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Posttraumatic Stress and Change in Lifestyle among the Hanshin-Awaji Earthquake Victims
Abstract
In 1995, Japan's Hanshin-Awaji area was severely damaged by a major earthquake. Lifestyle factors, sometimes associated with physical health and mortality, have also been known to be associated with mental health status. This report examines the relationship between the subsequent change in lifestyle and the psychological stress induced by the earth quake.
An investigation was made of 108 male inhabitants of Awaji Island as to their individual lifestyle before and after the great earthquake, any posttraumatic stress disorder (PTSD) symptoms, and their demographic variables.
The mean PTSD score was higher in the worse lifestyle group than in the no/better lifestyle change group. Category B or D of PTSD scores were higher in the worse lifestyle group than in the no/better lifestyle change group. The percentage of subjects who lived in temporary public housing was higher in the worse lifestyle group than in the no/better lifestyle change group.
Worse change in lifestyle might be associated with high PTSD score in victims of Hanshin-Awaji earthquake.
... 7 ) We consider the relationship between psychological distress and sociodemographic factors associated with differential responses to following mass trauma (age, 8 gender, 9 family finances, 10 significant loss (family fatalities, housing loss), 11 disease-related vulnerabilities 12 and opportunities for physical activity. 13 Previous work has indicated that friends, relatives and spouses may provide the main sources of emotional support, and relatives and friends may provide greater tangible support. 14 We include social support as an important resource against large-scale stressors, 9,15,16 when recognising the role of different supporters in Japan. ...
... As elsewhere, the Japanese prefer to turn for psychological support to families, friends and relatives rather than health professionals. 22 Social support from family, friends and community members following a disaster can help bolster resilience against multiple stressors 8,12,13 and can aid in the development of further social ties and altruism. 4 Our results are consonant with reports elsewhere showing the negative impact of social network disruption on mental health following an earthquake. ...
... First, in focusing on providing economic and housing support governmental agencies often neglect the mental health of survivors. 13 However, stressors following a trauma are likely to have a range of societal impacts, including increased rates of sickness absence, 31 and somatisation of stress may increase the burden on hospitals following major trauma. Those with a history of illness or present ailments may need particular help from health professionals, and loss of employment is also associated with less resilience postdisaster. ...
Background
The 2011 Great Japan tsunami and nuclear leaks displaced 300 000 people, but there are no large studies of psychological distress suffered by these refugees.
Aims
To provide a first assessment of major factors associated with distress and dysfunctional behaviour following the disasters.
Method
All refugee families living in Miyagi were sent a questionnaire 10–12 months after the disasters. 21 981 participants (73%) returned questionnaires. Questions assessed psychological distress (Kessler Psychological Distress Scale, K6), dysfunctional behaviours, demographics, event exposure, change in physical activity, household visitors and emotional support.
Results
Nine percent scored 13+ on the K6 indicating risk of severe mental illness. Psychological distress was greater among Fukushima refugees. Demographic variables, family loss, illness history and change in physical activity were associated with psychological distress and dysfunctional behaviours. Associations between psychological distress and dysfunction and visitors/supporters depended on relation to supporter.
Conclusions
Practitioners need to recognise existing disease burden, community histories and family roles when intervening following disasters.
Declaration of interest
None.
Copyright and usage
© The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
... Considering unfavourable socio-environmental changes to physical activity among victims of the disaster (Fukuda, Morimoto, Mure et al., 1999, Tsubokura et al., 2013, there is a possibility that their PA trend might be negatively affected due to increased PA barriers. At an individual level, there may be psychological damage among older adult subjects caused by loss of family, increased 170 economic burden due to a forced migration, and no positive future prospects (Fukuda et al., 1999). ...
... Considering unfavourable socio-environmental changes to physical activity among victims of the disaster (Fukuda, Morimoto, Mure et al., 1999, Tsubokura et al., 2013, there is a possibility that their PA trend might be negatively affected due to increased PA barriers. At an individual level, there may be psychological damage among older adult subjects caused by loss of family, increased 170 economic burden due to a forced migration, and no positive future prospects (Fukuda et al., 1999). ...
... Life-changing events induced negative health consequences such as psychological stress (Fujihara, Saito, Heianza et al., 2012, Fukuda et al., 1999, prevalence of undetected diabetes (Ramachandran, Snehalatha, Yamuna et al., 2006), impaired glycaemic control (Fujihara et al., 2012) and metabolic 245 profile (Di Castelnuovo, Di Pietro, Di Tomo et al., 2013), which was reported in observational studies targeting disaster survivors or populations in disaster affected areas. These studies used an observational design due to unavailability of pre-disaster data. ...
Background: Older adults are one of most vulnerable populations at the onset of disasters. Those survived could suffer from life- and environmental changes originated in the disaster. As disuse syndrome or solitary death are often referred as disaster-related morbidity and mortality among older survivors, their physical activity patterns should be given a greater attention.
Objective: The study aims to describe physical activity patterns of older people affected by a major natural disaster, and explore contexts of such PA patterns in terms of socio-ecological factors.
Method: A mixed approach was taken to obtain a holistic view of the situation. IPAQ-SF and pedometers were used for measuring PA of older adults ≧65 (n=80) living either in temporal housing or their own dwelling located in two cities in Japan. One-on-one interviews were conducted to 1 male and 30 female subjects from the same group.
Results: IPAQ scores showed internal correlations among PA intensities: between total PA and moderate-intensity PA (Pearson correlation .54, p=.000) and also between total PA and walking time (.87, p=.000). Mean daily steps suggested a low PA profile of the female group (μ3825.05, SD±2563.05) and positively correlated with non-migration (μdifference 2128.04, p=.029). As for the total PA, temporary housing dwellers reported significantly greater PA than those who live in their own house (p=.036). The difference in moderate PA was also significant between two groups, with greater PA among temporary housing residents (p=.002). Interviews explained some context of the observed PA pattern difference.
Conclusions: Total and moderate PA were mediated by forced relocation. PA programs in temporal housing implemented regularly may have contributed to see greater PA level among the migration group. But lack of amenities in the neighbourhood limited their daily walking. This study result merits replication with a larger sample and also an assessment of physical environment of the area.
... Due to the huge psychosocial stress generated by disasters (Buekens, 2006;Curtis et al., 2007), victims are likely to suffer from post-event mental health problems. These include but are not limited to Posttraumatic Stress Disorder (PTSD), (Erickson, 1976;Logue et al., 1979;Dynes et al., 1987;Lindell and Perry, 1992;McFarlane et al., 1992;Spurrell and McFarlane, 1993;Fukuda et al., 1999;Greenough and Kirsch, 2005;Bourque et al., 2006;Madrid et al., 2006;Curtis et al., 2007;Straker and Finister, 2007;Combs, 2007;Mosca et al., 2007). Post-disaster stress symptoms typically manifest as depression, recurrent nightmares, emotional detachment from others, etc. (Benight and Bandura, 2004;Williams, R., 2006). ...
... As discussed in the previous subsection, the huge psychological and physical stress factors (Buekens et al., 2006;Curtis and Leitner, 2006;Curtis et al., 2007a) generated by disasters are particularly relevant for less healthy and/or vulnerable populations (Fukuda, et al., 1999). A pregnant woman is particularly vulnerable during a disaster for a variety of reasons including healthcare availability concerns, and fears for the subsequent health of her baby in the event of a forced, often stressful and traumatic, relocation due to a disaster (Curtis and Leitner, 2006). ...
... Earthquake Najarian et al., 1996 Relocation after a disaster: Posttraumatic stress disorder in Armenia after the 1988 earthquake. Earthquake Fukuda et al., 1999 Posttraumatic Stress and Change in Lifestyle among Hanshin-Awaji Earthquake Victims Earthquake De La Fuente R, 1990 The mental health consequences of the 1985 earthquakes in Mexico. Earthquake Sharan P, , et al 1996 ...
... A central determinant of mental health may be the ability to maintain routine daily activities which has been associated with resilience in the face of mass trauma (Hou et al., 2018;Miller and Rasmussen, 2010). The ability to maintain regular daily activities has been evident among survivors of various natural disasters (Fukuda et al., 1999;Parks et al., 2018), and evidence shows that restoration of pre-disaster daily routines relates to lower psychological distress over time (Goodwin et al., 2020). Among international forced migrants who have been exposed to continuous sociopolitical unrest in their home countries, disruptions of personal, social, and materialistic dimensions of daily routines in host countries relate to higher levels of different psychiatric symptoms over and beyond the adverse mental health impact of pre-migration trauma exposure . ...
... Further work will be needed to reconcile the different prevalence of probable depression under civil unrest in Hong Kong reported by different studies. We showed high prevalences of probable depression and anxiety over time among persons with high daily routine disruptions relative to those with low disruptions; these findings were consistent with previous evidence in different populations (Fukuda et al., 1999;Goodwin et al., 2020;Lai et al., 2020;Parks et al., 2018). Although we are not aware that this has been demonstrated in population-based studies after multiple traumas, other work suggests that this is consistent with our ...
Both COVID-19 and unrest are posing a significant threat to population mental health across the globe. This study examined trends of probable depression and anxiety during a time of civil unrest and concurrent COVID-19 in Hong Kong. Four random digit dialing telephone surveys were conducted in July 2019 (n = 1112), February–March 2020 (n = 2003), April–May 2020 (n = 2008), and July–August 2020 (n = 2034). The prevalence of probable depression increased from 25.7% (95% CI: 23.2–28.3) in July 2019 to 28.2% (95% CI: 26.2–30.1) in February–March 2020, and then decreased to 15.3% (95% CI: 14.0–17.0) in April–May 2020 and 13.7% (95% CI: 12.2–15.2) in July–August 2020. The prevalence of probable anxiety was 19.2% (95% CI: 17.5–20.9) in February–March 2020 and then stabilized in April–May 2020 and July–August 2020 (14.1%, 95% CI: 12.0–15.8). Probable depression and anxiety were more prevalent among persons with high relative to low daily routine disruptions. Combined high unrest-COVID-19 stress was associated with probable depression and anxiety across all persons; high unrest stress alone was associated with probable mental disorders at high daily routine disruptions. Civil unrest and COVID-19 are jointly associated with depression and anxiety among Hong Kong citizens. While population mental health improved, daily routine disruptions is a risk factor of mental disorders at every time-point.
... Other work has indicated associations between post-disaster exposure, demographic factors and distress: family and housing loss were associated with greater distress following a hurricane, 5 and women suffered greater post-traumatic stress following the 2004 South-East Asian tsunami. 6 Subsequent resources and behaviours, such as the provision of social support 7 and the maintenance of daily activities, [8][9][10] have also been shown to be protective against mental illness across different natural disasters, whereas temporary prefabricated housing was associated with greater distress following the Niigata-Chuetsu earthquake. 11 However, much of the data collected has been cross-sectional, or has followed modest samples over time. 1 Furthermore, work has been primarily conducted at a single level, despite evidence that losses and opportunities are unevenly distributed across communities following disaster 5,7 and that shared environments are critical to the accumulation of resources over time. ...
... 12 Indeed, city-wide maintenance or enhancement of activities post-disaster provide positive opportunities that can ameliorate the disruption often experienced after a disaster. 8,9 Drawing on two substantial data-sets, collected by Miyagi Prefecture in the 6 years following the Great East Japan Earthquake, tsunami and Fukushima nuclear leak (hereafter, the Great East Japan Earthquake), we conducted longitudinal multilevel analyses examining associations between survivors' psychological distress and time (level 1), previous psychiatric disorders, disaster exposure, demographics, and individual support and activity (level 2), and wider, city-level activity levels and social support (level 3). Combining these individual-and social-level factors across two large samples allowed for a rare analysis of the differential influences of these factors over time. ...
Background
The Great East Japan Earthquake of 11 March 2011 led to the relocation of 300 000 survivors. Studies following disasters focus primarily on data collected in the immediate aftermath and neglect the influence of wider community factors.
Aims
A three-level prospective study examining associations between survivors' psychological distress and individual- and social-level factors in the 6 years following a complex disaster.
Method
We drew on two multi-wave data collections in the 6 years after the earthquake, using residents from different forms of housing. Sample 1 included six waves of private-housing residents from 2011 to 2016 ( n = 1084 per wave), sample 2 five waves of residents living in prefabricated housing from 2012 to 2016 ( n = 1515 per wave). We analysed prospective associations between distress and time (level 1), pre-existing disorders and disaster experiences and behaviours (level 2) and city-wide measures of support and physical activity (level 3).
Results
Multilevel models with random coefficients demonstrated greater distress in earlier waves (samples 1 and 2 respectively, adjusted β = −15 and β = −0.16, P < 0.001), among female respondents ( β = 0.58, P = 0.01 and β = 1.74, P = 0.001), in those with a previous psychiatric history ( β = 2.76, β = 2.06, P < 0.001) with diminished levels of activity post-earthquake ( β = 1.40, β = 1.51, P < 0.001) and those lacking in social support ( β = 1.95, β = 1.51, P < 0.001). Support from spouses and friends was most protective of psychological health. City-level support was negatively associated with distress, but only among those in prefabricated housing.
Conclusions
Psychological distress diminished with time, but varied across gender, psychiatric history, housing, levels of activity and availability of social support. Practitioners should consider individual- and city-level factors when devising effective interventions.
... In other words, we implied that peritraumatic distress can affect optimism and pessimism. However, there are also studies suggesting that optimism and pessimism may affect the impact of the traumatic event on individuals [49][50][51]. ...
Introduction: People encounter many events across their life span. However, some life experiences cause negative psychological outcomes. One of them is earthquakes. Therefore, in this study, it was aimed to examine the mediating role of peritraumatic distress in the relationship between childhood psychological maltreatment and optimism and pessimism among earthquake survivors.
Methods: Using a snowball sampling technique with a cross-sectional research design, the sample comprised 311 adults who survived earthquake survivors in Turkey. Participants ranged in age between 18 and 61 years (mean age = 27.57±8.03). Of the participants, 231 (74.3%) were females and 80 (25.7%) were males, and they completed the Psychological Maltreatment Questionnaire–Short Form, Peritraumatic Distress Inventory, and Optimism and Pessimism Questionnaire.
Results: The findings showed that childhood psychological maltreatment was positively related to peritraumatic distress and pessimism, and negatively related to optimism. Similarly, peritraumatic distress was positively related to pessimism and negatively related to optimism. More importantly, peritraumatic distress mediated the relationship between childhood psychological maltreatment and optimism and pessimism. These findings highlight the importance of addressing peritraumatic
distress as an important factor in improving individuals' perspectives on life.
Discussion: Implementing tailored interventions to mitigate peritraumatic distress could lead to a more optimistic mindset and reduced levels of pessimism. By providing individuals with effective coping strategies and support systems, such interventions may empower them to overcome the challenges posed by stressful situations and cultivate a more positive outlook on life.
... A considerable proportion of older adults have chronic conditions that, if left untreated or without prescription after a disaster, could deteriorate and become life-threatening (Chang et al., 2022). Additionally, the Downloaded from https://academic.oup.com/innovateage/advance-article/doi/10.1093/geroni/igad020/7067182 by guest on 03 March 2023 A c c e p t e d M a n u s c r i p t numerous disaster-related stressors have been proved to be linked with disorders of metabolic functions, organ aging, parasecretion, as well as the disruption of healthy lifestyle behaviors (Fukuda et al., 1999;Kivimaki et al., 2022;Razzoli et al., 2018). Hence, research on the impact of disasters specific to older adults is of rising importance Sands et al., 2022). ...
Background and Objectives
Fear of falling and falls are common in older adults. However, their associations with natural disaster exposures remain poorly understood. This study aims to examine longitudinal associations between disaster damage with fear of falling/falls among older disaster survivors.
Research Design and Methods
In this natural experiment study, the baseline survey (4,957 valid responses) took place 7 months before the 2011 Great East Japan Earthquake and Tsunami, and three follow-ups were conducted in 2013, 2016, 2020. Exposures were different types of disaster damage and community social capital. Outcomes were fear of falling and falls (including incident and recurrent falls). We used lagged outcomes in logistic models adjusting for covariates and further examined instrumental activities of daily living (IADL) as a mediator.
Results
The baseline sample had a mean (SD) age of 74.8 (7.1) years; 56.4% were female. Financial hardship was associated with fear of falling (OR, 1.75; 95% CI [1.33,2.28]) and falls (OR, 1.29; 95% CI [1.05,1.58]), especially recurrent falls (OR, 3.53; 95% CI [1.90,6.57]). Relocation was inversely linked with fear of falling (OR, 0.57; 95% CI [0.34,0.94]). Social cohesion was protectively associated with fear of falling (OR, 0.82; 95% CI [0.71,0.95]) and falls (OR, 0.88; 95% CI [0.78,0.98]) while social participation increased the risk of these issues. IADL partially mediated observed associations between disaster damage and fear of falling/falls.
Discussion and Implications
Experiences of material damage rather than psychological trauma were associated with falls and fear of falling, and the increased risk of recurrent falls revealed a process of cumulative disadvantage. Findings could inform targeted strategies for protecting older disaster survivors.
... Many surveys have reported that PTSD is often observed after earthquake disasters 19,20) . After the 1995 Hanshin -Awaji Great Earthquake in Japan, many survivors exhibited PTSD symptoms 21,22) . In a survey conducted sixteen months after the earthquake, the prevalence of PTSD among office workers in the disaster area was 3.1%, while 10.1% of the workers were not diagnosed with PTSD but had some PTSD symptoms 23) . ...
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.
... Also, sociodemographic, gender-specific, and lifestyle factor variation can confound the outcome with heterogeneity [284]. Having spoken about lifestyle, researchers should be aware that patients with traumatic stress-related disorders may be more likely to engage in unhealthy diet and behaviors, such as smoking, alcohol consumption, and sedentary lifestyle [285,286], all of them closely linked to pro-inflammatory states and higher OXS [45, [287][288][289][290]. ...
Traumatic stress may chronically affect master homeostatic systems at the crossroads of peripheral and central susceptibility pathways and lead to the biological embedment of trauma-related allostatic trajectories through neurobiological alterations even decades later. Lately, there has been an exponential knowledge growth concerning the effect of traumatic stress on oxidative components and redox-state homeostasis. This extensive review encompasses a detailed description of the oxidative cascade components along with their physiological and pathophysiological functions and a systematic presentation of both preclinical and clinical, genetic and epigenetic human findings on trauma-related oxidative stress (OXS), followed by a substantial synthesis of the involved oxidative cascades into specific and functional, trauma-related pathways. The bulk of the evidence suggests an imbalance of pro-/anti-oxidative mechanisms under conditions of traumatic stress, respectively leading to a systemic oxidative dysregulation accompanied by toxic oxidation byproducts. Yet, there is substantial heterogeneity in findings probably relative to confounding, trauma-related parameters, as well as to the equivocal directionality of not only the involved oxi-dative mechanisms but other homeostatic ones. Accordingly, we also discuss the trauma-related OXS findings within the broader spectrum of systemic interactions with other major influencing systems, such as inflammation, the hypothalamic-pituitary-adrenal axis, and the circadian system. We intend to demonstrate the inherent complexity of all the systems involved, but also put forth associated caveats in the implementation and interpretation of OXS findings in trauma-related research and promote their comprehension within a broader context.
... In the current study, significantly higher QoL scores were also noted in the group without probable PTSD or MDE. Fukuda et al. also reported an association between more severe negative changes in lifestyle and high PTSD scores in victims after an earthquake [43]. Compared to the QoL results for all participants, the results for those with probable psychiatric disorders showed no significant association with most factors. ...
To investigate factors associated with quality of life (QoL) and disaster-related psychiatric disorders, including posttraumatic stress disorder (PTSD) and major depressive episode (MDE), in the survivors of a gas explosion in Taiwan 5 years after the event. A community-based cross-sectional study of residents from an area that experienced a gas explosion was conducted 5 years after the event. The Short Form 12v2 (SF-12v2) was used to screen 2511 participants. The Disaster-Related Psychological Screening Test (DRPST) was used to assess probable MDE and PTSD. A total of 2511 participants, including 604 males and 1907 females, completed the QoL survey. The average age was 56.02 ± 16.78 years, and most participants were in the ≧65 age group (39.7%). The males had better QoL in the physical dimensions. Lifestyle was significantly positively associated with QoL. A total of 894 participants completed the DRPST, which showed some individuals with probable MDE (n = 93, 10.4%), probable PTSD (n = 22, 2.5%), or probable MDE and PTSD (n = 49, 5.5%); most people had no MDE or PTSD (n = 730, 81.7%). Those in the probable PTSD or MDE groups were significantly more likely to be female or to be experiencing stressors (p < 0.001). The participants continued to be affected by the disaster based on their QoL, even 5 years later. Females had a higher risk of probable psychiatric disorders and poorer QoL in the physical dimensions. Long-term follow-up, interventions and investigations after a disaster are needed.
... Recent surveys have indicated changes in physical activity levels, sleep quality, and exercise frequency compared with pre-COVID-19 levels [4,5]. Lifestyle changes caused by environmental factors can negatively affect mental health [6,7]. Although many stressful and drastic changes occur, an individual's sense of coherence (SOC) can be a critical factor for maintaining mental and physical health. ...
Sense of coherence (SOC) is a psychological factor that contributes to mental health maintenance under stressful environment. Likewise, level of SOC might affect mental health among healthcare workers during the COVID-19 pandemic differently. In this study, we investigated the relationships between lifestyle changes and mental health (General Health Questionnaire-12: GHQ-12) among different level of SOC (weak, moderate, or strong by SOC-13). The data of 898 healthcare workers from cross-sectional survey dataset were extracted and analyzed. As results, based on GHQ-12 score, 86.1% of 244 participants with weak SOC, 60.1% of 606 participants with moderate SOC, and 31.3% of 48 participants with strong SOC had poor mental health. Both SOC levels and lifestyle changes (except alcohol consumption) had significant main effects on the GHQ-12 score. Analysis on the association between lifestyle changes and mental health status stratified by SOC level reveled that among participants with weak SOC, those who increased their leisure and activity time had reduced odds of poor mental health than those who made no changes (OR: 0.08, CI: 0.01 to 0.64). Healthcare workers with weak SOC were at risk of poor mental health during the COVID-19 pandemic, and lifestyle changes may improve their mental health.
... Regularized routines have been found to buffer the adverse impact of stress exposure on mental health . Survivors of natural disasters tend to maintain regular daily activities in response to post-disaster stress (Fukuda et al., 1999;Parks et al., 2018), with the restoration or preservation of pre-disaster daily routines predictive of lower psychological distress prospectively in the years following the Great East Japan Earthquake (Goodwin et al., 2019). Meta-analysis of conflict-affected forced migrants found that a disruption in different types of daily experiences mediated the positive association between premigration trauma exposure and postmigration psychiatric symptoms, with premigration trauma related to more disrupted daily living and greater mental health problems in postmigration settings (Hou et al., 2020c). ...
Background
This study examined the associations between components of psychological resilience with mental health at different levels of exposure to COVID-19 stressors.
Methods
A population-representative sample of 4,021 respondents were recruited and assessed between February 25th and March 19th, 2020. Respondents reported current anxiety symptoms (7-item Generalized Anxiety Disorder scale [GAD-7]), cognitive components (perceived ability to adapt to change, tendency to bounce back after adversities) and behavioral components (regularity of primary and secondary daily routines) of resilience, worry about COVID-19 infection, and sociodemographics.
Results
Logistic regression revealed that cognitive and behavioral components of resilience were not correlated with probable anxiety (GAD-7≥10) among those reporting no worry. Among respondents who were worried, all resilient components were inversely associated with probable anxiety. Specifically, propensity to bounce back and regular primary routines were more strongly related to lower odds of probable anxiety among those reporting lower levels of worry.
Limitations
The cross-sectional design limits causal inference. Second, other resilient components and some key daily routines that could be related to better mental health were not assessed. Third, generalizability of the findings to other similar major cities is uncertain because cases and deaths due to COVID-19 in Hong Kong have been comparatively lower.
Conclusions
To foster mental health, cultivation of confidence in one's ability to adapt to change and a propensity to bounce back from hardship should be coupled with sustainment of regular daily routines. Such assessment and intervention protocols are more relevant to those who suffer heightened levels of exposure to COVID-19 stressors.
... Disaster victims suffer a unique and tremendous burden on their mental and physical health (7-10). It is well-known that natural disasters place individuals at substantial risk of post-traumatic stress disorder (11)(12)(13), and pet owners are no exception. Although pet ownership has been considered a potential mental health concern during disasters (1), research on human attitudes toward pets or the effect of pets on their owners' emotional states during disasters remain sparse. ...
Animal-related consequences were not anticipated in disaster preparedness planning in Japan at the time of its massive earthquakes in 2011. Evacuation failure was quite common due to pet ownership in this disaster. Public attention to the welfare of affected animals in this disaster triggered an awareness of the importance of caring for their needs. However, research on human behavior toward pets or effect of pets on human during disasters remains sparse. In this study, post-traumatic stress disorder (PTSD) scores among pet-owners and non-pet owners in Japan's 2011 earthquake disaster were compared, and attitudes toward pets were evaluated. A questionnaire was distributed to attendees, and interviews were performed at an annual animal welfare event. The Japanese-language version of the revised Impact of Event Scale was used to evaluate PTSD from the disaster. PTSD scores were higher in pet-owners compared to non-pet owners immediately after the earthquakes, but were lower in pet-owners compared to non-pet owners 4.4 years following the disaster. Most people opined that pets should evacuate with people, although less than half of non-pet owners agreed with having animals co-located at evacuation centers. In order to enhance safety and security of both humans and animals at evacuation centers, it is important to proactively address animal issues in disaster preparedness planning. Although pets were regarded by some as adverse risk factors for human health and safety during a disaster; this study instead suggests that pets may play an important positive and protective role for disaster victims.
... A recent epidemiological research reported that approximately 80% of individuals with PTSD also had a psychiatric comorbidity (3, 11). The most frequently identified medical problems in the current study were related to the changes in lifestyle and health-promoting activities caused by the earthquake (26). Our study, which includes a sample of earthquake young survivors, confirms that a catastrophic earthquake produced very high levels of mental disorders with significant long-term risk of chronic impairment like the development of a PTSD diagnosis (13.8%). ...
Earthquakes have been found to be associated with increased prevalence of psychiatric disorders: Post-traumatic Stress Disorder (PTSD) with a diagnosis range of 1.5%-74%, depression, anxiety and sleep disorders and substance abuse. Risk factors are varied: exposure to the earthquake, closeness to the epicenter, disruption of social network, financial loss, female sex, low educational level, etc. PTSD diagnosis is difficult because people unconsciously neglect traumatic history and ignore consequences. Between April 6 th 2009 and September 2009, 323 young survivors aged between 18 and 30 years were screened for PTSD symptoms at the S.M.I.L.E., a psychiatric service for young people at the L'Aquila Camp Hospital. The screening assessment consisted of: a socio-demographic schedule with questions about earthquake experience, the General Health Questionnaire-12 items (GHQ-12), Impact Event Scale-Revised (IES-R) and Semi-structured Clinical Interview Diagnosis II (SCID-II). Regarding psychiatric morbidity, 44.2% and 37.4% had respectively moderate and high stress levels. Female gender and unemployment were significantly correlated (p
... üm tehdidi, ciddi yaralanma veya olgunun kendisi veya çevresindekilerin fiziksel bütünlü¤üne tehdit sonucu duyulan yo¤un korku ve çâresizlik durumudur. PTSB yeniden yaflama, kaç›nma ve artm›fl uyar›lm›fll›k olarak ifâde edilen üç belirti grubu ile karakterizedir. Depremin de aralar›nda bulundu¤u do¤al felâketlerin PTSB'ye yol açt›¤› bilinmektedir (Fukuda ve ark. 1999, Hsu ve ark. 2002, Wang ve ark. 2000, Livanou M ve ark. 2002). Yap›lan çal›flmalarda deprem yaflayan olgular›n %24-43'ünde PTSB geliflti¤i ortaya konmufltur (Hsu ve ark. 2002, Wang ve ark. 2000, Livanou M ve ark. 2002). " Olaylar›n Etkisi Ölçe¤i " (IES-R), herhangi bir travma yaflayan olgular›n ölçek uyguland›¤› s›radaki stresini belirl ...
Objective: This study was designed to determine the validity and reliability of Turkish version of "Impact of Event Scale-Revised" (IES-R). Method: A total of 104 subjects with diagnosis of posttraumatic stress disorder (PTSD) and 65 subjects without PTSD were enrolled to the study. After the record of sociodemographic characteristics, all subject were assessed with both IES-R and "Clinician Administered Post Traumatic Stress Disorder Scale" (CAPS), of which reliability and validity of Turkish version have been shown. The validity of IES-R refering to CAPS and internal-consistency were determined using relevant statistical methods. Findings: Total IES-R score (r=0.705, p<0.001) and intrusion (r=0.693, p<0.001), hyperarousal (r=0.639, p<0.001), avoidance (r=0.491, p<0.001) IES-R subscale scores were found to correlated with the corresponding scores of CAPS with Spearman analysis. The area under the ROC curve was defined as 0.878±0.031 (p<0.001). For cut-off points of IES-R between 24 and 33, both sensitivity and specificity were over 70%. Cronbach a was 0.937 (p<0.0001). Discussion and Conclusion: This study demonstrated that Turkish version of IES-R is valid and has good diagnostical performance for cut-off points of IES-R between 24 and 33 and high internal-consistency.
... People in the disaster area are gradually recovering; however, some still suffer from earthquake-related stress. Previous studies have suggested that victims suffer various psychological problems that were caused by the experience of being involved in the earthquake [1][2][3][4][5][6]. The mental health of victims continues to be of concern, because problems can emerge long after a disaster occurs [7][8][9][10]. ...
... Effects of natural disasters on certain aspects of mental health in survivors have been identified in most studies reviewed by Norris and Elrod [2]. In Japan, the influence of disaster on survivors' mental health has been examined in relation to previous earthquakes [3][4][5][6][7][8][9]. The impact of the Great East Japan Earthquake (also known as the 3/11 earthquake) on mental health has been examined in various groups: people evacuated in shelters [10], young people [11][12][13], and others [14]. ...
This study examined the prevalence of mental health problems and related factors among dialysis patients living in prefectures that were heavily damaged by the Great East Japan Earthquake. Research was conducted two years following the disaster, and data of 1500 residents of the prefectures were analyzed. This study examined disaster related stressors, gender, socioeconomic status, health problems prior the earthquake, and social support, all of which have been identified as aggravating/mitigating factors in previous research on disaster survivors. We also examined advanced awareness of emergency planning as a dialysis specific factor. Mental health problems after the disaster were categorized into three types: PTSD and depression comorbidity, PTSD only, and depression only. Results indicated that people with comorbidity, PTSD, and depression comprised 7.5%, 25.0%, and 2.9% of the sample, respectively. Not only disaster related stressors but also health problems prior to the disaster had an aggravating direct effect on comorbidity and PTSD. In addition, social support and advanced awareness of disaster planning had a mitigating effect on comorbidity. These results suggest that advanced awareness of disaster planning is a dialysis specific factor that could decrease the occurrence of comorbidity among dialysis patients following a disaster.
... Similarly, Norris et al. (2002) found that Hurricane Andrew delivered an atypically severe psychological impact on the affected population, especially with the associated disruption of the social support and financial systems (see also Bourque et al., 2006;Ironson et al., 1997;Norris et al., 1999). To reiterate the point, psychological stress factors are more likely to be felt by a health-challenged and/or socially vulnerable cohort (Beaudoin, 2007;Fukuda et al., 1999). One such group is women, who after a disaster are more likely to experience disproportionate feelings of isolation and loss of protective social networks, insecurity in terms of personal safety, and a lack of access to female-specific healthcare including reproductive health services (Morrow and Enarson, 1996), as was found after Hurricane Andrew (David et al., 1996;Perilla et al., 2002). ...
Disasters and displacement increasingly affect and challenge urban settings. How do pregnant women fare in the aftermath of a major disaster? This paper investigates the effect of pregnancies in disaster situations. The study tests a hypothesis that pregnant women residing in hurricane-prone areas suffer higher health risks. The setting is Louisiana in the Gulf Coast, United States, a state that continually experiences hurricane impacts. The time period for the analysis is three years following the landfall of Hurricane Andrew in 1992. We analysed low birth weight and preterm deliveries before and after landfall, as a whole and by race. Findings support an association between hazards and health of a community and indicate that pregnant women in the affected area, irrespective of race, are more likely to experience preterm deliveries compared to pre-event births. Results suggest there is a negative health legacy impact in Louisiana as a result of hurricane landfall.
© 2015 The Author(s). Disasters © Overseas Development Institute, 2015.
... Control variables include socio-demographic variables, such as sex and education, social support and the impact of the earthquake, such as injury or death of relative(s) or friend(s), and life threat from the earthquake. Previous research indicated that the psychological problems of disaster survivors are associated with exposure to event and life changes (Armenian et al., 2002;Fukuda et al, 1999;Sumer et al., 2005), social support (Ke et al., 2010;Lowe et al., 2010) and education and gender differences (Basoglu et al., 2002;Basoglu et al., 2004;Ben-Zur and Zeidner, 1996). ...
This study examines the effects of economic loss on the life satisfaction and mental health of Wenchuan earthquake survivors. Economic loss is measured by earthquake impacts on the income and houses of the survivors. The correlation analysis shows that earthquake impact on income is significantly correlated with life satisfaction and depression. The regression analyses indicate that earthquake impact on income is indirectly associated with life satisfaction and depression through its effect on financial strain. The research highlights the importance of coping strategies in maintaining a balance between economic status and living demands for disaster survivors.
© 2015 The Author(s). Disasters © Overseas Development Institute, 2015.
... The psychological reaction would change with gender and age [14] . If there are great varieties in population life style of fore-and post-earthquake, the mental problem, which could be judged through the PTSD (Post-traumatic stress disorder) scores, is easy to occur [15] . ...
The psychological intervention and reconstruction after disaster are very important as well as infrastructure reconstruction in loss reduction. In this paper, a new psychological intervention and reconstruction model is developed depending on the different disasters, areas and population characteristics, according to which the pre-plan system of psychological rescue is established. People who suffered from the disaster could stabilize and recover from their psychological trauma as soon as possible with the help of the system, and the number of fatal accidents causing by mental fluctuation of people would decrease. Communication style, mental and behavior games for psychological intervention and reconstruction are also improved based on the feedback chart obtained through psychological questionnaires after disasters. The efficiency of psychological recovery would be improved and the psychological rebounding would be controlled in the later stage of post-disaster.
... Şimdilik önceden zamanı belirlenemez ve önlenmesi mümkün olmayan, etkilediği bölgede yaşayan tüm insanları olumsuz etkileyen deprem de en önemli doğal olaylardan (yada afetlerden) biridir ( 13). Kalaba lık yerle şim alanları, yüksek binalar nedeniyle dar alanda yoğun nüfusun yaşaması deprem esnas ında ve sonrasında bir anda fazla say ıda ölüm, sakatlanma, yıkımlar ve yangınlar sonucu ciddi ekonomik kay ıplar; ço ğu kez bunların kolayca telafi edilememesi 've olumsuz etkilerinin genellikle yıllarca devam etmesine yol açmaktad ır. ...
ZET Son y ı llarda psikiyatrik bozukluklar ve sosyo-demografik özelliklerini belirlemek için yap ı lan çalışmalar hızla a • tmakta ve psikiyatrik yard ıma ihtiyacı olanlarla psikopatoloji geli şme riski olan gruplar tanınmaya çalışı lmak-tadı,: Bu çalışmada yeni kurulmu ş olan fakültemiz hastanesi psikiyatri poliklini ğine başvuran hastaların sosyo-demog • afik özellikleri, tan ılar e bölgemizde (Gölcük ve Düzce 1999) ya şanan iki büyük depremin hasta grubu-muza yans ımasını belirlemek istedik. Bu amaçla deprem öncesi ve sonras ı toplam 30 aylık dönemde psikiyatri polikliniğine başvuran hastaların kart kay ıtlarını retrospektif olarak inceledik. Polikliniğimize daha çok kad ın, evli, çocuklu, ev han ım ı ve 19-45 ya ş grubu müracaat etmektedir. Depremden sonra özellikle baz ı anksiyete, bozukluklar ı (PTSB, akut stres bkz.
... Mental health care is one of the most important issues in disaster-stricken areas 3,7,[17][18][19][20] . In addition to emotional responses, such as grief, loss, fear and anger, some survivors experienced survivor's guilt over surviving the death of a loved one or guilt about being better off than others 21,22 . ...
Preface
The Great East Japan Earthquake and subsequent tsunami destroyed large parts of Japan's Tohoku district. Special efforts were made regarding the prompt distribution of medical supplies, including insulin, for diabetic patients. However, many diabetic patients in the shelters lost their blood glucose control as a result of the unfavorable living environment. The high‐calorie food provided led to severe postprandial hyperglycemia. Furthermore, mental stress can aggravate diabetic control and these patients require special mental care. We have a few suggestions to propose in preparation for future disasters based on the experience gained from our shelter visits during this disaster. First, people in the affected areas had no way of accessing such information in the early days after the disaster. Therefore, we should consider the practical means of distributing important information in various situations. Second, guidelines and manuals for both diabetic patients and healthcare providers need to be created for the various situations that occur in the event of a natural disaster. We already have a few, but situations vary and several guidelines are required to cover different conditions. Manuals for the prescription of antidiabetic agents will be useful, especially for doctors who are not specialized in diabetes. Third, patients should be educated beforehand as to what to do and what to be prepared for in the case of a disaster; each of the various situations that might be encountered should be covered. Lectures about these issues might be included in educational classes for diabetic patients organized by each medical institution.
... However, recognition by Japanese media and health professionals of PTSD and other post-disaster mental health difficulties has increased since a large scale 1995 earthquake in Kobe, Japan (McCurry, 2004). Since the Kobe earthquake, many peer-reviewed scientific publications have explored PTSD-related constructs in Japanese samples via patient self-disclosure (see Asukai, Saito, Tsuruta, Ogami, & Kishimoto, 2008;Fukuda, Morimoto, Mure, & Maruyama, 1999;Kato, Asukai, Miyake, Minakawa, & Nishiyama, 1996;Kuwabara et al., 2008;Nishi, Matsuoka, Noguchi, Sakuma, Yonemoto, Yanagita, et al., 2009; for a thoughtful review of PTSD-related research specific to Japan, see Goto & Wilson, 2003;Norris, 2011). The Japanese Society for Traumatic Stress Studies (JSTSS) was established in 2002 and currently has over 1,000 members. ...
The current article describes the results of posttraumatic stress educational outreach and screening offered to 141 citizens of Japan who attended a public-service mental health training regarding post-disaster coping 40 days after a 6.8 Richter Scale earthquake, local and regional deaths, and an ongoing nuclear radiation threat. Attendees were given access to anonymous questionnaires that were integrated into the training as a tool to help enhance mental health literacy and bridge communication gaps. Questionnaires were turned in by a third of those in attendance. Among respondents, multiple exposures to potentially-traumatic events were common. More than a quarter of respondents met criteria for probable PTSD. Physical health and loss of sense of community were related to PTSD symptoms. Associations and diagnosis rates represented in these data are not generalizable to the population as a whole or intended for epidemiological purposes; rather, they are evidence of a potentially useful approach to post-disaster clinical screening, education, and engagement. Results are presented in the context of previous findings in Japan and ecologically-supportive post-disaster field research is discussed.
... Interestingly, Pollice et al. have recently demonstrated psychological distress and post traumatic stress disorder in young survivors of the L'Aquila earthquake [3]. This finding, confirms that a natural disaster produces high psychological distress with long-term sequelae [4] [5]. Although mental stress can correlate with long-term worsening health conditions and incidence of cardiovascular disease [6], social disruption, displacement, or dietary and lifestyle changes might all have contributed to the increased risk factor status of L'Aquila earthquake survivors. ...
... Over the past dozen years or so there have been several serious disaster events in Japan, including the Hokkaido Nansei-oki Earthquake of 1993, the Great Hanshin-Awaji earthquake of 1995, shocking cases such as the sarin gas attack on the Tokyo subway system in 1995, and so on. Many researchers have studied survivors' mental health and physical changes after such events123456. According to many previous studies of survivors of disaster areas, prevalence of posttraumatic stress disorder (PTSD) ranging from approximately 5 percent to 60 percent is seen in the first 1–2 years after a disaster [7,8]. ...
On March 11, 2011, the Pacific side of Japan's northeast was devastated by an earthquake and tsunami. For years, many researchers have been working on ways of examining the psychological effects of earthquakes on survivors in disaster areas who have experienced aftershocks, catastrophic fires, and other damage caused by the earthquake. The goal of this study is to examine scores on psychological measures and salivary cortisol level in these individuals both before and three months after the earthquake. The participants had been measured for these variables before the earthquake. After the earthquake, we carried out PTSD screening using CAPS for participants for another experiment, and then again conducted the aforementioned tests. We collected saliva samples from all survivors. Our results show that social relationship scores on the WHO-QOL26, negative mood scores of the WHO-SUBI, total GHQ score, POMS confusion scores, and CMI emotional status score after the earthquake showed scores indicating significantly decreased compared to before the earthquake. On the other hand, salivary cortisol levels after the earthquake was significantly increased compared to before the earthquake. Moreover, the result of a multiple regression analysis found that negative mood score on the WHO-SUBI and social relationship score on the WHO-QOL26 were significantly related to salivary cortisol levels. Our results thus demonstrate that several psychological stress induced by the earthquake was associated with an increase in salivary cortisol levels. These results show similar findings to previous study. We anticipate that this study will provide a better understanding of posttraumatic responses in the early stages of adaptation to the trauma and expand effective prevention strategies and countermeasures for PTSD.
... The majority of the survivors stated that these emotional problems still distressed them after sixteen months. Fukuda, Morimoto, Mure, and Maruyama (1999) investigated 108 male inhabitants of Awaji Island as to their individual lifestyle and the psychological stress by the earthquake. They found that worse change in lifestyle might be associated with high PTSD score in victims of the Hanshin-Awaji earthquake. ...
This study investigated whether sex differences and earthquake experiences affect the earthquake victims as to their future expectations, their reactions during the earthquake and their first feelings after the earthquake. Especially, conditional relationships among reaction, expectation and first feeling by sex and earthquake experiences were investigated. Graphical Log-linear models were used in order to determine the interaction structure among the variables taken into consideration in this study. A survey of earthquake victims in Kocaeli and Adapazarı (two cities in North-Western, Turkey) was conducted to discover the destructive effects of the earthquake. For this purpose a questionnaire of 25 questions was given to the 800 people in Kocaeli and Adapazarı where the most destruction and dead people were to be found. As a result of this investigation, it was found that sex and earthquake experience play an important role on future expectations, reaction during earthquake and first feelings after the earthquake.
... With the exception of work on social support, there has been little work to assess how post-trauma conditions may be related to psychopathology [1-5]. In a suggestive study, Fukuda et al [6] examined highly exposed Awaji Island survivors of the Hanshin-Awaji (Japan) earthquake at 20 months following the disaster. Those with more difficult life circumstances following the disaster, who were also more likely to be still living in temporary housing, had higher mean scores on a DSM-IV-based post-traumatic stress disorder measure. ...
The goal of this study was to collect information to inform the design of a mental health response following the massive December 2004 earthquake and tsunami in Aceh and North Sumatra, Indonesia. As well as exploring the effect on mental health of direct exposure to the tsunami the study was designed to examine the effect on mental health of immediate post-disaster changes in life circumstances (impact).
Information was collected from a sample of 783 people aged 15 years and over in earthquake and tsunami-affected areas of Aceh and Nias, 616 Internally Displaced Persons (IDPs) and 167 non-IDPs. The structured questionnaire that was designed for data collection consisted of demographic information, measures of disaster exposure and of changes in life circumstances (impact), the extended version of the Self-Reporting Questionnaire (SRQ), and a brief measure of resilience. Group comparisons, contrasting responses of IDPs and non-IDPs, were by chi-square for frequency data and t-tests for ordinal or continuous data. Hierarchical multiple linear regression analyses were performed to examine the relative contributions to psychopathology of demographic variables and measures of exposure, impact and resilience.
High rates of psychopathology, including symptoms of anxiety and affective disorders and post-traumatic stress syndrome, were recorded in the overall sample, particularly in Internally Displaced Persons (IDPs) who experienced more substantial post-disaster changes in life circumstances (impact). The IDP group experienced significantly more SRQ symptoms than did the non-IDP group. Demographic factors alone accounted for less two percent of variance in SRQ-scores. Higher SRQ-20 scores were observed among women, those with lower education, those with diminished resilience beliefs, those experiencing high scores on disaster impact, those experiencing direct exposures to the disaster, and due to (unmeasured) conditions related to being an IDP. The greatest effect among these was due to disaster impacts. The pattern was similar when considering post-traumatic stress symptoms separately.
Negative changes in a person's life circumstances following a disaster appear to have as important an effect on psychopathology as the direct experience of the disaster. Ameliorating the extent and duration of post-disaster negative changes in life circumstances may play an important role in prevention of post-disaster psychological morbidity.
... Women who are stressed or depressed are more likely to relapse to smoking. (32)(33)(34). Breastfeeding is often deemphasized in the aftermath of a disaster, because donors may provide formula in an effort to help. Mothers and medical personnel may not realize that most traumatized women still produce good-quality milk (35), although cases of stress-induced cessation of lactation were reported after the 1985 Mexico City earthquake (36). ...
We review the literature on the effects of Hurricane Katrina on perinatal health, and providing data from our own research on pregnant and postpartum women. After Katrina, obstetric, prenatal, and neonatal care was compromised in the short term, but increases in adverse birth outcomes such as preterm birth, low birthweight, and maternal complications were mostly limited to highly exposed women. Both pregnant and postpartum women had rates of post-traumatic stress disorder similar to, or lower than, others exposed to Katrina, and rates of depression similar to other pregnant and postpartum populations. Health behaviors, such as smoking and breastfeeding, may have been somewhat negatively affected by the disaster, whereas effects on nutrition were likely associated with limited time, money, and food choices, and indicated by both weight gain and loss. We conclude that, with a few specific exceptions, postdisaster concerns and health outcomes for pregnant and postpartum women were similar to those of other people exposed to Hurricane Katrina. In such situations, disaster planners and researchers should focus on providing care and support for the normal concerns of the peripartum period, such as breastfeeding, depression, and smoking cessation. Contraception needs to be available for those who do not want to become pregnant. Although additional physical and mental health care needs to be provided for the most severely exposed women and their babies, many women are capable of surviving and thriving in postdisaster environments.
The lifestyles greatly changed as the social structure, the economic status and the features of diseases afflicting people have changed following rapid development of information technology, an aging society and the internationalization. Under these circumstances, there is an important need for individuals to make active efforts to find scientific methods for the primary prevention of diseases and search for positive methods to improve their quality of life (QOL) while still healthy. We think it is important that individuals voluntarily and actively commit themselves to modifying their lifestyles to make it more stress-resistant and healthier. The overall lifestyle of individuals, including smoking, drinking and physical exercise, has been found to be associated with physical health, mental health. We examined the health potentials using health-related questionnaires, general health-check-up data, and the measurements of typical biomarkers such as lymphocyte chromosome alterations, natural-killer (NK) cell activity and serum IgE or cortisol levels among workers, elderly people, general populations, and the Hanshin-Awaji earthquake victims. We selected the 8 healthy lifestyles based on our previous studies and the health-related habits reported by Breslow. The 8 healthy lifestyles are 1) not smoking, 2) not drinking too much alcohol, 3) doing physical exercise regularly, 4) sleeping 7 to 8 hr per night, 5) keeping nutritional balance in meals, 6) not working more than 10 hr per day, 7) eating breakfast every day, and 8) keeping mental stress levels moderately. The Health Practice Index (HPI) was calculated by the number of good lifestyles. According to the results of 6-yr follow-up of 2148 workers, the unhealthy workers were found to have had significantly higher risks for the developments of chronic diseases. The NK cell activity was found to be significantly higher in the good-lifestyle workers. The genetic health status was estimated by the frequency of chromosomal alterations (sister chromatid exchange ; SCE, chromosomal structural aberrations, and micronuclei) in the blood lymphocytes. Individuals having good lifestyles showed a significantly lower level of chromosome alterations compared to those with poor lifestyles. The persons having unhealthy lifestyles showed abnormally high IgE levels. Earthquake victims reporting poor lifestyles or high posttraumatic stress disorder (PTSD) scores had lower natural killer (NK) cell activity and higher cortisol than those reporting healthy lifestyles. The data of the workers or the aged indicated the those people having good lifestyles or more human supports had higher quality of life scores in spite of having high job strain or low physical health status compared to those having poor lifestyles or low human supports. The reason why we recommended that people modify their lifestyles to a healthier life is that it is easier to achieve self-realization within our short life span, as one's lifestyle becomes healthier. In this sense, the creation of a healthier life will provide a source of reserve force, adaptive force, defensive force or resistive force against future loads which can destroy one's health.
The objective of this study was to examine the longitudinal health consequences of the Wenchuan earthquake. Based on descriptive analyses of national-level data and multivariate analyses on a six-wave repeated cross-sectional survey, the findings suggested that after 8 years health risks remained high among earthquake-affected survivors; however, a process of recovery existed. To conceptualize these findings, in this study, we proposed a three-stage recovery model in which the postdisaster health status was divided into three stages: acute, stagnant, and adaptive. At each stage, the health risk varied, and over time, associations between health outcomes and protective factors varied. The three-stage recovery model identified the trends of long-term health consequences among adult earthquake survivors and provided guidance for postdisaster reconstruction in China on the basis of protective factors analyses.
Background:
Posttraumatic stress disorder (PTSD) increases risk of future respiratory illness. However, mechanisms that underpin the association between these common and debilitating conditions remain unknown. The aim of this study was to identify modifiable, health-related behaviors they may explain the link between PTSD and respiratory problems.
Methods:
World Trade Center responders (N = 452, 89% male, mean age = 55 years) completed baseline PTSD and sleep questionnaires, followed by 2-weeks of daily diaries, actigraphy and ambulatory spirometry to monitor lower respiratory symptoms, pulmonary function, activity levels, stressors, and sleep. Lipid levels were obtained from electronic medical records.
Results:
Cross-sectional mediation analyses revealed that the association between PTSD and self-reported respiratory symptoms was explained by poor sleep, low activity, and daily stressors. The association between PTSD symptoms and pulmonary function was explained by insomnia and low activity.
Conclusions:
A range of health-related daily behaviors and experiences, especially sleep disturbances and inactivity, may explain excess respiratory illness morbidity in PTSD. The findings were generally consistent across daily self-report and spirometry measures of respiratory problems. Targeting these behaviors might enhance prevention of and intervention in respiratory problems in traumatized populations.
The Great East Japan Earthquake of March 11, 2011 provoked tsunami waves with inland penetration up to 5 km and run-up heights to 40 m. More than 400 km² were flooded, mainly along the northeast coast of Japan's largest island, Honshu. Nearly 20,000 human lives were abruptly taken by this natural disaster. Four coastal nuclear facilities went into automatic shutdown; at one, Fukushima Daiichi, cooling system failures resulted in the meltdown of three reactor cores, accompanied by explosive release of radioisotopes.
Essentials of modern blood banking and transfusion medicine were lost: roads, vehicles, blood collection venues, and facilities for blood testing and processing. Normal channels of communication were interrupted, not only by physical damage but also due to circuit overload as mobile phone users sought information and tried to exchange messages about their own and others' health, welfare, and whereabouts.
The Japanese Red Cross, as a monopoly supplier of allogeneic blood, responded with a nationally coordinated effort that met the transfusion demands of a disaster characterized by immediate mass fatality rather than mass injury. Japan's routine transfusion demands are also met by hospital-based autologous blood programs, which could be pressed into service for emergency allogeneic collections. Herein we report institutional and personal experience in anticipation of future disasters, in which transfusion needs might differ from routine demand.
World-wide, there is an increasing scientific evidence to support the importance of psychosocial interventions on the mental health of disaster victims. The objective of this article is to provide an international perspective on post-disaster mental health and the progress achieved thus far with a special focus to India. The article briefly presents new evidences on the magnitude of mental health following different disasters. It then takes into account an emerging understanding of the biological mechanisms that contributes to mental distress. One such remarkable understanding has been the association between psychosocial factors (life events, life style choices, availability of help in the occurrence, course) and post-traumatic stress disorder. The main section of the article analyses different psychosocial interventions that have been used to meet the mental health needs of the population and their effectiveness. The article concludes with the discussion on the relevance of such interventions in the context of India, its implications at different levels and future recommendations.
Objective: The aim of the study is to determine symptoms of PTSD and anxiety disorders and evaluate related factors after six years from Marmara Earthquake in Sapanca. Method: This descriptive study was conducted in Sapanca at July-August 2005. The data of 62 participants were collected by a questionnaire which included questions about their sociodemografic characteristics and experiences in Marmara eathquake. Also Clinician Administered Post Traumatic Stress Disorder Scale [CAPS] and Beck Anxiety Inventory were questioned. Findings: Only 24.2% of participants had PTSD, 64.5% had minimal-light anxiety and 25.8% had medium-severe anxiety. There was a statistically significant difference between education status and PTSD and anxiety status [p<0.05]. Both PTSD and anxiety scores were high at low educational status. PTSD and medium to severe anxiety were significantly high at the participants who saw earthquake at their dreams and changed their daily habits [p<0.05]. Seeing earthquake at dream was found related factor with PTSD and changing daily habits was found related factor with PTSD and anxiety in the multivariable analysis. Discussion and Conclusion: In this study we found that, the effects of the earthquake on mental health were still continuing after 6 years. This results show that mental problems related with eathquake continues long period after great disasters. For this reason, community community-based interventional mental health studies are important for promoting community mental health.
The study determined differential psychological vulnerability of people with disabilities across different age groups in worst affected areas in tsunami disaster. A total of 275 tsunami affected people with various disabilities aged between 16 and 85 years were included in the final sample. Self Reporting Questionnaire (psychological distress), Impact of Event Scale (post-traumatic stress), and quality of life (QOL) were measured. People in their late adulthood and elderly years reported significantly higher psychological distress when compared with the teens and early adults and the young adults. People across different age groups reported equal posttraumatic stress. Increase in age resulted in more psychological distress and poor physical, social, and environmental QOL. Age and severity of disability were found to be significant predictors of psychological distress. The findings primarily supported the "differential vulnerability hypothesis" in the context of a disaster; therefore, implications are far reaching for the policy makers and planners, administrators/disaster managers, and mental health/psychosocial service providers. Long-term psychosocial and psychiatric interventions are suggested to be provided till the reconstruction and rebuilding phase continues.
In 2001, the mountain town of San Sebastian, El Salvador experienced a series of earthquakes that affected the livelihood of its people.MethodsA convenience sample of 100 households of 594 inhabitants of San Sebastian and the surrounding rural farming areas was completed. One study participant for each household was evaluated for mental health and psychosocial changes after the earthquakes. The participant's questionnaire was used to investigate the relationship between physical health, access to health care, housing, food and water, and the occurrence of negative mental health markers six months after the disasters.ResultsFindings indicate that the majority (67%) of respondents experienced 6 or more mental health complaints. Risk factors associated with multiple negative mental health symptoms included change in household income and loss of job, a new illness or a new injury in the household, reliance on healthcare services since the earthquake, and managing a chronic illness.Conclusion
Findings indicate a need for rapid, acute mental health screening with at-risk groups and the need to educate the entire community regarding what medical and mental health treatments are available to reduce barriers to treatment and increase public awareness.
The current study examined contributions of post-disaster stressful life events in relation to the maintenance of WTC-related posttraumatic stress, depressive symptoms, and overall functioning among rescue, recovery, and clean-up workers who responded to the September 11, 2001 World Trade Center (WTC) terrorist attacks.Methods
Participants were 18,896 WTC responders, including 8,466 police officers and 10,430 non-traditional responders (85.8% male; 86.4% Caucasian; Mage = 39.5, SD = 8.8) participating in the WTC Health Program who completed an initial examination between July, 2002 and April, 2010 and who were reassessed, on average, 2.5 years later.ResultsPath analyses were conducted to evaluate contributions of life events to the maintenance of WTC-related posttraumatic stress, depressive symptoms, and overall functioning. These analyses were stratified by police and non-traditional responder groups and adjusted for age, sex, time from 9/11 to initial visit, WTC exposures (three WTC contextual exposures: co-worker, friend, or a relative died in the disaster; co-worker, friend, or a relative injured in the disaster; and responder was exposed to the dust cloud on 9/11), and interval from initial to first follow-up visit. In both groups, WTC-related posttraumatic stress, depressive symptoms, and overall functioning were stable over the follow-up period. WTC exposures were related to these three outcomes at the initial assessment. WTC-related posttraumatic stress, depressive symptoms, and overall functioning, at the initial assessment each predicted the occurrence of post-disaster stressful life events, as measured by Disaster Supplement of the Diagnostic Interview Schedule. Post-disaster stressful life events, in turn, were associated with subsequent mental health, indicating partial mediation of the stability of observed mental health.Conclusions
The present findings suggest a dynamic interplay between exposure, post-disaster stressful life events, and WTC-related posttraumatic stress, depressive symptoms, and overall functioning among WTC disaster responders.
Many survivors of severe disasters, even those without posttraumatic stress disorder (PTSD), need psychological support. To understand the pathogenesis of PTSD symptoms and prevent the development of PTSD, the critical issue is to distinguish neurological abnormalities as vulnerability factors from acquired signs of PTSD symptoms in the early stage of adaptation to the trauma in the normal population. The neurological underpinnings of PTSD have been well characterized, but the causal relationships with the traumatic event are still unclear. We examined 42 non-PTSD subjects to find brain morphometric changes related to the severity of PTSD symptoms in a longitudinal magnetic resonance imaging study extending through the Great East Japan Earthquake. We found that regional grey matter volume (rGMV) in the right ventral anterior cingulate cortex (ACC) before the earthquake, and decreased rGMV in the left orbitofrontal cortex (OFC) through the earthquake were negatively associated with PTSD symptoms. Our results indicate that subjects with smaller GMV in the ACC before the earthquake, and subjects with decreased GMV in the OFC through the earthquake were likely to have PTSD symptoms. As the ACC is involved in processing of fear and anxiety, our results indicate that these processing are related to vulnerability for PTSD symptoms. In addition, decreased OFC volume was induced by failing to extinct conditioned fear soon after the traumatic event. These findings provide a better understanding of posttraumatic responses in early stage of adaptation to the trauma and may contribute to the development of effective methods to prevent PTSD.
Many survivors of severe disasters need psychological support, even those not suffering post-traumatic stress disorder (PTSD). The critical issue in understanding the psychological response after experiencing severe disasters is to distinguish neurological microstructural underpinnings as vulnerability factors from signs of emotional distress acquired soon after the stressful life event. We collected diffusion-tensor magnetic resonance imaging (DTI) data from a group of healthy adolescents before the Great East Japan Earthquake and re-examined the DTIs and anxiety levels of 30 non-PTSD subjects from this group 3-4 months after the earthquake using voxel-based analyses in a longitudinal DTI study before and after the earthquake. We found that the state anxiety level after the earthquake was negatively associated with fractional anisotropy (FA) in the right anterior cingulum (Cg) before the earthquake (r = -0.61, voxel level p<0.0025, cluster level p<0.05 corrected), and positively associated with increased FA changes from before to after the earthquake in the left anterior Cg (r = 0.70, voxel level p<0.0025, cluster level p<0.05 corrected) and uncinate fasciculus (Uf) (r = 0.65, voxel level p<0.0025, cluster level p<0.05 corrected). The results demonstrated that lower FA in the right anterior Cg was a vulnerability factor and increased FA in the left anterior Cg and Uf was an acquired sign of state anxiety after the earthquake. We postulate that subjects with dysfunctions in processing fear and anxiety before the disaster were likely to have higher anxiety levels requiring frequent emotional regulation after the disaster. These findings provide new evidence of psychophysiological responses at the neural network level soon after a stressful life event and might contribute to the development of effective methods to prevent PTSD.
In Taiwan, there are sufficient supplies and well-trained medical professional manpower to be mobilized during disasters. Also known and famous in the world are Taiwan's well established and fully equipped medical delivery system and the public health system. These are high level, enthusiastic, experienced medical staff. However, vulnerable areas subjected to disasters in Taiwan are often located at the remote mountain sites, and most victims are aboriginals. These people are viewed as marginalized with inferiority within the power hierarchy. This study surveyed the conflicts of public health administration during Typhoon Morakot disaster in 2009. Since disasters destroyed local endogenous social relationships, the rescue actions of mobilization and postdisaster reconstruction were under the exogenous efforts with “mercy” hegemony. Ethical issues came from the power struggle and practice, and all showed explicit control and suppression characters.
In the 17 August 1999 Kocaeli Earthquake about 20,000 people died and 3,000,000 were affected either directly or indirectly. A survey of earthquake victims in Kocaeli and Adapazari (two cities in North-Western Turkey) was conducted 8 months after this major earthquake to find out its physically and psychologically destructive effects. For this purpose a questionnaire containing 25 questions was given to 800 people in Kocaeli and Adapazari where the most destruction and greatest number of deaths occurred. Results indicate that changes in expectations from life after an earthquake are highly correlated with gender, marital status, and education level
The Hanshin-Awaji Earthquake of 1995 and has moved through the various phases into the recovery stage. After the earthquake we conducted two surveys involving approximately 8000 families with pre-school aged children and 466 families with disabled children. Symptoms related to PTSD were found more frequently in the small children whose houses had been severely damaged one year after the earthquake. Although the symptoms decreased, they were still present more frequently in the children and their mothers with severely damaged homes in 1998. Our results show children with intellectual or emotional disabilities displayed many behavioral problems. The physically disabled children required medical resources and specialized support in a structured environment. Both groups voiced the need to set up specialized facilities for people with disabilities. Following the Central Java Earthquake in 2006, we have engaged in "children house" activities in the disaster stricken area in collaboration with Gadjah Mada University. Through this activity, we have been able to share what works in helping children with disabilities and their families. From our experience we have found exchanging of information among the people in the disaster stricken areas helps to reduce the psychological damage of the children and aids in their recovery process.
Background:
The Great East Japan Earthquake of March 11, 2011, and subsequent tsunami took nearly 20 000 lives in Tohoku, the northeastern part of Japan's main island. Most victims were either carried away by the tsunami or drowned. The ability to collect blood was disrupted on the Pacific coast of Tohoku. Inland areas were less affected, but allogeneic blood collected in Tohoku is tested at the Miyagi Red Cross Blood Center (Miyagi Center) in the coastal city of Sendai. Miyagi Center was damaged and could not test for 2 months.
Objectives:
The aims of this study are as follows: (1) to assess transfusion practice at 8 disaster response hospitals in Tohoku's Fukushima Prefecture, for equal intervals before and after March 11, 2011; (2) to report activities related to blood collection and distribution in response to the disaster; and (3) to describe the Great East Japan Earthquake in the context of other disasters.
Methods:
Data were collected through a survey of transfusion services at 8 major disaster response hospitals, communication at transfusion conferences, and literature review.
Results:
Transfused patients and units transfused were about 70% and 60% of normal in the surveyed hospitals because this was a disaster of mass casualty rather than mass injury, and patients requiring chronic care were evacuated out. A nationally coordinated effort allowed excess blood collected outside Tohoku to be transported in, despite infrastructure damage.
Conclusion:
Japan's national system of blood collection and distribution responded effectively to local needs after the Great East Japan Earthquake. Disasters such as Japan's 3.11 should guide discourse about emergency preparedness and centralization of services.
In 2002, my colleagues and I published an empirical review of the disaster literature that presented results for 160 samples that were coded as to sample type, disaster type, disaster location, outcomes observed, and overall severity of impairment. Here, I present an update of this review, now based on 225 samples and 132 events. Outcomes included PTSD, depression, anxiety, nonspecific distress, and health problems. Regression analyses showed that samples were most likely to be affected severely if they were from developing countries or experienced mass violence (e.g., terrorism, shooting sprees). Most samples of rescue and recovery workers showed remarkable resilience. (Review posted to www.redmh.org March 2005.) On average, a disaster occurs somewhere in the world each day. It may be a flood, hurricane, or earthquake, a nuclear, industrial, or transportation accident, a shooting spree or peacetime terrorist attack. What these various events share in common is their potential to affect many persons simultaneously and to engender an array of stressors, including threat to one's own life and physical integrity, exposure to the dead and dying, bereavement, profound loss, social and community disruption, and ongoing hardship. As a result of both the high prevalence and high stressfulness of disasters, the question of whether they impact mental health has been of interest for decades, and a substantial literature has developed that identifies these effects.
Objective: This study was designed to determine the validity and reliability of Turkish version of PTSD Checklist-Civilian Version (PCL-C) Method: A total of 104 subjects with the diagnosis of posttraumatic stress disorder (PTSD) and 65 subjects without PTSD were enrolled in the study in order to show the reliability of the questionnaire in determining the PTSD and that it could distinguish patients with PTSD from those without. After recording sociodemographic characteristics, all subjects were assessed with both PCL-C and Clinician Administered Post Traumatic Stress Disorder Scale (CAPS). The validity of PCL-C with respect to CAPS and internalconsistency were determined using relevant statistical methods. Findings: Total PCL-C score (r=0.655, p<0.001) and intrusion (r=0.618, p<0.001), hyperarousal (r=0.563, p<0.001), avoidance (r=0.458, p<0.001) PCL-C subscale scores were found to be correlated with the corresponding scores of CAPS with Spearman analysis.The area under the ROC curve was defined as 0.829 ± 0.037 (p<0.001). For cut-off points of PCL-C between 22 and 24, both sensitivity and specificity were over 70%. Cronbach ( of PCL-C was 0. 922 (p<0.0001). Discussion: The results in this study suggested that the Turkish version of PCL-C is useful for the diagnosis and assessment of severity of PTSD, is valid, and has good diagnostical performance for cut-off points of PCL-C between 22 and 24, and high internal- consistency. PCL-C is also found useful to differentiate earthquake induced PTSD from other psychiatric diagnosis and normal subjects. Conclusion: PCL-C can be used in Turkish subjects in assessing PTSD in the context of routine application or international research
Objective: This study was designed to determine the validity and reliability of Turkish version of Peritraumatic Dissociative Experiences Questionnaire (PDEQ). Method: A total of 104 subjects with the diagnosis of posttraumatic stress disorder (PTSD) and 65 subjects without PTSD were enrolled in the study in order to show the reliability of the questionnaire in determining the PTSD and that it could distinguish patients with PTSD from those without. After recording sociodemographic characteristics, all subjects were assessed with PDEQ and patients with diagnosis of PTSD were assessed with Dissociation Questionnaire (DIS-Q). The validity of PDEQ with respect to DIS-Q and inter-reliability-consistency were determined using relevant statistical methods. Findings: Mean total PDEQ score in the PTSD group was 24.26±9.91, which was significantly higher than that (18.02±9.30) of the subjects in the control group (p<0.001). Mean total DIS-Q scores in the PTSD group only were 130.83±42.69 in those with earthquake trauma and 165.84±47.80 in those without, respectively, and was statistically significantly different (p<0.001). Total PDEQ score was found to be correlated moderately with the total scores of DIS-Q with Spearman analysis (r=0.569, p<0.001). Cronbach α of PDEQ was 0.853 (p<0.0001). Discussion: The results in this study suggested that the Turkish version of PDEQ is useful for the assessment of peritraumatic dissociation, is valid and has high internal-consistency. PDEQ is also found useful to differentiate earthquake induced PTSD from other psychiatric diagnosis and normal subjects. Conclusion: PDEQ can be used in Turkish subjects in assessing the peritraumatic dissociation in the context of routine application or international research.
The 6.3 Richter earthquake in Bam killed 26,000 and injured 30,000 people, and destroyed 85% of houses according to the literature. Children are affected more than others by disasters. In this study, we assessed the rate of post-traumatic stress disorder and psychological problems in survived Bam students in Kerman four months after the earthquake and their relations with demographic factors, family loss, house destruction, and body injury.
A group of 433 students attended this cross sectional study. Watson post traumatic stress disorder questionnaire and Symptom Checklist-90 were applied for students older than 15 years of age and Yule post-traumatic stress disorder and Rutter (parents' version) questionnaires were used for students younger than 15. Multiple regression analysis was used to assess the effects of variables on psychopathologies.
Post-traumatic stress disorder was detected in 36.3% of the students older than 15 years of age and 51.6% of the students younger than 15. Behavioral problems were present in 31.3% of the children and the mean score of Global Symptom Index was 1.13+/-0.59. Body injury and living with family were correlated with post-traumatic stress disorder and Symptom Checklist-90 items in students older than 15. Female sex was correlated with post-traumatic stress disorder and behavioral problems in students younger than 15.
The prevalence of post-disaster post-traumatic stress disorder was high in children. Younger age, female gender, living apart from family, geographic living conditions, being in the center of stress or not after the earthquake, body injury, and loss of family members form the basis for developing post-disaster psychopathology. Due to incomplete presence of post-traumatic stress disorder criteria or high rate of overlooking post-traumatic stress disorder in children, the disorder may be misdiagnosed or remain undiagnosed in them, which warrants more consideration.
The association of knowledge of health risks, living arrangements, and perceived stress with health-risk behaviors was examined in a sample of college students included in the Health Promotion and Disease Prevention Supplement of the National Health Interview Survey. Regressions of each health-risk behavior (dependent variable) were performed on the predicted correlates. Although knowledge was not associated with participation in physical activity or smoking, the study found that students who knew more about the harmful effects of alcohol drank less, and those with greater knowledge of health risks practiced fewer risky behaviors. Students living independently were more likely to smoke, and those living in residence halls were less like to do so. Drinking, however, was more common among students living in residence halls or independently than among those living at home. Hall residents engaged in more group physical activity than other students did, but their physical activity was unrelated to health-risk behaviors. Stress was associated with smoking but not with other health practices. The findings suggest that smoking may be less influenced by health knowledge and more associated than drinking is with a response to stress. Drinking appears to be a social activity associated with living among peers and is potentially modifiable by increased knowledge about the effects of alcohol on health.
This study examines the role of coping in the onset of post-traumatic stress disorder (PTSD) in a nonpatient population following exposure to a natural disaster. In contrast to other studies, the use of all coping strategies was found to be associated with the presence of PTSD rather than the absence of symptoms. These data suggest that coping (in this sense) represents a psychological process used to contain the distress caused by symptoms as well as to manage environmental adversity.
Chromosome alterations, which are directly visible changes in the DNA, have close associations to cancer development (German 1973; Carins 1981; Klein 1981). Lymphocytes in the circulating blood are human cell samples that can most easily be obtained, carrying information on both exposure doses and genetic effects of the mutagenic and carcinogenic factors. Thus, short-term cultures of phytohemagglutinin (PHA)-stimulated human lymphocyte are widely used to detect chromosome-damaging agents and possible human exposure to mutagens/carcinogens, and to study the immune response of blood.
Recent studies have demonstrated an increasing number of cases of allergy in economically developed societies. Many of these allergic reactions are mediated by IgE antibodies whose levels are under genetic control. However, this large increase of allergy prevalence cannot be explained by genetic mutations; comprehensive lifestyles may also play roles in determining total IgE levels. Total IgE levels were determined from scrum samples taken from 706 hard metal workers who responded lo a questionnaire including 17 items related to physical and mental health practices. Five actors tending to normalize IgE upward and three tending to normalize IgE downward when we keep good lifestyles were extracted using MANOVA analysis. We therefore constructed a Health Practice Index in Allergic reactions (HPIA); eight physical and mental health practices were significantly (P < 0.05) associated with cumulative elevations or suppressions of total IgE levels when sex, age and environmental factors were controlled for. Multivariate analyses demonstrated a dramatic synergism (Relative Risk > 2.0, P < 0.05) of unhealthy lifestyles determining a bipolar high risk for elevated or suppressed IgE levels which in turn may result in allergic diseases or immuno-suppression. Maintenance of healthy lifestyles may prove beneficial for reducing the prevalence of allergic disorders.
The nature of psychiatric morbidity in previously non-ill subjects from the area most affected by Hurricane Andrew was investigated at 6–12 months posthurricane. Preliminary associations of morbidity with personal and event-related risk factors were also determined. Fifty one percent (31/61) met criteria for a new-onset disorder, including posttraumatic stress disorder (PTSD) in 36%, major depression (MD) in 30%, and other anxiety disorders in 20%. Thirty four subjects (56%) had significant symptoms persisting beyond 6 months. Having sustained severe damage was the risk factor most strongly associated with outcome. Our data underscore the range of psychiatric morbidity related to a natural disaster, and suggest a relationship to chronic stressors.
To ascertain the effects of a natural disaster on adolescents, 1482 South Carolina high school students who were exposed to Hurricane Hugo were surveyed 1 year after the disaster. Subjects completed a self-administered questionnaire measuring Hugo exposure, nonviolent and violent life events, social support, self-efficacy, and psychological distress. Results showed that the students reported minimal exposure to the hurricane and psychological distress variables approximated national norms. As exposure increased, adolescents reported increased symptoms of psychological distress; i.e., anger, depression, anxiety, and global mental distress. Females and white students experienced higher levels of distress. In most cases, other stressful life events were at least as strong a predictor of psychological distress as was exposure to the hurricane. Self-efficacy and social support were protective.
A household probability sample of 229 adults was interviewed four to seven months after the Sierra Madre earthquake (June 28, 1991; Los Angeles County). The study predicted psychological distress from these variables: demographics, traumatic event history, low magnitude event history, earthquake related threat perceptions, and earthquake related resource loss. Based on the Conservation of Resources (COR) stress model, it was predicted that resource loss would be central in predicting psychological distress. Three major hypotheses were supported: (1) resource loss was positively associated with psychological distress; (2) resource loss predicted psychological distress when other predictors were statistically controlled; and (3) resource loss was associated with mild to moderate elevations in of psychological distress. The findings support COR stress theory. Theoretical and practical implications are discussed.
To investigate the association of individual lifestyle with immune response against tumors, we assayed peripheral blood lymphocytes of 62 healthy males ranging in age from 30 to 60 years for natural killer (NK) cell activity, which is the first line of defense against tumors, and for frequencies of NK cell subsets.
The NK cell activity was determined by 51Cr release assay, and NK cell subsets were counted using surface antigens (CD16, CD57) which recognize NK cell subgroups with different cytolytic potentials. Subjects were classified into groups reporting good, moderate, and poor lifestyles according to their responses on a questionnaire regarding eight health practices (tobacco smoking, alcohol consumption, hours of sleep, physical exercise, eating breakfast, balanced nutrition, hours of work habits, and mental stress).
Individuals reporting good lifestyle habits were found to have the highest NK cell activity and it was significantly higher than the NK cell activity in those reporting poor lifestyle habits. Those reporting good health practices regarding smoking and physical exercise showed significantly higher NK cell activity at an effector-to-target-cell ratio of 40:1.
The higher NK cell activity among individuals reporting good lifestyle practices may reflect an increase in the cytolytic potential of NK cell activity within the CD16+, CD57- subset.
A population of the fire fighters who had been exposed to a natural disaster were screened using the General Health Questionnaire 4, 11, and 29 months after a natural disaster. On the basis of these data, a high-risk group of subjects who had scored as cases and probable cases and a symptom-free comparison group were interviewed using the Diagnostic Interview Schedule 42 months after the disaster. The prevalence of posttraumatic stress disorder (PTSD), affective disorders, and anxiety disorders was examined. Only 23% of the 70 subjects who had developed a PTSD did not attract a further diagnosis, with major depression being the most common concurrent disorder. Comorbidity appeared to be an important predictor of chronic PTSD, especially with panic disorder and phobic disorders. The subjects who had only a PTSD appeared to have had the highest exposure to the disaster. Adversity experienced both before and after the disaster influenced the onset of both anxiety and affective disorders.
Recent studies have demonstrated an increasing number of cases of allergy in economically developed societies. Many of these allergic reactions are mediated by IgE antibodies whose levels are under genetic control. However, this large increase of allergy prevalence cannot be explained by genetic mutations; comprehensive lifestyles may also play roles in determining total IgE levels. Total IgE levels were determined from serum samples taken from 706 hard metal workers who responded to a questionnaire including 17 items related to physical and mental health practices. Five factors tending to normalize IgE upward and three tending to normalize IgE downward when we keep good lifestyles were extracted using MANOVA analysis. We therefore constructed a Health Practice Index in Allergic reactions (HPIA); eight physical and mental health practices were significantly (P less than 0.05) associated with cumulative elevations or suppressions of total IgE levels when sex, age and environmental factors were controlled for. Multivariate analyses demonstrated a dramatic synergism (Relative Risk greater than 2.0, P less than 0.05) of unhealthy lifestyles determining a bipolar high risk for elevated or suppressed IgE levels which in turn may result in allergic diseases or immuno-suppression. Maintenance of healthy lifestyles may prove beneficial for reducing the prevalence of allergic disorders.
This investigation examined the relationship between six of seven Alameda County health habits and four dietary practices and three indices of mental health in a probability sample of 2,436 adults 20 to 64 years of age, residing in the coterminous United States. The sample consisted of all respondents to Wave 2 of the National Survey of Personal Health Practices and Consequences conducted in 1980. I found a strong relationship between poor health habits and risk of depressed mood and "nervous breakdown." The magnitude and direction of the association varied by sex, age group, the specific habit examined, and the measure of mental health used. For women, infrequent participation in active sports consistently predicted mental health problems, but was not important for men. In young men, I found no association between health habits and mental health. Dietary practices and mental health generally showed a negative association, especially among men, for whom those reporting good practices had a significantly higher risk of nervous breakdown than those reporting poor practices.
This paper explores the relationship of a number of personal health practices and mortality in the years after a survey made in Alameda County, California in 1965. Age-adjusted mortality rates were higher for men, for persons reporting disability, and for those with inadequate incomes.The individual health practices, smoking, weight in relation to desirable standards for height, drinking, hours of sleep, regularity of meals, and physical activity, were related to mortality in the expected direction. When accumulated to form a health practice score from 0 to 7, the number of health practices showed a striking inverse relationship with mortality rates, especially for men. This relationship was independent of income level and physical health status.The age-specific death rates by number of health practices were used to develop a life table. The average life expectancy of men aged 45 who reported six or seven “good” practices was more than 11 years more than that of men reporting fewer than four. For women the relationship between health practices and mortality was less strong, and the difference between the life expectancy at age 45 for those who reported six or seven, and those who reported fewer than four, was 7 years.
This paper continues the analysis previously reported of physical health status in an adult population and its relationship to various independent variables. Data for the study were gathered by questionnaires completed by a probability-based sample of adult residents of Alameda County, California, in 1965.Physical health is measured along a spectrum ranging from severe disability to high energy level with absence of chronic conditions or symptoms. The “ridit” which places each individual along the spectrum can be averaged for comparison of groups, and can be adjusted for differences due to age and sex.This paper examines the relation between common health practices, including hours of sleep, regularity of meals, physical activity, smoking and drinking, and physical health status. Good practices are shown to be associated with positive health, and the relationship of these activities was cumulative; those who followed all of the good practices being in better health, even though older, than those who failed to do so. This association was found to be independent of age, sex, and economic status.
Lymphocytes from passive smokers, and patients with FA, Alz, or FPC were studied for SCEs in cultures treated with MMC, 4NQO, or MNNG. Fanconi anemia lymphocytes were also studied for cell cycle Tab. 3. Mean SCE frequencies in FPC or normal cells. (Table; see text) kinetics, and CAs after completion of 1, 2, or 3 or more divisions in MMC-treated cultures. The results can be summarized as follows: (1) lymphocytes from passive smokers showed a slightly higher induction of SCEs than nonsmokers when exposed to MMC. (2) FA cells had about 1.4 times higher frequencies of SCEs than normal cells in both MMC-treated and untreated cultures while they showed several times higher frequencies of CAs in both cultures. Analyses of cell cycle kinetics by the sister chromatid differential staining method revealed that MMC treatments of FA and normal cells led to a clearly dose-related delay in cell turnover times, the duration of delay being much longer in FA than in normal cells. (3) Alz cells showed about 1.5 times higher induction of SCEs in MMC-treated cultures whereas they had only 10% as much SCEs as controls when exposed to 4NQO. Familial polyposis coli cells showed no significant difference in the induction of SCEs in untreated cultures and cultures treated with MMC, 4NQO, and MNNG.
Certain aspects of daily life-style were predictive of future health status among survivors in a 9-year longitudinal study. In a sample of 3,892 white adults under the age of 70, cigarette smoking, alcohol consumption, physical exercise, hours of sleep per night, and weight in relation to height are significantly associated with overall health outcomes 9 years later, controlling for initial level of health. An index of health practices combining these five elements is associated with future health status within subgroups defined by socioeconomic level. These findings do not appear to be due to selective panel attrition or measurement error in the health indicator.
This paper explores the relationship of seven personal health practices and subsequent mortality in the years between an initial survey of 6,928 adults made in Alameda County, California, in 1965 and a follow-up survey in 1974. The seven health practices are: never smoking cigarettes, regular physical activity, moderate or no use of alcohol, 7–8 hr sleep/day regularly, maintaining proper weight, eating breakfast, and not eating between meals. When accumulated to form a health practice score from 0 to 7, the number of health practices showed a striking inverse relationship with age-adjusted mortality rates, especially for men. Men following seven health practices had a mortality rate only 28% that of men following zero to three health practices. Women following seven health practices had a mortality rate 43% that of women following zero to three health practices. Both the health practices themselves and their relationship to mortality are shown to be reasonably stable over the -year period of follow-up. These results lend support to the hypothesis that good health practices and not the initial health status of the survey respondents are largely responsible for the observed mortality relationships. These and other methodological issues are explored.
To determine current rates of posttraumatic stress disorder (PTSD), depressive disorder, and separation anxiety disorder (SAD) among children 1 1/2 years after the 1988 earthquake in Armenia; to determine current rates of comorbid PTSD and depressive disorder; and to assess the contribution of exposure, gender, loss of family members, and loss of residence.
Two hundred eighteen school-age children from three cities at increasing distances from the epicenter were evaluated using the Child Posttraumatic Stress Disorder Reaction Index, the Depression Self-Rating Scale, and the section on SAD from the Diagnostic Interview for Children and Adolescents.
On the basis of these evaluations, high rates of current PTSD, depressive disorder, and their co-occurrence were found among victims residing in the two heavily impacted cities. SAD was comparatively less frequent, although symptoms of SAD had been pervasive throughout the region. Severity of posttraumatic stress and depressive reactions were highly correlated. Extent of loss of family members was independently correlated with each.
After a catastrophic natural disaster, children are at risk for comorbid PTSD and secondary depression. Based on the findings, an interactive model is proposed of postdisaster psychopathology. Early clinical intervention is recommended to prevent chronic posttraumatic stress reactions and secondary depression.
Lifestyle factors, sometimes associated with physical health and mortality, have also been known to be associated with mental health status. This study seeks to correlate behavioral lifestyles with major components of mental health among Japanese factory workers.
We administered the 28-item version of the General Health Questionnaire (GHQ-28) and a questionnaire concerning eight personal health practices to 2,132 male and 668 female factory workers at a camera-manufacturing company in Japan.
There were strong negative relationships of a higher total number of favorable lifestyles as indicated by the Health Practice Index (HPI) to psychological distress and its components: somatic symptoms, anxiety-insomnia, and social dysfunction. After controlling for the effects of confounding factors that included age, marital status, and somatic condition, multiple logistic regression analysis indicated that five of the eight health factors among male workers--mental stress, nutritional balance, eating breakfast regularly, physical exercise, and working hours--were significantly related to the grade of psychological distress or its three components. Among female workers, five health practices, i.e., mental stress, physical exercise, sleeping hours, working hours, and cigarette smoking, were significantly associated with the grade of psychological distress or its three components.
Good health practices might be individually and as a whole associated with better mental health status in factory workers.
Among Harvard alumni aged 35–74 in 1962 or 1966, incidence rates of physician-diagnosed depression, together with suicide rates, were examined during a 23–27-year follow-up period, by antecedent physical activity habits and other personal characteristics. A total of 387 first attacks of depression developed among 10,201 alumni who survived through 1988; 129 suicides occurred among 21,569 alumni during follow-up through 1988. Depression rates were lower among the physically active and sports players, higher among cigarette smokers, unrelated to alcohol consumption, and higher among alumni reporting such personality traits as insomnia, exhaustion, cyclothymia, and self-consciousness. Suicide rates were largely unrelated to antecedent physical activity and alcohol consumption, higher among smokers, and substantially higher among men reporting the personality traits that predicted increased rates of depression.
Report number LIII in a series on chronic disease in former college students.
This study was undertaken 1 1/2 years after the 1988 earthquake in Armenia to assess the frequency and severity of posttraumatic stress reactions among elderly and younger adult victims and to assess the relation of exposure, age, sex, and death of a family member to these reactions.
One hundred seventy-nine subjects of both sexes were evaluated with the Posttraumatic Stress Disorder (PTSD) Reaction Index. A subgroup of 60 individuals were also assessed for PTSD with the DSM-III-R criteria.
There was a strong association between the presence of severe symptoms on the index and a DSM-III-R diagnosis of PTSD. Elderly and younger adult victims in cities closer to the epicenter (higher exposure) had significantly higher index scores than elderly and adult victims in more distant locations. In comparison with previous studies of natural disasters, much greater rates of chronic severe posttraumatic stress reactions were found among the highly exposed individuals. Although there was no difference in total mean score on the Posttraumatic Stress Disorder Reaction Index, a significant difference in symptom profile was found between the elderly and younger adults; the elderly scored higher on arousal symptoms and lower on intrusive symptoms. There was a positive correlation between loss of family members and severity of posttraumatic stress reaction.
These findings indicate that after a major natural disaster with subsequent multiple adversities, a substantial proportion of the adult population may experience severe and chronic posttraumatic stress reactions. The risk factors identified in this study may prove useful in screening exposed individuals for appropriate treatment.
Short-term cultures of human lymphocytes were used to investigate the in vitro metabolism of benzene and its genotoxicity, and to monitor genetic health effects of lifestyles. Metabolic (S9) activation of benzene and its metabolites, catechol, hydroquinone, and phenol, caused an increase in sister-chromatid exchanges (SCEs) with different optimal concentrations of S9 mix for converting each compound into further reactive forms. The data indicate that catechol and hydroquinone can be optimally metabolized to produce reactive species, presumably benzo(semi)quinones, under conditions of lower metabolic activity than those necessary for phenol and benzene. We have further investigated the correlations between chromosome alterations (SCEs, structural aberrations and micronuclei) in peripheral lymphocytes and individual lifestyles. Healthy lifestyles, or "good health practices" examined were 1) not smoking, 2) not drinking too much alcohol, 3) doing physical exercise regularly, 4) sleeping more than 6 h per night, 5) keeping nutritional balance in meals, 6) not snacking, 7) having breakfast everyday, and 8) not having too much perceived stress. The persons were categorized into 3 groups having good, moderate and poor lifestyles by the number of good health practices they do. Mean frequencies of chromosome alterations in lymphocytes from men with poor lifestyles have been shown to be significantly higher than those in cells from men having good lifestyles.(ABSTRACT TRUNCATED AT 250 WORDS)
The authors' goal was to study psychiatric morbidity after a natural disaster in rural India.
As members of a volunteer medical team assigned to 23 households in three villages in India affected by an earthquake, the authors examined the results of semi-structured interviews used to interview all of the adults (older than 14 years) in these households (N=56). DSM-III-R diagnoses were assigned on the basis of these interviews, and non-parametric tests were applied to comparisons of subjects who were or were not given a psychiatric diagnosis.
Thirty-three (59%) of the subjects received a psychiatric diagnosis; the most common diagnoses were posttraumatic stress disorder (13 subjects [23%]) and major depression (12 subjects [21%]). Psychiatric morbidity was associated with female sex, destruction of house, and destruction of possessions.
Attention to the mental health needs of disaster survivors in third world countries is indicated.
This study evaluated basal salivary cortisol, 3-methoxy-4-hydroxyphenylglycol (MHPG), and cortisol suppression following dexamethasone administration in adolescents exposed to two levels of earthquake-related trauma.
Five years after the 1988 earthquake, saliva samples were obtained from 37 adolescents from two cities in Armenia at different distances from the epicenter. Baseline saliva samples were obtained at 8:00 a.m., 4:00 p.m., and 11:00 p.m., following which 0.5 mg of dexamethasone was administered. Nine and 17 hours later, saliva samples were again obtained. Subjects were evaluated for posttraumatic stress and depressive reactions through use of self-report instruments.
Significantly lower mean baseline 8:00 a.m. cortisol levels and greater day 24:00 p.m. cortisol suppression following dexamethasone were observed in the more symptomatic adolescents living in the city closer to the epicenter. Of the three symptom categories of posttraumatic stress disorder (PTSD), only intrusion (category B) symptoms were significantly correlated with basal morning cortisol levels and percent suppression by dexamethasone. The more highly exposed adolescents also exhibited a more rapid decline in MHPG levels over the course of day 1.
The findings indicate that chronic posttraumatic stress reactions among adolescents exposed to catastrophic disaster are associated with hypothalamic-pituitary-adrenal (HPA) axis alterations. The findings are congruent with those previously described in adults with chronic PTSD. Persistent intrusion (category B) symptoms may constitute continued episodes of distress and evoke repeated physiological stress responses, which, over time, alter HPA axis function. The MHPG findings suggest that there may be diurnal changes associated with severity of posttraumatic stress symptoms.
To explore the relationship between exposure to the earthquake in Armenia on December 7, 1988, and relocation from the disaster zone, and the subsequent development of posttraumatic stress disorder (PTSD), depression, and behavioral difficulties in children.
The PTSD module of the Diagnostic Interview for Children and Adolescents-Revised and the Depression Self-Rating Scale were administered to 25 children, aged 11 through 13 years, who had high exposure to the earthquake and remained in the earthquake city. They were compared with a demographically similar group of 24 children exposed to the earthquake who were relocated to another city after the earthquake and 25 nonexposed children. For each child the mothers responded to the Child Behavior Checklist and the teachers responded to the Teacher's Report Form.
The hypothesis that relocated children would present with less PTSD, depression, and behavioral problems was not confirmed. Both groups of children with high exposure to the earthquake, one remaining in the earthquake city and one relocating, demonstrated significantly higher rates of PTSD, depression, and behavioral difficulties than the comparison group. There were no differences between the relocated children and those who remained in the earthquake zone.
Children who were relocated after a natural disaster did no worse than children who remained in the disaster zone. Relocation should be considered as an alternative after catastrophic natural disasters in situations where resources are so limited that rebuilding cannot take place for an indefinite period of time.
We assessed the frequency of short-term, post-traumatic symptoms among evacuees of the Hanshin-Awaji earthquake. A total of 67 younger subjects (under 60 years) and 75 elderly subjects (60 years or above) were interviewed during the third week after the earthquake, and 50 and 73 subjects, respectively, were interviewed during the eighth week. All subjects were assessed using the Post-Traumatic Symptom Scale. During the first assessment, subjects from both age groups experienced sleep disturbances, depression, hypersensitivity and irritability. During the second assessment, the percentage of younger subjects experiencing symptoms did not decrease, while elderly subjects showed a significant decrease in 8 of 10 symptoms. This may have been due to such factors as decreased psychological stress, extensive social networks, and previous disaster experiences in the case of the elderly subjects.
Lifestyle determines the amount of exposure to environmental carcinogens/mutagens. We examined the relationship between various lifestyle factors and the urinary level of mutagens, which reflects both exposure dose and metabolism of these carcinogens/ mutagens.
Twenty-four-hour urine specimens obtained from 69 males were subjected to blue rayon extraction, after which the elutions were fractionated by carboxymethyl cellulose column chromatography. The mutagens were measured by using an S9-mediated Salmonella mutagenicity test. The subjects were classified into three groups according to their total scores on a questionnaire regarding eight health practices: cigarette smoking, alcohol drinking, nutritional balance, eating breakfast, sleeping hours, working hours, physical exercise, and mental stress.
Compared with those with "poor" health practice, subjects with "good" health practice showed a significantly lower urinary level of mutagens in all chromatography fractions, as well as in the acid- and alkali-elutable fractions. Cigarette smoking and nutritional balance were the most highly correlated factors.
Our findings show that poor health practices increase the urinary level of mutagens, suggesting that a healthy lifestyle reduces exposure to carcinogens/ mutagens and may reduce cancer risk.
To investigate the association between lifestyle factors and immune responses to tumors, we determined lymphokine-activated killer (LAK) cell activity and proportions of lymphocyte subsets in 54 healthy males.
LAK cell activity was determined by 51Cr release assay. The proportions of natural killer cells (CD3-16+56-, CD3-16-56+ or CD3-16+56+ cells), helper/ inducer T cells (CD4+8-), and cytotoxic/suppressor T cells (CD4-8+) in lymphocytes were also determined by flow cytometry. Subjects were classified into two groups, good or poor overall lifestyle, according to their answers on a questionnaire regarding eight health practices (cigarette smoking, alcohol consumption, physical exercise, mental stress, sleeping pattern, nutritional balance, eating breakfast, working pattern).
Subjects with good health practices regarding smoking showed significantly higher LAK cell activity. They also showed a significantly higher proportion of natural killer cells and a lower proportion of helper/inducer T cells. LAK cells activity was significantly higher in subjects with a good overall lifestyle than in those with a poor overall lifestyle after controlling for the effects of smoking. There were no significant differences in the proportions of lymphocyte subsets between the two lifestyle groups.
Lifestyle factors are associated with LAK cell activity and the proportion of lymphocyte subsets.
This study is a three-month follow-up study in order to assess the short-term impact of traumatic stress among 53 Swedish survivors of the Estonia disaster.
A questionnaire consisting of general questions about conditions during and after the disaster and self-assessment by Post Traumatic Symptom Scale (PTSS-10), Impact of Event Scale (IES), Sense of Coherence-short version (SoC-12), and the DSM-IV list of dissociative symptoms of Acute Stress Disorder formulated as questions regarding individual reactions was distributed.
The response rate was 79.2% (n = 42). The participants scored an average of 3.9 on PTSS-10, 28.5 on IES ('intrusion' and 'avoidance' subscales) and 62.8 on SoC-12, which shows elevated levels of post-traumatic stress reactions but a normal level of sense of coherence. The reported occurrence of dissociative symptoms during the disaster was as follows: emotional numbing in 43% of the survivors, reduction of awareness in 55%, derealisation in 67%, depersonalisation in 33%, and dissociative amnesia in 29%. Survivors scoring low in SoC scored significantly higher in both PTSS-10 and IES than those with high scores in SoC. All dissociative symptoms were predictive of post-traumatic reactions.
This study substantiates the importance of assessing dissociative symptoms during a life-threatening event as a possible for later post-traumatic reactions and possible PTSD. The Sense of Coherence Scale may be useful as an instrument to sort out survivors at risk.
The relationship between social network disturbances following earthquake evacuation and self-reported psychological distress (reduced version of the SCL-90-R) 3 to 4 years later was studied among 817 Italian male factory workers. Increased distress was reported by permanently relocated men, while those who were evacuated, but returned to their original homes, reported distress levels comparable to their nonevacuated co-workers. Additionally, among evacuated men, only those whose relocation placed them at an increased distance from family and/or friends reported distress levels higher than the nonevacuated. Change in visiting frequency with family and/or friends following evacuation was not related to distress. Although these data are correlational and cross-sectional, they are consistent with the hypothesis that disaster related distress is, in part, a function of resulting social network disruption.
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Understanding acute psychological distress following natural disaster
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Psychological distress of adolescents exposed to Hurricane Hugo
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Psychiatric morbidity following Hurricane Andrew
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