福島県立医科大学 学術機関リポジトリ

Title

Disruption of Child Environments and Its PsychologicalConsequences After the Fukushima Disaster: a Narrative
Review Based on the Ecological Systems Model

Author(s)Mizuki, Rie; Kobayashi, Tomoyuki; Maeda, Masaharu

Citation

Current psychiatry reports. 23(8): 49

Issue Date

2021-08

URL

http://ir.fmu.ac.jp/dspace/handle/123456789/1868

Rights© 2021, The Author(s), under exclusive licence to Springer
Science Business Media, LLC, part of Springer Nature. Thisversion of the article has been accepted for publication, after
peer review (when applicable) and is subject to Springer
Nature s AM terms of use, but is not the Version of Recordand does not reflect post-acceptance improvements, or any
corrections. The Version of Record is available online at:https://doi.org/10.1007/s11920-021-01263-7

DOI

10.1007/s11920-021-01263-7

Text Version author

This document is downloaded at: 2024-10-16T09:07:23Z

Fukushima Medical University

Disruption of Child Environments and Its PsychologicalConsequences After the Fukushima Disaster: a Narrative Review
Based on the Ecological Systems Model
Rie Mizuki1 & Tomoyuki Kobayashi2 & Masaharu Maeda2* Rie Mizuki
mizuki-r@fmu.ac.jp
1 Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima
Medical University,
Fukushima, Japan
2 Department of Disaster Psychiatry, Fukushima Medical University, School of Medicine,
Fukushima, Japan

Abstract
Purpose of Review: A high prevalence of clinically significant mental health problems wasfound in children affected by the Fukushima disaster in Japan. We reviewed the literature on
child mental health to examine how disasters impacted children in Fukushima.
Recent Findings: Children’s environments, such as family and peer systems, were disrupted
by radiation concerns and evacuation. As children struggled with less resources at home andschool, they also had to deal with discrimination. Various interventions were implemented,
ranging from government financial assistance to several mental health services provided by
local care resources to families and children. In addition to organizing such interventions
discretely in each microsystem, a collaborative approach involving various intervening
entities across multiple levels was deemed necessary for providing comprehensive support tothe affected children and their families.
Summary: To promote the healthy psychological development of children, it is necessary toprovide multidimensional support for their families, particularly parents, throughmultidisciplinary collaboration between professionals involved in child and family care.
Keywords: Nuclear disaster . Child mental health. Child development. Parenting. Great East
Japan Earthquake
Introduction
Nuclear disasters greatly impact the mental health and development of children [1].
Based on parental reports of child mental health, 16 to 25% of affected children showedmental health problems at clinical level 1 year after the Fukushima disaster [2••], while theJapanese standard was 9.3% [3]. A longitudinal study revealed that 8.8% and 8.5% of thesechildren continued to experience very severe emotional symptoms and peer relationshipproblems, respectively, even 3 years after the disaster [4••]. Disasters not only affectchildren’s mental health as an immediate reaction to disaster experiences [5] but also
incessantly impede their mental growth [6], which could consequently influence theirdevelopment in the long run [7].
Nuclear disasters overwhelm family and social figures in the children’s environment.
For instance, family disruption, deterioration of parental mental health, discrimination inschools, immature friendships, and unstable identity development were observed after nuclear
disasters [7–9]. The development of children is usually influenced by every component intheir environment. Bronfenbrenner [10] conceptualized that a child is at the center of an
ecological system, in which the child is surrounded by layers of systems, such as the
microsystem, mesosystem, exosystem, and macrosystem. The microsystems are the systems
which immediately surround and directly interact with the child, such as family and peers.
The mesosystem represents the interactions among various microsystems (e.g., parent-teacher
associations). The exosystems include societal conventions, such as laws, government
policies, and political systems, which influence the child by impacting their meso- andmicrosystems. The macrosystem encompasses the value systems of the culture (e.g.,collectivistic cultural values and ideologies), which have implicit but pervasive bearings on
all systems previously mentioned, as well as the child. The determinants of healthy
psychological development of children rely on the construction of healthy relationships andinteractions with those systems involving parents, significant adults such as other family
members and school teachers, as well as friends and schoolmates. In these relationships,
children have certain experiences related to responsive/sensitive caregiving, acceptance, trust,and identity, at each developmental stage, which are indispensable for their healthy
psychological development. In the ecological systems model, these systems interact with eachother while being impacted by systems at higher levels, such as by the national and local
governments.
In this review, we discuss the impact of disruption of children’s environments on
their deteriorated mental health conditions after the Fukushima nuclear disaster. We adopted
Bronfenbrenner’s [10] ecological model of human development to examine the environmentof and interventions for child development by family, peers, and individual systems (Fig. 1)[10].
Environmental Systems for Child Development After the Fukushima Disaster
Family System
The family system, the most important element of child development, comprises
family members, such as the mother, father, siblings, and grandparents. The Fukushima
nuclear disaster had serious implications on children’s family lives due to radiation exposurerisk and/or evacuation [11–13]. Optimum places of evacuation in terms of safety, work,school, and livelihood were often unavailable. Many families with children had to decidewhether to let their mothers and children evacuate without their fathers to alleviate financial
burdens [14–16]. In fact, 22.7% of men reported that they decided to voluntarily evacuate
their wives and children before prioritizing themselves [17]. Two years after the disaster, 20–
40% of evacuees reported living separately from their family members with whom they used
to once live in the same household [8, 18].
Even though the evacuation demanded a change in family routines, it demanded aneven more drastic change in family composition. Adjustment to new routines increases stressamong children and adults [19], which is associated with fluctuating parental resources,
deteriorating parenting quality, and emotional insecurity [20]. Such instability could cause
children to develop behavioral and cognitive problems in their home and school [19] anddecrease their resilience from the disaster [21]. The decision-making process left manyfamilies with a sense of guilt and conflict in balancing health risks and economic needs [22,23].
Mothers’ mental health conditions are known to influence children’s psychologicalstatus. A link between parental and child mental health has been found in nuclear disaster
research, including maternal anxiety and children’s emotional disorders [7], somatic, andmemory problems [6, 24]. A study found that in children affected by the Fukushima disaster,mothers’ post-traumatic stress symptoms predicted children’s mental health problems 2 years
post the incident [25].
Many mothers have been living with severe nervousness and anxiety after the
Fukushima nuclear disaster because of their children. They reported feeling isolated andburdened with single parenting [15, 16], and had to resolve their children’s problems such as
school concerns, anxiety about the future, sense of loss of their pre-disaster life, and lack offriends, on their own [14]. A study involving mothers with infants revealed that the mothersin Fukushima scored higher on psychological distress and post-partum depression thanmothers from other areas of Japan. The mothers’ anxiety about radiation exposure, such as
negative feelings toward their pregnancy due to adverse effects of radiation exposure,predicted higher depressive symptoms [26]. In fact, depressive symptoms were found in 28%
of mothers with infants 1 year after the accident [27]. A longitudinal study by Kuroda et al.
[26] found that over 30% and 16–17% of mothers in Fukushima had anxiety and depressive
symptoms as well as post-partum depression, respectively, during 5 years after the accident;
these rates were higher than the rates in other areas of Japan. Long-lasting poor mental healthin mothers of Fukushima was congruent with the previous findings from Three Mile Island
and Chernobyl incidents (see [5, 28–30]), indicating that children may struggle as a result ofsignificant changes in the family system, which could be attributed to the deteriorated mental
health of their parents after nuclear disasters.
Inadequate emotional availability of parents toward their children could induce
delayed behavioral problems in them, particularly after disasters. The use of corporalpunishment by parents was associated with more behavioral problems in children affected by

the Great East Japan Earthquake (GEJE) and the Fukushima nuclear disaster [31]. Many
parents with young children, especially mothers, hesitated to allow children to participate inoutdoor activities for a long time because of deep concerns about radiation exposure, resulting
in insufficient exercise and arrested development of athletic abilities in the affected children[32, 33]. Lower levels of exercise were associated with poor mental health in children of
Fukushima in the long term [4••, 34].
Although there are fewer reports on the effects of family members other thanmothers in the context of the Fukushima disaster, roles of other members in the familysystem, such as the father, should also be considered [35, 36]. For some voluntarily evacuatedmothers, the absence of fathers in their lives emerged as a concern and a trigger for anxiety.
Mothers reported confined and strained relationships between them and their children, in
which mediation by fathers was not available [37]. These mothers who voluntarily evacuatedalso faced unstable mental states due to the father’s absence [23]. In many cases, children
reluctantly accepted their fathers’ absence [16, 37]. Given the importance of a father’s role inchild development, his absence could affect the child’s psychological development in the longrun.
Peer System
The peer system of children was significantly affected by the GEJE and the
Fukushima disaster. Children establish relationships with peers, build social skills, and learn
how to adapt to the social demands of the world, through which they develop their sense of
self and establish self-identity. Schools usually function as one of the major sources of social
relationships for school-aged children. Since severely affected schools were evacuated andmoved to a substitute location, schools that survived the tsunami and nuclear disaster wereordered to function as long-term shelters for displaced people and were thus closed for an
extended period of time [38]. As the needs of displaced people for housing increased,
prefabricated, temporary housings occupied the schoolyards, which led children to lose theirplayground and a place dedicated to them [39]. Even after schools resumed, children faced
restrained outdoor activities, suspension of extracurricular activities, and many classmates
moving away [38, 40], leading to significant changes in their peer relationships.
The situation was even worse for children from evacuated families. Evacuatedchildren experienced multiple school transfers, which were accompanied by the disruption of
their peer relationships. Within 2 years after the Fukushima disaster, 34.8% and 30.9% ofevacuated families changed their residential location three to four times and five times or
more,respectively [8], which led to frequent changes in their schools. As they left their hometown,
children lost touch with most of their life-long friends and struggled to make new friends inthe new schools, not knowing how long the evacuation would last [23]. Concerns for theirschool and education, as well as lack of friends, impacted children’s mental health [14]. Anoverwhelming majority (81.0%) of evacuated children reported feeling distressed andsuffering at their new school: taking a long time to make friends (41.2%), facing difficulty incommunicating due to different dialects (52.9%), not wanting to attend school (64.7%), andbeing unable to attend school eventually (23.5%) [41]. In fact, behavioral problems, such as
aggression and a lack of concentration, were associated with changing schools [42]. Children
also suffered from difficulties in relationships with their peers; 77.5% of the affected children
from 1st to 9th grade had moderate to severe peer relationship problems, which wereconsistent for over 3 years [4••], denoting their persisting struggles at school. These studies
show how changes in the school environment impacted the development of children’s social
and interpersonal competency as well as development of the “self.” Such negative
consequences occurred for both evacuated and non-evacuated children from Fukushima.
Individual System
Children encounter challenges related to the development of their identity andsociability, as they often experience discrimination as nuclear disaster survivors. Parents
feared that their children would suffer discrimination regarding marriage and reproduction, as
there will be a risk and fear of potentially damaged DNA and malformation in future
offspring [22, 43]. Such concerns reflect similar discrimination experienced by atomic bomb
survivors reported almost half a century ago [44]. Female college students affected by the
Fukushima disaster also reported similar concerns [45]. Discrimination against atomic bomb
survivors engendered the long-term stigma that impacted survivors’ life decisions regarding
marriage, pregnancy, and employment [46, 47]. Additionally, inconsistent information onradiation effects on reproduction made the residents of Fukushima vulnerable todiscrimination [48].
In an attempt to avoid becoming targets of discrimination, many evacuated families
often chose to hide their identities in their new host communities. Mothers reported that they
did not disclose their identity as an evacuee family from Fukushima, the name of theirhometown in the ordered evacuation zone, or information on receiving financial
compensation, with the residents in their new community as well as with the parents of theirchildren’s school friends [49].
In the family, some mothers found it difficult to communicate with their children
about their hometown, while others reported that their children hardly talked about or had
little memory of their hometown [49]. Children thus grew up in an environment wherereminders of their hometown, Fukushima, vanished, leading to the development of identities
different from that of their parents.
Furthermore, many children affected by the Fukushima disaster faced bullying.
Almost 200 cases of bullying in schools toward children evacuees from Fukushima prefecture
were reported by the Ministry of Education, Culture, Sports, Science, and Technology [50].
This report revealed that verbal bullying ranged from subtle insinuation and teasing toobvious discrimination (i.e., being told “Go back to Fukushima,” and “Don’t come near me
because I will get infected with radioactive particles”) while serious cases resulted in
extortion of money or violence. Research conducted with evacuated children
reflected the incidence of bullying. Three years after the Fukushima disaster, 20% of parents
reported that their children had been targets of bullying [51]. In fact, the evacuated children
were significantly more likely to report victimization by bullying than anything else [52].
These experiences of bullying and discrimination toward affected children could lead to selfstigmatization and, in the long run, could jeopardize a healthy identity development.
As described previously, children’s peer relationships were disrupted by various
social factors, such as radiation and evacuation. Children experience a lack of play, social
recreation, and extracurricular school activities, which might lead to stable friendships thatallow for the development of healthy social skills and identity. The period of mid-childhood
to adolescence is crucial for the development of various competencies through peer relations,self-integration, and individuation through identity development, peer networks, and intimacy[53]. Deprived social relationships at school as well as communities could casta shadow on their development of who they are. Recent findings obtained from a large-scale
survey revealed that the prevalence of probable depression among adolescents and young
adults affected by the disaster was considerably higher than that of the national standard [54].
This suggests prolonged developmental effects on young people experiencing an unstableenvironment in adolescence, which is crucial to establish a healthy self-identity.
Interventions for Child Development After the Fukushima Disaster
Interventions for the Family System
After the Fukushima nuclear disaster, there were many interventions targeting thefamily, peer groups, and individual children. First, immediately after the disaster struck,
guidelines laid out by the national and local government established the foundation for
mitigating the damage to children’s environment and family system. This included theprovision of temporary housing, financial assistance, and dispatching public servants toaffected local municipal offices, such as child protective services [55, 56].
In the aftermath of the disaster, provision of temporary
housing and financial resources were two of the most important issues that could determine
whether families, particularly those that included extended family members, could remain
intact and continue to sustain their lives together after evacuation. The national government
encouraged prefectural governments to dispatch support personnel, such as social service
workers, to facilitate local governments to provide continuous services to people affected by
the disaster. In addition, even if local governments could not provide direct instrumental
support, they played a key role in providing informational support. The local government in
the affected areas assisted their residents in recovering their living by procuring anddisseminating the latest information on available housing, financial assistance, radiation

exposure, and health concerns. The local governments developed a network of evacuated andnon-evacuated residents and communicated with them through newsletters, websites, social
media, telephone consultation services, and home visits by social service workers.
Furthermore, interventions aimed at improving the mental health of family members
and providing information regarding risk perception that was related to their mental healthwere also important in restoring the family system of children. Local mental health services,such as psychiatric clinics and counseling centers, were crucial given the high prevalence ofdepression and anxiety among mothers and children. Meanwhile, home visit programs forevacuee mothers with young children for providing emotional support were reported asnecessary and helpful by evacuee mothers [11]. In addition, Fukushima Health Management
Survey (FHMS) conducted longitudinal epidemiological studies including the Mental Healthand Lifestyle Survey targeting residents from the evacuation zones and the Pregnancy andBirth Survey targeting mothers who had registered their pregnancies in Fukushima prefecture.
The FHMS established a Mental Health Support Team that provided outreach telephonecounseling for emotional support, and information regarding mental health care and radiation
concerns to the parents of high-risk children and high-risk mothers for post-partum
depression, as identified in their survey [57]. Additionally, members of the Support Team of
FHMS connected struggling families with relevant local government offices, so that the
public health nurses from local governments could provide home visits to high-risk families ifnecessary [58]. Furthermore, local communities, municipalities, or medical/scientificinstitutions organized risk communication meetings involving radiation professionals to
educate the affected residents, such as the meetings organized by the Radiation Medical
Science Center for FHMS [59].
Interventions for the Peer System
To enhance peer-support functioning among children, psychoeducation classes aimed
at teaching the relationship between disaster and stress reactions were conducted, so that theschool culture could be more trauma-informed [55]. Furthermore, bullying associated with the
Fukushima nuclear disaster reflected the prejudice against the evacuated families existing inthe society, which had become pervasive even among school-aged children. Since stigma anddiscrimination could stem from the lack of accurate information and understanding of nuclear
disasters and radiation risks, classes on radiation effects were conducted using supplemental
textbooks prepared by the Ministry of Education, Culture, Sports, Science and Technology[56] and by inviting experts of radiological medicine as guest lecturers [57].
Furthermore, since indoor children’s playgrounds, space where children could playwithin the grounds of temporary housing facilities, or parks and schoolyards in thecommunities were unavailable, children were able to take advantage of interventions provided
by adults to improve their disrupted peer system. Non-profit organizations visited shelters andprovided play equipment and conducted activities for children, which were welcomed byparents, who also enjoyed communicating with each other [58]. One of the unique aspects ofpost-nuclear disasters was that children’s outdoor play became strongly restricted due toconcerns about adverse health effects of radiation, despite play spaces being available.
Concerns for obesity and poor motor
function development in children stemmed from a lack of physical exercises [32]. This led tothe construction of indoor playgrounds in Fukushima [59]. While the provision of
playgrounds was useful for younger children to socialize with other children, school-aged
children tended to rely heavily on the initiatives of each school for various activities.
Interventions for the Individual
Disrupted schooling and changes in schools made keeping up with schoolwork
difficult for many evacuated children. Afterschool study programs were implemented by anon-profit organization in Fukushima. Such activities were welcomed by affected families
since they supplemented reduced parental support for children and prevented them fromfalling behind, academically [60].
To support children’s mental health, delivering interventions directly on-site inschools was effective as it provided easier accessibility to affected children. Psychoeducation
classes to learn about the relationship between disaster and stress reactions could help
children cope with the impact of the disaster [55]. Similarly, learning about accurate
information on radiation risks [56, 57] could reduce their unwarranted anxiety and selfstigmatization, and help them resist prejudice and discrimination, leading to a healthierdevelopment of identity. To achieve the abovementioned objective, the government
dispatched its employees to affected areas as well as in schools in the area. This ensured
mental health care for affected children was supported by school counselors who wererecruited from various areas of Japan.
Moreover, multidisciplinary teams, including psychiatrists, clinical psychologists,and social workers, provided local schools with outreach consultation and made referrals tomental health facilities as well as dispatched professionals to provide
assessment/psychological testing [61•]. These interventions helped improve the quality ofmental health care at school as well as at local mental health facilities where children could
seek support.
Conclusion
The development of children is fostered by the combined dynamic influence of theirfamilies and peers, whose functions are also under the influence of systems at higher levels,
including the local and national governments. In this review, challenges posed to children’s
psychological development after the Fukushima disaster were discussed by examining family,
peer, and individual systems. Research on children affected by the Fukushima nuclear disasterrevealed that mental health problems deteriorated to reach a clinically significant level after

the disaster and these problems persisted for several years. While the literature points toaccumulated consistent findings of the negative impact of the nuclear disaster on children, thepsychological problems among children were caused by the negative alterations in theirenvironment at multiple levels, namely the family system, peer system, and individual system,
based on the ecological systems model.
Changes in the family system where the family experienced separation due toevacuation were also linked to disrupted parenting routines and parents bearing thetremendous weight of raising their children under stressful circumstances.
Children’s peer system was disrupted by moving to new communities and schools. Changing
schools multiple times deprived children of their life-long social network at home and placed
an enormous burden on them to adapt to their new schools. Moreover, evacuated families andchildren experienced discrimination which led them to hide their regional identity to avoid
discrimination. This in turn resulted in them losing connections to their hometown as well as
the disruption of childhood peer relationships, possibly hindering the development of ahealthy self-concept.
Previous and ongoing interventions have been implemented by systems at multiple
levels, ranging from micro- to exosystems. While interventions at the exosystem level were
instrumental in laying the foundation, such as temporary housing provision and financial
assistance, various organizations at the microsystem level implemented interventions
addressing mental health issues, including telephone counseling, home visits by social
services workers, and risk communication meetings for radiation concerns. Education on
stress reaction and health risks from radiation, and peer support that were provided at school
may have contributed to preventing discrimination against the affected children. Facilitationof children’s play implemented by non-profit organizations assisted in developing children’speer system.
The ecological systems model suggests the importance of collaborations among
different systems that includes children’s immediate environments as well as the impact of thesystems at higher levels, which provides a structure for relief and recovery for children andtheir families. We have described various initiatives supporting children and their families,
each of which has derived positive effects at the immediate environment level.
Simultaneously, we need to invest our efforts in identifying strategies to coordinate those
activities and collaborate to maximize their positive effects on children’s healthy
development, particularly to tackle issues associated with nuclear disasters, such as risk
perception and discrimination, which are rooted across multiple levels of the society. For
instance, when mental health providers treat children, it is critical to promote coordination
between their families and schools because these systems share the major responsibilities fora child’s care. Furthermore, in order to tackle discrimination against children affected by the
nuclear disaster, the national government must commit to educating students and theirfamilies about radiation through the school system and their communities across the country.

In other words, discrimination cannot be addressed by focusing solely on the areas affected by
the disaster.
This paper reviewed the various challenges faced by evacuees of Fukushima, as wellas ascertained the secure future of Fukushima. However, the issues discussed here should beapplied in case of any future nuclear disaster. It is vital that each system supporting childdevelopment should prepare to collaborate with one another at the immediate level of thechild’s environment, while the national and local governments should create supporting
structures that coordinate with and allow collaboration of such systems for a favorable
outcome.
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This article described the collaboration between university-based mental health professionals
and schools as well as local mental health facilities in Fukushima to support the children
affected by the nuclear disaster, primarily involving the experts’ outreach initiatives.

Fig. 1 Factors affecting children’s mental health after the Fukushima nuclear disaster