items. This was followed by multiple regression analysis with anxiety as the objective variable and those showing significant differences in the univariate analysis as the explanatory ones. We then conducted multiple regression analysis, that included the interaction means between explanatory variables and evacuation areas.Results　Of the 500, 201 respondents were from Hamadori (40.2%) and 192 from the evacuation areas (38.4%). Multiple regression analysis revealed that anxiety was significantly lower among those who trusted government ministries and those who were healthy. Anxiety was also significantly lower among those who correctly answered the question on the genetic influence of radiation, while it was significantly higher among those who correctly answered the question on the dose-response model of radiation-induced cancer. In Hamadori, anxiety was significantly higher among those who watched private national television. In the evacuation areas, the result was the same as that of the combined data.Conclusion　Different information sources and media were significantly associated with anxiety about the effects of radiation on future generations. Therefore, media sensationalism should be reduced to prevent anxiety among citizens. Our findings highlight the importance of selecting information sources and media that disseminate accurate information, as well as the need to improve media literacy among citizens. Furthermore, a dose-response model of radiation-induced cancer must be communicated in a way that is not misleading. Receiving accurate information on the genetic effects of radiation can reduce anxiety among citizens.

The 2011 Great East Japan Earthquake and consequent Fukushima Daiichi Nuclear Power Station accident caused a large-scale evacuation, generating various health issues. Although residents gradually returned, their independence of daily living and associated factors remain unknown. This study examines the hypothesis that physical and mental status are associated with the instrumental activities of daily living (IADL) of older returnees (65 years and above) after the disaster. Older returnees to Kawauchi Village, Fukushima Prefecture, located 20-30 km southwest of the power plants, were recruited. IADL was assessed using the Japan Science and Technology Agency Index of Competence, physical function via the 30-s chair stand test, and mental health via the Japanese version of the World Health Organization Five Well-Being Index. To examine the association of IADL and possible factors, a t-test or Pearson's product-moment correlation coefficient was used, stratified by sex. The data of 29 participants (75.5 ± 7.4 years, 19 female) were analyzed. Physical function was associated with IADL in females. Mental health was associated with IADL in males and females. Taking measures to strengthen physical function in females, as well as to improve mental health in both sexes, for enhancing IADL ability could be beneficial.

After the accident at the Fukushima nuclear power plant in 2011, caused by the Great East Japan Earthquake, some evacuees had no one to consult despite many local care providers offering assistance. This study identified the characteristics of individuals who did not receive consultations and the relevant determinants, and proposed the available measures to address this issue. Altogether, 32,699 participants aged 16 years or older and residing in the disaster area at Fukushima were surveyed. Those with no one to consult showed a significantly higher prevalence of psychological distress (16.2%, p < 0.001) and drinking problems (21.5%, p < 0.001). Multivariate analysis revealed that these behaviors were associated with the middle age group (i.e., 40-64 years old) (odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.16-1.46), men (OR = 2.46; 95% CI, 2.27-2.66), bad financial circumstances (OR = 2.11; 95% CI, 1.96-2.27), and living alone (OR = 1.53; 95% CI, 1.39-1.68). This research verifies that people with such characteristics were more likely to be isolated and vulnerable to psychiatric problems, such as depression. We suggest that it is integral for local care providers to recognize those who have no one to consult and provide targeted support.

The Great East Japan Earthquake severely damaged the Tohoku and Kanto districts, and Fukushima Prefecture faced a subsequent nuclear disaster. Few studies have reported the effects of socioeconomic stressors on individuals' mental status following disasters. We analyzed the responses of 60,704 adult residents of a designated restricted area to the PTSD Checklist-Stressor-Specific Version (PCL-S). The relationships between the PCL-S scores and demographic, socioeconomic, and damage-related variables were analyzed using regression analysis to predict participants' severity of PTSD symptoms. Approximately 14.1% of evacuees had severe PTSD symptoms (PCL-S ≥50) eighteen months post-earthquake. The PCL-S scores were higher among women, older adults, less educated people, those with a history of mental illness, and those living outside Fukushima Prefecture. The PCL-S scores increased with participants' scores on the Kessler Psychological Distress Scale. The number of trauma-exposure stressors and socioeconomic stressors were associated with 1.52 and 3.77 increases in the PCL-S score, respectively. Furthermore, psychological distress, unemployment, decreased income, house damage, tsunami experience, nuclear power plant accident experience, and loss of someone close due to the disaster were associated with the prevalence of severe PTSD symptoms. The complex triple disaster of a major earthquake, tsunami, and nuclear accident created significant socioeconomic changes that may be important determinants of PTSD among residents of restricted access areas in Fukushima.

The 2011 nuclear disaster in Fukushima was not only a health disaster, but also an information disaster. Although media can promote health communication following disasters, studies have revealed associations between media information and negative psychological reactions. To clarify the relationship between media utilization and current health anxiety due to radiation exposure, a cross-sectional questionnaire survey was conducted in Fukushima. We selected 2000 subjects from evacuation (i.e., 500) and non-evacuation (i.e., 1500) areas by two-stage stratified random sampling. As the independent variable, participants were asked about current health anxiety due to radiation exposure at the time of answering the questionnaire. For utilization of media about radiation exposure, local media, national media, Internet media, public broadcasts, and public relations information from local government were set as the dependent variables. Questionnaire data were analyzed by evacuation type (i.e., forced/voluntary). In a multivariate logistic regression analysis, the use of public relations information was significantly associated with lower anxiety for the forced evacuees (odds ratio: 0.72; 95% confidence interval: 0.56-0.93). Our findings highlight the importance of public relations information from local government in terms of it being associated with lower current health anxiety, and this could potentially aid in preparing for future disasters., Competing Interests: The authors declare no conflict of interest

Background: Currently, few studies have thoroughly investigated the socioeconomic factors related to sleep problems among evacuees following a disaster., Objectives: To examine sleep problems in evacuees using data from a large-scale cohort survey of evacuees conducted after the 2011 Great East Japan Earthquake (GEJE)., Methods: In sum, 73,433 residents who were living in evacuation zones responded to The 2011 Fukushima Health Management Survey. We excluded 16,659 participants who did not answer the question about sleep problems or those younger than 20 years. Thus, data from 56,774 participants (24,959 men and 31,815 women) were used for this analysis. Evacuees' self-reported sleep dissatisfaction was determined based on their response to the question 'Are you satisfied with the quality of your sleep? '. The response options 'Unsatisfied' and 'Very unsatisfied' were considered as the outcome for the present study. Prevalence ratios (PRs) and 95% confidence intervals (CIs) for the prevalence of self-reported sleep disturbance were estimated using modified Poisson regression models., Results: Of the qualifying survey respondents, 20.3% (4387 men and 7128 women) reported sleep dissatisfaction. Compared with participants living in their own or a relative's home (PR = 1), those living in temporary housing or rental accommodation had a higher prevalence of sleep dissatisfaction (1.47; 95% CI 1.44-1.50 and 2.16; 95% CI 2.07-2.26 in men; 1.39; 95% CI 1.36-1.41 and 1.92; 95% CI 1.86-1.99 in women). Higher educational attainment was also associated with a higher prevalence of sleep dissatisfaction in men, as were job loss and decreased income in both men and women., Conclusion: Self-reported sleep dissatisfaction after the GEJE was associated with a deteriorated socioeconomic status among evacuees. However, future longitudinal studies are warranted., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Following the accident at the Fukushima Nuclear Power Plant in March 2011, both experts and the national government provided insufficient information on radiation, leading to widespread distrust in the community. This study aimed at clarifying the association between anxiety about radiation and health literacy among residents in evacuation and non-evacuation areas in Fukushima. A questionnaire survey was sent to randomly sampled residents between August and October 2016, and data from 777 responses (38.9% valid response) were analyzed. The questionnaire assessed current radiation anxiety and discrimination and prejudice based on radiation exposure through seven items and communicative and critical health literacy through five items. Multiple regression analysis of the association between radiation anxiety and health literacy showed that the level of health literacy was significantly negatively associated with radiation anxiety in the evacuation areas (marginally in the non-evacuation areas) and marginally negatively associated with discrimination and prejudice in the evacuation areas but not in the non-evacuation areas. Therefore, improving health literacy could alleviate radiation anxiety.

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.

Purpose: This study examined the incidence of depression and associated factors among elderly persons from Iitate village after the March 2011 earthquake., Method: This was a prospective cohort study. As a baseline survey, in May 2010 a self-assessment Basic Checklist (BCL) was distributed to 1611 elderly villagers, of which 1277 responded. Of these respondents, 885 without a tendency to depression (69.3%) were given a follow-up survey in May 2013. The BCL was used to assess depression tendency, instrumental activities of daily living (IADL), physical function, nutritional status, oral function, homeboundness, cognitive function and social activities. Univariate analysis was used to examine differences in risk between those with a presence of depression tendency (PDT) and those without (non-PDT) depending on demographic and BCL variables. Variables found to be significant were analysed by Poisson regression analysis., Results: Of the 438 respondents in the second survey, 163 (37.2%) showed depression tendency. PDT risk was significantly increased by female gender, age, history of diabetes and cognitive disorder. It was significantly reduced by increased IADL. Engagement in social activities decreased PDT risk in rental accommodation., Discussion: Renters faced a higher risk of PDT than persons evacuated in groups to purpose-built housing. The inclusion of social activities in the multivariate Poisson regression analysis weakened this effect. Female gender, a history of diabetes, reduced IADL and a tendency to cognitive disorder each independently affected PDT risk. These findings may inform future responses to earthquakes and the technical disasters that may accompany them., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

The disaster at the Fukushima Daiichi Nuclear Power Plant after the Great East Japan Earthquake on March 11, 2011, might have affected the mental health status of children. To assess the mental health status, we measured the Strengths and Difficulties Questionnaire (SDQ) in 15 274 children (aged 4-15 years). The proportions of those who scored above the cutoff (≥16) of SDQ, reflecting the clinical range of the mental health status, were 25.0% (aged 4-6 years), 22.0% (aged 7-12 years, and 16.3% (aged 13-15 years), which were higher than that in the usual state (9.5%). We also explored the possibility that the distribution on the Fukushima prefectural map of the proportions of those who scored above the cutoff (≥16) of SDQ might correspond with the environmental radiation levels, but there was no significant correlation.

Background: Relocation 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., Methods: Data 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., Results: Multivariate 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)., Conclusions: Frequent 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.