Risk and resilience in trajectories of post-traumatic stress symptoms among first responders after the 2011 Great East Japan Earthquake: 7-year prospective cohort study.

BACKGROUND: First responders to disasters are at risk of developing post-traumatic stress disorder (PTSD). The trajectories of post-traumatic stress symptom severity differ among individuals, even if they are exposed to similar events. These trajectories have not yet been reported in non-Western first responders. AIMS: We aimed to explore post-traumatic stress symptom severity trajectories and their risk factors in first responders to the 2011 Great East Japan Earthquake (GEJE) - a historically large earthquake that resulted in a tsunami and a nuclear disaster. METHOD: A total of 55 632 Japan Ground Self-Defense Force (JGSDF) personnel dispatched to the GEJE were enrolled in this 7-year longitudinal cohort study. PTSD symptom severity was measured using the Impact of Event Scale-Revised. Trajectories were identified using latent growth mixture models (LGMM). Nine potential risk factors for the symptom severity trajectories were analysed using multinomial logistic regression. RESULTS: Five symptom severity trajectories were identified: 'resilient' (54.8%), 'recovery' (24.6%), 'incomplete recovery' (10.7%), 'late-onset' (5.7%), and 'chronic' (4.3%). The main risk factors for the four non-resilient trajectories were older age, personal disaster experiences and working conditions. These working conditions included duties involving body recovery or radiation exposure risk, longer deployment length, later or no post-deployment leave and longer post-deployment overtime. CONCLUSIONS: The majority of first responders to GEJE were resilient and developed few or no PTSD symptoms. A substantial minority experienced late-onset and chronic symptom severity trajectories. The identified risk factors can inform policies for prevention, early detection and intervention in individuals at risk of developing symptomatic trajectories.

Assessment of Factors Associated With Long-term Posttraumatic Stress Symptoms Among 56 388 First Responders After the 2011 Great East Japan Earthquake.

Importance: First responders are at risk for developing symptoms of posttraumatic stress disorder (PTSD). Little is known about the risk factors for developing PTSD during a years-long period after complex mass disasters. Objective: To explore the long-term course of PTSD symptoms and to identify risk factors and their relative association with PTSD among first responders dispatched to the 2011 Japanese earthquake, tsunami, and nuclear disaster. Design, Setting, and Participants: This 6-year, large, prospective cohort study was part of a continuous longitudinal study of Japan Ground Self-Defense Force first responders. The data were collected at 1, 6, 12, 24, 36, 48, 60, and 72 months after mission completion from 2011 to 2017. Of approximately 70 000 eligible participants, 56 388 were enrolled in this study. Data were analyzed from 2017 to 2020. Exposures: Stress exposures owing to personal or professional disaster experience (eg, duties with body recovery or radiation exposure risk) and working conditions (eg, deployment length, postdeployment overtime work). Main Outcomes and Measures: The Impact of Event Scale-Revised score assessed PTSD symptoms; scores of at least 25 were defined as probable PTSD. Cox proportional hazards regression models assessed the risk factors for incidence of probable PTSD. Results: Among the 56 388 participants, 97.1% were men, and the median age at enrollment was 34 (range, 18-63) years. A probable PTSD rate was 2.7% at 1 month and showed a downward trend in the first year and a subsequent plateau. The cumulative incidence of probable PTSD was 6.75%. The severity of PTSD symptoms demonstrated a high degree of rank-order stability over time. Rather than professional disaster experience, sociodemographic factors and working conditions were independently associated with the incidence of probable PTSD: personal experience of the disaster (hazard ratio [HR], 1.96; 95% CI, 1.72-2.24), deployment length of at least 3 months (HR vs <1 month, 1.75; 95% CI, 1.52-2.02), increased age (HR for ≥46 vs ≤25 years, 2.28; 95% CI, 1.79-2.92), and postdeployment overtime work of at least 3 months (HR vs little to none, 1.61; 95% CI, 1.39-1.87). Conclusions and Relevance: Given these findings, in the future, first responders' PTSD symptoms might be mitigated by shortening deployment length, avoiding postdeployment overtime work, and paying special attention to the needs of personnel with personal experience of the disaster or older age. Efforts to alleviate responders' initial symptoms will be required.

General psychological distress among Japan Self-Defense Forces personnel dispatched on United Nations peacekeeping operations and their spouses.

AIM: The importance of family care during international deployment is emphasized within military organizations, but mental health interactions between deployed personnel and their spouses have not yet been assessed. This study addressed this gap by examining couples' mental health throughout a deployment period. METHODS: The mental health of 324 spousal dyads of Japan Self-Defense Forces personnel dispatched for a half-year United Nations Disengagement Observer Force mission was examined, using longitudinal data derived from a survey at four time points: one-month pre-deployment, initial deployment, middle deployment, and immediately after homecoming. The 30-item General Health Questionnaire was used to evaluate general psychological distress, with high scores (≥7) indicating adverse mental health. RESULTS: The spouses' general psychological distress was significantly higher compared with the deployed personnel (P < 0.001). The high general psychological distress of personnel was significantly related to that of their spouses (odds ratio = 2.24; 95% confidence interval, 1.32-3.80), and vice versa (odds ratio = 2.38; 95% confidence interval 1.39-4.08). CONCLUSION: Mental health care will be beneficial for not only deployed personnel but also their spouses.

The Psychological Impact of the Great East Japan Earthquake on Japan Ground Self-Defense Force Personnel: A Three-Wave, One-Year Longitudinal Study.

OBJECTIVE: Approximately 70,000 Japan Ground Self-Defense Force (JGSDF) personnel were dispatched in the wake of the 2011 Great East Japan Earthquake and the tsunami and nuclear disaster that followed. This study was conducted to evaluate the mental health of the JGSDF personnel and the correlates. METHODS: Data collected from 56,753 participants at three time points (one, six, and 12 months after mission completion) were analyzed. Those who scored 25 or more points on the Impact of Events Scale-Revised (IES-R) and the Kessler Psychological Distress Scale (K10) were allocated into the high posttraumatic stress response (high-PTSR) group, and the high general psychological distress (high-GPD) group, respectively. RESULTS: The multiple logistic regression analysis identified the following factors as the significant risk factor related to high-PTSR or high-GPD status, with odds ratios of 2.0 or higher: deployment length of three or more months, being personally affected by the disaster, and being overworked continuously for three or more months after mission completion. No significant association was observed for duties with radiation exposure risk. CONCLUSIONS: Our findings suggest that disaster workers may be able to conduct disaster relief activities more safely with mission-related considerations of shorter deployment length and recognizing the effects on personnel personally affected by the disaster, in addition to avoiding overworking personnel after mission completion.

Perceived Workplace Interpersonal Support Among Workers of the Fukushima Daiichi Nuclear Power Plants Following the 2011 Accident: The Fukushima Nuclear Energy Workers' Support (NEWS) Project Study.

OBJECTIVE: The 2011 Fukushima Daiichi nuclear accident was the worst nuclear disaster since Chernobyl. The Daiichi workers faced multiple stressors (workplace trauma, victim experiences, and public criticism deriving from their company's post-disaster management). Literatures suggest the importance of workplace interpersonal support (WIS) in enhancing psychological health among disaster workers. We sought to elucidate the role of their demographics, disaster-related experiences, and post-traumatic stress symptoms on perceived WIS. METHODS: We analyzed self-report questionnaires of 885 workers 2-3 months post-disaster. We used sociodemographic and disaster exposure-related variables and post-traumatic stress symptoms (measured by the Impact of Event Scale-Revised) as independent variables. We asked whether WIS from colleagues, supervisors, or subordinates was perceived as helpful, and used yes or no responses as a dependent variable. Logistic regression analyses were performed to assess correlates of WIS. RESULTS: Of the participants, one-third (34.7%) reported WIS. WIS was associated with younger age (20-28 years [vs 49-], adjusted odds ratio [aOR]: 3.25, 95% CI: 1.99-5.32), supervisory work status (aOR: 2.30, 95% CI: 1.35-3.92), and discrimination or slur experience (aOR: 1.65, 95% CI: 1.08-2.53). CONCLUSIONS: Educational programs focusing on WIS might be beneficial to promote psychological well-being among nuclear disaster workers, especially younger workers, supervisors, and workers with discrimination experiences. (Disaster Med Public Health Preparedness. 2018;12:460-463).

Suicide prevention strategies in Japan: a 15-year review (1998-2013).

Suicide is a global public health problem and solutions to it can be found only through a global dialog. The suicide rate in Japan has been alarming, but Japan has made substantial efforts to reduce this rate, making prevention a high priority. This report reviews the developmental stages of a comprehensive policy of suicide prevention in Japan from 1998 to 2013. Our review suggests that suicide prevention activities were facilitated by the 2006 Basic Act for Suicide Prevention and the 2007 General Principles of Suicide Prevention Policy. Along with the establishment of a Special Fund program for local governments, the Basic Act and General Principles led to the development of a comprehensive and multi-sector approach to suicide prevention. Suicide rates in Japan, especially among middle-aged men, decreased consistently after 2009, suggesting that the initiatives were effective. Continuous monitoring is needed to evaluate Japan's suicide prevention policy.

[The national strategies for suicide prevention by the United Nation/World Health Organization and the present situation of suicide in the East Asia].

We discussed "Prevention of suicide: Guidelines for the formulation and implementation of national strategies" formulated by the United Nations and the World Health Organization in 1996 and the present situation of suicide in the East Asia. Although much public attention has been paid to a high suicide rate of Japan in the world, the increasing tendency of suicide rates have been found in other East Asian countries as well. For example the Republic of Korea shows a recent suicide rate higher than 30 per 100,000, which surpasses the suicide rate of Japan. Facing the fact, various measures for suicide prevention have been conducted. The UN guidelines for suicide prevention point out that these strategies should be discussed to meet each country's need for more appropriate suicide prevention. The Japanese government had the Basic Law on Suicide Prevention enforced in 2006 to implement measures that society must tackle because various social factors are behind suicides. In recent years, some countries in the East Asia also show increasing suicide rates, which attract the society's serious concern. The rapid economic growth and globalization have led to personnel cut, performance-based compensation, and the widening gap between the rich and the poor and the society cannot maintain the conventional employment system. In addition, socio-economic changes have brought collapse of the original societal and familial system, which might have existed behind the increase of suicide in this region.

[Suicide prevention in Japan in contrast to overseas].

In 1996, the United Nations (UN) and the World Health Organization (WHO) published guidelines for developing suicide prevention measures at national level. In Japan, the Basic Act on Suicide Prevention was promulgated in June 2006 and a Comprehensive Suicide Measures Framework was formulated in June 2007, which announced that suicide prevention is an official concern and that entire societies should be engaged in such suicide prevention efforts. One of the fundamental principles moving forward is to place emphasis on coordination between medical and community models of care. The medical model is based on the notion that mental disorders that could lead to suicide should be diagnosed at earlier stages and addressed through appropriate psychiatric treatment. The community model, which concerns awareness activities that emphasize earlier detection and attentive social support, is also important. Implementing policies with a long-term perspective that maintain close linkages between these models is a critical strategy for suicide prevention. This presentation investigates the current conditions and issues around Japanese suicide prevention with reference to the UN/WHO guidelines for suicide prevention, and compares the situation to that in other countries.

Psychosocial and psychiatric characteristics of suicide completers with psychiatric treatment before death: a psychological autopsy study of 76 cases.

AIM: The present study was conducted to examine differences in psychosocial and psychiatric characteristics between suicide completers with and without a history of psychiatric treatment within the year before death, using a psychological autopsy method. METHODS: A semi-structured interview was administered by a psychiatrist and other mental health professionals for the closest bereaved of 76 suicide completers. RESULTS: Suicide completers with a history of psychiatric treatment (n = 38) were significantly younger than those without (n = 38) (P < 0.01), and a significantly higher proportion of cases in the treatment group were estimated to be suffering from schizophrenia. Further, in 57.9% of the treatment group, the fatal suicidal behavior involved overdose with prescribed psychotropic drugs. In addition, female suicide completers in the treatment group were more likely to have a history of self-harm or non-fatal suicidal behavior. CONCLUSION: Many suicide completers who received psychiatric treatment were young adults. It was common for suicide completers to overdose on prescribed drugs as a supplementary means of suicide, and many experienced self-harming behavior before death. In addition, a higher proportion of the treatment cases suffered from schizophrenia.

[Recommendation for revision of the General Principles of Suicide Prevention Policy].

Since the promulgation of the Basic Act for Suicide Prevention, suicide prevention in Japan has developed rapidly. In order to further reinforce such activities, it is necessary to balance universal, selective, and indicated prevention. For the revision of the General Principles of Suicide Prevention Policy, the Center for Suicide Prevention announced this recommendation with 29 societies. We hope that it will promote suicide prevention in Japan and lead to expansion of the suicide prevention network by academic organizations, NGOs, as well as local and central government.

[Postvention: how a psychiatrist should face a patient's suicide].

Suicide by a patient in therapy, which is not a rare encounter for most psychiatrists, may be a traumatic experience for the treating psychiatrist. The psychiatrist should sincerely face the patient's suicide, which can be a part of crisis management in psychiatric care. If a patient commits suicide, appropriate care should be offered to: 1) the patient's family members, 2) other vulnerable patients, 3) medical and nursing staff, and 4) the treating psychiatrist and nurse in charge of the deceased patient. The patient's family members should be informed of patient factors before the suicide and the care required by the family members. Information on what actually happened before the suicide should be given to other patients, and individuals who are severely influenced by the suicide should be offered appropriate care. The medical and nursing staff should examine the case from the viewpoint of what they can learn from the death. With the help of the supervisor, the treating psychiatrist and nurse in charge of the deceased patient should look into the case, and his/her negative countertransference and attitude toward death and suicide. This can help the psychiatrist acquire better therapeutic skills for treating suicidal patients in the future.

[Suicide prevention strategies around the world and in Japan].

"Prevention of suicide: Guidelines for the formulation and implementation of national strategies" was published by the United Nations and the World Health Organization in 1996. It emphasizes the importance of each country developing suicide prevention strategies in accordance with its own socio-cultural characteristics. Finland is known as one of the countries that successfully reduced its suicide rate. The medical model, which detects mental disorders at an early stage and starts appropriate psychiatric treatments, should be closely integrated with the community model, which educates the general public with accurate information on mental disorders and suicide prevention. Suicide prevention strategies should be conducted on a long-term basis. The author describes some considerations on current suicide prevention activities in Japan, and compares them against UN/WHO guidelines and national activities in Finland.

[Psychosocial classification of suicide completers by employment situation: a psychological autopsy study].

OBJECTIVE: This study sought to clarify psychosocial and psychiatric differences of suicide-completers dependent on their employment situation. METHODS: Since December 2007, we have been conducting a Japan-wide study on suicide-completers using a psychological autopsy method, a semi-structured interview by a psychiatrist and a mental health professional including a public health nurse with the closest bereaved. Items questioned included family environment, suicide situation, life history f, labor situation, economic problems, and psychiatric diagnosis according to DSM-IV criteria at the time of death. As of July 2009, we had collected psychosocial and psychiatric information for 46 Japanese suicide cases. RESULTS: More than half of 31 suicide-completers with a job at the time of their death were married men aged 40-59 (mean age 48.1 +/- 12.6). Many had social difficulties such as alcohol-related problems or debt (38.7% and 41.9%, respectively). More than sixty percent of the 15 unemployed suicide-completers were unmarried and aged 20-39 (mean age 43.4 +/- 19.9). The percentage of women in the unemployed suicide-completers was significantly higher than that for women with a job. Although social problems were not confirmed in the unemployed, the prevalence of alcohol use disorders was significantly higher in suicide-completers with ajob than in those who were unemployed. However, the prevalence of schizophrenia was significantly higher in the unemployed. CONCLUSIONS: Our findings suggest that to prevent suicide of those with ajob, enhanced mental health support in the workplace and a better understanding of the association between alcohol use disorders and suicide are required. To prevent suicide of those who are unemployed, mental health support for the younger generation, particularly in cases with schizophrenia, is recommended.

[Psychosocial features of suicide cases with alcohol problem: a psychological autopsy study].

AIMS: Alcohol use disorder is a well-known risk factor for suicide, as alcohol problems can deteriorate the medical and psychosocial conditions of individuals. Furthermore, the pharmacological effect of alcohol can cause impulsive behavior in individuals. However, few studies have investigated the association of alcohol problems with suicide in Japan. The purpose of the present study was to investigate psychosocial and psychiatric features of suicide-completers with alcohol problems in last one year before their death. METHODS: Since December 2007, we have been conducting a Japan-wide study on suicide-completers using a psychological autopsy method, a semi-structured interview by a psychiatrist and a mental health professional including a public health nurse with the closest bereaved. Items questioned included family environment, suicide situation, history of life, labor situation, economic problems, and psychiatric diagnosis according to DSM-IV criteria at the time of death. As of December 2009, we had collected psychosocial and psychiatric information about 76 Japanese suicide cases. RESULTS: 16 suicide-completers with alcohol problems ("Alcohol problem" group 21.1%) were all males and almost middle-aged workers. The percentages of debt and accident proneness in "Alcohol problem" group were significantly higher than "Non-alcohol problem" group. In "Alcohol problem group", none of them have had treatment of alcohol dependence. The prevalence of alcohol use disorders in "Alcohol problem group" was significantly higher than in "Nonalcohol problem" group (81.2% vs. 0%). CONCLUSION: The findings of the present study suggest that it is important to improvement of psychiatric care in alcohol dependence for prevention future suicides among alcoholics. Furthermore, enlightenment the association between alcohol problems and suicide to the public and medical doctors is required.

Difference in binocular rivalry rate between patients with bipolar I and bipolar II disorders.

OBJECTIVE: When dissimilar figures are presented to each eye individually, perception alternates spontaneously between each monocular view. This phenomenon, known as binocular rivalry, has been used as a powerful tool to investigate conscious visual awareness. Of clinical relevance, Pettigrew and Miller (Proc Biol Sci 1998; 265: 2141-2148) found slow perceptual alternation rates in patients with bipolar I disorder (BD-I). For a better understanding of differences between BD-I and bipolar II disorder (BD-II), we examined whether perceptual alternation rates of binocular rivalry differ between the two subtypes of bipolar disorder. METHODS: The subjects comprised 25 healthy controls, 11 patients with BD-I, and 17 patients with BD-II. They underwent binocular rivalry examination. One-way analysis of variance was conducted to determine differences in the phase duration of binocular rivalry between the control, BD-I, and BD-II groups. RESULTS: Significant differences were observed in the mean phase duration of binocular rivalry between the groups. Although the medication administered did not differ significantly between the BD-I and BD-II patients, the phase duration was significantly longer among the BD-I patients than the BD-II patients and controls, whereas no significant difference was observed in the phase duration between the BD-II patients and controls. CONCLUSION: The present results reveal a significant difference in the mean phase duration of binocular rivalry between subjects with BD-I and those with BD-II, suggesting the presence of some neurobiological difference between these two subtypes of bipolar disorder.

Relationship between post-traumatic stress disorder-like behavior and reduction of hippocampal 5-bromo-2'-deoxyuridine-positive cells after inescapable shock in rats.

AIM: Inescapable shocks (IS) have been reported to reduce the number of 5-bromo-2'-deoxyuridine (BrdU)-positive cells in hippocampus. Antidepressants prevent this reduction, and the role of neurogenesis in depression is now suggested. It has been reported, however, that the number of BrdU-positive cells was not different between the rats that developed learned helplessness and those that did not. This suggests that reduction of neurogenesis does not constitute a primary etiology of depression. It has been previously shown that IS can cause various post-traumatic stress disorder (PTSD)-like behavioral changes in rats. The aim of the present was therefore to examined whether the reduction of BrdU-positive cells relates to any PTSD-like behavioral changes in this paradigm. METHODS: Rats were given either inescapable foot-shocks (IS) or not shocked (non-S) treatment in a shuttle box on day 1 and received BrdU injections once daily during the first week after IS/non-S treatment. On day 14, rats treated with IS and non-S were given an avoidance/escape test in the shuttle box and dorsal hippocampal SGZ were analyzed by BrdU immunohistochemistry. RESULTS: In accordance with previously reported results, IS loading resulted in fewer BrdU-positive cells in the hippocampal subgranular zone (SGZ). Furthermore, in the IS-treated group, the number of BrdU-positive cells in the hippocampal SGZ was negatively correlated at a significant level with several hyperactive behavioral parameters but not with hypoactive behavioral parameters. Earlier findings had indicated that chronic selective serotonin re-uptake inhibitor administration, which is known to increase hippocampal neurogenesis, restored the increase in hypervigilant/hyperarousal behavior but did not attenuate the increase in numbing/avoidance behavior. CONCLUSION: The regulatory mechanism responsible for the decreased proliferation and survival of cells in the hippocampus may be related to the pathogenic processes of hypervigilance/hyperarousal behaviors.

Mental health in Japanese members of the United Nations peacekeeping contingent in the Golan Heights: effects of deployment and the Middle East situation.

This study evaluates the mental health of Japan Self-Defense Force (JSDF) members of the peacekeeping contingent in the Golan Heights before and since the Second Gulf War between 1998 and 2003. Before the war, the General Health Questionnaire 30 (GHQ30) scores during and after duty tended to be lower than those before duty; all scores were lower than those of adult Japanese men in general. After the war, GHQ30 scores did not significantly change between before, during, and after duty. Manifest Anxiety Scale (MAS) scores were not significantly different between groups. Stressors identified included problems with foreign language and familial matters at home. Post war stressors included work content and relationships with collaborating foreign army units. These findings suggest that the mental health of contingent members remained stable, with some variation in mental health conditions influenced by the situation in the Middle East. This study suggests that the stable mental condition of JSDF personnel during their deployment in the absence of combat, and that this could be enhanced by education about mental health issues and by providing counseling support to their families.

Effects of selective 5-HT1A agonist tandospirone on the rate and rhythmicity of binocular rivalry.

RATIONALE: When dissimilar figures are presented to each eye individually, perception alternates spontaneously between each monocular view. This phenomenon, binocular rivalry, has been suggested to depend on serotonergic neural systems. OBJECTIVE: To investigate the relationship between binocular rivalry and serotonergic neural systems in more detail, we measured the perceptual alternation rate and rhythmicity of binocular rivalry under the influence of the 5-HT(1A) agonist tandospirone. MATERIALS AND METHODS: Fifteen healthy volunteers were tested under placebo and 60 mg tandospirone conditions using the single-blind method. The perceptual alternation rate and rhythmicity of binocular rivalry were measured at pre-administration and at 90, 180, and 360 min post-administration. RESULTS: Compared to placebo, the administration of tandospirone decreased the rate and rhythmicity of perceptual switching significantly at 90 and 180 min post-administration in a manner that is consistent with its pharmacokinetics. CONCLUSIONS: The present results suggest that the 5-HT(1A) neural pathways, mainly located in the mesolimbic system and brainstem, may play a crucial role as an oscillator in perceptual rivalry alternations.