Depression, Insomnia, and Probable Post-Traumatic Stress Disorder among Survivors of the 2016 Kumamoto Earthquake and Related Factors during the Recovery Period Amidst the COVID-19 Pandemic.

The aftereffects of the severe 2016 Kumamoto earthquake were complicated by the COVID-19 pandemic. This study aimed to identify mental health problems and related factors among survivors five years after the earthquake and clarify its long-term effects. A cross-sectional survey was conducted in 2020 among 19,212 survivors affected by the earthquake who moved from temporary to permanent housing. We analysed 8966 respondents (5135 women, 3831 men; mean age 62.25 ± 17.29 years). Logistic regression analysis was conducted to examine associations between mental health problems and socioeconomic factors. Prevalence rates of psychological distress, insomnia, and probable post-traumatic stress disorder were 11.9%, 35.2%, and 4.1%, respectively. Female gender (OR = 1.33, 95% CI = 1.13-1.57; OR = 1.21, 95% CI = 1.08-1.34; OR = 1.81, 95% CI = 1.41-2.32), public housing (OR = 2.14, 95% CI = 1.63-2.83; OR = 1.54, 95% CI = 1.26-1.88; OR = 2.41, 95% CI = 1.62-3.58), loneliness (OR = 9.08, 95% CI = 7.71-10.70; OR = 5.55, 95% CI = 4.90-6.30; OR = 3.52, 95% CI = 2.77-4.49), COVID-19-induced activity reduction (OR = 1.41, 95% CI = 1.19-1.66; OR = 1.86, 95% CI = 1.68-2.07; OR = 1.80, 95% CI = 1.40-2.31), and COVID-19-induced income reduction (OR = 1.33, 95% CI = 1.12-1.57; OR = 1.43, 95% CI = 1.28-1.59; OR = 1.92, 95% CI = 1.51-2.43) were significantly associated with mental health problems. These results suggest that gender, current housing, loneliness, and COVID-19 affected the survivors' mental health during recovery.

The meaning of self-care in persons with cervical spinal cord injury in Japan: a qualitative study.

BACKGROUND: Professionals in Japan tend to regard the individual contexts of persons with spinal cord injury (SCI) as the cause of their passive participation in self-care activities or self-management. However, the meaning of self-care involves variables that interrelate with sociocultural factors. Thus, it is necessary to uncover its meaning in the perceptions of persons with cervical spinal cord injury (CSCI) in order not only to implement better rehabilitation but also to understand the sociocultural constraints that determine the injured person's attitudes to self-care and long-term health outcomes. METHODS: Semi-structured interviews with 29 CSCI participants from fourteen municipalities of Osaka, Hyogo, and Ehime prefectures were conducted. Participants contributed diverse perspectives on rehabilitation, lay-professional and family relationships, health promotion, and body conceptions. Interviews were recorded, transcribed and analyzed using the grounded theory approach to inter-relate categories and to develop theoretical constructions. RESULTS: Four main themes emerged from the data: rehabilitation for independence in ADLs; detachment from the body and self; embodiment; and self-management. From the participants' point of view, rehabilitation programs in Japan aim at improving body functions for ADL performance, but provide little health education. These rehabilitation values might hinder some participants from developing self-esteem for their bodies. Moreover, socially-shaped family caregivers' active engagement in the participants' self-care allowed many participants to entirely rely on them for care. Through embodiment, participants found that self-care was not merely a means of independence in ADLs but also of self-management to enhance health and well-being, requiring collaborative relationships with caregivers. CONCLUSION: Personal factors such as low motivation for self-care might be in part a reflection of social expectations of dependence for persons with CSCI. However, the shift in the meaning of self-care from ADLs to self-management implies more active participation in health care needs, shaped through social exchanges. Not only personal factors but also sociocultural factors influence the injured person's valuation of self-care. There is a need for further research to better understand sociocultural influences on illness behaviors among persons with CSCI, so that clinical and community practice can develop accordingly.

Illness experience of adults with cervical spinal cord injury in Japan: a qualitative investigation.

BACKGROUND: There is growing recognition that healthcare policy should be guided by the illness experience from a layperson's or insider's perspective. One such area for exploration would include patient-centered research on traumatic Spinal Cord Injury (SCI), a condition associated with permanent physical disability requiring long-term and often complex health care. The chronicity of SCI can, in turn, affect individuals' sense of self. Although previous research in Western countries suggests that people with SCI find a way to cope with their disability through social participation and family bonds, the process of adjustment among people with cervical SCI (CSCI) living in Japan may be different because of the restrained conditions of their social participation and the excessive burden on family caregivers. The purpose of this study was to examine the impact of injury and the process of accommodation in people with CSCI in Japan. METHODS: Semi-structured home interviews were conducted with 29 participants who were recruited from a home-visit nursing care provider and three self-help groups. Interviews were recorded, transcribed and analyzed based on the grounded theory approach. RESULTS: Five core categories emerged from the interview data: being at a loss, discrediting self by self and others, taking time in performance, restoring competency, and transcending limitations of disability. Overall, the process by which participants adjusted to and found positive meaning in their lives involved a continuous search for comfortable relationships between self, disability and society. CONCLUSIONS: The results of this study suggest that persons with CSCI do not merely have disrupted lives, but find positive meaning through meaningful interactions. Family members added to the discredit of self by making the injured person entirely dependent on them. Gaining independence from family members was the key to restoring competency in people with CSCI. At the same time, social participation was pursued for transcending the limitations of disability. The results also imply that social issues affect how people interpret their disability. These findings suggest that public health policy makers should recognize the need to enhance independence in people with disability as well as change the social assumptions about their care.

A cross-sectional study of factors associated with intentions to leave among newly graduated nurses in eight advanced treatment hospitals: job stressors, job readiness, and subjective health status.

OBJECTIVES: This study was performed to examine job stressors, job readiness, and subjective health status as factors associated with intentions to leave among newly graduated nurses (NGNs) in advanced treatment hospitals in Japan. METHODS: From June to August 2007, anonymous self-administered questionnaires were distributed to all NGNs in nine advanced treatment hospitals. The questionnaire items addressed individual attributes, employment characteristics, organizational characteristics, the 22-item Job Content Questionnaire, a novel job readiness scale, and scales for subjective health status (cumulative fatigue and psychological distress) and intentions to leave. The response rate was 73% (n=414), and 377 completed questionnaire data sets from eight hospitals were analyzed. A hierarchical multiple regression analysis was performed to investigate the factors associated with intentions to leave and subjective health status. RESULTS: The results of hierarchical multiple regression analysis showed 55% of the variance in intentions to leave. "orientation as nurse", subjective health status influenced by psychological job demand, and "supervisor support" were important independent factors of intentions to leave. Psychological job demand and job readiness were also important factors of subjective health status. CONCLUSION: To intervene in early resignation of NGNs, job stressors should be minimized to improve subjective health status; while simultaneously raising job readiness.