[The mental health of school children after the Great Hanshin-Awaji Earthquake: I. Epidemiological study and risk factors for mental distress].

UNLABELLED: We conducted surveys to study the magnitude and nature of psychological consequences of school children affected by the Great Hanshin Awaji Earthquake, which occurred in Kobe on January 17th, 1995. It measured 7.2 in magnitude, killed more than 6000 people and destroyed at least 170,000 buildings and houses. The investigations were carried out 4 months following of the disaster. SUBJECTS: About 9000 school children in the 3rd grade, the 5th grade, the 8th grade living in the disaster areas. About 2000 children living in distant areas were also surveyed as control subjects. METHOD: The questionnaire was in a self-descriptive format and consisted of 10 items regarding situation and behavior when the earthquake occurred and 22 items about mental health condition. The responses were rated from 1 to 4 depending on the frequency of the symptoms, and statistically analyzed. RESULT: By factor analysis, three factors were elicited. Factor 1 was interpreted as being related to fear and anxiety, factor 2 as related to depression and physical symptoms, and factor 3 as related to pro-social tendencies. The highest mean score of factor 1 was associated with the most heavily damaged areas. Less severe damage was associated with a lower mean score, and the control areas showed the lowest score. These results show that the children in the damaged areas were strongly affected. Factor 2 shows a different pattern from factor 1. The score of heavily damaged areas is conspicuously high. However, the differences between the other areas were not significant, the control areas had scores almost the same as these of the slightly damaged areas. These results may mean that in less damaged areas than in more heavily damaged areas, there was a more remarkable "heroic phase" after the disaster, which hid depressive moods and lasted longer than in the more severely damaged areas, where people had to face stern reality in the early stages. Factor 3 shows the reverse pattern of factor 2. The slightly damaged areas had the highest score. This result also shows the influence of the "heroic stage". As for the mean scores of factors 1 and 2, younger children showed higher scores. There were no differences in the scores of factor 3 between students in the 3rd grade and 5th grade. The score of the students in the 8th grade was the lowest among all. It can be seen that adolescents generally lessen their consideration for society as a developmental stage in their growth. All of the mean scores of factors 1, 2 and 3 of females are higher than those of males. In the heavily damaged areas, factor 1 is associated with an experience of being rescued and injuries of the children themselves. Factor 2 is associated with injuries of the children themselves. In the moderately damaged areas, factors 1 and 2 are associated with injuries of the children themselves and taking in victims in the children's homes. In the slightly damaged areas, factor 1 is associated with injuries within families. Factor 2 is associated with injuries within families and taking in victims in the childrens' homes. CONCLUSIONS: School-aged children exposed to a high-magnitude natural disaster had 3 categories of emotions: "fear and anxiety," "depressive mood and physical symptoms" and "pro-social tendency." The severity of disaster, younger age, and female gender were high risk factors for distress. In the heavily damaged areas, an experience of being rescued and injuries of the children themselves had a great influence on the mental health of children. In lesser damaged areas, taking in victims in the childrens' homes and injuries within families had an influence.

[The mental health of school children after the Great Hanshin-Awaji Earthquake: II. Longitudinal analysis].

UNLABELLED: We conducted surveys to investigate the nature of the recovery processes and psychological reactions of children and adolescents affected by the Great Hanshin Awaji Earthquake. The investigations were carried out 4 times at 4 months, 6 months, one year and two years after the disaster. SUBJECTS: About 9000 school children in the 3rd grade, the 5th grade, the 8th grade living in the disaster area. METHOD: The questionnaire consisted of 9-12 items regarding situation and behavior when the earthquake occurred, and 22 items regarding mental health condition, and was filled out in the classroom under supervision by the teacher in charge. The responses were rated from 1 to 4 depending on the frequency of the symptoms, and statistically analyzed. RESULTS: By factor analysis, three factors were elicited. Factor 1 was interpreted as being related to fear and anxiety, factor 2 as related to depression and physical symptoms, and factor 3 as related to pro-social tendencies. These 3 factors were distinct and stable throughout all 4 surveys and each of them showed unique recovery processes. The mean score of factor 1 was highest at 4 months after the earthquake, and decreased as time passed. This factor shows that fear and anxiety seem to be directly related to the experience of the earthquake. According to the severity of the disaster, more severe damage brought about a higher mean score of factor 1. Furthermore, younger children and girls were more strongly affected. Each of the differences in the severity of disaster, in age, and in gender decreased as time passed. The mean score of factor 2 peaked at 6 months, and it slightly recovered after one year. However, the score at the 1st year was still higher than that of the 4th month. At two years the score returned to almost the same level as that of the 4th month. We think that factor 2, involving depressive mood and psychophysical symptoms, may be a secondary phenomenon to fear and anxiety. Other possibilities are that they may be caused by environmental changes after the disaster, inconveniences of daily life, loss of jobs of parents, or masked by hypomanic mood which covered over the disaster area soon after the earthquake (so-called heroic phase). Older children have a greater tolerance for depressive mood and psychophysical symptoms, but those symptoms occurring in older children have a tendency to continue for a longer time. Girls are more heavily affected and need more time to recover from trauma than boys. The mean score of factor 3 showed a gradual decrease as time passed. There was no difference in the way of decrease according to the severity of disaster, age and gender. It may be natural that, since the interest in the earthquake decreased as time passed, consideration for the victims decreased. CONCLUSIONS: The problems of mental health of children and adolescents after the disaster may consist of at least 2 different components; "fear and anxiety," which appeared just after the disaster and decreased earlier; "depressive and psychophysical symptoms" appeared later and stayed longer.