List of Iwanuma Project Papers (by Order of topics)
1 Gero K, Aida J, Shirai K, Kondo K, Kawachi I: Dispositional optimism and disaster resilience: A natural experiment from the 2011 Great East Japan Earthquake and tsunami. Soc Sci Med.
2021 Mar; 273:113777. doi: 10.1016/j.socscimed.2021.113777.
2 Sasaki Y, Aida J, Tsuji T, Koyama S, Tsuboya T, Saito T, Kon do K, Kawachi I: Pre-disaster social support is protective for onset of post-disaster depression: Prospective study from the Great
East Japan Earthquake & tsunami. Sci Rep. 2019 Dec 19;9(1):19427. doi:10.1038/s41598-019-55953-7.
3 Inoue Y, Stickley A, Yazawa A, Aida J, Kawachi I, Kondo K, Fujiwara T: Adverse childhood experiences, exposure to a natural disaster and posttraumatic stress disorder among survivors ofthe 2011 Great East Japan Earthquake and tsunami. Epidemiol Psychiatr Sci. 2019 Feb;28(1):45-53. doi:10.1017/S2045796017000233. Epub 2017 May 15.
4 Hikichi H, Aida J, Tsuboya T, Kondo K, Kawachi I: Can community social cohesion prevent posttraumatic stress disorder in the aftermath of a disaster? A natural experiment from the 2011
Tohoku Earthquake and tsunami. Am J Epidemiol. 2016 May 15;183(10):902-10. doi:10.1093/aje/kwv335. Epub 2016 Mar 29.
5 Hikichi H, Kondo K, Aida J, Kondo N: Social capital in disaster medicine Group interviews with public health nurses working in areas stricken by the Tohoku earthquake. Japanese Journalof Disaster Medicine 2015;20 (1):51-56.
6 Hikichi H, Sawada Y, Tsuboya T, Aida J, Kondo K, Koyama S, Kawachi I: Residential relocation and change in social capital: A natural experiment from the 2011 Great East Japan
Earthquake and tsunami. Sci Adv. 2017 Jul 26;3(7): e1700426. doi:10.1126/sciadv.1700426
7 Li X, Buxton OM, Hikichi H, Haneuse S, Aida J, Kondo K, Kawachi I: Predictors of persistent sleep problems among older disaster survivors: a natural experiment from the 2011 Great East
Japan Earthquake and tsunami. Sleep. 2018 Jul 1;41(7): zsy084. doi:10.1093/sleep/zsy084.
8 Zhang W, Tsuji T, Yokoyama M, Ide K, Aida J, Kawachi I, Kondo K: Increased frequency of participation in civic associations and reduced depressive symptoms: Prospective study of older
Japanese survivors of the Great Eastern Japan Earthquake. Soc Sci Med. 2021 Mar 8; 276:11 3827. doi: 10.1016/j.socscimed.2021.113827.
9 Tsuji T, Sasaki Y, Matsuyama Y, Sato Y, Aida J, Kondo K, Kawachi I: Reducing depressive symptoms after the Great East Japan Earthquake in older survivors through group exercise
participation and regular walking: a prospective observational study. BMJ Open. 2017 Mar 3;7(3): e013706. doi:10.1136/bmjopen-2016-013706.
10 Hikichi H, Aida J, Matsuyama Y, Tsuboya T, Kondo K, Kawachi I: Community-level social capital and cognitive decline after a natural disaster: A natural experiment from the 2011 Great
East Japan Earthquake and tsunami. Soc Sci Med. 2018 Sep:111981. doi: 10.1016/j.socscimed.2018.09.057.
11 Aida J, Hikichi H, Matsuyama Y, Sato Y, Tsuboya T, Tabuchi T, Koyama S, Subramanian SV, Kondo K, Osaka K, Kawachi I: Risk of mortality during and after the 2011 Great East Japan
Earthquake and tsunami among older coastal residents. Sci Rep. 2017 Nov 29;7(1):16591. doi:10.1038/s41598-017-16636-3.
12 Hikichi H, Tsuboya T, Aida J, Matsuyama Y, Kondo K, Subramani an SV, Kawachi I: Social capital and cognitive decline in the aftermath of a natural disaster: a natural experiment from the2011 Great East Japan Earthquake and tsunami. Lancet Planet Health. 2017 Jun;1(3): e105-e113. doi:10.1016/S2542-5196(17)30041-4.
13 Gero K, Hikichi H, Aida J, Kondo K, Kawachi I: Associations between community social capital and preservation of functional capacity in the aftermath of a major disaster. Am J Epidemiol.
2020 Nov 2;189(11):1369-1378. doi:10.1093/aje/kwaa085.
14 Koyama S, Aida J, Kawachi I, Kondo N, Subramanian SV, Ito K, Kobashi G, Masuno K, Kondo K, Osaka K: Social support improves mental health among the victims relocated to temporary
housing following the Great East Japan Earthquake and tsunami. Tohoku J Exp Med. 2014 Nov;234(3):241-7. doi:10.1620/tjem.234.241.
15 Kawachi I, Aida J, Hikichi H, Kondo K: Disaster resilience in aging populations: lessons from the 2011 Great East Japan Earthquake and tsunami. Journal of the Royal Society of New
Zealand. 2020 Feb 4;50(2):263-278. doi:10.1080/03036758.2020.1722186.
16 Sasaki Y, Tsuji T, Koyama S, Tani Y, Saito T, Kondo K, Kawachi I, Aida J: Neighborhood ties reduced depressive symptoms in older disaster survivors: Iwanuma study, a natural experiment.
Int J Environ Res Public Health. 2020 Jan 3;17(1):337. doi:10.3390/ijerph17010337.
17 Gero K, Aida J, Kondo K, Kawachi I: Evaluation of trust within a community after survivor relocation following the Great East Japan Earthquake and tsunami. JAMA Netw Open. 2020
Nov;3(11): e2021166. doi:10.1001/jamanetworkopen.2020.21166.
18 Matsuyama Y, Aida J, Tsuboya T, Hikichi H, Kondo K, Kawachi I, Osaka K: Are lowered socioeconomic circumstances causally related to tooth loss? A natural experiment Involving the 2011
Great East Japan Earthquake. Am J Epidemiol. 2017 Jul 1;186(1):54-62. doi:10.1093/aje/kwx059.
19 Shiba K, Yazawa A, Kino S, Kondo K, Aida J, Kawachi I: Depressive symptoms in the aftermath of major disaster: Empirical test of the social support deterioration model using naturalexperiment. Wellbeing, Space and Society. 2020 Jan 1; 1:100006. doi: 10.1016/j.wss.2020.100006.
20 Tsuboya T, Aida J, Hikichi H, Subramanian SV, Kondo K, Osaka K, Kawachi I: Predictors of depressive symptoms following the Great East Japan Earthquake: A prospective study. Soc Sci
Med. 2016 Jul; 161:47-54. doi: 10.1016/j.socscimed.2016.05.026. Epub 2016 May 20.
21 Tsuboya T, Aida J, Hikichi H, Subramanian SV, Kondo K, Osaka K, Kawachi I: Predictors of decline in IADL functioning among older survivors following the Great East Japan Earthquake: A
prospective study. Soc Sci Med. 2017 Mar;176:34-41. doi: 10.1016/j.socscimed.2017.01.022. Epub 2017 Jan 18.
22 Hikichi H, Aida J, Kondo K, Tsuboya T, Kawachi I: Residential relocation and obesity after a natural disaster: A natural experiment from the 2011 Japan Earthquake and tsunami. Sci Rep.
2019 Jan;9(1):374. doi:10.1038/s41598-018-36906-y.
23 Shiba K, Hikichi H, Aida J, Kondo K, Kawachi I: Long-term associations between disaster experiences and cardiometabolic risk: A natural experiment from the 2011 Great East Japan
Earthquake and tsunami. Am J Epidemiol. 2019 Jun 1;188(6):1109-1119. doi:10.1093/aje/kwz065.
24 Sasaki Y, Aida J, Tsuji T, Miyaguni Y, Tani Y, Koyama S, Matsuyama Y, Sato Y, Tsuboya T, Nagamine Y, Kameda Y, Saito T, Kakimoto K, Kondo K, Kawachi I: Does type of residential housing
matter for depressive symptoms in the aftermath of a disaster? Insights from the Great East Japan Earthquake and tsunami. Am J Epidemiol. 2018 Mar;187(3):455-464.
doi:10.1093/aje/kwx274.
25 Li X, Aida J, Hikichi H, Kondo K, Kawachi I: Association of postdisaster depression and posttraumatic stress disorder with mortality among older disaster survivors of the 2011 Great East
Japan Earthquake and tsunami. JAMA Network Open. 2019;2(12): e1917550. doi:10.1001/jamanetworkopen.2019.17550.
26 Hikichi H, Aida J, Kondo K, Tsuboya T, Matsuyama Y, Subramani an SV, Kawachi I: Increased risk of dementia in the aftermath of the 2011 Great East Japan Earthquake and tsunami. Proc
Natl Acad Sci USA. 2016 Nov 8;113(45):E6911-E6918. doi:10.1073/pnas.1607793113. Epub 2016 Oct 24.
27 Ikeda T, Aida J, Kawachi I, Kondo K, Osaka K: Causal effect of deteriorating socioeconomic circumstances on new-onset arthritis and the moderating role of access to medical care: A
natural experiment from the 2011 Great East Japan Earthquake and tsunami. Soc Sci Med. 2020 Nov;26 4:113385. doi: 10.1016/j.socscimed.2020.113385. Epub 2020 Sep 25.
28 Shiba K, Aida J, Kondo K, Nakagomi A, Arcaya M, James P, Kawachi I: Mediation of the relationship between home loss and worsened cardiometabolic proﬁles of older disaster survivors
by post-disaster relocation: A natural experiment from the Great East Japan Earthquake and tsunami. Health & Place. 2020 Nov 1; 66:102456. doi: 10.1016/j.healthplace.2020.102456.
29 Hikichi H, Aida J, Kondo K, Kawachi I: Persistent impact of housing loss on cognitive decline after the 2011 Great East Japan Earthquake and tsunami: Evidence from a 6-year
longitudinal study. Alzheimers Dement. 2019 Aug;15(8):1009-1018. doi: 10.1016/j.jalz.2019.04.016. Epub 2019 Aug 1.
30 Kino S, Aida J, Kondo K, Kawachi I: Long-term trends in mental health disorders after the 2011 Great East Japan Earthquake and tsunami. JAMA Netw Open. 2020 Aug 3;3(8): e2013437.
doi:10.1001/jamanetworkopen.2020.13437.
31 Shiba K, Hanazato M, Aida J, Kondo K, Arcaya M, James P, Kawachi I: Cardiometabolic proﬁles and change in neighborhood food and built environment among older adults: A naturalexperiment. Epidemiology. 2020 Nov;31(6):758-767. doi:10.1097/EDE.0000000000001243.
32 Shiba K, Kawahara T, Aida J, Kondo K, Kondo N, James P, Arcaya M, Kawachi I: Causal inference in studying the long-term health effects of disasters: Challenges and potential solutions.
Am J Epidemiol. 2021 Mar 17. doi:10.1093/aje/kwab064.
33 Kino S, Aida J, Kondo K, Kawachi I: Persistent mental health impacts of disaster. Five-year follow-up after the 2011 Great East Japan Earthquake and tsunami: Iwanuma Study. J Psychiatr
Res. 2021 Apr; 136:452-459. doi: 10.1016/j.jpsychires.2020.08.016. Epub 2020 Aug 23.
34 Hikichi H, Aida J, Kondo K, Kawachi I. Six-year follow-up study of residential displacement and health outcomes following the 2011 Japan Earthquake and tsunami. Proc Natl Acad Sci U S
A. 2021 Jan 12;118(2): e2014226118. doi: 10.1073/pnas.2014226118.

Iwanuma Project Research Results
Social capital and functional recovery of older adults after theGreat East Japan Earthquake and Tsunami

Editing : Iwanuma Project
Date: July 1, 2021 (March 31, 2022 English version)
Publishing : Division of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University
Design : Liberty Area Incorporate

I

W

A

N

U

M

A

P

R

O

J

E

C

T

Social capital and functional recovery of older adults after the Great East Japan
Earthquake and Tsunami

Iwanuma Project
Research Results

Conclusion
OutlineIwanuma Project

The higher the social capital, the higher the resilience to disaster• Developing social capital in daily life in preparation for earthquakes and disasters.
• Taking measures, such as group relocation, to maintain social capital after the disaster.

I

Three typesof Social
Capital

W

A

N

U

M

A

Bonding Type P

Refers to the bond between people who have something in common.
R
O
J
E
C
T
While strong bonds are created inside groups, there is also an aspect of exclusivity.

Bridging Type

Bonding type refers to ties within the same area, whereas the bridging type refers to looser
ties with the outside world.
Connecting with the external world provides added information and resources.

Linking TypeThe link between the general public and authority represented by the administration.
It is the relationship of trust that exists between people who cross the boundaries ofsocial power and authority.

Iwanuma Project Suggestions

The impact of social capital on the physical andmental health of disaster survivors
Growing attention has been focused on the role of social connections (“social capital”) in assisting recovery after natural disasters.
Social capital is thought to be a factor that promotes community resilience after a disaster.
Seven months before the 2011 Great East Japan Earthquake, a survey was conducted on the relationship between social capital andhealth in Iwanuma City, Miyagi Prefecture, Japan. Survivors have been followed since, providing a unique opportunity to study the
impact of social capital on their health.
Through collaboration between the Japan Gerontological Evaluation Study (JAGES), Iwanuma City, and Professor Ichiro Kawachi ofHarvard University's School of Public Health, the Iwanuma Study has contributed to our understanding of the factors that promote

External Connections

recovery among older disaster survivors.
Social capital can be strengthened byallowing people from different regions tointeract, instead of staying within one
region.

331

Exercise and Hobbies

Social capital can be improved among
local residents through exercise andhobby group activities, festivals, andother events in which participation canoccur.

Temporary Housing

Group relocation to temporary housing after anearthquake is more likely to bring people closer
together and has less impact on health whencompared to individual relocation by lottery.

Public Space

It is possible to provide public spaces that areaccessible to a wider range of local residents byfocusing on places where people are likely tocongregate, such as town halls, community
centers, schools, and parks.

Places for Experience

In addition to creating places, it isimportant to offer a variety of events,
experiences, and activity programs inparks and sports facilities.

Neighborhood Environment

The study demonstrated that aneighborhood environment in which local
residents can go out, exercise, communicate,and shop on a daily basis has a positive
impact on health.

234

Conclusion
OutlineIwanuma Project

The higher the social capital, the higher the resilience to disaster• Developing social capital in daily life in preparation for earthquakes and disasters.
• Taking measures, such as group relocation, to maintain social capital after the disaster.

I

Three typesof Social
Capital

W

A

N

U

M

A

Bonding Type P

Refers to the bond between people who have something in common.
R
O
J
E
C
T
While strong bonds are created inside groups, there is also an aspect of exclusivity.

Bridging Type

Bonding type refers to ties within the same area, whereas the bridging type refers to looser
ties with the outside world.
Connecting with the external world provides added information and resources.

Linking TypeThe link between the general public and authority represented by the administration.
It is the relationship of trust that exists between people who cross the boundaries ofsocial power and authority.

Iwanuma Project Suggestions

The impact of social capital on the physical andmental health of disaster survivors
Growing attention has been focused on the role of social connections (“social capital”) in assisting recovery after natural disasters.
Social capital is thought to be a factor that promotes community resilience after a disaster.
Seven months before the 2011 Great East Japan Earthquake, a survey was conducted on the relationship between social capital andhealth in Iwanuma City, Miyagi Prefecture, Japan. Survivors have been followed since, providing a unique opportunity to study the
impact of social capital on their health.
Through collaboration between the Japan Gerontological Evaluation Study (JAGES), Iwanuma City, and Professor Ichiro Kawachi ofHarvard University's School of Public Health, the Iwanuma Study has contributed to our understanding of the factors that promote

External Connections

recovery among older disaster survivors.
Social capital can be strengthened byallowing people from different regions tointeract, instead of staying within one
region.

331

Exercise and Hobbies

Social capital can be improved among
local residents through exercise andhobby group activities, festivals, andother events in which participation canoccur.

Temporary Housing

Group relocation to temporary housing after anearthquake is more likely to bring people closer
together and has less impact on health whencompared to individual relocation by lottery.

Public Space

It is possible to provide public spaces that areaccessible to a wider range of local residents byfocusing on places where people are likely tocongregate, such as town halls, community
centers, schools, and parks.

Places for Experience

In addition to creating places, it isimportant to offer a variety of events,
experiences, and activity programs inparks and sports facilities.

Neighborhood Environment

The study demonstrated that aneighborhood environment in which local
residents can go out, exercise, communicate,and shop on a daily basis has a positive
impact on health.

234

Conclusion
OutlineIwanuma ProjectC R O S S T We
A LfoundK numerous links between areas with rich social capital
Implications of the Iwanuma Project(connections between people) and better health pre- and post-disaster.

It suggestsfor
that disasterincreasing social
capital before a disaster can lesad to disaster mitigation-Steps to maintain- is a key strategysocial connections
Strengtheningsocial capital
preparedness

The higher the pre- and post-disaster social capital,
the lower the health risk after a disaster.

Pre- and post-disaster factors that increase the riskof health deterioration after a disaster:
P

R

O

F

I

L

P

E

Risk factors that aggravated health after the earthquake

ICHIRO KAWACHI

Graduated from University of Otago. He received his M.D. from the University of Otago in 1985. After
Factors before the earthquake
working as a physician, Dr. Kawachi was awarded his Ph.D. in 1991. Since 1992, he has taught at Harvard
Pre-disaster
University, where he is currently the John L. Loeb and Frances Lehman Loeb Professor of Social● Distance from coastline (mortality risk on day of disaster)(Preparedness
stage)
Epidemiology in the Department of Social and Behavioral
Sciences at the Harvard
University T.H. Chan
● Severe depression before the earthquake (mortality risk on the dayof theearthquake)
Schoolof Public
Health. Kawachi is an elected member ofFactors
the National
AcademyofMedicineof the United
for disasterStates and an Honorary Fellow of the Royal Society of New Zealand.

mitigation● Damage to the house (depression, PTSD, loss of teeth, loss of independence, risk of dementia)

What
was
your
to start● Facing thedisasterwithout motivation
having experienced adversity(PTSD)● LossIwanumaof loved ones
the
Project?
● Difﬁculty
in seeking
medicalimmediately
after
the disaster
Kawachi:Globally,
disasters
areattention
becoming
increasingly
severeand(depression, declining degree of independence)
frequent.
However,the impact
of disasters
on older adults is still● Relocation
to temporary
housing(depression)

arises from peoples' social connections.

Post-disaster
Factors for disasterarranging evacuation shelters.
Our hypothesis was that resilience
mitigation

Disaster preparedness involves stockpiling food, water, medicines, andpoorly understood. After the tragedy of the Great East Japan

What have been the main
Earthquake in March 2011, we have had an invaluable opportunityﬁndings so far?
Methodofrelocation
totemporary
housing
through the Iwanuma Research Project to deepen our understanding
post-disaster affects health

L

E

Post-earthquake
Down!
PTSD

Group
Relocation

houses, those who lived in communities with high social capital before

Earthquake
the disaster, or who became richer in social
capital before and after theCommunication

Down!
Depression

heterogeneity of health outcomes following exposure to the same
traumatic events. For example, only half of the people who experiencedisaster, were less likely to deterioration. This means thatsevere trauma develop severe post-traumatic stress disorder
Down! (PTSD),

strengthening the social capital of a community is an important

while the other half remain relatively asymptomatic.
Dementia Using machine

Neighborhood
strategy for disaster preparedness.
Relationships

Neighborhood
Relationships

learning, we can identify the characteristics of resilient individuals. This

Kondo: There are dual aspects here: hard disaster preparedness, suchinformation can help focus resources more efﬁciently on people andas building breakwaters, and soft disaster preparedness. One such

communities that are vulnerable to disasters.

example is the development of social capital. The National Institute of

Kondo: We are also working with the National Research Institute

Down!

Mortalityof the impact of disasters on the health of older adults, their recovery,

Kawachi: First, we found a marked increase in cognitive disability and

Health in the United States also provided research grant for thefor Earth Science and Disaster Resilience, Japan, to develop aand the factors that contribute to it.

metabolic syndrome among those who moved into temporary

Iwanuma Project. Was it useful for the United States?

disaster preparedness "visualization" system (see p. 29), which

Kawachi: The valuable lessons learned from the Iwanuma Project areallows you to see which areas are resistant or vulnerable toLongitudinal panel data for post-disaster relocation of socially connected groups 2010–2013

Kondo:Social
We wanted
to demonstrateties
increasescientiﬁcally, using data, not just1

withthatgroup
relocation
anecdotally,social capitalor "connections" between people canhousing.
However, wefoundallocationthat older adults
more resilient(compared
to alsogroup)
waswereassociated2 Lottery（Hikichi, 2017 No. 6）

contribute to disaster preparedness and resilience (recovery from a

withinlesssocialthree
support.
termsproviding/receivingof mental health. For example,
years after the disaster,（Koyama, 2014 No. 14）

Group Physical Exercise

Group Physical Exercise

withties arelower post-earthquake
risks.
・Neighborhoods
useful,not only in Japan but
alsostrongaround pre-earthquake
the world. For example,
we likely to havedisasters.
This system will healthbe usedby residents and local

relocation, lowers post-disaster health risks.
・Group relocation of communities, rather than individual or lottery
governments in workshops for disaster preparedness. We hopefound that when relocating people to temporary housing, it was best to

30%

rates in the community had returned to pre-disaster levels.

do so in groups that maintained pre-existing neighborhood relationshipsthat the Iwanuma Project will serve as an opportunity to foster

There was an inconclusive debate in the studies that started after the25%

Kondo: We observed other health concerns as well, including

to preserve social capital. After learning about the results of the Iwanuma

social capital and connections between residents during normal

disaster about which came ﬁrst—health or social capital—the cause and20%

post-traumatic stress disorder (PTSD), instrumental activities of daily

Project through The Wall Street Journal, theCity of Houston contacted
times, the signiﬁcanceof which has been demonstrated by
Implications
ofus the Iwanuma
Project

15%

living (IADL), and tooth loss. What surprised me was that the greater theand made use of this insight during their response to Hurricane Harvey.

Changes in Social Ties Scores

0.04

0.053(p=0.013)

0.02
0.00

Individual relocation

Percentage of people without social support

the majority of people had recovered from theirLottery
grief,Allocationand depression

0.06
major shock).

the effect. However,City conducted a survey on the healthGroupIwanuma
Relocation-0.02

and social capital of older adults in August 2010, seven months before-0.04

the earthquake, which gave us a rare -0.039(p=0.035)
opportunity to settle this debate.
-0.06

What was the goal of this plan?
Relationship between relocation methodsocial connection
Kawachi: Our goal was andto examine
whether communities with high social(n=3,421)

313

I

Graduated from Chiba University Graduate School of Medicine in 1983. After working as a physician, Dr.
Kondo became Associate Professor at the Nihon Fukushi University in 1997. After a stint as a Visiting
Research Fellow at the University of Kent at Canterbury (UK) (2000-2001) and then as Professor at Nihon
Fukushi University, he has been the Professor at Chiba University since 2014, and a Head of Department of
the National Center for Geriatrics and Gerontology since 2016 (Cross-Appointment Post). In 2020, he
received the Medical Award of the Japan Medical Association in 2020.

Communication

capital could help people overcome the damage caused by disasters.

● Declining economic conditions (loss of teeth)F

Pre-earthquake KATSUNORI KONDO

Factors after the earthquake● Loss of loved ones (PTSD)

O

Professor, Center for Preventive Medical Sciences, Chiba University;
Head of the Department of Gerontological Evaluation, National Center for Geriatrics and Gerontology

Professor, School of Public Health, Harvard University● Dependence on others before the earthquake (mortality risk from the day after the earthquake)

R

Lottery Allocation

Group Allocation

Group Allocation

10%

damage to the house, the greater the health hazard. However, we were5%

also able to identify the factors that alleviated these health hazards.

0%

Kawachi: We
found that even among peopleProviding
who had suffered difﬁcult
Receivingsocial supportsocial support
experiences, such as losing their loved ones and damaging their

the project.

Increasing social capital before
and after the disaster
We would like to thank the people of Iwanuma City and everyone who
is the key to disastermitigation.
cooperated
with this project. We are working on a follow-up study inWhat are your plans for the future?

2022 to for
examineits long-termand look forward to yourearthquakes
andimpact
disasters・Developing social capital in daily life in preparation
measuressuchgroup relocation
to continued
maintaincooperation.
social capital after the disaster・Taking
Kawachi: The next phaseof the Iwanuma
Project
is toasunderstand
the

432

Conclusion
OutlineIwanuma ProjectC R O S S T We
A LfoundK numerous links between areas with rich social capital
Implications of the Iwanuma Project(connections between people) and better health pre- and post-disaster.

It suggestsfor
that disasterincreasing social
capital before a disaster can lesad to disaster mitigation-Steps to maintain- is a key strategysocial connections
Strengtheningsocial capital
preparedness

The higher the pre- and post-disaster social capital,
the lower the health risk after a disaster.

Pre- and post-disaster factors that increase the riskof health deterioration after a disaster:
P

R

O

F

I

L

P

E

Risk factors that aggravated health after the earthquake

ICHIRO KAWACHI

Graduated from University of Otago. He received his M.D. from the University of Otago in 1985. After
Factors before the earthquake
working as a physician, Dr. Kawachi was awarded his Ph.D. in 1991. Since 1992, he has taught at Harvard
Pre-disaster
University, where he is currently the John L. Loeb and Frances Lehman Loeb Professor of Social● Distance from coastline (mortality risk on day of disaster)(Preparedness
stage)
Epidemiology in the Department of Social and Behavioral
Sciences at the Harvard
University T.H. Chan
● Severe depression before the earthquake (mortality risk on the dayof theearthquake)
Schoolof Public
Health. Kawachi is an elected member ofFactors
the National
AcademyofMedicineof the United
for disasterStates and an Honorary Fellow of the Royal Society of New Zealand.

mitigation● Damage to the house (depression, PTSD, loss of teeth, loss of independence, risk of dementia)

What
was
your
to start● Facing thedisasterwithout motivation
having experienced adversity(PTSD)● LossIwanumaof loved ones
the
Project?
● Difﬁculty
in seeking
medicalimmediately
after
the disaster
Kawachi:Globally,
disasters
areattention
becoming
increasingly
severeand(depression, declining degree of independence)
frequent.
However,the impact
of disasters
on older adults is still● Relocation
to temporary
housing(depression)

arises from peoples' social connections.

Post-disaster
Factors for disasterarranging evacuation shelters.
Our hypothesis was that resilience
mitigation

Disaster preparedness involves stockpiling food, water, medicines, andpoorly understood. After the tragedy of the Great East Japan

What have been the main
Earthquake in March 2011, we have had an invaluable opportunityﬁndings so far?
Methodofrelocation
totemporary
housing
through the Iwanuma Research Project to deepen our understanding
post-disaster affects health

L

E

Post-earthquake
Down!
PTSD

Group
Relocation

houses, those who lived in communities with high social capital before

Earthquake
the disaster, or who became richer in social
capital before and after theCommunication

Down!
Depression

heterogeneity of health outcomes following exposure to the same
traumatic events. For example, only half of the people who experiencedisaster, were less likely to deterioration. This means thatsevere trauma develop severe post-traumatic stress disorder
Down! (PTSD),

strengthening the social capital of a community is an important

while the other half remain relatively asymptomatic.
Dementia Using machine

Neighborhood
strategy for disaster preparedness.
Relationships

Neighborhood
Relationships

learning, we can identify the characteristics of resilient individuals. This

Kondo: There are dual aspects here: hard disaster preparedness, suchinformation can help focus resources more efﬁciently on people andas building breakwaters, and soft disaster preparedness. One such

communities that are vulnerable to disasters.

example is the development of social capital. The National Institute of

Kondo: We are also working with the National Research Institute

Down!

Mortalityof the impact of disasters on the health of older adults, their recovery,

Kawachi: First, we found a marked increase in cognitive disability and

Health in the United States also provided research grant for thefor Earth Science and Disaster Resilience, Japan, to develop aand the factors that contribute to it.

metabolic syndrome among those who moved into temporary

Iwanuma Project. Was it useful for the United States?

disaster preparedness "visualization" system (see p. 29), which

Kawachi: The valuable lessons learned from the Iwanuma Project areallows you to see which areas are resistant or vulnerable toLongitudinal panel data for post-disaster relocation of socially connected groups 2010–2013

Kondo:Social
We wanted
to demonstrateties
increasescientiﬁcally, using data, not just1

withthatgroup
relocation
anecdotally,social capitalor "connections" between people canhousing.
However, wefoundallocationthat older adults
more resilient(compared
to alsogroup)
waswereassociated2 Lottery（Hikichi, 2017 No. 6）

contribute to disaster preparedness and resilience (recovery from a

withinlesssocialthree
support.
termsproviding/receivingof mental health. For example,
years after the disaster,（Koyama, 2014 No. 14）

Group Physical Exercise

Group Physical Exercise

withties arelower post-earthquake
risks.
・Neighborhoods
useful,not only in Japan but
alsostrongaround pre-earthquake
the world. For example,
we likely to havedisasters.
This system will healthbe usedby residents and local

relocation, lowers post-disaster health risks.
・Group relocation of communities, rather than individual or lottery
governments in workshops for disaster preparedness. We hopefound that when relocating people to temporary housing, it was best to

30%

rates in the community had returned to pre-disaster levels.

do so in groups that maintained pre-existing neighborhood relationshipsthat the Iwanuma Project will serve as an opportunity to foster

There was an inconclusive debate in the studies that started after the25%

Kondo: We observed other health concerns as well, including

to preserve social capital. After learning about the results of the Iwanuma

social capital and connections between residents during normal

disaster about which came ﬁrst—health or social capital—the cause and20%

post-traumatic stress disorder (PTSD), instrumental activities of daily

Project through The Wall Street Journal, theCity of Houston contacted
times, the signiﬁcanceof which has been demonstrated by
Implications
ofus the Iwanuma
Project

15%

living (IADL), and tooth loss. What surprised me was that the greater theand made use of this insight during their response to Hurricane Harvey.

Changes in Social Ties Scores

0.04

0.053(p=0.013)

0.02
0.00

Individual relocation

Percentage of people without social support

the majority of people had recovered from theirLottery
grief,Allocationand depression

0.06
major shock).

the effect. However,City conducted a survey on the healthGroupIwanuma
Relocation-0.02

and social capital of older adults in August 2010, seven months before-0.04

the earthquake, which gave us a rare -0.039(p=0.035)
opportunity to settle this debate.
-0.06

What was the goal of this plan?
Relationship between relocation methodsocial connection
Kawachi: Our goal was andto examine
whether communities with high social(n=3,421)

313

I

Graduated from Chiba University Graduate School of Medicine in 1983. After working as a physician, Dr.
Kondo became Associate Professor at the Nihon Fukushi University in 1997. After a stint as a Visiting
Research Fellow at the University of Kent at Canterbury (UK) (2000-2001) and then as Professor at Nihon
Fukushi University, he has been the Professor at Chiba University since 2014, and a Head of Department of
the National Center for Geriatrics and Gerontology since 2016 (Cross-Appointment Post). In 2020, he
received the Medical Award of the Japan Medical Association in 2020.

Communication

capital could help people overcome the damage caused by disasters.

● Declining economic conditions (loss of teeth)F

Pre-earthquake KATSUNORI KONDO

Factors after the earthquake● Loss of loved ones (PTSD)

O

Professor, Center for Preventive Medical Sciences, Chiba University;
Head of the Department of Gerontological Evaluation, National Center for Geriatrics and Gerontology

Professor, School of Public Health, Harvard University● Dependence on others before the earthquake (mortality risk from the day after the earthquake)

R

Lottery Allocation

Group Allocation

Group Allocation

10%

damage to the house, the greater the health hazard. However, we were5%

also able to identify the factors that alleviated these health hazards.

0%

Kawachi: We
found that even among peopleProviding
who had suffered difﬁcult
Receivingsocial supportsocial support
experiences, such as losing their loved ones and damaging their

the project.

Increasing social capital before
and after the disaster
We would like to thank the people of Iwanuma City and everyone who
is the key to disastermitigation.
cooperated
with this project. We are working on a follow-up study inWhat are your plans for the future?

2022 to for
examineits long-termand look forward to yourearthquakes
andimpact
disasters・Developing social capital in daily life in preparation
measuressuchgroup relocation
to continued
maintaincooperation.
social capital after the disaster・Taking
Kawachi: The next phaseof the Iwanuma
Project
is toasunderstand
the

432

Essay34 6-year followup study of the health impacts of residential relocation

Iwanuma Project

OutlineIwanuma ProjectLong-term Impact

Group relocation to disaster relief housing increases the risk of obesity and depression* p < 0.01

1.60*
M E S1.50S
A G E

1.40

M E S S A G E

Regression Coefﬁcient

1.20
1.00

P

0.80

P

0.79*

0.60
0.40

F

I

L

E

Relocating topermanent housing

BMI

F

I

L

E

TSUNEAKI IGUCHIIs a Core Member of the Japan Gerontological Evaluation
Study. Since 2020, Dr. Aida has-0.10
worked as a Professor in the Department of Oral Health Promotion, Graduate School of Medical
Relocating
disaster and Dental
Relocating
to Tokyo, Japan, and Professor in theand Dental Sciences,
Tokyo toMedical
University,
housing Liaisonpermanent
Regional Community relief
Development,
Center forhousing
Innovative Dentistry, Graduate School of
Dentistry, Tohoku University (Cross-Appointment,
Depression until May 2021). He has specialized in social
epidemiology and dental public health.

-0.20

O

Former Mayor of Iwanuma City

JUN AIDA

0.00

Relocating to disaster
relief housing

O

Professor, Tokyo Medical and Dental University

0.19

0.20

R

R

Graduated from Miyagi University of Education, worked in a tutoring school, and was elected to
the Iwanuma City Council at the age of 25. He served as the Chairman of the Iwanuma City
Social Welfare Council for seven consecutive terms. After serving as Council Chairman, he waselected mayor, and served four terms for 16 years. During this time, he also served as the Vice
President of the Japan Association of City Mayors. Mr. Iguchi was awarded Order of the RisingSun, Gold Rays with Neck Ribbon for his distinguished service to local government. Currently,
he is a Visiting Professor at the Tohoku Fukushi University, an Interim Member of the Social
Security Council, and Director of the Millennium Hope Hills Association.

Hikichi H, Aida J, Kondo K, Kawachi I. Six-year follow-up study of residential displacement and health outcomes following the 2011 Japan Earthquake andtsunami. Proc Natl Acad Sci U S A. 2021 Jan 12;118(2): e2014226118. doi: 10.1073/pnas.2014226118.

Studies examining the long-term health consequences of residential displacement following large-scale disasters remain sparse. Following the 2011 Japan Earthquake and Tsunami, victims who lost theirhomes were resettled by two primary means: 1) group relocation to public housing or 2) individual relocation, in which victims moved into public housing by lottery or arranged for their own
accommodation. Little is known about how the speciﬁc method of residential relocation affects survivors’ health. We examined the association between residential relocation and long-term changes inmental and physical well-being. Our baseline assessment predated the disaster by 7 months. Two follow-up surveys were conducted approximately 2.5 and 5.5 years after the disaster to ascertain thelong-term association between housing arrangement and health status. Group relocation was associated with increased body mass index and depressive symptoms at 2.5-year follow-up but was no longer
signiﬁcantly associated with these outcomes at 5.5-year follow-up. Individual relocation at each follow-up survey was associated with lower instrumental activities of daily living as well as a higher risk ofcognitive impairment. Our ﬁndings underscore the potential complexity of long-term outcomes associated with residential displacement, indicating both positive and negative impacts on mental versus
physical dimensions of health.

We would like to connect the value of the preearthquake data with internationally useful evidence.

Many results of the Iwanuma Project provide lessons
that will guide us in the "Era of Disasters."

The Iwanuma Project started in 2007 when the Iwanuma City Care

After taking up the post of Mayor, I established the goal of "Building a

The factors that contribute to protecting the health of disastersurvivors and promoting
their recovery are not clear.
Development of disaster
preparedness
and Community Oral Health, Graduate School of Dentistry, Tohoku
Most disaster research has been conducted after disasters have"visualization" system
and Welfare Division, together with the Department of International

JAGES HEART 2019

University, jointly implemented a model project for preventive care,occurred. Few studies have used data on pre-disaster conditions. As

JAGES built a "visualization" system for regional analysis using health and lifestyle survey data.
a result, the Iwanuma Project has been recognized in Japan and the
The name of the system is "Community-based Management Support System (JAGES HEART)."“Healthy and Happy City." As part of this effort, we conducted a healthpeople. We were able to establish commercial facilities necessary for

The
Iwanuma
Project compareddataobtained
beforethecommunities
disaster withthat
and lifestyle survey for all people over the age of 65
under
the guidance
daily life
becausethe six
affected
wererelocated enafterwards
gain several insights
to answer
questionof thehowdevelopment
much of theof Professors Ken Osaka and Jun Aida obtainedof Tohoku University.
Seventomonths
masse toanda single
location. theWe alsopromoted

led by Professor Ken Osaka, under whom I worked with his

reductionofIwanuma
social capitala major natural
disasteraffects
health.
later, the Great East Japan Earthquakethe
struck
48% of theCity due toMillenium
Hope Hills,
which wasnamedpeoples'
as a symbolof reconstruction.

department at the time.

US as a valuable source of pre-earthquake data. Therefore, we have
It performs visualizations like those given below
The JAGES 2010 survey was conducted before the earthquake, which
received funding to continue research related to health andParticipants in disaster andWhich regions are
The more social capital a community has,became thevulnerable
baseline fortothe
Iwanuma Project, and follow-up
surveysdisasters. This projectis being
conducted
the cooperation of
emergency
drills (%)
disasters?
the moreprepared
it is forwith
disasterarea, claiming many victims. There were no other surveys with data on the

Many people throughout Japan participated in a tree-planting

health status of older adults and people’ s connections before theceremony featuring broad-leaved trees, used as symbols for adisaster. The Iwanuma Project was created based on these data.

torch-relay course for the Reconstruction Olympics. The forest on thehave continued every three years.

In the process of reconstruction, we decided to protect lives, work

hill will serve as a breakwater in addition to the concrete embankment.

Percentage of participants in
disaster and emergency drills

Coefﬁcient
0.4924citizens and theCorrelation
Iwanuma
local: government.
We will continue our

100

90

In addition to the direct risk of injury and death, disasters also

efforts to produce results that will be useful to the people ofquickly, and become self-reliant. Iwanuma City was able to achieve thePillars and memorabilia from houses that were washed away were also

destroy houses, farmlands, and factories. This causes damage to jobs

75
Iwanuma City
and generate helpful evidence for global

fastest mass relocation among the affected areas. We did not apply aused. We became a top runner in the reconstruction process since we50
and the economy. Residential relocation andmigration also change

communities.60

lottery when transferring people from evacuation shelters to temporaryplan
I formulatedW
Aa recoveryNU early
M andAworked to implement it. Manysocial relationships. From the viewpoint of25 social determinants of

We look forward to your continued support and encouragement.

housing and group relocation. Each community was relocatedP

individually because we wanted to protect the bonds between

communicated with the assistance of teachers. There are many lessons

residents. The decision on what kind of town to build was made at a

to be learned that will guide us in the "Era of Disasters."

75

38.5-95.5%
health, these changes in the physical and social environmentare0

believed to have a signiﬁcant impact on health. Comparison between primary school
districts and municipalities

29
5of village representatives, including women and young
Conclusions ofmeeting
Iwanuma
Project 2021.6

45

18

19

20

Social capital (Mutual aid)

21

R

O

J

E

C

T

results were announced from the Iwanuma Project, which we

6Essay34 6-year followup study of the health impacts of residential relocation

Iwanuma Project

OutlineIwanuma ProjectLong-term Impact

Group relocation to disaster relief housing increases the risk of obesity and depression* p < 0.01

1.60*
M E S1.50S
A G E

1.40

M E S S A G E

Regression Coefﬁcient

1.20
1.00

P

0.80

P

0.79*

0.60
0.40

F

I

L

E

Relocating topermanent housing

BMI

F

I

L

E

TSUNEAKI IGUCHIIs a Core Member of the Japan Gerontological Evaluation
Study. Since 2020, Dr. Aida has-0.10
worked as a Professor in the Department of Oral Health Promotion, Graduate School of Medical
Relocating
disaster and Dental
Relocating
to Tokyo, Japan, and Professor in theand Dental Sciences,
Tokyo toMedical
University,
housing Liaisonpermanent
Regional Community relief
Development,
Center forhousing
Innovative Dentistry, Graduate School of
Dentistry, Tohoku University (Cross-Appointment,
Depression until May 2021). He has specialized in social
epidemiology and dental public health.

-0.20

O

Former Mayor of Iwanuma City

JUN AIDA

0.00

Relocating to disaster
relief housing

O

Professor, Tokyo Medical and Dental University

0.19

0.20

R

R

Graduated from Miyagi University of Education, worked in a tutoring school, and was elected to
the Iwanuma City Council at the age of 25. He served as the Chairman of the Iwanuma City
Social Welfare Council for seven consecutive terms. After serving as Council Chairman, he waselected mayor, and served four terms for 16 years. During this time, he also served as the Vice
President of the Japan Association of City Mayors. Mr. Iguchi was awarded Order of the RisingSun, Gold Rays with Neck Ribbon for his distinguished service to local government. Currently,
he is a Visiting Professor at the Tohoku Fukushi University, an Interim Member of the Social
Security Council, and Director of the Millennium Hope Hills Association.

Hikichi H, Aida J, Kondo K, Kawachi I. Six-year follow-up study of residential displacement and health outcomes following the 2011 Japan Earthquake andtsunami. Proc Natl Acad Sci U S A. 2021 Jan 12;118(2): e2014226118. doi: 10.1073/pnas.2014226118.

Studies examining the long-term health consequences of residential displacement following large-scale disasters remain sparse. Following the 2011 Japan Earthquake and Tsunami, victims who lost theirhomes were resettled by two primary means: 1) group relocation to public housing or 2) individual relocation, in which victims moved into public housing by lottery or arranged for their own
accommodation. Little is known about how the speciﬁc method of residential relocation affects survivors’ health. We examined the association between residential relocation and long-term changes inmental and physical well-being. Our baseline assessment predated the disaster by 7 months. Two follow-up surveys were conducted approximately 2.5 and 5.5 years after the disaster to ascertain thelong-term association between housing arrangement and health status. Group relocation was associated with increased body mass index and depressive symptoms at 2.5-year follow-up but was no longer
signiﬁcantly associated with these outcomes at 5.5-year follow-up. Individual relocation at each follow-up survey was associated with lower instrumental activities of daily living as well as a higher risk ofcognitive impairment. Our ﬁndings underscore the potential complexity of long-term outcomes associated with residential displacement, indicating both positive and negative impacts on mental versus
physical dimensions of health.

We would like to connect the value of the preearthquake data with internationally useful evidence.

Many results of the Iwanuma Project provide lessons
that will guide us in the "Era of Disasters."

The Iwanuma Project started in 2007 when the Iwanuma City Care

After taking up the post of Mayor, I established the goal of "Building a

The factors that contribute to protecting the health of disastersurvivors and promoting
their recovery are not clear.
Development of disaster
preparedness
and Community Oral Health, Graduate School of Dentistry, Tohoku
Most disaster research has been conducted after disasters have"visualization" system
and Welfare Division, together with the Department of International

JAGES HEART 2019

University, jointly implemented a model project for preventive care,occurred. Few studies have used data on pre-disaster conditions. As

JAGES built a "visualization" system for regional analysis using health and lifestyle survey data.
a result, the Iwanuma Project has been recognized in Japan and the
The name of the system is "Community-based Management Support System (JAGES HEART)."“Healthy and Happy City." As part of this effort, we conducted a healthpeople. We were able to establish commercial facilities necessary for

The
Iwanuma
Project compareddataobtained
beforethecommunities
disaster withthat
and lifestyle survey for all people over the age of 65
under
the guidance
daily life
becausethe six
affected
wererelocated enafterwards
gain several insights
to answer
questionof thehowdevelopment
much of theof Professors Ken Osaka and Jun Aida obtainedof Tohoku University.
Seventomonths
masse toanda single
location. theWe alsopromoted

led by Professor Ken Osaka, under whom I worked with his

reductionofIwanuma
social capitala major natural
disasteraffects
health.
later, the Great East Japan Earthquakethe
struck
48% of theCity due toMillenium
Hope Hills,
which wasnamedpeoples'
as a symbolof reconstruction.

department at the time.

US as a valuable source of pre-earthquake data. Therefore, we have
It performs visualizations like those given below
The JAGES 2010 survey was conducted before the earthquake, which
received funding to continue research related to health andParticipants in disaster andWhich regions are
The more social capital a community has,became thevulnerable
baseline fortothe
Iwanuma Project, and follow-up
surveysdisasters. This projectis being
conducted
the cooperation of
emergency
drills (%)
disasters?
the moreprepared
it is forwith
disasterarea, claiming many victims. There were no other surveys with data on the

Many people throughout Japan participated in a tree-planting

health status of older adults and people’ s connections before theceremony featuring broad-leaved trees, used as symbols for adisaster. The Iwanuma Project was created based on these data.

torch-relay course for the Reconstruction Olympics. The forest on thehave continued every three years.

In the process of reconstruction, we decided to protect lives, work

hill will serve as a breakwater in addition to the concrete embankment.

Percentage of participants in
disaster and emergency drills

Coefﬁcient
0.4924citizens and theCorrelation
Iwanuma
local: government.
We will continue our

100

90

In addition to the direct risk of injury and death, disasters also

efforts to produce results that will be useful to the people ofquickly, and become self-reliant. Iwanuma City was able to achieve thePillars and memorabilia from houses that were washed away were also

destroy houses, farmlands, and factories. This causes damage to jobs

75
Iwanuma City
and generate helpful evidence for global

fastest mass relocation among the affected areas. We did not apply aused. We became a top runner in the reconstruction process since we50
and the economy. Residential relocation andmigration also change

communities.60

lottery when transferring people from evacuation shelters to temporaryplan
I formulatedW
Aa recoveryNU early
M andAworked to implement it. Manysocial relationships. From the viewpoint of25 social determinants of

We look forward to your continued support and encouragement.

housing and group relocation. Each community was relocatedP

individually because we wanted to protect the bonds between

communicated with the assistance of teachers. There are many lessons

residents. The decision on what kind of town to build was made at a

to be learned that will guide us in the "Era of Disasters."

75

38.5-95.5%
health, these changes in the physical and social environmentare0

believed to have a signiﬁcant impact on health. Comparison between primary school
districts and municipalities

29
5of village representatives, including women and young
Conclusions ofmeeting
Iwanuma
Project 2021.6

45

18

19

20

Social capital (Mutual aid)

21

R

O

J

E

C

T

results were announced from the Iwanuma Project, which we

6Outline
Essay

This project was possible due to the existenceof data from a survey of all older adults conductedseven months before the earthquake
-50

-25

0

25

50

-10

-5

0

5

-20

0

20

40

Marumori
Town

32

govts.

It was possible to create a system to obtain accurate follow-up surveys and information in cooperation with Iwanuma City.

Long Follow-up Period

Risk ratio (95% conﬁdence interval)

Most of the previous research on earthquakes was completed within a few years after the earthquake; in this project, wewere able to analyze survey results with a long follow-up period of approximately eight and a half years after the earthquake.
1.21 (0.85,1.60)

Unadjusted bias

Impact on Older Adults

Few previous studies have examined the impact of earthquakes
on older adults; however, this project was able to shed lighton (0.96,1.68)
this topic
1.34

Bias adjustment
method 1

Bias adjustment
method 3

2.00 (1.21,2.87)

Previous Research
Risk ratio

Cross-sectional

0.5Time ﬂow
1.0

1.5

2.0

2.5

3.0

With data

3.11
Shiba K, Kawahara T, Aida J, Kondo K, Kondo N, James P,No
Arcayaprevious
M, Kawachi I: Causal
inference in studying the long-term health effects of disasters: Challenges
data
and potential solutions. Am J Epidemiol. 2021 Mar 17. doi:10.1093/aje/kwab064.
Great East Japan
LongitudinalWith data
Earthquake

The people who lost their homes had atwice as high risk of depressive symptoms
in 2016
Note: Bias adjustment method three assess the health effects of losing
one's house among a subset of the affected population (people who
would have participated in the survey 5.5 years later, regardless of whether
they had lost their homes).

Natural Experiment
27
7

ed

ici
n

Jo
b

ec

are

los
s

us
m

De

ic
s

str
oy

M
e:
ag

tat

ed

r
ajo

r
in
o
M
e:
ag

na

in
in
t

ion

us

ub

jec

in
g

tiv

er

m

ee

co

lm

no

e:

ag

m

da

in
g

da

pt
ru
ter

govts.

Interviews withpublic health nurses
and othergovts.

PTSS (n=106)

No PTSS (n=147)

PTSS (n=109)

No PTSS (n=1,913)

TrajectoryGroupsPersistent

Recovered (ref)DelayedNever (ref)2010

Depression (n=504)

No Depression (n=1,231)

Great East Japan Earthquake

High social capital
Low social capital(Event behind decline of health)
2013

2016

JAGES
2010
TrajectoryGroupsDepression (n=338)

No Depression (n=166)

Depression (n=258)

No Depression (n=80)

Persistent

Recovered

Depression (n=63)

JAGES
Persistent
2013

Risk of persistenceWith data

Several studies reported that trauma caused by disasters has long-term negative effects on health. However, analyzing data acquired after an earthquake using conventional statistical methods can lead tobias and underestimation. We therefore used follow-up data from about 4,800 survivors of the Great East Japan earthquake to compare the differences in the estimated long-term effects of disaster-related
home loss on health. The results showed the link between the traumatic experience of the disaster and subsequent health problems was likely underestimated. For instance, they demonstrated that people
who experienced home loss (versus no home loss) had a two times higher risk of depressive symptoms ﬁve and a half years after the earthquake. The result indicates that negative effects do not diminish indataWith data
the long-term; thus, continued healthExistingsupports forprevious
survivors is necessary.

This Study

govts.

2016

Conventional analytical methods do notappear to link loss of housing anddepressive symptoms.

While previous research on earthquakes mostly focused on mental health, this project was able to analyze the effects of the disaster(0.70,1.69)
on physical functioning, cognitive deterioration, and social1.21
participationof the older population in particular.

(Questionnaire)

Veriﬁcation of Hypothesis 2

Health Status/ Function

Impacton Physical Function
Bias adjustment
and Social
Participation
method2

JAGES2019(Questionnaire)・ Iwanuma
・ Iwanuma
・ Iwanuma
・ Iwanuma
Unemployment and deterioration of ﬁnancial status
due to the earthquake affect persistent and delayed onset PTSS
Earthquake-related
・
・
・
・
items
(Extent of damage, etc.)
・・・・
Follow up
Follow up
Follow up
PTSS(n=253)No
PTSS(n=2,022)
2013
・(Longitudinal ・(Longitudinal ・Cross-sectional (Longitudinal ・Study)
Study)
Analysis・Other local
・Other local
・Other local Study)
・Other local

Existenceof Survey
Dataimpacts of an
Information
on disastervictimssurveyed
beforethe earthquake
The long-term
healthearthquake
may
have
been
underestimated(n=4,857)

JAGES2016(Questionnaire)

In August 2010, seven months before the Great East Japan Earthquake, the Japan Gerontological Evaluation Study (JAGES) conducted a survey ofall older adults in Iwanuma City.
The survey included data on social capital and health, which made it possible to compare situations before and after the disaster, providing new
betweena traumatic
Long-term Impact
insightsLong-term
into the causalrelationshiprelationship betweensocial capitaland health.experience and health

Analysis Methodus

Research design for JAGES and Iwanuma Project
Kino S, Aida J, Kondo K, Kawachi I: Persistent mental healthimpacts of disaster. Five-year follow-up after the 2011 Great East Japan Earthquake and tsunami: Iwanuma Study. J
JAGES2010
JAGES2013
Psychiatr Res. 2021 Apr; 136:452-459. doi: 10.1016/j.jpsychires.2020.08.016. Epub 2020 Aug 23.
(Questionnaire)
Iwanuma Project

Shiba K, Hanazato M, Aida J, Kondo K, Arcaya M, James P, Kawachi I: Cardiometabolic proﬁles and change in neighborhood food and built environment among older adults: A natural experiment.
Epidemiology. 2020 Nov;31(6):758-767. doi:10.1097/EDE.0000000000001243.

Survey System

ted

In

Yamamoto
Town

NonDisplacedinsShichikashuku
Town

Dr
op

200 companies in the industrial park

Longitudinal Study and Interview Survey
Ho

Displaced

Ho● Extensive damage to agricultural lands and

0.0

m

Whole

● Severe land subsidence / 8% of city area below sea level

Kino et al. (2021) explored a lingering inﬂuence of persistence ordelayed onsets of mental health problems after 5.5 years. They
found that job loss was associated with persistent post-traumaticstress symptoms (PTSS) while a drop in subjective economic status
predicted delayed onset of PTSS. In addition, depressive symptoms
pre-dating the disaster was a strong predictor of persistent anddelayed onset PTSS.
Worsening economic situation due to the disaster rather than theuncontrollable disaster experience itself affects post-traumatic
symptoms, suggesting that chronic mental health problems after
the disaster would be addressable by economic support.

1.0

da

LDL (mg/dL)● Approximately 5400 homes damaged(ADL/IADL) after the disaster (2013, 2016, 2019).

aff
ec

1.0

e:

0.5

in
g

0.0

us

● Six coastal Triglycerides
villages destroyed,
187 dead/missing(mg/dL)HDL (mg/dL)

-0.5

Ho

-1.0

nd

-1.5

ag

5

m

0

da

-5

ily
/fr
ie

-10

in
g

10

led to good health (ADL/IADL) two and a half

2.0

us

0

access to3.0medical care, etc.), the worse the health status

Ho

-10

Delayed(e.g., loss of family and friends, damage to house, reduceds(Largest affected municipalities)-20

Persistent
Recovered in 2016

Higher social Delayed
capitalPTSS
before the earthquake
Never in 2013 or 2016

4.0

om

● Over ~48% of the city area ﬂooded by the tsunami

The more5.0 severe the damage caused by the disasterff
am

Displaced

Hypothesis 2Persistent PTSS

6.0

pt

Iwanumadamage assessment
Non-

7.0

Hypothesis 1
Odds ratio

Displaced

Minamisanriku
Tomehomes
City to theSome people who lost theirtsunami in
Waist Circumference(cm) Osaki City
Town
the coastal areas of Iwanuma were ﬁrst displaced totemporary housing, and then moved to public
Kami Town
permanent housing approximately 4 km further away
Wakuyafrom the temporary
housing. Shiba et al. (2020) foundTown
Shikamathat moving from a place far from supermarkets,
Town
Ishinomaki City
Ohira restaurants, and pachinko parlors to a place near those
Villagedestinations worsened the risks of metabolic
Onagawa Town
Osato
syndrome.
HigashiTaiwa Town
Town
Matsushima
The JAGES
analyzedMatsushima
survey
data
from
2010,
2013, andCity
Town
2016 of older
adults in Iwanuma, which was linked
TomiyaCitywith the results of health check-up records. The
Rifu
Izumi Ward
City
Town Shiogamabetween
relationships
environmental changes
Aoba Ward-50Shichigahama
Tagajo City withassociatedmovingTown
and cardiometabolic proﬁlesSendai City
Taihaku Ward
wereMiyagino
examined.
Ward Residential areas were rated on ascale of "high," "medium," and "low" based on the
Wakabayashi
Type of neighborhood /density
Ward of shops and other factors. Moving from "low"Kawasaki
Town
walkability
to "high" was associated with worse cardiometabolic
Natori City
proﬁles: BMI increased by 0.46, waist circumference
Low (Reference
Value)
Murataincreased by 1.8 cm, LDL cholesterol increased, andMedium Town
Zao Town
Shibatathere
was a decreaseCity
in HDL cholesterol. BMI increased
IwanumaHigh
Town
only for females. Thus, the effects of efforts to maintain
OgawaraTown
Watari the health of survivors, such as promoting physicalBoth genders
Town
activities, may be cancelled out by the adverse effect of
KakudaShiroishi
Male
City
City
environmental changes associated with relocation.
FemaleLong-term Impact

Didsocialcapitalhave
an post-traumatic
impact onstressthesymptoms
functional deterioration and recovery
Predictorsof persistentversusdelayedof older adults after the Great East Japan Earthquake?

ym

Located approximately 17.6 km south of Sendai, Miyagi Prefecture, the city’ s
Systolic(mmHg)coast andDiastolic
Pressure (mmHg)
BMI (kg/m2)Sendai
eastern borderis Pressure
the Paciﬁcthe westernborder is mountainous.
AirportWholewas established, followed by the development of an adjacent industrial
area. Population of approximately 44,000 / area of approximately 60km2.

Kurihara City

Lo
ss
o

Correlation between
neighborhood
environment
Iwanumalocationandterrainand lifestyle-related diseases

es

Kesennuma
City

Predictors of persistent mental health problems 6 years after disaster
33Research
Designpressiv

Long-term Impact

De

Relocation linked with increased cardiometabolic risks
31Description

Iwanuma Project

Depression (n=168)

Depression (n=83)

JAGES
Recovered

JAGES
Persistent
2019

2016

No Depression (n=1,063)

All older adults (65 years old and over)living in Iwanuma City.

No Depression (n=103)

Risk of ﬂuctuation

TargetNo Depression (n=85)

Method 1

Depression (n=101)

No Depression (n=962)

Postal distribution and on-site collection of the JAGES

questionnaire (including
Recovered
Delayedearthquake-related
Never items,

Iwanuma City version) for 5,058 respondents of the

JAGES 2010 after Risk
the ofearthquake(2013,
2016, 2019)
Risk of symptoms persisting
delayed onsetof symptoms

Comparison of health pre- and post-earthquake

Method 2

Few studies have tracked the long-term mental health outcomes following major disasters. Therefore, they sought to document the trajectories of depressive symptoms and PTSS in the aftermath of theInterview2.5withpublichealthnurses,localhalf
welfareofﬁcers,
2011 Great East Japan earthquake and tsunami. Among people without pre-disaster depressive symptoms, 13.6% had developed depressive symptoms
years
after thedisaster.
Of these,of those
had recovered and half had persisted at the 5.5-year follow-up. Exactly 11.1% of survivors reported PTSS in 2013; of these, 58% recovered by 2016, while 4.8% experienced delayed onset.
Council of Social Welfare staff, residents, etc.
The experience of job loss and drop in subjective economic status appeared to exert a lingering inﬂuence on the persistence or delayed onset of PTSS.

2010

2011
3.11

2013

2016

2019
28
8

Outline
Essay

This project was possible due to the existenceof data from a survey of all older adults conductedseven months before the earthquake
-50

-25

0

25

50

-10

-5

0

5

-20

0

20

40

Marumori
Town

32

govts.

It was possible to create a system to obtain accurate follow-up surveys and information in cooperation with Iwanuma City.

Long Follow-up Period

Risk ratio (95% conﬁdence interval)

Most of the previous research on earthquakes was completed within a few years after the earthquake; in this project, wewere able to analyze survey results with a long follow-up period of approximately eight and a half years after the earthquake.
1.21 (0.85,1.60)

Unadjusted bias

Impact on Older Adults

Few previous studies have examined the impact of earthquakes
on older adults; however, this project was able to shed lighton (0.96,1.68)
this topic
1.34

Bias adjustment
method 1

Bias adjustment
method 3

2.00 (1.21,2.87)

Previous Research
Risk ratio

Cross-sectional

0.5Time ﬂow
1.0

1.5

2.0

2.5

3.0

With data

3.11
Shiba K, Kawahara T, Aida J, Kondo K, Kondo N, James P,No
Arcayaprevious
M, Kawachi I: Causal
inference in studying the long-term health effects of disasters: Challenges
data
and potential solutions. Am J Epidemiol. 2021 Mar 17. doi:10.1093/aje/kwab064.
Great East Japan
LongitudinalWith data
Earthquake

The people who lost their homes had atwice as high risk of depressive symptoms
in 2016
Note: Bias adjustment method three assess the health effects of losing
one's house among a subset of the affected population (people who
would have participated in the survey 5.5 years later, regardless of whether
they had lost their homes).

Natural Experiment
27
7

ed

ici
n

Jo
b

ec

are

los
s

us
m

De

ic
s

str
oy

M
e:
ag

tat

ed

r
ajo

r
in
o
M
e:
ag

na

in
in
t

ion

us

ub

jec

in
g

tiv

er

m

ee

co

lm

no

e:

ag

m

da

in
g

da

pt
ru
ter

govts.

Interviews withpublic health nurses
and othergovts.

PTSS (n=106)

No PTSS (n=147)

PTSS (n=109)

No PTSS (n=1,913)

TrajectoryGroupsPersistent

Recovered (ref)DelayedNever (ref)2010

No Depression (n=1,231)

Depression (n=504)

Great East Japan Earthquake

High social capital
Low social capital(Event behind decline of health)
2013

2016

JAGES
2010
TrajectoryGroupsNo Depression (n=166)

Depression (n=338)

Depression (n=258)

No Depression (n=80)

Persistent

Recovered

Depression (n=63)

JAGES
Persistent
2013

Risk of persistenceWith data

Several studies reported that trauma caused by disasters has long-term negative effects on health. However, analyzing data acquired after an earthquake using conventional statistical methods can lead tobias and underestimation. We therefore used follow-up data from about 4,800 survivors of the Great East Japan earthquake to compare the differences in the estimated long-term effects of disaster-related
home loss on health. The results showed the link between the traumatic experience of the disaster and subsequent health problems was likely underestimated. For instance, they demonstrated that people
who experienced home loss (versus no home loss) had a two times higher risk of depressive symptoms ﬁve and a half years after the earthquake. The result indicates that negative effects do not diminish indataWith data
the long-term; thus, continued healthExistingsupports forprevious
survivors is necessary.

This Study

govts.

2016

Conventional analytical methods do notappear to link loss of housing anddepressive symptoms.

While previous research on earthquakes mostly focused on mental health, this project was able to analyze the effects of the disaster(0.70,1.69)
on physical functioning, cognitive deterioration, and social1.21
participationof the older population in particular.

(Questionnaire)

Veriﬁcation of Hypothesis 2

Health Status/ Function

Impacton Physical Function
Bias adjustment
and Social
Participation
method2

JAGES2019(Questionnaire)・ Iwanuma
・ Iwanuma
・ Iwanuma
・ Iwanuma
Unemployment and deterioration of ﬁnancial status
due to the earthquake affect persistent and delayed onset PTSS
Earthquake-related
・
・
・
・
items
(Extent of damage, etc.)
・・・・
Follow up
Follow up
Follow up
PTSS(n=253)No
PTSS(n=2,022)
2013
・(Longitudinal ・(Longitudinal ・Cross-sectional (Longitudinal ・Study)
Study)
Analysis・Other local
・Other local
・Other local Study)
・Other local

Existenceof Survey
Dataimpacts of an
Information
on disastervictimssurveyed
beforethe earthquake
The long-term
healthearthquake
may
have
been
underestimated(n=4,857)

JAGES2016(Questionnaire)

In August 2010, seven months before the Great East Japan Earthquake, the Japan Gerontological Evaluation Study (JAGES) conducted a survey ofall older adults in Iwanuma City.
The survey included data on social capital and health, which made it possible to compare situations before and after the disaster, providing new
betweena traumatic
Long-term Impact
insightsLong-term
into the causalrelationshiprelationship betweensocial capitaland health.experience and health

Analysis Methodus

Research design for JAGES and Iwanuma Project
Kino S, Aida J, Kondo K, Kawachi I: Persistent mental healthimpacts of disaster. Five-year follow-up after the 2011 Great East Japan Earthquake and tsunami: Iwanuma Study. J
JAGES2010
JAGES2013
Psychiatr Res. 2021 Apr; 136:452-459. doi: 10.1016/j.jpsychires.2020.08.016. Epub 2020 Aug 23.
(Questionnaire)
Iwanuma Project

Shiba K, Hanazato M, Aida J, Kondo K, Arcaya M, James P, Kawachi I: Cardiometabolic proﬁles and change in neighborhood food and built environment among older adults: A natural experiment.
Epidemiology. 2020 Nov;31(6):758-767. doi:10.1097/EDE.0000000000001243.

Survey System

ted

In

Yamamoto
Town

NonDisplacedinsShichikashuku
Town

Dr
op

200 companies in the industrial park

Longitudinal Study and Interview Survey
Ho

Displaced

Ho● Extensive damage to agricultural lands and

0.0

m

Whole

● Severe land subsidence / 8% of city area below sea level

Kino et al. (2021) explored a lingering inﬂuence of persistence ordelayed onsets of mental health problems after 5.5 years. They
found that job loss was associated with persistent post-traumaticstress symptoms (PTSS) while a drop in subjective economic status
predicted delayed onset of PTSS. In addition, depressive symptoms
pre-dating the disaster was a strong predictor of persistent anddelayed onset PTSS.
Worsening economic situation due to the disaster rather than theuncontrollable disaster experience itself affects post-traumatic
symptoms, suggesting that chronic mental health problems after
the disaster would be addressable by economic support.

1.0

da

LDL (mg/dL)● Approximately 5400 homes damaged(ADL/IADL) after the disaster (2013, 2016, 2019).

aff
ec

1.0

e:

0.5

in
g

0.0

us

● Six coastal Triglycerides
villages destroyed,
187 dead/missing(mg/dL)HDL (mg/dL)

-0.5

Ho

-1.0

nd

-1.5

ag

5

m

0

da

-5

ily
/fr
ie

-10

in
g

10

led to good health (ADL/IADL) two and a half

2.0

us

0

access to3.0medical care, etc.), the worse the health status

Ho

-10

Delayed(e.g., loss of family and friends, damage to house, reduceds(Largest affected municipalities)-20

Persistent
Recovered in 2016

Higher social Delayed
capitalPTSS
before the earthquake
Never in 2013 or 2016

4.0

om

● Over ~48% of the city area ﬂooded by the tsunami

The more5.0 severe the damage caused by the disasterff
am

Displaced

Hypothesis 2Persistent PTSS

6.0

pt

Iwanumadamage assessment
Non-

7.0

Hypothesis 1
Odds ratio

Displaced

Minamisanriku
Tomehomes
City to theSome people who lost theirtsunami in
Waist Circumference(cm) Osaki City
Town
the coastal areas of Iwanuma were ﬁrst displaced totemporary housing, and then moved to public
Kami Town
permanent housing approximately 4 km further away
Wakuyafrom the temporary
housing. Shiba et al. (2020) foundTown
Shikamathat moving from a place far from supermarkets,
Town
Ishinomaki City
Ohira restaurants, and pachinko parlors to a place near those
Villagedestinations worsened the risks of metabolic
Onagawa Town
Osato
syndrome.
HigashiTaiwa Town
Town
Matsushima
The JAGES
analyzedMatsushima
survey
data
from
2010,
2013, andCity
Town
2016 of older
adults in Iwanuma, which was linked
TomiyaCitywith the results of health check-up records. The
Rifu
Izumi Ward
City
Town Shiogamabetween
relationships
environmental changes
Aoba Ward-50Shichigahama
Tagajo City withassociatedmovingTown
and cardiometabolic proﬁlesSendai City
Taihaku Ward
wereMiyagino
examined.
Ward Residential areas were rated on ascale of "high," "medium," and "low" based on the
Wakabayashi
Type of neighborhood /density
Ward of shops and other factors. Moving from "low"Kawasaki
Town
walkability
to "high" was associated with worse cardiometabolic
Natori City
proﬁles: BMI increased by 0.46, waist circumference
Low (Reference
Value)
Murataincreased by 1.8 cm, LDL cholesterol increased, andMedium Town
Zao Town
Shibatathere
was a decreaseCity
in HDL cholesterol. BMI increased
IwanumaHigh
Town
only for females. Thus, the effects of efforts to maintain
OgawaraTown
Watari the health of survivors, such as promoting physicalBoth genders
Town
activities, may be cancelled out by the adverse effect of
KakudaShiroishi
Male
City
City
environmental changes associated with relocation.
FemaleLong-term Impact

Didsocialcapitalhave
an post-traumatic
impact onstressthesymptoms
functional deterioration and recovery
Predictorsof persistentversusdelayedof older adults after the Great East Japan Earthquake?

ym

Located approximately 17.6 km south of Sendai, Miyagi Prefecture, the city’ s
Systolic(mmHg)coast andDiastolic
Pressure (mmHg)
BMI (kg/m2)Sendai
eastern borderis Pressure
the Paciﬁcthe westernborder is mountainous.
AirportWholewas established, followed by the development of an adjacent industrial
area. Population of approximately 44,000 / area of approximately 60km2.

Kurihara City

Lo
ss
o

Correlation between
neighborhood
environment
Iwanumalocationandterrainand lifestyle-related diseases

es

Kesennuma
City

Predictors of persistent mental health problems 6 years after disaster
33Research
Designpressiv

Long-term Impact

De

Relocation linked with increased cardiometabolic risks
31Description

Iwanuma Project

Depression (n=168)

Depression (n=83)

JAGES
Recovered

JAGES
Persistent
2019

2016

No Depression (n=1,063)

All older adults (65 years old and over)living in Iwanuma City.

No Depression (n=103)

Risk of ﬂuctuation

TargetNo Depression (n=85)

Method 1

Depression (n=101)

No Depression (n=962)

Postal distribution and on-site collection of the JAGES

questionnaire (including
Recovered
Delayedearthquake-related
Never items,

Iwanuma City version) for 5,058 respondents of the

JAGES 2010 after Risk
the ofearthquake(2013,
2016, 2019)
Risk of symptoms persisting
delayed onsetof symptoms

Comparison of health pre- and post-earthquake

Method 2

Few studies have tracked the long-term mental health outcomes following major disasters. Therefore, they sought to document the trajectories of depressive symptoms and PTSS in the aftermath of theInterview2.5withpublichealthnurses,localhalf
welfareofﬁcers,
2011 Great East Japan earthquake and tsunami. Among people without pre-disaster depressive symptoms, 13.6% had developed depressive symptoms
years
after thedisaster.
Of these,of those
had recovered and half had persisted at the 5.5-year follow-up. Exactly 11.1% of survivors reported PTSS in 2013; of these, 58% recovered by 2016, while 4.8% experienced delayed onset.
Council of Social Welfare staff, residents, etc.
The experience of job loss and drop in subjective economic status appeared to exert a lingering inﬂuence on the persistence or delayed onset of PTSS.

2010

2011
3.11

2013

2016

2019
28
8

Essay28 Risk of increased BMI due to relocation to temporary housing
W

A

N

U

M

A

EmpiricalPevidenceonproperty damage/relocation to temporary housing and increased BMIR
O theJrelationshipE
C between
T
BMI ( kg/m2)

LDL cholesterol (mg/dL)

30 Long-term trends in mental health after disaster
Published Papers [ I n d e x ]Total effects

Pre- and Post-Earthquake

9.73(100%)

Social support before the earthquake reduced the risk of•Social support before the earthquake reduced the risk of developing depressive symptoms by 30%

Unexpected higher risk of PTSD among people who did not•Post-traumatic stress disorder (PTSD) after the earthquake became more pronounced in those
who did not experience adverse childhood experiences
No PTSS (n=2,022)

2 developing depressive symptoms by 30%
3 experience early life adversity

2013

0.65
(100%)

PTSS (n=253)•Relationship between pre-disaster community social ties, disaster experiences, and the risk ofdeveloping PTSD

Pre-disaster community social ties prevent incident

4 posttraumatic stress disorder (PTSD)

Bonding, bridging and linking social capital –20165 Qualitative study
PTSSof(n=106)
public health nurses

Total effects

Long-term Impact

have5.5
feweryears
depressive
and post-traumaticstress symptoms after a disasterare more resilient
after
the earthquake
1 Optimists
Trajectoriesof post-traumaticstresssymptoms
and depression,•Optimists
2.5 andafter
the disaster

Pre-EarthquakeI

Post-earthquake

Iwanuma Project

No PTSS (n=147)

6 Maintaining social ties through group relocation•Clarifying human connections among public health nurses, external organizations, and disaster
PTSS (n=109)
No PTSS (n=1,913)
survivor groups•The relationship between methods of relocation and social ties

Persistent symptoms (n = 106) 4.7%
Recovery (n = 147) 6.5%
Delayed onset (n = 109) 4.8%
No onset (n = 1,913) 84.1%•People facing ﬁnancial hardship after a disaster had up to 1.47 times higher risk of sleep disordersof sleep problems in disaster survivors
7 Predictors

Transition of PTSS

0.47
(72.6%)

Effects explainedby moving totemporary housing

1.47(15.1%)

Effects explainedby moving totemporary housing

0.25

0.50

0.75

1.00

0

Changes from 2010 to 2013

10

2013

Iwanuma Project

After the Great East Japan Earthquake in 2011, there was an increased risk of metabolic syndrome in people who experienced property damage; however, the underlying mechanism was unclear. Shiba etal. (2020) analyzed pre- and post-disaster (2010 and 2013) data from approximately 1,165 older survivors aged 65 years and over affected by the Great East Japan Earthquake and demonstrated that 72.6%of the effect on worsening BMI was mediated by property damage and relocation to temporary housing. Potential explanations include changes in the neighborhood environment, such as the proximity torestaurants or the difﬁculty of cooking in the new living environment; however, further research is needed to determine if there is a link between moving to temporary housing and increased BMI.

Published Papers 2021.6

The Iwanuma Project focuses on the impacts of social capital – both preceding theDepression (n=258)

No Depression (n=80)

Depression (n=63)•In areas with high social participation, the negative health impact of housing damage was reduced
No Depression (n=103)
Depression (n=83) No Depression (n=85)
Depression (n=101) No Depression (n=962)•Survivors who underwent group allocation to temporary housing were signiﬁcantly more likely toreport receiving social support than those who underwent lottery allocation

Positive effects on mental health of group relocation into
14 temporary housing•Increasing levels of symptoms of dementia depending on the severity of damage to housing
article: Disaster resilience in older populations
Transition
15of ReviewPersistent
symptoms (n = 404) 23.3%
Recovery (n = 268) 15.4%
Delayed onset (n = 101) 5.8%
No onset (n = 962) 55.4%
depressive symptoms•Relationship between changes in neighborhood relationships and the degree of severity ofSocializing with neighbors post-earthquake reduces
16 depressive symptoms
depressive symptoms

Kino S, Aida J, Kondo K, Kawachi I: Long-term trends in mental health disorders after the 2011 Great East

Japan Earthquake and tsunami. JAMA Netw Open. 2020 Aug 3;3(8): e2013437.
•Changes in community relations(trust) among nonrelocated Iwanuma City residents
doi:10.1001/jamanetworkopen.2020.13437.

•People severely affected by the earthquake were more likely to lose their teeth
18 after disaster
Severe emotional
trauma, such as the loss of a relative or damage to one's home in a disaster, can lead to post-traumatic stress symptoms (PTSS), such as sudden ﬂashes of painful memories, anddepression. Kinoetal.
(2020)
analyzedtheresults
of
the
JAGES
surveysofolder
adultsin
IwanumaCity
in 2010, 2013,
andsupport
2016 toexaminethe long-termof doesthe disasteron mental
health;in13.6% of•Decreasein socialandsocial capital
after theeffects
disaster
not explain
the increase
Decreased social capital does not explain post-disaster19hadincreased
people who
no depressive
symptoms before
the disaster had depressive symptoms in 2013. By 2016,
50% of themhad recovered.
In contrast,
the number of people with PTSS was 11% of the total as ofdepressive
symptoms
among disastersurvivors
depressive
symptoms
2013. As of 2016, 60% had recovered, while 40% still had PTSS.

20 Predictors of worsened depressive symptoms after disaster
Access to medical care is key to preserving functional

21 independence•Relationship between disaster experiences and decline in functional independence

Residential relocation linked to increased obesity due toLong-term effects of total destruction of one’ s house on•Degree of property damage and changes in cardiometabolic proﬁles before and after theearthquake (2010–2013)

2435of depression

Relocation to prefabricated housing doubled the risk

•Odds ratios of depression according to type of post-disaster housing

25 Post-disaster mental health as a predictor of mortality•Post-disaster depressive symptoms, post-traumatic stress disorder (PTSD), and mortality rates

23 cardiometabolic risks

30

Housing damage is associated with increased cognitive

25

0.08
0.07
0.06
0.04

Hikichi H, Aida J, Kondo K, Kawachi I: Persistent impact of housing
loss on cognitive decline after the 2011 Great East Japan
Earthquake and tsunami: Evidence from a 6-year longitudinal
study. Alzheimers Dement. 2019 Aug;15(8):1009-1018. doi:
10.1016/j.jalz.2019.04.016. Epub 2019 Aug 1.

0.01
Depression

Rate of PrevalenceLong-Term Impact

Regression Coefﬁcient

26 disability
0.10*

Destroyed

Community social capital helps to preserve functional

13 independence in older survivors

2016(n=2,810)* p <.01 statistically signiﬁcant association withcognitive decline

0.12*

Major

Depression
No Depression (n=166)
Individual-levelsocial(n=338)
ties mitigate post-earthquake

22 symptoms
Individual
mental illness changed pre- and post-earthquake; however, prevalence in community did notchanged foodofenvironment

0.14

Minor

•Mortality risk during disaster is four times higher for those with depressive symptoms.
Post-disaster mortality risk reduced by about half through interaction with friends.
Depression (n=168)
No Depression (n=1,063)•Social ties mitigate the progression of dementia due to a disaster12 progression of cognitive disability

Post-Earthquake

Long-term Impact

Persistent impact of housing loss on cognitive disability 6 years after disaster

Affected

Depressive symptoms and higher mortality on the day ofWorsening ﬁnancial status increases risk of tooth loss

"Pre-Earthquake,""Pre- and loss
Post-Earthquake,""Post-Earthquake,""Long-term
impact of housing
on cognitive disability 6 yearsand
after
disasterEffects."
29 Persistent

0.00

No Depression(n=1,231) cognitive disability•Social ties mitigate the impact of disaster experienceson post-disaster

Relocation affects social relationships in areas receiving

We have classiﬁed the published papers into four phases of the disaster:

0.02

Community-level social capital mitigates progression of

17 displaced survivors

disaster and after the disaster – on the physical and mental health of survivors.

0.06•Relationships with changes in depressive symptoms pre- and post-disaster11 the disaster

Changes from 2010 to 2013

0.10

Physical activity helps to prevent depressive symptoms in

Depression (n=504)
10 cognitive disability after a disaster

Shiba K, Aida J, Kondo K, Nakagomi A, Arcaya M, James P, Kawachi I: Mediation of the relationship between home loss and worsened cardiometabolic proﬁles of older disaster survivors by post-disaster relocation: A natural experiment from the Great East Japan Earthquake and tsunami.
Health & Place. 2020 Nov 1; 66:102456. doi: 10.1016/j.healthplace.2020.102456.

0.12•Increased participation in exercise and hobby groups reduces depressive symptoms

9 older disaster survivors

2010
0.00

Increased participation in exercise and hobby groups help to

8 reduce depressive symptoms in disaster survivors

Increased risk of developing arthritis associated with

27 disaster trauma
20

28 Risk of increased BMI due to relocation to temporary housing
15Persistent impact of housing loss on cognitive disability

29 6 years after disaster•Association between severity of housing damage and increased cognitive disability score

Depressive symptoms
PTSS•Empirical evidence on the relationship between property damage/relocation to temporary
housing and increased BMI•Persistent impact of housing loss on cognitive disability 6 years after disaster10•Trajectories of post-traumatic stress symptoms and depression, 2.5 and 5.5 years after the disaster•Individual symptoms of mental illness changed pre- and post-earthquake; however, prevalence in community did not

5•Correlation between neighborhood environment and lifestyle-related diseases

30 Long-term trends in mental health after disaster
31 Relocation linked with increased cardiometabolic risksLong-term relationship between a traumatic experience

32 0and health
2010

2013

Predictors of persistent mental health problems 6 years

33 after disaster•The long-term health impacts of an earthquake may have been underestimated2016•Predictors of persistent versus delayed post-traumatic stress symptoms•Unemployment and deterioration of ﬁnancial status due to the earthquake affect persistent and delayed onset PTSS

6-year followup study of the health impacts of residential

We previously established that housing loss and residential dislocation in the 2011 Japan earthquake and tsunami was a risk factor for cognitive decline among older survivors. The present study extends
the follow-up of survivors to six years. The baseline for our natural experiment was established in a survey of older community-dwelling adults who lived 80 km west of the epicenter seven months before
the earthquake and tsunami. Two follow-up surveys were conducted approximately 2.5 and 5.5 years after the disaster to ascertain the housing status and cognitive decline from 2810 older individuals(follow-up rate through three surveys: 68.4%). The experience of housing loss was persistently associated with cognitive disability (coefﬁcient = 0.14, 95% conﬁdence interval: 0.04 to 0.23). Experiences of
housing loss continued to be signiﬁcantly associated with cognitive disability even six years after the disaster.

25•Group relocation to disaster relief housing increases the risk of obesity and depression
34 relocation
Post-traumatic stresssymptoms (PTSS) and depression are common among survivors of major disasters. However, few studies have followed participants over an extended period to identify the symptoms ofmental illness or to document the prevalence of mental illness symptoms in the community. In a study of 2,781 older adult survivors in Iwanuma City, about half of older adults who reported PTSS andPapers on5.5theyears
effects
pre-earthquake
health
Pre-Earthquake
Post-Earthquake
PaperstheHowever,effects offorpost-earthquake
factorsthe
on prevalence
health of depression was founddepression
had recovered
afterofthedisaster, whilefactors
about on
halfpost-earthquake
were still reporting
symptoms
more than ﬁve
years onlater.
the region as a whole,constant
between pre- andpost-disasterdata. Thissuggests
thatinthe
regionitselfhas thebe ﬂexible
and Papers
resilienton
inthe
the effects
face of ofadversity
difﬁculty."
Paperson the effectsof thechangesfactors
frombeforeto "capacity toLong-Term
Pre- and Post-Earthquake
Impactfactorsandon healthmore than 5.5 years after the earthquake

after the earthquake on post-earthquake health26

Essay28 Risk of increased BMI due to relocation to temporary housing
W

A

N

U

M

A

EmpiricalPevidenceonproperty damage/relocation to temporary housing and increased BMIR
O theJrelationshipE
C between
T
BMI ( kg/m2)

LDL cholesterol (mg/dL)

30 Long-term trends in mental health after disaster
Published Papers [ I n d e x ]Total effects

Pre- and Post-Earthquake

9.73(100%)

Social support before the earthquake reduced the risk of•Social support before the earthquake reduced the risk of developing depressive symptoms by 30%

Unexpected higher risk of PTSD among people who did not•Post-traumatic stress disorder (PTSD) after the earthquake became more pronounced in those
who did not experience adverse childhood experiences
No PTSS (n=2,022)

2 developing depressive symptoms by 30%
3 experience early life adversity

2013

0.65
(100%)

PTSS (n=253)•Relationship between pre-disaster community social ties, disaster experiences, and the risk ofdeveloping PTSD

Pre-disaster community social ties prevent incident

4 posttraumatic stress disorder (PTSD)

Bonding, bridging and linking social capital –20165 Qualitative study
PTSSof(n=106)
public health nurses

Total effects

Long-term Impact

have5.5
feweryears
depressive
and post-traumaticstress symptoms after a disasterare more resilient
after
the earthquake
1 Optimists
Trajectoriesof post-traumaticstresssymptoms
and depression,•Optimists
2.5 andafter
the disaster

Pre-EarthquakeI

Post-earthquake

Iwanuma Project

No PTSS (n=147)

6 Maintaining social ties through group relocation•Clarifying human connections among public health nurses, external organizations, and disaster
PTSS (n=109)
No PTSS (n=1,913)
survivor groups•The relationship between methods of relocation and social ties

Transition of PTSS

0.47
(72.6%)

Effects explainedby moving totemporary housing

1.47(15.1%)

Effects explainedby moving totemporary housing

Delayed onset (n = 109) 4.8%
No onset (n = 1,913) 84.1%
Persistent symptoms (n = 106) 4.7%
Recovery (n = 147) 6.5%
•People facing ﬁnancial hardship after a disaster had up to 1.47 times higher risk of sleep disordersof sleep problems in disaster survivors
7 Predictors

0.25

0.50

0.75

1.00

0

Changes from 2010 to 2013

10

2013

Iwanuma Project

After the Great East Japan Earthquake in 2011, there was an increased risk of metabolic syndrome in people who experienced property damage; however, the underlying mechanism was unclear. Shiba etal. (2020) analyzed pre- and post-disaster (2010 and 2013) data from approximately 1,165 older survivors aged 65 years and over affected by the Great East Japan Earthquake and demonstrated that 72.6%of the effect on worsening BMI was mediated by property damage and relocation to temporary housing. Potential explanations include changes in the neighborhood environment, such as the proximity torestaurants or the difﬁculty of cooking in the new living environment; however, further research is needed to determine if there is a link between moving to temporary housing and increased BMI.

Published Papers 2021.6

The Iwanuma Project focuses on the impacts of social capital – both preceding theDepression (n=258)

No Depression (n=80)

Depression (n=63)•In areas with high social participation, the negative health impact of housing damage was reduced
No Depression (n=103)
Depression (n=83) No Depression (n=85)
Depression (n=101) No Depression (n=962)•Survivors who underwent group allocation to temporary housing were signiﬁcantly more likely toreport receiving social support than those who underwent lottery allocation

Positive effects on mental health of group relocation into
14 temporary housing•Increasing levels of symptoms of dementia depending on the severity of damage to housing
article: Disaster resilience in older populations
Transition
15of ReviewPersistent
symptoms (n = 404) 23.3%
Recovery (n = 268) 15.4%
Delayed onset (n = 101) 5.8%
No onset (n = 962) 55.4%
depressive symptoms•Relationship between changes in neighborhood relationships and the degree of severity ofSocializing with neighbors post-earthquake reduces
16 depressive symptoms
depressive symptoms

Kino S, Aida J, Kondo K, Kawachi I: Long-term trends in mental health disorders after the 2011 Great East

Japan Earthquake and tsunami. JAMA Netw Open. 2020 Aug 3;3(8): e2013437.
•Changes in community relations(trust) among nonrelocated Iwanuma City residents
doi:10.1001/jamanetworkopen.2020.13437.

•People severely affected by the earthquake were more likely to lose their teeth
18 after disaster
Severe emotional
trauma, such as the loss of a relative or damage to one's home in a disaster, can lead to post-traumatic stress symptoms (PTSS), such as sudden ﬂashes of painful memories, anddepression. Kinoetal.
(2020)
analyzedtheresults
of
the
JAGES
surveysofolder
adultsin
IwanumaCity
in 2010, 2013,
andsupport
2016 toexaminethe long-termof doesthe disasteron mental
health;in13.6% of•Decreasein socialandsocial capital
after theeffects
disaster
not explain
the increase
Decreased social capital does not explain post-disaster19hadincreased
people who
no depressive
symptoms before
the disaster had depressive symptoms in 2013. By 2016,
50% of themhad recovered.
In contrast,
the number of people with PTSS was 11% of the total as ofdepressive
symptoms
among disastersurvivors
depressive
symptoms
2013. As of 2016, 60% had recovered, while 40% still had PTSS.

20 Predictors of worsened depressive symptoms after disaster
Access to medical care is key to preserving functional

21 independence•Relationship between disaster experiences and decline in functional independence

Residential relocation linked to increased obesity due toLong-term effects of total destruction of one’ s house on•Degree of property damage and changes in cardiometabolic proﬁles before and after theearthquake (2010–2013)

2435of depression

Relocation to prefabricated housing doubled the risk

•Odds ratios of depression according to type of post-disaster housing

25 Post-disaster mental health as a predictor of mortality•Post-disaster depressive symptoms, post-traumatic stress disorder (PTSD), and mortality rates

23 cardiometabolic risks

30

Housing damage is associated with increased cognitive

25

0.08
0.07
0.06
0.04

Hikichi H, Aida J, Kondo K, Kawachi I: Persistent impact of housing
loss on cognitive decline after the 2011 Great East Japan
Earthquake and tsunami: Evidence from a 6-year longitudinal
study. Alzheimers Dement. 2019 Aug;15(8):1009-1018. doi:
10.1016/j.jalz.2019.04.016. Epub 2019 Aug 1.

0.01
Depression

Rate of PrevalenceLong-Term Impact

Regression Coefﬁcient

26 disability
0.10*

Destroyed

Community social capital helps to preserve functional

13 independence in older survivors

2016(n=2,810)* p <0.01 statistically signiﬁcant association withcognitive decline

0.12*

Major

Depression
No Depression (n=166)
Individual-levelsocial(n=338)
ties mitigate post-earthquake

22 symptoms
Individual
mental illness changed pre- and post-earthquake; however, prevalence in community did notchanged foodofenvironment

0.14

Minor

•Mortality risk during disaster is four times higher for those with depressive symptoms.
Post-disaster mortality risk reduced by about half through interaction with friends.
Depression (n=168)
No Depression (n=1,063)•Social ties mitigate the progression of dementia due to a disaster12 progression of cognitive disability

Post-Earthquake

Long-term Impact

Persistent impact of housing loss on cognitive disability 6 years after disaster

Affected

Depressive symptoms and higher mortality on the day ofWorsening ﬁnancial status increases risk of tooth loss

"Pre-Earthquake,""Pre- and loss
Post-Earthquake,""Post-Earthquake,""Long-term
impact of housing
on cognitive disability 6 yearsand
after
disasterEffects."
29 Persistent

0.00

No Depression(n=1,231) cognitive disability•Social ties mitigate the impact of disaster experienceson post-disaster

Relocation affects social relationships in areas receiving

We have classiﬁed the published papers into four phases of the disaster:

0.02

Community-level social capital mitigates progression of

17 displaced survivors

disaster and after the disaster – on the physical and mental health of survivors.

0.06•Relationships with changes in depressive symptoms pre- and post-disaster11 the disaster

Changes from 2010 to 2013

0.10

Physical activity helps to prevent depressive symptoms in

Depression (n=504)
10 cognitive disability after a disaster

Shiba K, Aida J, Kondo K, Nakagomi A, Arcaya M, James P, Kawachi I: Mediation of the relationship between home loss and worsened cardiometabolic proﬁles of older disaster survivors by post-disaster relocation: A natural experiment from the Great East Japan Earthquake and tsunami.
Health & Place. 2020 Nov 1; 66:102456. doi: 10.1016/j.healthplace.2020.102456.

0.12•Increased participation in exercise and hobby groups reduces depressive symptoms

9 older disaster survivors

2010
0.00

Increased participation in exercise and hobby groups help to

8 reduce depressive symptoms in disaster survivors

Increased risk of developing arthritis associated with

27 disaster trauma
20

28 Risk of increased BMI due to relocation to temporary housing
15Persistent impact of housing loss on cognitive disability

29 6 years after disaster•Association between severity of housing damage and increased cognitive disability score

Depressive symptoms
PTSS•Empirical evidence on the relationship between property damage/relocation to temporary
housing and increased BMI•Persistent impact of housing loss on cognitive disability 6 years after disaster10•Trajectories of post-traumatic stress symptoms and depression, 2.5 and 5.5 years after the disaster•Individual symptoms of mental illness changed pre- and post-earthquake; however, prevalence in community did not

5•Correlation between neighborhood environment and lifestyle-related diseases

30 Long-term trends in mental health after disaster
31 Relocation linked with increased cardiometabolic risksLong-term relationship between a traumatic experience

32 0and health
2010

2013

Predictors of persistent mental health problems 6 years

33 after disaster•The long-term health impacts of an earthquake may have been underestimated2016•Predictors of persistent versus delayed post-traumatic stress symptoms•Unemployment and deterioration of ﬁnancial status due to the earthquake affect persistent and delayed onset PTSS

6-year followup study of the health impacts of residential

We previously established that housing loss and residential dislocation in the 2011 Japan earthquake and tsunami was a risk factor for cognitive decline among older survivors. The present study extends
the follow-up of survivors to six years. The baseline for our natural experiment was established in a survey of older community-dwelling adults who lived 80 km west of the epicenter seven months before
the earthquake and tsunami. Two follow-up surveys were conducted approximately 2.5 and 5.5 years after the disaster to ascertain the housing status and cognitive decline from 2810 older individuals(follow-up rate through three surveys: 68.4%). The experience of housing loss was persistently associated with cognitive disability (coefﬁcient = 0.14, 95% conﬁdence interval: 0.04 to 0.23). Experiences of
housing loss continued to be signiﬁcantly associated with cognitive disability even six years after the disaster.

25•Group relocation to disaster relief housing increases the risk of obesity and depression
34 relocation
Post-traumatic stresssymptoms (PTSS) and depression are common among survivors of major disasters. However, few studies have followed participants over an extended period to identify the symptoms ofmental illness or to document the prevalence of mental illness symptoms in the community. In a study of 2,781 older adult survivors in Iwanuma City, about half of older adults who reported PTSS andPapers on5.5theyears
effects
pre-earthquake
health
Pre-Earthquake
Post-Earthquake
PaperstheHowever,effects offorpost-earthquake
factorsthe
on prevalence
health of depression was founddepression
had recovered
afterofthedisaster, whilefactors
about on
halfpost-earthquake
were still reporting
symptoms
more than ﬁve
years onlater.
the region as a whole,constant
between pre- andpost-disasterdata. Thissuggests
thatinthe
regionitselfhas thebe ﬂexible
and Papers
resilienton
inthe
the effects
face of ofadversity
difﬁculty."
Paperson the effectsof thechangesfactors
frombeforeto "capacity toLong-Term
Pre- and Post-Earthquake
Impactfactorsandon healthmore than 5.5 years after the earthquake

after the earthquake on post-earthquake health26

Essaymore resilienthousing
after thedoubled
earthquake
Relocationare
to prefabricatedthe risk of depression
1 Optimists
24

Post-earthquake
Pre-earthquake

2.07*

0.5
1.50
0.4
0.3
1.00
0.2

1.49

1.40

1.00
0.80

0.50
0.1
0
0.00

Note: Adjusted for the impact of age, gender,
subjective health, educational history, income,living alone, losing close loved ones due to theearthquake, and damage to the house.
※* Indicates that there was a statisticallysigniﬁcant association.
* The analysis included 2,242 people who did nothave depressive symptoms at the time of the 2010
survey.

No damagePartial damage

No relocation(n=2,084)

Half destroyed

Mostly destroyed

PrefabricatedExisting private
Newly established
Severity of housing damage
housing
housing
housing(n=42)(n=19)(n=36)

Destroyed
Other(n=10)

support before the earthquake reduced the risk of
Post-disaster mental health as a predictor of mortality
25
2 Socialdeveloping depressive symptoms by 30%

Pre-earthquake
Post-earthquake

Post-disasterstressdisorder (PTSD),
and mortality
rates
Social supportdepressive
before thesymptoms,
earthquakepost-traumatic
reduced the riskof developing
depressive
symptoms
by 30%

1

2.5
2
1.5
0.50
1

We adjusted for age, sex, income, living alone, and the effects of house damage andlosing loved ones.
* indicates a statistically signiﬁcant association.

0.7*

0.5
0
0.00

Depression(n=974)
Yes (n = 1,743)

Depression and PTSD
No (Standard) (n = 317)

PTSD
(n=747)

Li X, Aida J, Hikichi H, Kondo K, Kawachi I: Association of postdisaster depression
and posttraumatic stress disorder with mortality among older disaster survivors of2011 T,GreatJapan
Earthquake
tsunami.social
JAMAsupport
NetworkisOpen.
2019;2
Sasaki Y, Aida J, Tsuji T, Koyama S,theTsuboya
SaitoEast
T, Kondo K,
Kawachi I:and
Pre-disasterprotectivefore1917550.
doi:10.1001/jamanetworkopen.2019.17550.
onset of post-disaster depression:(12):Prospective
study
from the Great East Japan Earthquake & tsunami. Sci Rep. 2019
Dec 19;9(1):19427. doi:10.1038/s41598-019-55953-7.

(n=580)

2
0.10

0.000

No experience of adversity

Post-earthquake

0.20
3
0.15
0.12*
Pre-earthquake

0.07

0.05

Pre-earthquake

Partial damage
Half damage
Damageto a house (n=257)(n=1,496)* p < 0.05** p < 0.01 indicates statistical signiﬁcanceExperienced adversity

0.29**

0.25
4

0.051

Major damage
Complete destruction
Loss of a relative/friend(n=131)(n=158)* Of the people included in each group: Damage to house Yes/
Experienced adversity during Childhood Yes (n=30); Yes / No (n=13);
No / Yes (n=320); No / No (n=217). Lost loved ones Yes / Experienced
Adversity during Childhood Yes (n=135); Yes / No (n=84); No / Yes(n=215); No / No (n=146).
Inoue Y, Stickley A, Yazawa A, Aida J, Kawachi I, Kondo K, Fujiwara T: Adverse childhood
experiences, exposure to a natural disaster and posttraumatic stress disorder among
AidaEast
J, Kondo
Tsuboya T, Matsuyama
Y, Subramani
an SV, Kawachi
survivors of theHikichi
2011 H,
Great
JapanK,Earthquake
and tsunami.
Epidemiol Psychiatr
Sci.
I: Increased
risk of dementia in the aftermathEpubof the2011
Great
2019 Feb;28(1):45-53.
doi:10.1017/S2045796017000233.
2017May
15. East Japan
Earthquake and tsunami. Proc Natl Acad Sci USA. 2016 Nov 8;113(45):E6911-E6918. doi:10.1073/pnas.1607793113. Epub 2016 Oct 24.

Noprevious study
hasdisorderbeen able
to examine
the association
by takingaccountsomethingof risk factors
for dementia
beforeafter thedisaster.
Wewithprospectively
whetherexperiencesof a disaster
werePost-traumaticstress(PTSD)
is a disorderwhere a person
undergoesintensely
distressing,theandmemoryof whichstays
them, andexamined
they repeatedly
reliveit in a frightening
manner.
associatedaftermathof the 2011
Great
East
Japan Earthquake
and Tsunami.
our signiﬁcantly
natural experiment
was ofestablishedin aofsurveyof olderPeople whowith
hadcognitive
not gonedecline
throughinantheadverse
experienceduringtheirchildhood,such as losing
a parent, The
werebaseline
found toforhave
higher rate
PTSD in casedamagefromcommunity-dwellingthe earthquake thanadultswho hadlivedno80suchkm westof the epicenter
monthsbeforethe earthquake
andoftsunami.
Approximately
yearsofafter
theadults
disaster,the follow-up
aboutpeople
personal
those who
experience.
Inoue et7al.
(2019)
presented
the results
such a study.
In a 20132.5
surveyolder
in Iwanuma
City,survey
JAGESgathered
analyzedinformation
data from 580
whoexperiencesansweredofdisaster about
as welladverse
as incidence
of dementia
3,594 survivors(82.1% follow-uprate).
Ourﬁnancial
primarydistress;
outcome9.7%
was dementia
by in-homefollow-up
period.
questionsexperiencesin theirfrom
childhood,such as bereavement,
abuse,
andof people diagnosis
were foundascertained
to have PTSD
after theassessment
earthquake.during
Peoplethewhose
houseswere
Amongourandanalytic= 3,566), 38.0%
losingfriends indisaster,andloss
58.9%
reporteddamage.
Fixed-effects
regression
indicated
thatwhomajor
housing
damageanddamagedthose sample
who lost(nrelative/friend
werereported
also at highriskrelativesof PTSD.orDamage
to thehousesand theof loved
onesproperty
due to disasterwaslinked to theonset of PTSD
in those
had
not faced
adversity,
home
destroyed
associatedwith cognitive
whereasno such wereassociation
was found
for those decline:
who hadregression
undergonecoefﬁcient
adversity. for levels of dementia symptoms = 0.12, 95% conﬁdence interval (CI): 0.01 to 0.23 and coefﬁcient = 0.29, 95% CI: 0.17 to
0.40, respectively. The effect size of destroyed home is comparable to the impact of incident stroke (coefﬁcient = 0.24, 95% CI: 0.11 to 0.36). The association between housing damage and cognitive decline
remained statistically signiﬁcant in the instrumental variable analysis. Housing damage is an important risk factor for cognitive decline among older survivors in natural disasters.

community social ties prevent incident posttraumatic stress disorder
Increased risk of developing arthritis associated with disaster trauma
27
4 Pre-disaster(PTSD)

Pre- and PostEarthquake
Post-earthquake

Relationship between pre-disaster community social ties, disaster experiences, and the risk of developing PTSD
Percentage of peopleOdds
who ratio
develop arthritis (%)

Risk of
HazardDeveloping
ratio forDepressive
mortality Symptoms* The ﬁgure shows the hazard ratios for mortality among
There was 30% lower
risk of developing depressive symptoms
people who had depression alone, depression and PTSD
after the disaster iftogether,
personsandhador received
socialPTSDgivenalone (relative
to people
who have neither
support before thedepression
disaster.nor PTSD).

Post-earthquake

0.30
5Sasaki Y, Aida J, Tsuji T, Miyaguni Y, Tani Y, Koyama S, Matsuyama Y,
Sato Y, Tsuboya T, Nagamine Y, Kameda Y, Saito T, Kakimoto K, Kondo
K, Kawachi I: Does type of residential housing matter for depressive
symptoms in the aftermath of a disaster? Insights from the Great East
Gero K, Aida J, Shirai K, Kondo K, Kawachi I: Dispositional optimism andJapan Earthquake and tsunami. Am J Epidemiol. 2018 Mar;187
disaster resilience: A natural experiment from the 2011 Great East Japan(3):455-464. doi:10.1093/aje/kwx274.
Earthquake and tsunami. Soc Sci Med. 2021 Mar; 273:113777. doi:
10.1016/j.socscimed.2021.113777.

Dispositional optimism - the general belief that good things will happen - is considered a key asset for the preservation of mental health after a traumatic life event. However, it has been hypothesized that inextremesituations
such astomajordisasters
wherecannotovercome therealityon thehasground,being
optimistic
be a disadvantage.
et al. (2021)
testedmismatchManypeoplewere forced
relocatebecausethey positive
lost theirexpectations
homes due tothe earthquake.
No grimprevious
research
analyzed
relocation
andmight
psychologicalproblems ofGerosurvivors
using preandthis
post-disasterhypothesis,
exploringwhether
dispositional
optimism
is associatedwith higher
posttraumaticstress(PTS) and depressive
symptoms
962 individuals
experienced
the 2011
data.
The JAGES
analyzeddata higher
from a pre-disastersurvey of 3,567
older adults
in Iwanuma
City, conducted
in 2010(before theearthquake)and in 2013
(after theamong
earthquake).
The studywho
examined
the association
Great Eastrelocation
Japan Earthquake
andofTsunami.
The depressive
results showsymptoms
that higher
pre-disasterdispositional
associatedwithrisklower
odds of developing
depressiveandPTS symptoms
2.5didyears
thebetweenand the risk
developingafter
the disaster.
The results optimism
showed nowas
differencein theof developing
depressive
symptoms
betweenthose who
notafterrelocateearthquake.
Further,hightodispositional
optimismbuffered
theestablishedadverse impact
of housing
damageonofdepressive
symptoms,
butsymptoms
not on PTSafter
symptoms.
In contrast
thethosemismatchhypothesis,
the results
andthose who
relocatedexisting private
housing
or newly
housing.
However,the riskdeveloping
depressive
the disasterdoubledtofor
who moved
to prefabricatedsuggest that
dispositional
optimisma resilience
resource among
survivorsof a todisaster.
housing.
It suggeststhat older
adultsismoving
to prefabricatedhousing
may leadthe risk of developing depressive symptoms.

1.003

0.356

Prevalence(PR)
RegressionRatio
coefﬁcient

ProbabilityRiskof havingof developing
high depressive
depression
symptoms

0.7
2.00
0.6

Unexpected
higherof PTSDwith
amongpeoplecognitive
who did notexperience early life adversity Post-earthquake
damageis risk
associatedincreaseddisability
Pre-earthquake
3 Housing26
Post-traumatic stress disorder (PTSD) after the earthquake became more pronounced in those who did not experience
Association
betweenseverity of housing damage and increased cognitive disability scoreadverse childhood
experiences

Odds
ratioshaveof depression
accordingtype of post-disasterhousing after a disaster
Optimists
fewer depressive
andtopost-traumaticstress symptoms

2.50
0.8

Iwanuma Project

7
2.5
6
2.05
1.54
3
1.0
2

6.3
1.94***

4.8

1.64***

3.4

3.0
0.87*

0.51
0.00

Those who were affected by the earthquake had ahigher incidence of arthritis after the disaster(n=2,360)*p < 0.05; **p < 0.01; ***p < 0.0001

No change
Loss of loved
ones

Deteriorated
Damageto house

Changes in economic conditions
due to the earthquake

Individual-levelsocial ties

0.75**No damage
DamageCommunity-levelsocial ties

Damage to house

Ikeda T, Aida J, Kawachi I, Kondo K, Osaka K: Causal effect of deteriorating socioeconomic
circumstances on new-onset arthritis and the moderating role of access to medical care: A
natural experiment from the 2011 Great East Japan Earthquake and tsunami. Soc Sci Med.
Hikichi H, Aida J, Tsuboya T, Kondo K, Kawachi I: Can community social cohesion prevent posttraumatic stress2020 Nov;26 4:113385. doi: 10.1016/j.socscimed.2020.113385. Epub 2020 Sep 25.
disorder in the aftermath of a disaster? A natural experiment from the 2011 Tohoku Earthquake and tsunami. Am J
Epidemiol. 2016 May 15;183(10):902-10. doi:10.1093/aje/kwv335. Epub 2016 Mar 29.

Giving and receiving social support
To assess whether postdisaster depression and PTSD were associated with mortality in older disaster survivors, this cohort study was conducted. Prospective data were retrieved from older Japanese adults in
Iwanuma City, Miyagi Prefecture, which was directly affected by the 2011 Great East Japan Earthquake and Tsunami. Mortality data were obtained by linkage to the national long-term care insurance
database. Cox proportional hazards regression models were adjusted for predisaster sociodemographic characteristics, health behaviors, social cohesion, predisaster depression, and disaster experiences. In
adjusted
associatedwith more
doublethe riskasofamortality(hazard ratio, 2.29;
95%toCI,
1.54-3.42);
PTSD wasnot associatedwith increased
risk survivorsof mortality(hazard
Sasaki et models,al. (2019)depression
examinedwas
whether
pre-disastersocialthan
supportfunctionsdisaster preparedness
resource
mitigate
post-disaster
depressive
symptoms
among olderof the2011ratio,
Great1.10;
East95%
0.73-1.64).andWhen
evaluatingof thedata
4-category
comorbid
depression
and PTSD
survivors
with depression
onlysurvey(HR, 2.24;
CI, 1.43-3.49),
as wellsurvey
as thoseJapanCI,Earthquake
Tsunami.
Basedtheon association
JAGES Iwanuma
from 2010
and 2013,
2,242 older
adultsvariable
who didwith
notmortality,
have depressive
symptoms
in the 2010
were95%analyzed.
In the follow-up
inwithand PTSD(HR, 2.54;
95% CI, 1.50-4.27),
at increasedriskalloffour
death
duringthe follow-up
with thosewith neither
depression support)
nor PTSD.priorDepression,
but not
2013,comorbid
16.2% ofdepression
those surveyed
developed
depressive
symptoms.were
Survivors
who hadtypes
of socialsupport period(givingcomparedand receiving
emotional
and instrumental
to the disaster
PTSD,
was associatedduringdepressive
3.3 years ofsymptoms
follow-up than
among
older
disastersurvivors.
These
ﬁndingsevensuggestlong-term
health consequencesof natural disasters
may exist
andthat
experienced
a lower withrisk mortalityof developing
those
who
did not
have suchsupport,afterthat
adjustingfor mental
demographicand disaster-damage-related
variables.
This
resulttreating
depressionin oldersurvivorsof disasters
beolderbeneﬁcial.
demonstrates
that social
supportin dailylife mightmay
help
adults maintain psychological health following disasters.

11
23

The
results
showofthe
importanceof identifying
and treating
people(PTSD)
with arthritis
initialtostages
after
a disaster.
It has beenlevel
reported
that the social
healthcohesion
effects ofwas
theassociateddisaster are
andIn theaftermatha disaster,
the riskof posttraumaticstress disorderis high. in
Wethesoughtexaminewhetherthe predisasterof community
withlong-terma lower riskofwide-ranging.
noand
study
has everwhether
it affects
onset
of baseline
arthritis. for
Weouranalyzed
datawasfromestablished
2,360 older
aged
65 andover before (2010) andafter(2013)PTSD after the However,
earthquake
tsunamiin examined
Tohoku, Japan,
on March
11,the2011.
Thenaturalfollow-up
experimentinadults
a surveyof oldercommunity-dwelling
adultswho
lived the80
earthquake
to examine
the impactof the disaster
andearthquake
the onset ofandarthritis.
Results
showedsurvey
a 16%wasincreasein theapproximately
risk of developing
arthritisinthe
thedisaster.
group withconditions
to thekilometers westof the epicenter
7 months
before thetsunami.
A follow-up
conducted
2.5 years
after
Weworseused aeconomic
spatial Durbin
modelcompared
to examine
groupwith ofnocommunity-levelchange in economic
conditions.
Similarly,
the risk ofrisk
arthritisonset
was 8%
the group
experienced
destructionof thesevere
home comparedto thoseno housing
associationsocialcohesion with
the individualof PTSD.
Among
our higher
analyticinsample(n =that
3,567),
11.4% oftotal
respondents
reported
PTSD symptoms.
In withthe spatial
Durbindamage.
model,
Injuries
causedby the earthquakesocial
werecohesion
not only before
externalthebut
also extended
to the tissue
within thetypesof symptoms
injuries in (oddsthe joints
such aninterval:
earthquake
thought
to resultindividualand community-leveldisaster
were signiﬁcantly
associatedwithjoints.
lowerTheserisks of
PTSD
ratioimmediately= 0.87, 95%after
conﬁdence
0.77,are0.98
and odds
ratio in
=
the
onset
chronic arthritis.
Therefore,
in addition
to assessing
external
injuries,
for symptoms
injuries thatbeand
easilyvisually conﬁrmed,
as joint
tissue injury,
evacuation
sheltersdamage,
immediately
0.75,
95%ofconﬁdence
interval:
0.63, 0.90,
respectively),
even after
adjustment
forchecking
depression
at cannot
baselineexperiences
during thesuch
disaster(including
loss ofinloved
ones, housing
and
after
the earthquake,to be Community-level
important for earlysocial
detectionand strengthens
treatment. the resilience of community residents in the aftermath of a disaster.
interruptionof accessistothought
health care).
cohesion

1224Essaymore resilienthousing
after thedoubled
earthquake
Relocationare
to prefabricatedthe risk of depression
1 Optimists
24

Post-earthquake
Pre-earthquake

2.07*

0.5
1.50
0.4
0.3
1.00
0.2

1.49

1.40

1.00
0.80

0.50
0.1
0
0.00

Note: Adjusted for the impact of age, gender,
subjective health, educational history, income,living alone, losing close loved ones due to theearthquake, and damage to the house.
※* Indicates that there was a statisticallysigniﬁcant association.
* The analysis included 2,242 people who did nothave depressive symptoms at the time of the 2010
survey.

No damagePartial damage

No relocation(n=2,084)

Half destroyed

Mostly destroyed

PrefabricatedExisting private
Newly established
Severity of housing damage
housing
housing
housing(n=42)(n=19)(n=36)

Destroyed
Other(n=10)

support before the earthquake reduced the risk of
Post-disaster mental health as a predictor of mortality
25
2 Socialdeveloping depressive symptoms by 30%

Pre-earthquake
Post-earthquake

Post-disasterstressdisorder (PTSD),
and mortality
rates
Social supportdepressive
before thesymptoms,
earthquakepost-traumatic
reduced the riskof developing
depressive
symptoms
by 30%

1

2.5
2
1.5
0.50
1

We adjusted for age, sex, income, living alone, and the effects of house damage andlosing loved ones.
* indicates a statistically signiﬁcant association.

0.7*

0.5
0
0.00

Depression(n=974)
Yes (n = 1,743)

Depression and PTSD
No (Standard) (n = 317)

PTSD
(n=747)

Li X, Aida J, Hikichi H, Kondo K, Kawachi I: Association of postdisaster depression
and posttraumatic stress disorder with mortality among older disaster survivors of2011 T,GreatJapan
Earthquake
tsunami.social
JAMAsupport
NetworkisOpen.
2019;2
Sasaki Y, Aida J, Tsuji T, Koyama S,theTsuboya
SaitoEast
T, Kondo K,
Kawachi I:and
Pre-disasterprotectivefore1917550.
doi:10.1001/jamanetworkopen.2019.17550.
onset of post-disaster depression:(12):Prospective
study
from the Great East Japan Earthquake & tsunami. Sci Rep. 2019
Dec 19;9(1):19427. doi:10.1038/s41598-019-55953-7.

(n=580)

2
0.10

0.000

No experience of adversity

Post-earthquake

0.20
3
0.15
0.12*
Pre-earthquake

0.07

0.05

Pre-earthquake

Partial damage
Half damage
Damageto a house (n=257)(n=1,496)* p < 0.05** p < 0.01 indicates statistical signiﬁcanceExperienced adversity

0.29**

0.25
4

0.051

Major damage
Complete destruction
Loss of a relative/friend(n=131)(n=158)* Of the people included in each group: Damage to house Yes/
Experienced adversity during Childhood Yes (n=30); Yes / No (n=13);
No / Yes (n=320); No / No (n=217). Lost loved ones Yes / Experienced
Adversity during Childhood Yes (n=135); Yes / No (n=84); No / Yes(n=215); No / No (n=146).
Inoue Y, Stickley A, Yazawa A, Aida J, Kawachi I, Kondo K, Fujiwara T: Adverse childhood
experiences, exposure to a natural disaster and posttraumatic stress disorder among
AidaEast
J, Kondo
Tsuboya T, Matsuyama
Y, Subramani
an SV, Kawachi
survivors of theHikichi
2011 H,
Great
JapanK,Earthquake
and tsunami.
Epidemiol Psychiatr
Sci.
I: Increased
risk of dementia in the aftermathEpubof the2011
Great
2019 Feb;28(1):45-53.
doi:10.1017/S2045796017000233.
2017May
15. East Japan
Earthquake and tsunami. Proc Natl Acad Sci USA. 2016 Nov 8;113(45):E6911-E6918. doi:10.1073/pnas.1607793113. Epub 2016 Oct 24.

Noprevious study
hasdisorderbeen able
to examine
the association
by takingaccountsomethingof risk factors
for dementia
beforeafter thedisaster.
Wewithprospectively
whetherexperiencesof a disaster
werePost-traumaticstress(PTSD)
is a disorderwhere a person
undergoesintensely
distressing,theandmemoryof whichstays
them, andexamined
they repeatedly
reliveit in a frightening
manner.
associatedaftermathof the 2011
Great
East
Japan Earthquake
and Tsunami.
our signiﬁcantly
natural experiment
was ofestablishedin aofsurveyof olderPeople whowith
hadcognitive
not gonedecline
throughinantheadverse
experienceduringtheirchildhood,such as losing
a parent, The
werebaseline
found toforhave
higher rate
PTSD in casedamagefromcommunity-dwellingthe earthquake thanadultswho hadlivedno80suchkm westof the epicenter
monthsbeforethe earthquake
andoftsunami.
Approximately
yearsofafter
theadults
disaster,the follow-up
aboutpeople
personal
those who
experience.
Inoue et7al.
(2019)
presented
the results
such a study.
In a 20132.5
surveyolder
in Iwanuma
City,survey
JAGESgathered
analyzedinformation
data from 580
whoexperiencesansweredofdisaster about
as welladverse
as incidence
of dementia
3,594 survivors(82.1% follow-uprate).
Ourﬁnancial
primarydistress;
outcome9.7%
was dementia
by in-homefollow-up
period.
questionsexperiencesin theirfrom
childhood,such as bereavement,
abuse,
andof people diagnosis
were foundascertained
to have PTSD
after theassessment
earthquake.during
Peoplethewhose
houseswere
Amongourandanalytic= 3,566), 38.0%
losingfriends indisaster,andloss
58.9%
reporteddamage.
Fixed-effects
regression
indicated
thatwhomajor
housing
damageanddamagedthose sample
who lost(nrelative/friend
werereported
also at highriskrelativesof PTSD.orDamage
to thehousesand theof loved
onesproperty
due to disasterwaslinked to theonset of PTSD
in those
had
not faced
adversity,
home
destroyed
associatedwith cognitive
whereasno such wereassociation
was found
for those decline:
who hadregression
undergonecoefﬁcient
adversity. for levels of dementia symptoms = 0.12, 95% conﬁdence interval (CI): 0.01 to 0.23 and coefﬁcient = 0.29, 95% CI: 0.17 to
0.40, respectively. The effect size of destroyed home is comparable to the impact of incident stroke (coefﬁcient = 0.24, 95% CI: 0.11 to 0.36). The association between housing damage and cognitive decline
remained statistically signiﬁcant in the instrumental variable analysis. Housing damage is an important risk factor for cognitive decline among older survivors in natural disasters.

community social ties prevent incident posttraumatic stress disorder
Increased risk of developing arthritis associated with disaster trauma
27
4 Pre-disaster(PTSD)

Pre- and PostEarthquake
Post-earthquake

Relationship between pre-disaster community social ties, disaster experiences, and the risk of developing PTSD
Percentage of peopleOdds
who ratio
develop arthritis (%)

Risk of
HazardDeveloping
ratio forDepressive
mortality Symptoms* The ﬁgure shows the hazard ratios for mortality among
There was 30% lower
risk of developing depressive symptoms
people who had depression alone, depression and PTSD
after the disaster iftogether,
personsandhador received
socialPTSDgivenalone (relative
to people
who have neither
support before thedepression
disaster.nor PTSD).

Post-earthquake

0.30
5Sasaki Y, Aida J, Tsuji T, Miyaguni Y, Tani Y, Koyama S, Matsuyama Y,
Sato Y, Tsuboya T, Nagamine Y, Kameda Y, Saito T, Kakimoto K, Kondo
K, Kawachi I: Does type of residential housing matter for depressive
symptoms in the aftermath of a disaster? Insights from the Great East
Gero K, Aida J, Shirai K, Kondo K, Kawachi I: Dispositional optimism andJapan Earthquake and tsunami. Am J Epidemiol. 2018 Mar;187
disaster resilience: A natural experiment from the 2011 Great East Japan(3):455-464. doi:10.1093/aje/kwx274.
Earthquake and tsunami. Soc Sci Med. 2021 Mar; 273:113777. doi:
10.1016/j.socscimed.2021.113777.

Dispositional optimism - the general belief that good things will happen - is considered a key asset for the preservation of mental health after a traumatic life event. However, it has been hypothesized that inextremesituations
such astomajordisasters
wherecannotovercome therealityon thehasground,being
optimistic
be a disadvantage.
et al. (2021)
testedmismatchManypeoplewere forced
relocatebecausethey positive
lost theirexpectations
homes due tothe earthquake.
No grimprevious
research
analyzed
relocation
andmight
psychologicalproblems ofGerosurvivors
using preandthis
post-disasterhypothesis,
exploringwhether
dispositional
optimism
is associatedwith higher
posttraumaticstress(PTS) and depressive
symptoms
962 individuals
experienced
the 2011
data.
The JAGES
analyzeddata higher
from a pre-disastersurvey of 3,567
older adults
in Iwanuma
City, conducted
in 2010(before theearthquake)and in 2013
(after theamong
earthquake).
The studywho
examined
the association
Great Eastrelocation
Japan Earthquake
andofTsunami.
The depressive
results showsymptoms
that higher
pre-disasterdispositional
associatedwithrisklower
odds of developing
depressiveandPTS symptoms
2.5didyears
thebetweenand the risk
developingafter
the disaster.
The results optimism
showed nowas
differencein theof developing
depressive
symptoms
betweenthose who
notafterrelocateearthquake.
Further,hightodispositional
optimismbuffered
theestablishedadverse impact
of housing
damageonofdepressive
symptoms,
butsymptoms
not on PTSafter
symptoms.
In contrast
thethosemismatchhypothesis,
the results
andthose who
relocatedexisting private
housing
or newly
housing.
However,the riskdeveloping
depressive
the disasterdoubledtofor
who moved
to prefabricatedsuggest that
dispositional
optimisma resilience
resource among
survivorsof a todisaster.
housing.
It suggeststhat older
adultsismoving
to prefabricatedhousing
may leadthe risk of developing depressive symptoms.

1.003

0.356

Prevalence(PR)
RegressionRatio
coefﬁcient

ProbabilityRiskof havingof developing
high depressive
depression
symptoms

0.7
2.00
0.6

Unexpected
higherof PTSDwith
amongpeoplecognitive
who did notexperience early life adversity Post-earthquake
damageis risk
associatedincreaseddisability
Pre-earthquake
3 Housing26
Post-traumatic stress disorder (PTSD) after the earthquake became more pronounced in those who did not experience
Association
betweenseverity of housing damage and increased cognitive disability scoreadverse childhood
experiences

Odds
ratioshaveof depression
accordingtype of post-disasterhousing after a disaster
Optimists
fewer depressive
andtopost-traumaticstress symptoms

2.50
0.8

Iwanuma Project

7
2.5
6
2.05
1.54
3
1.0
2

6.3
1.94***

4.8

1.64***

3.4

3.0
0.87*

0.51
0.00

Those who were affected by the earthquake had ahigher incidence of arthritis after the disaster(n=2,360)*p < 0.05; **p < 0.01; ***p < 0.0001

No change
Loss of loved
ones

Deteriorated
Damageto house

Changes in economic conditions
due to the earthquake

Individual-levelsocial ties

0.75**No damage
DamageCommunity-levelsocial ties

Damage to house

Ikeda T, Aida J, Kawachi I, Kondo K, Osaka K: Causal effect of deteriorating socioeconomic
circumstances on new-onset arthritis and the moderating role of access to medical care: A
natural experiment from the 2011 Great East Japan Earthquake and tsunami. Soc Sci Med.
Hikichi H, Aida J, Tsuboya T, Kondo K, Kawachi I: Can community social cohesion prevent posttraumatic stress2020 Nov;26 4:113385. doi: 10.1016/j.socscimed.2020.113385. Epub 2020 Sep 25.
disorder in the aftermath of a disaster? A natural experiment from the 2011 Tohoku Earthquake and tsunami. Am J
Epidemiol. 2016 May 15;183(10):902-10. doi:10.1093/aje/kwv335. Epub 2016 Mar 29.

Giving and receiving social support
To assess whether postdisaster depression and PTSD were associated with mortality in older disaster survivors, this cohort study was conducted. Prospective data were retrieved from older Japanese adults in
Iwanuma City, Miyagi Prefecture, which was directly affected by the 2011 Great East Japan Earthquake and Tsunami. Mortality data were obtained by linkage to the national long-term care insurance
database. Cox proportional hazards regression models were adjusted for predisaster sociodemographic characteristics, health behaviors, social cohesion, predisaster depression, and disaster experiences. In
adjusted
associatedwith more
doublethe riskasofamortality(hazard ratio, 2.29;
95%toCI,
1.54-3.42);
PTSD wasnot associatedwith increased
risk survivorsof mortality(hazard
Sasaki et models,al. (2019)depression
examinedwas
whether
pre-disastersocialthan
supportfunctionsdisaster preparedness
resource
mitigate
post-disaster
depressive
symptoms
among olderof the2011ratio,
Great1.10;
East95%
0.73-1.64).andWhen
evaluatingof thedata
4-category
comorbid
depression
and PTSD
survivors
with depression
onlysurvey(HR, 2.24;
CI, 1.43-3.49),
as wellsurvey
as thoseJapanCI,Earthquake
Tsunami.
Basedtheon association
JAGES Iwanuma
from 2010
and 2013,
2,242 older
adultsvariable
who didwith
notmortality,
have depressive
symptoms
in the 2010
were95%analyzed.
In the follow-up
inwithand PTSD(HR, 2.54;
95% CI, 1.50-4.27),
at increasedriskalloffour
death
duringthe follow-up
with thosewith neither
depression support)
nor PTSD.priorDepression,
but not
2013,comorbid
16.2% ofdepression
those surveyed
developed
depressive
symptoms.were
Survivors
who hadtypes
of socialsupport period(givingcomparedand receiving
emotional
and instrumental
to the disaster
PTSD,
was associatedduringdepressive
3.3 years ofsymptoms
follow-up than
among
older
disastersurvivors.
These
ﬁndingsevensuggestlong-term
health consequencesof natural disasters
may exist
andthat
experienced
a lower withrisk mortalityof developing
those
who
did not
have suchsupport,afterthat
adjustingfor mental
demographicand disaster-damage-related
variables.
This
resulttreating
depressionin oldersurvivorsof disasters
beolderbeneﬁcial.
demonstrates
that social
supportin dailylife mightmay
help
adults maintain psychological health following disasters.

11
23

The
results
showofthe
importanceof identifying
and treating
people(PTSD)
with arthritis
initialtostages
after
a disaster.
It has beenlevel
reported
that the social
healthcohesion
effects ofwas
theassociateddisaster are
andIn theaftermatha disaster,
the riskof posttraumaticstress disorderis high. in
Wethesoughtexaminewhetherthe predisasterof community
withlong-terma lower riskofwide-ranging.
noand
study
has everwhether
it affects
onset
of baseline
arthritis. for
Weouranalyzed
datawasfromestablished
2,360 older
aged
65 andover before (2010) andafter(2013)PTSD after the However,
earthquake
tsunamiin examined
Tohoku, Japan,
on March
11,the2011.
Thenaturalfollow-up
experimentinadults
a surveyof oldercommunity-dwelling
adultswho
lived the80
earthquake
to examine
the impactof the disaster
andearthquake
the onset ofandarthritis.
Results
showedsurvey
a 16%wasincreasein theapproximately
risk of developing
arthritisinthe
thedisaster.
group withconditions
to thekilometers westof the epicenter
7 months
before thetsunami.
A follow-up
conducted
2.5 years
after
Weworseused aeconomic
spatial Durbin
modelcompared
to examine
groupwith ofnocommunity-levelchange in economic
conditions.
Similarly,
the risk ofrisk
arthritisonset
was 8%
the group
experienced
destructionof thesevere
home comparedto thoseno housing
associationsocialcohesion with
the individualof PTSD.
Among
our higher
analyticinsample(n =that
3,567),
11.4% oftotal
respondents
reported
PTSD symptoms.
In withthe spatial
Durbindamage.
model,
Injuries
causedby the earthquakesocial
werecohesion
not only before
externalthebut
also extended
to the tissue
within thetypesof symptoms
injuries in (oddsthe joints
such aninterval:
earthquake
thought
to resultindividualand community-leveldisaster
were signiﬁcantly
associatedwithjoints.
lowerTheserisks of
PTSD
ratioimmediately= 0.87, 95%after
conﬁdence
0.77,are0.98
and odds
ratio in
=
the
onset
chronic arthritis.
Therefore,
in addition
to assessing
external
injuries,
for symptoms
injuries thatbeand
easilyvisually conﬁrmed,
as joint
tissue injury,
evacuation
sheltersdamage,
immediately
0.75,
95%ofconﬁdence
interval:
0.63, 0.90,
respectively),
even after
adjustment
forchecking
depression
at cannot
baselineexperiences
during thesuch
disaster(including
loss ofinloved
ones, housing
and
after
the earthquake,to be Community-level
important for earlysocial
detectionand strengthens
treatment. the resilience of community residents in the aftermath of a disaster.
interruptionof accessistothought
health care).
cohesion

1224EssayBonding, bridging and linking social capital – Qualitative study ofof worsened depressive symptoms after disaster20
5 Predictors
public health nurses

Pre- and PostPost-earthquake
Earthquake

Clarifying human connections among public health nurses, external organizations, and disaster survivor groups3• Connection with regional leaders • Livelihood support• Information gathering • Health counseling2

Public health nurse

Communities in shelters
and temporary housing

Bonding
Social capital(Connections within the local
community)* Values on the Y-axis show the reduced scores on
the depressive symptom scale for older adults(15-item version of the geriatric depression scale)* Total destruction
house, losssupportersof work, and• Connections
among ofexternalbarriers to psychiatric consultation (failure to see a
psychiatrist) had a statistically signiﬁcant impact onetc.
the worseningVolunteer
of depressiongroups
three years
after thedisaster.

Predictors ofrelocation
sleep problems
survivors
linked in
to disasterincreasedobesity due to changed food environment Pre- and PostEarthquake
Post-earthquake
22
7 Residential
People facing ﬁnancial hardship after a disaster had up to 1.47 times higher risk of sleep disorders
1.48

Aggravating Factors
Details of damage caused
1.46
by the earthquake
Odds ratio

Change in Geriatric Depression Scale (GDS)

Linking Social Capital (Connection with administration)

Financialhardship
1.44

Preventing sleep problems

Note: Odds ratios mean the risks of being obese signiﬁcantly associated
Li X, Buxton OM, Hikichi H, Haneuse S, Aida J,
with each 1 km shortening of the distanceKondo
to theK, nearest
Kawachi I:foodPredictors of persistent
sleep problems among older disaster survivors:
establishmenta natural experiment from the 2011 Great East

Aggravation of sleep disorders

Short sleep duration
Sleep insufﬁciency
Poor sleep quality

1.44

Sleep medication use

1.43
Hikichi H, Aida J, Kondo K, Tsuboya T, Kawachi I: Residential relocation and obesity after a natural disaster:A natural experiment from the 2011 Japan Earthquake and tsunami. Sci Rep. 2019 Jan;9(1):374.
doi:10.1038/s41598-018-36906-y.

Short sleep duration• Isolated people exchanging
information to rebuild their lives

Bridging Social Capital(Connections with external organizations)0House Entirely
destroyed

House Entirely
destroyed (Men)House Entirely
destroyed (Women)• Isolated support• Event sponsorship
Have lost jobs
Disruption of access• Emergency food distribution
to psychiatry

Tsuboya T, Aida J, Hikichi H, Subramanian SV, Kondo K, Osaka K, Kawachi I:
Predictors of depressive symptoms following the Great East Japan
Earthquake: A prospective study. Soc Sci Med. 2016 Jul; 161:47-54. doi:
10.1016/j.socscimed.2016.05.026. Epub 2016 May 20.

Japan Earthquake and tsunami. Sleep. 2018 Jul
1;41(7): zsy084. doi:10.1093/sleep/zsy084.

Financial hardshipexacerbates sleep
problems

1.46

Insomnia symptoms

1.42• Mutual aid1

Iwanuma Project

Complete1.40
destructionof house0

Sleep insufﬁciency
Poor sleep quality
Insomnia symptoms
Bar
Sleep medication use

Fast food outlet

Supermarket

Complete or partial

Hikichi H, Kondo K, Aida J, Kondo N: Social capital in disaster medicine Group interviews with public health nurses working in areas stricken by the Tohoku earthquake. Japanese Journal of Disaster Medicine 2015;20 (1):51-56.

AInuniqueour study
the availability
information
aboutwithmentalhealthhealthstatus nurses
pre-dating
the disaster.
Our sample
comprisedsurvivors
aged 65We
andobtained
older, who
Octoberfeature
2013,ofHikichi
et al.was(2015)
conductedofgroupinterviews
22 publicin Miyagi
prefecture
involvedin healthcommunity-dwellingcare activities for disastersurvivors.
theresponded
followingtosurveys inabout
2010the(i.e.effects
one yearbeforethe disaster)in 2013= 3464).
Wethe
categorized
exposure
three types
experiences:
lossemergency
of family/friends,
property
damage,andsuggestionsof social
capitalin affectedandareas.
Social(ncapital
beforeearthquakedisaster
facilitatedmutualaccording
aid amongtoevacuees.
Theyofwere
able to sharefood anddrinks, andlaunched
disruptioninaccesstomedicalservice.
Ourmainoutcomewaschangeindepressive
symptoms,
measuredbythe
15-item
geriatric
depression
scale(GDS).
Amongtheparticipants,
917(26.5%)
community groups to exchange information. One municipality in Miyagi prefecture established a meeting hall to prevent solitary death by improving social connections among victims. reported
In otherlosinga family member
the disaster,while a further
537 (15.5%)
reported losing
a friend.their
Morepre-disasterthan half ofsocial
the participants
to hadtheirfew
homes.
After adjusting
fortemporary
demographics
andmunicipalities,
survivorstorelocatedto disaster
relief housing
in communities
to preserve
networks. reported
Althoughsome
somedamage
survivorsacquaintancesin thehousingbaseline
health,peoplewhose homes
were completely
hadsigniﬁcantly
depressive
symptom
scoresthreecapital
years (bonding,later (+1.22
points, 95%CI:
0.80,could
1.64,bep <more0.0001).
Disruption
complex,mental
they could
makeconnections
by participating
in socialdestroyed
events. We
alsofound thatelevatedcombinationsof different
types
of socialbridging,
and linking)effective
for theofpsychiatricalso associatedwith change
in GDSnurses
scores could(+2.51points,victims
95%CI:effectively
1.28, 3.74,< 0.0001).
By contrast,
loss theirof family/friends
longerdiseases
associatedwith
GDS afterThey
3 years;+0.18
victims’
healthcare
andwaslivelihood.
For example,
public healthsupportbypcollecting
information
about
personalitieswas
andnochronicfromneighbors.
would
thus
points-0.018,0.37,= 0.08) inforcooperation
loss of family,-0.045pointssocial(95%CI:-0.28,= 0.71)for lossamongof friends.
Threeyears after
disaster, survivors of the 2011 earthquake and tsunami
be able(95%CI:
to conduct
healthcarepactivities
withandvictims(linking
capital),by0.19,usingpsocial
networks
victims(bondingsocialthe
capital).
appeared to have recovered from the loss of loved ones. By contrast, property loss and disruption of psychiatry care were associated with persistent adverse impact on mental health.

Short sleep duration
destructionof in an increased body mass index. However, there are
Natural disasters are often associated with forced residential relocation; thereby, affected people experience a change in food environmentthat results
Sleep insufﬁciency
house
causinguseof a natural experiment of residential relocationsomestudiesthathaveexamined
whetherachangeinfoodenvironment
causesrisks
ofobesityafter
anaturaldisaster.
To
address
thisquestion,weleveraged
Partial destruction
Poor
sleep quality
in the aftermath of the 2011 Japan
Earthquake
and Tsunami. Our baseline data came from a nationwide cohort study of older community-dwelling
sleeping medicationadults
use conducted 7 months prior to the disaster. Byofhouse
chance, one of the ﬁeld sites (Iwanuma
Miyagi Prefecture) was directly in the line of the tsunami. Approximately 2.5 years after the disaster, we ascertained the residential addresses and health statuses
InsomniaCity,
symptoms
of 3,594 survivors aged 65 years or older (82.1% follow-up rate). Fixed effects multinomial logistic regression showed that shortened distances to food outlets/bars increased the risks of transitioning from
Sleep medication
BMI in the normal range (18.5–22.9)
to obesity use(≥25.0) (Odds ratios: 1.46 for supermarkets; 1.43 for bars; 1.44 times for fast food outlets). Radically changed food access after a natural disaster may raise
the risk of obesity among older survivors.
Short sleep duration

Disruption ofaccess to healthcare predict poor
sleep quality

Sleep insufﬁciency

Health caredisruption

Poor sleep quality
Insomnia symptoms
Sleep medication use

to medical
key to preserving
functional independence
Maintaining
socialcare
tiesisthroughgroup relocation21
6 Access

Post-earthquake
Pre- and PostEarthquake

effects of total destruction of one’ s house on cardiometabolicrisks
No signiﬁcant
23 Long-term
Loss of close
association with
Short sleep duration

relatives/friends

Relationshipbetweendisasterexperiencesand decline
in functional
independence
The relationshipbetweenmethodsof relocationand social
ties
Change in instrumental
activities
of dailyliving (IADL) scores
Change inSocial Ties
Score

0.06

House Entirely
destroyed

Have lost jobs

Disruption of accessto medical service(Internal Medicine)

On yearincrement of age

0.053 (p=0.013)(n=3,547)

0
0.04
-0.2
0.02
-0.4
0.00

-0.039 (p=0.035)
n=79

The value on the Y-axis is the decline in the level of independence score of older
adults (13-item version of Instrumental Activities of Daily Living, IADL).
House damage (entirely destroyed), loss of job, and disruption of access to medical
service were associated with signiﬁcant adverse impact on decline in physical andcognitive functions.

-0.6
-0.02

Instrumental
Half damage
MajorSupport
damage

n=96

-0.06
-1
Group relocation

T, AidaJ, HikichiT,H,Aida
SubramanianSV,Koyama
Kondo K,S,OsakaK, Kawachi
I: Predictorsof decline
IADL functioning
Hikichi Tsuboya
H, Sawada
Y, Tsuboya
J, Kondo K,
Kawachi
I: Residential
relocation
andinchange
in socialoldersurvivorsfrom
following
the Great
A prospective
study.
SciJulMed.
2017
capital:among
A naturalexperimentthe 2011
Great East
East Japan
Japan Earthquake:
Earthquake andtsunami. Sci
Adv.Soc201726;3(7):
Mar;176:34-41.
doi:
10.1016/j.socscimed.2017.01.022.
Epub
2017
Jan
18.
e1700426. doi:10.1126/sciadv.1700426

Individual relocationWe
described
associations
between thetype ofcapital”
disasterexperiencechangesource
in instrumental
activities
of daily living
amongolder adultsurvivors
andabout
after howa terrible
disaster.
The study
tookSocialconnectionsin the community( “social) represent
anandimportantof resiliencein the aftermathof majordisasters.
However,
littlebefore
is known
residential
relocationdue
toadvantageof a “naturalexperiment”
by the Japan
GerontologicalStudy (JAGES),
nationwide
cohortestablished2010, sevenand
monthspriorPeople
to the earthquake
andhomestsunami.
A
housing destruction
affects
survivors’affordedsocial capital.
We examinedchangesEvaluation
in social capital
among asurvivorsof the2011studyGreat
East JapaninEarthquake
Tsunami.
who lost theirwerefollow-up
surveywasconducted
in
2013.
This
study
was
conducted
inIwanuma,which
wasdirectly
struckbyatsunami.
Oursamplecomprisedcommunity-dwellingaged
survivorsin
Iwanumawho
resettled to new locations by two primary means: (i) group relocation to public temporary trailer housing or (ii) individual relocation, in which victims moved into government-provided housing by lottery or
responded
questionsabout personal(market
circumstancesand functional
statusboth beforeconstruction).
and after the The
disaster(N =for3547).
Individual
experiencesof earthquake
andmonths
tsunamibefore
damageused asanarranged fortotheirown accommodation
rental housing
or private
purchase/new
baseline
our naturalexperiment
was establishedseven
the were
11 March,
2011
exposurevariable.
The outcome
was changes
self-reported 13-item
instrumentalof dailyliving(IADL), which
was assessedboth before
andafterafterthethedisaster,
disaster.theAmongthe participants,
931
disaster, when
we conducteda surveyof olderincommunity-dwelling
adultswho livedactivities
80-km westof theearthquake
epicenter.
Approximately
2.5 years
follow-up
survey gatheredreportedlosingfamilymember(s)to the disaster,whilefurther
549 reported
losingfriend(s).
thanhalfpeopleof the participants
damagetheirhouseswhile approximately
1 in 8 losttheir
car(s).
informationabout
individual
experiencesof disaster
asawellas healthstatus andsocialcapital.More
Among
3421
in our study,reported
79 people
movedtovia
group
relocation
to public temporary
trailerhousing,The
multivariable
regression
completehouse lossmodeland disruptionof internal
medicinewas
wereassociatedassociatedwithsigniﬁcantly
worse
IADL: −0.67(95%CI: −0.99,−0.34) for=entirely
whereas96 peopleOLS
moved
on theirrevealed
own. Thethat
individual
ﬁxed-effects
showed thatgroup relocation
withimproved
informalsocializing
and points
social participation(B coefﬁcient
0.053,
destroyed
homes;interval:−0.40 points
CI: −0.71,−0.092)for disruptionof internal
medicine.
By contrast,of family/friends/pets/cars
disruption (Bto coefﬁcientthe other medical
servicewere
not associatedwith95% conﬁdence
0.011 (95%
to 0.095).
In contrast,
individual
relocation
was associatedwithdecliningloss
informalsocializing and socialandparticipation= −0.039,
95%
conﬁdence
interval:−
decline
IADL. Completehouse lossasanddisruptionof access tointernal medicine
a disasterwere
associated andwithinformal
signiﬁcant
adverse inimpacts
on declines in physical and cognitive functions 2.5 years
0.074 toin−0.003).
Group relocation,compared
to individual
relocation,
appeared after
to preservesocialparticipationsocializing
the community.
after the disaster, while loss of family/friends was not.

loss of close
relatives/friends

Insomnia symptoms

Preventing sleep problems
BMI (kg/m2)
Short sleep duration

Aggravation of sleep disorders
No Damage to house

Sleep insufﬁciency

Partial damage

Poor sleep quality

Half damage

Insomnia symptoms

Major damage

Sleep medication use

Complete destruction-0.5

Complete destruction

0.0

0.5

1.0

-2.5

Short sleep duration
HDL cholesterol (mg/dL)
Sleep insufﬁciency

Partial damage

0Complete destruction
-7.5

-5.0

-2.5

2.5

7.5

5.0

Figure. Relationship between earthquake experience / presenceof social support before the disaster and sleep problems 3 years
after the disaster.
(Male n = 1,542 female n = 2,005)

Half damage

Sleep medication use

Major damage

sleep problems
0.0

LDL cholesterol (mg/dL)

Insomnia symptoms

Half damage(1) The value (risk ratio) in the ﬁgure:
Waist circumference (cm)-The greater the number is than one,and the more often sleep problems occur.
-The smaller the number is than one,
Pre-disaster social
lower the incidence of sleep problems.
support associated(2) If the horizontal line does notwith reduced risksintersect the vertical line with a risk ratioof havingof one, the result is statistically signiﬁcant.

No Damage to house

Poor sleep quality

PartialSupport
damage

-1.2

13
21

Availability of social support
No Damage to house
before the disaster
Partial damage

No Damageto house
Emotional

-0.8
-0.04

Poor sleep quality

Sleep medication use
Degree of property damage
and changes in cardiometabolic proﬁles before and after the earthquake (2010–2013)

Preventive Factors

Ten years
increment of age

Post-earthquake

Sleep insufﬁciency

0.5
0.0

1

Risk ratio
2.5

Major damage
1.5

Complete destruction

2
-10

0

10

Shiba K,Sleep
Hikichi H,
Aida J, Kondoare
K, Kawachi
I: Long-term
betweendisasterand cardiometabolic
risk: Adiseases
natural experimentthe 2011
n=1,195.
Estimateschangesvaluesbefore andafterproblems
the earthquake
are indicatedSleepdisorders
areofoneof theinmost
commonhealthfor people
affectedbyby•.natural disasters.
disordersreported
to beassociations
associatedwiththeexperiencesdevelopmentof chronicsuch fromas Type2
Great East Japan Earthquake and tsunami. Am J Epidemiol. 2019 Jun 1;188(6):1109-1119. doi:10.1093/aje/kwz065.
diabetes
cardiovasculardisease,as wellthat
as thepsychiatric
Li et al.signiﬁcant.
(2018) analyzed datafrom the 2010 and 2013 JAGES surveys of older adults in Iwanuma City to ﬁnd ways to alleviate sleep
If the linesandaroundit do not cross0, it indicatesdifferencedisorders.
was statistically
disturbances after the disaster. As of 2013, 41% of all respondents answered "experiencing insomnia symptoms," 27% answered they had "Poor sleep quality," and 22% reported "sleep medication use." Of
the damage caused by the earthquake, "ﬁnancial hardship," "damage to the house," and "health care disruption," were found to predict sleep problems. It was also found that instrumental support ("having
someone to look after you") before the disaster was more conducive to alleviating sleep problems than emotional support ("having someone listened to your concerns and complaints.") This is the ﬁrst study
Olderadults,on
whose
homesstate
wereofcompletely
destroyed
the period
disasterafter(versusno property
damage),proﬁles two
andusuala halfsupport
years after
the disaster.
Shibaﬁnancial
et al. (2019)conducted
tofollow-up
the actual
sleep problems
over abylong
a disaster.
For olderadults,hadtheworse
study cardiometabolic
showed that, in addition
to thesystems,
post-disastersupport,house
such a study
that revealed
themaylong-term
healtheffects of a natural
disaster.
They combined data from 2010 and 2013, from the survey of older adults in Iwanuma by JAGES, with data from health check-ups
repairs,
and medical
supportbe helpful
in maintaining
long-term
health.
carried out by the city, and analyzed data from 1,195 individuals. People whose homes were destroyed had a higher body mass index (BMI) by 0.81,kg/m2 and waist circumference by 4.26 cm than those
whose homes were not damaged, and their HDL cholesterol was 4.77 mg/dl lower. There was no association between losing a family/friend or minor property damage and cardiometabolic proﬁles, whichsuggests the long-term associations between home loss and the outcomes may be due to circumstances speciﬁc to those whose homes were completely destroyed, such as relocation to temporary housing.

14
22

EssayBonding, bridging and linking social capital – Qualitative study ofof worsened depressive symptoms after disaster20
5 Predictors
public health nurses

Pre- and PostPost-earthquake
Earthquake

Clarifying human connections among public health nurses, external organizations, and disaster survivor groups3• Connection with regional leaders • Livelihood support• Information gathering • Health counseling2

Public health nurse

Communities in shelters
and temporary housing

Bonding
Social capital(Connections within the local
community)* Values on the Y-axis show the reduced scores on
the depressive symptom scale for older adults(15-item version of the geriatric depression scale)* Total destruction
house, losssupportersof work, and• Connections
among ofexternalbarriers to psychiatric consultation (failure to see a
psychiatrist) had a statistically signiﬁcant impact onetc.
the worseningVolunteer
of depressiongroups
three years
after thedisaster.

Predictors ofrelocation
sleep problems
survivors
linked in
to disasterincreasedobesity due to changed food environment Pre- and PostEarthquake
Post-earthquake
22
7 Residential
People facing ﬁnancial hardship after a disaster had up to 1.47 times higher risk of sleep disorders
1.48

Aggravating Factors
Details of damage caused
1.46
by the earthquake
Odds ratio

Change in Geriatric Depression Scale (GDS)

Linking Social Capital (Connection with administration)

Financialhardship
1.44

Preventing sleep problems

Note: Odds ratios mean the risks of being obese signiﬁcantly associated
Li X, Buxton OM, Hikichi H, Haneuse S, Aida J,
with each 1 km shortening of the distanceKondo
to theK, nearest
Kawachi I:foodPredictors of persistent
sleep problems among older disaster survivors:
establishmenta natural experiment from the 2011 Great East

Aggravation of sleep disorders

Short sleep duration
Sleep insufﬁciency
Poor sleep quality

1.44

Sleep medication use

1.43
Hikichi H, Aida J, Kondo K, Tsuboya T, Kawachi I: Residential relocation and obesity after a natural disaster:A natural experiment from the 2011 Japan Earthquake and tsunami. Sci Rep. 2019 Jan;9(1):374.
doi:10.1038/s41598-018-36906-y.

Short sleep duration• Isolated people exchanging
information to rebuild their lives

Bridging Social Capital(Connections with external organizations)0House Entirely
destroyed

House Entirely
destroyed (Men)House Entirely
destroyed (Women)• Isolated support• Event sponsorship
Have lost jobs
Disruption of access• Emergency food distribution
to psychiatry

Tsuboya T, Aida J, Hikichi H, Subramanian SV, Kondo K, Osaka K, Kawachi I:
Predictors of depressive symptoms following the Great East Japan
Earthquake: A prospective study. Soc Sci Med. 2016 Jul; 161:47-54. doi:
10.1016/j.socscimed.2016.05.026. Epub 2016 May 20.

Japan Earthquake and tsunami. Sleep. 2018 Jul
1;41(7): zsy084. doi:10.1093/sleep/zsy084.

Financial hardshipexacerbates sleep
problems

1.46

Insomnia symptoms

1.42• Mutual aid1

Iwanuma Project

Complete1.40
destructionof house0

Sleep insufﬁciency
Poor sleep quality
Insomnia symptoms
Bar
Sleep medication use

Fast food outlet

Supermarket

Complete or partial

Hikichi H, Kondo K, Aida J, Kondo N: Social capital in disaster medicine Group interviews with public health nurses working in areas stricken by the Tohoku earthquake. Japanese Journal of Disaster Medicine 2015;20 (1):51-56.

AInuniqueour study
the availability
information
aboutwithmentalhealthhealthstatus nurses
pre-dating
the disaster.
Our sample
comprisedsurvivors
aged 65We
andobtained
older, who
Octoberfeature
2013,ofHikichi
et al.was(2015)
conductedofgroupinterviews
22 publicin Miyagi
prefecture
involvedin healthcommunity-dwellingcare activities for disastersurvivors.
theresponded
followingtosurveys inabout
2010the(i.e.effects
one yearbeforethe disaster)in 2013= 3464).
Wethe
categorized
exposure
three types
experiences:
lossemergency
of family/friends,
property
damage,andsuggestionsof social
capitalin affectedandareas.
Social(ncapital
beforeearthquakedisaster
facilitatedmutualaccording
aid amongtoevacuees.
Theyofwere
able to sharefood anddrinks, andlaunched
disruptioninaccesstomedicalservice.
Ourmainoutcomewaschangeindepressive
symptoms,
measuredbythe
15-item
geriatric
depression
scale(GDS).
Amongtheparticipants,
917(26.5%)
community groups to exchange information. One municipality in Miyagi prefecture established a meeting hall to prevent solitary death by improving social connections among victims. reported
In otherlosinga family member
the disaster,while a further
537 (15.5%)
reported losing
a friend.their
Morepre-disasterthan half ofsocial
the participants
to hadtheirfew
homes.
After adjusting
fortemporary
demographics
andmunicipalities,
survivorstorelocatedto disaster
relief housing
in communities
to preserve
networks. reported
Althoughsome
somedamage
survivorsacquaintancesin thehousingbaseline
health,peoplewhose homes
were completely
hadsigniﬁcantly
depressive
symptom
scoresthreecapital
years (bonding,later (+1.22
points, 95%CI:
0.80,could
1.64,bep <more0.0001).
Disruption
complex,mental
they could
makeconnections
by participating
in socialdestroyed
events. We
alsofound thatelevatedcombinationsof different
types
of socialbridging,
and linking)effective
for theofpsychiatricalso associatedwith change
in GDSnurses
scores could(+2.51points,victims
95%CI:effectively
1.28, 3.74,< 0.0001).
By contrast,
loss theirof family/friends
longerdiseases
associatedwith
GDS afterThey
3 years;+0.18
victims’
healthcare
andwaslivelihood.
For example,
public healthsupportbypcollecting
information
about
personalitieswas
andnochronicfromneighbors.
would
thus
points-0.018,0.37,= 0.08) inforcooperation
loss of family,-0.045pointssocial(95%CI:-0.28,= 0.71)for lossamongof friends.
Threeyears after
disaster, survivors of the 2011 earthquake and tsunami
be able(95%CI:
to conduct
healthcarepactivities
withandvictims(linking
capital),by0.19,usingpsocial
networks
victims(bondingsocialthe
capital).
appeared to have recovered from the loss of loved ones. By contrast, property loss and disruption of psychiatry care were associated with persistent adverse impact on mental health.

Short sleep duration
destructionof in an increased body mass index. However, there are
Natural disasters are often associated with forced residential relocation; thereby, affected people experience a change in food environmentthat results
Sleep insufﬁciency
house
causinguseof a natural experiment of residential relocationsomestudiesthathaveexamined
whetherachangeinfoodenvironment
causesrisks
ofobesityafter
anaturaldisaster.
To
address
thisquestion,weleveraged
Partial destruction
Poor
sleep quality
in the aftermath of the 2011 Japan
Earthquake
and Tsunami. Our baseline data came from a nationwide cohort study of older community-dwelling
sleeping medicationadults
use conducted 7 months prior to the disaster. Byofhouse
chance, one of the ﬁeld sites (Iwanuma
Miyagi Prefecture) was directly in the line of the tsunami. Approximately 2.5 years after the disaster, we ascertained the residential addresses and health statuses
InsomniaCity,
symptoms
of 3,594 survivors aged 65 years or older (82.1% follow-up rate). Fixed effects multinomial logistic regression showed that shortened distances to food outlets/bars increased the risks of transitioning from
Sleep medication
BMI in the normal range (18.5–22.9)
to obesity use(≥25.0) (Odds ratios: 1.46 for supermarkets; 1.43 for bars; 1.44 times for fast food outlets). Radically changed food access after a natural disaster may raise
the risk of obesity among older survivors.
Short sleep duration

Disruption ofaccess to healthcare predict poor
sleep quality

Sleep insufﬁciency

Health caredisruption

Poor sleep quality
Insomnia symptoms
Sleep medication use

to medical
key to preserving
functional independence
Maintaining
socialcare
tiesisthroughgroup relocation21
6 Access

Post-earthquake
Pre- and PostEarthquake

effects of total destruction of one’ s house on cardiometabolicrisks
No signiﬁcant
23 Long-term
Loss of close
association with
Short sleep duration

relatives/friends

Relationshipbetweendisasterexperiencesand decline
in functional
independence
The relationshipbetweenmethodsof relocationand social
ties
Change in instrumental
activities
of dailyliving (IADL) scores
Change inSocial Ties
Score

0.06

House Entirely
destroyed

Have lost jobs

Disruption of accessto medical service(Internal Medicine)

On yearincrement of age

0.053 (p=0.013)(n=3,547)

0
0.04
-0.2
0.02
-0.4
0.00

-0.039 (p=0.035)
n=79

The value on the Y-axis is the decline in the level of independence score of older
adults (13-item version of Instrumental Activities of Daily Living, IADL).
House damage (entirely destroyed), loss of job, and disruption of access to medical
service were associated with signiﬁcant adverse impact on decline in physical andcognitive functions.

-0.6
-0.02

Instrumental
Half damage
MajorSupport
damage

n=96

-0.06
-1
Group relocation

T, AidaJ, HikichiT,H,Aida
SubramanianSV,Koyama
Kondo K,S,OsakaK, Kawachi
I: Predictorsof decline
IADL functioning
Hikichi Tsuboya
H, Sawada
Y, Tsuboya
J, Kondo K,
Kawachi
I: Residential
relocation
andinchange
in socialoldersurvivorsfrom
following
the Great
A prospective
study.
SciJulMed.
2017
capital:among
A naturalexperimentthe 2011
Great East
East Japan
Japan Earthquake:
Earthquake andtsunami. Sci
Adv.Soc201726;3(7):
Mar;176:34-41.
doi:
10.1016/j.socscimed.2017.01.022.
Epub
2017
Jan
18.
e1700426. doi:10.1126/sciadv.1700426

Individual relocationWe
described
associations
between thetype ofcapital”
disasterexperiencechangesource
in instrumental
activities
of daily living
amongolder adultsurvivors
andabout
after howa terrible
disaster.
The study
tookSocialconnectionsin the community( “social) represent
anandimportantof resiliencein the aftermathof majordisasters.
However,
littlebefore
is known
residential
relocationdue
toadvantageof a “naturalexperiment”
by the Japan
GerontologicalStudy (JAGES),
nationwide
cohortestablished2010, sevenand
monthspriorPeople
to the earthquake
andhomestsunami.
A
housing destruction
affects
survivors’affordedsocial capital.
We examinedchangesEvaluation
in social capital
among asurvivorsof the2011studyGreat
East JapaninEarthquake
Tsunami.
who lost theirwerefollow-up
surveywasconducted
in
2013.
This
study
was
conducted
inIwanuma,which
wasdirectly
struckbyatsunami.
Oursamplecomprisedcommunity-dwellingaged
survivorsin
Iwanumawho
resettled to new locations by two primary means: (i) group relocation to public temporary trailer housing or (ii) individual relocation, in which victims moved into government-provided housing by lottery or
responded
questionsabout personal(market
circumstancesand functional
statusboth beforeconstruction).
and after the The
disaster(N =for3547).
Individual
experiencesof earthquake
andmonths
tsunamibefore
damageused asanarranged fortotheirown accommodation
rental housing
or private
purchase/new
baseline
our naturalexperiment
was establishedseven
the were
11 March,
2011
exposurevariable.
The outcome
was changes
self-reported 13-item
instrumentalof dailyliving(IADL), which
was assessedboth before
andafterafterthethedisaster,
disaster.theAmongthe participants,
931
disaster, when
we conducteda surveyof olderincommunity-dwelling
adultswho livedactivities
80-km westof theearthquake
epicenter.
Approximately
2.5 years
follow-up
survey gatheredreportedlosingfamilymember(s)to the disaster,whilefurther
549 reported
losingfriend(s).
thanhalfpeopleof the participants
damagetheirhouseswhile approximately
1 in 8 losttheir
car(s).
informationabout
individual
experiencesof disaster
asawellas healthstatus andsocialcapital.More
Among
3421
in our study,reported
79 people
movedtovia
group
relocation
to public temporary
trailerhousing,The
multivariable
regression
completehouse lossmodeland disruptionof internal
medicinewas
wereassociatedassociatedwithsigniﬁcantly
worse
IADL: −0.67(95%CI: −0.99,−0.34) for=entirely
whereas96 peopleOLS
moved
on theirrevealed
own. Thethat
individual
ﬁxed-effects
showed thatgroup relocation
withimproved
informalsocializing
and points
social participation(B coefﬁcient
0.053,
destroyed
homes;interval:−0.40 points
CI: −0.71,−0.092)for disruptionof internal
medicine.
By contrast,of family/friends/pets/cars
disruption (Bto coefﬁcientthe other medical
servicewere
not associatedwith95% conﬁdence
0.011 (95%
to 0.095).
In contrast,
individual
relocation
was associatedwithdecliningloss
informalsocializing and socialandparticipation= −0.039,
95%
conﬁdence
interval:−
decline
IADL. Completehouse lossasanddisruptionof access tointernal medicine
a disasterwere
associated andwithinformal
signiﬁcant
adverse inimpacts
on declines in physical and cognitive functions 2.5 years
0.074 toin−0.003).
Group relocation,compared
to individual
relocation,
appeared after
to preservesocialparticipationsocializing
the community.
after the disaster, while loss of family/friends was not.

loss of close
relatives/friends

Insomnia symptoms

Preventing sleep problems
BMI (kg/m2)
Short sleep duration

Aggravation of sleep disorders
No Damage to house

Sleep insufﬁciency

Partial damage

Poor sleep quality

Half damage

Insomnia symptoms

Major damage

Sleep medication use

Complete destruction-0.5

Complete destruction

0.0

0.5

1.0

-2.5

Short sleep duration
HDL cholesterol (mg/dL)
Sleep insufﬁciency

Partial damage

0Complete destruction
-7.5

-5.0

-2.5

2.5

7.5

5.0

Figure. Relationship between earthquake experience / presenceof social support before the disaster and sleep problems 3 years
after the disaster.
(Male n = 1,542 female n = 2,005)

Half damage

Sleep medication use

Major damage

sleep problems
0.0

LDL cholesterol (mg/dL)

Insomnia symptoms

Half damage(1) The value (risk ratio) in the ﬁgure:
Waist circumference (cm)-The greater the number is than one,and the more often sleep problems occur.
-The smaller the number is than one,
Pre-disaster social
lower the incidence of sleep problems.
support associated(2) If the horizontal line does notwith reduced risksintersect the vertical line with a risk ratioof havingof one, the result is statistically signiﬁcant.

No Damage to house

Poor sleep quality

PartialSupport
damage

-1.2

13
21

Availability of social support
No Damage to house
before the disaster
Partial damage

No Damageto house
Emotional

-0.8
-0.04

Poor sleep quality

Sleep medication use
Degree of property damage
and changes in cardiometabolic proﬁles before and after the earthquake (2010–2013)

Preventive Factors

Ten years
increment of age

Post-earthquake

Sleep insufﬁciency

0.5
0.0

1

Risk ratio
2.5

Major damage
1.5

Complete destruction

2
-10

0

10

Shiba K,Sleep
Hikichi H,
Aida J, Kondoare
K, Kawachi
I: Long-term
betweendisasterand cardiometabolic
risk: Adiseases
natural experimentthe 2011
n=1,195.
Estimateschangesvaluesbefore andafterproblems
the earthquake
are indicatedSleepdisorders
areofoneof theinmost
commonhealthfor people
affectedbyby•.natural disasters.
disordersreported
to beassociations
associatedwiththeexperiencesdevelopmentof chronicsuch fromas Type2
Great East Japan Earthquake and tsunami. Am J Epidemiol. 2019 Jun 1;188(6):1109-1119. doi:10.1093/aje/kwz065.
diabetes
cardiovasculardisease,as wellthat
as thepsychiatric
Li et al.signiﬁcant.
(2018) analyzed datafrom the 2010 and 2013 JAGES surveys of older adults in Iwanuma City to ﬁnd ways to alleviate sleep
If the linesandaroundit do not cross0, it indicatesdifferencedisorders.
was statistically
disturbances after the disaster. As of 2013, 41% of all respondents answered "experiencing insomnia symptoms," 27% answered they had "Poor sleep quality," and 22% reported "sleep medication use." Of
the damage caused by the earthquake, "ﬁnancial hardship," "damage to the house," and "health care disruption," were found to predict sleep problems. It was also found that instrumental support ("having
someone to look after you") before the disaster was more conducive to alleviating sleep problems than emotional support ("having someone listened to your concerns and complaints.") This is the ﬁrst study
Olderadults,on
whose
homesstate
wereofcompletely
destroyed
the period
disasterafter(versusno property
damage),proﬁles two
andusuala halfsupport
years after
the disaster.
Shibaﬁnancial
et al. (2019)conducted
tofollow-up
the actual
sleep problems
over abylong
a disaster.
For olderadults,hadtheworse
study cardiometabolic
showed that, in addition
to thesystems,
post-disastersupport,house
such a study
that revealed
themaylong-term
healtheffects of a natural
disaster.
They combined data from 2010 and 2013, from the survey of older adults in Iwanuma by JAGES, with data from health check-ups
repairs,
and medical
supportbe helpful
in maintaining
long-term
health.
carried out by the city, and analyzed data from 1,195 individuals. People whose homes were destroyed had a higher body mass index (BMI) by 0.81,kg/m2 and waist circumference by 4.26 cm than those
whose homes were not damaged, and their HDL cholesterol was 4.77 mg/dl lower. There was no association between losing a family/friend or minor property damage and cardiometabolic proﬁles, whichsuggests the long-term associations between home loss and the outcomes may be due to circumstances speciﬁc to those whose homes were completely destroyed, such as relocation to temporary housing.

14
22

Essayparticipation in exercise and hobby groups help to reduce depressive
Socializing with neighbors post-earthquake reduces depressive symptoms
8 Increased
16
symptoms in disaster survivors

Pre- and Post- Earthquake

Increased participationin exercise
and hobby groups
reduces depressive
symptoms
Relationshipbetween changes
in neighborhood
relationships
and the degreeof severity of depressive symptoms-0.1-0.0025-0.003-0.2-0.0035-0.3-0.004No ➡ Yes(n=257)0.01-0.002*Yes ➡ No
(n=336)Neighborhood relationships
Yes ➡ Yes (Standard)-0.003*(n=2,195)

No ➡ No(n=323)-0.004-0.4-0.0045

Note:* adjusted
for changessigniﬁcantin age, gender, medical treatment, living
p <0.05, statisticallyalone, social participation, smoking habits, drinking habits, subjective
economic status, and walking habits before and after the earthquake, as
Factors considered for statistical impact
well as for the effects of relocation and losing loved ones.
Adjusted
for agesex, educational
attainment,
impaired ADL,
* Indicatesthat there
wasanda statisticallysigniﬁcantassociation.
change in drinking habits, change in smoking status, change injob status, dwelling house damage, death of family members,change in equivalent income, and change in IADL score.

Zhang W, Tsuji T, Yokoyama M, Ide K, Aida J, Kawachi I, Kondo K: Increased frequency ofparticipation in civic associations and reduced depressive symptoms: Prospective study of
Sasaki Y, Tsuji T, Koyama S, Tani Y, Saito T, Kondo K, Kawachi I, Aida J: Neighborhood ties reduced
older Japanese survivors of the Great Eastern Japan Earthquake. Soc Sci Med. 2021 Mar 8;
depressive symptoms in older disaster survivors: Iwanuma study, a natural experiment. Int J Environ
276:11 3827. doi: 10.1016/j.socscimed.2021.113827.
Res Public Health. 2020 Jan 3;17(1):337. doi:10.3390/ijerph17010337.

-0.39*

Change in frequency
Change in frequency
Change in frequency
Change in frequencyof sports groupof hobby groupof volunteer groupof senior citizens'participation
participationclubearthquake
participation
Changes in neighborhood
relationshipsparticipation
before and after the-0.5

affectshelps
socialtorelationships
in areassymptoms
receiving in
displacedsurvivors
Physical activity
prevent depressive
older disastersurvivors
17
9 Relocation

Pre- and Post- Earthquake

p <0.05 Statistically signiﬁcantp < 0.10 Statistically signiﬁcant trend

1.00
0.95
0.90
0.85
0.80
0.75

1

or

1

Gero K, Aida J, Kondo K, Kawachi I: Evaluation of trust within a community after survivor relocation following the Great East Japan Earthquake and tsunami. JAMA Netw Open. 2020 Nov;3(11):e2021166. doi:10.1001/jamanetworkopen.2020.21166.

Walking duration"75 minutes / day"

0.97

(n=3,567)

0.89

Housing damage "1 Stage*"* None / Partial damage /Half-destroyed /Major partial damage/
0.96 Completely
destroyed
0.95

0.90

0.84 in an
For example, if a person with a "half-destroyed" house participates
exercise group ﬁve to six times a month or walks about 75 minutes aday, their depressive symptoms would be alleviated to the same level as
someone with "partial damage" to their house.
St(n= rong
55 er
3)
Mu
ch
str
o
(n= nge
36 r)

0.0251.05

W(n= eake
61 r
)

1.10

1.15

Frequency of participation in
exercisegroups 5-6 times / month"
1.07

Mu
ch
w
(n= eake
12 r
)

1.15

Tsuji T, Sasaki Y, Matsuyama Y, Sato Y, Aida J, Kondo K, Kawachi I: Reducing depressive
symptoms after the Great East Japan Earthquake in older survivors through group exercise
participation and regular walking: a prospective observational study. BMJ Open. 2017 Mar
3;7(3): e013706. doi:10.1136/bmjopen-2016-013706.

IDPs Within 100 m
IDPs Within 250 m

After the disaster, support activities were conducted in many areas to encourage people to exercise and walk to improve the health of those affected by the disaster. However, it was unclear what effect these
activities would have. Therefore, Tsuji et al. (2017) analyzed data from JAGES' surveys of older people in Iwanuma City in 2010 and 2013. The study examined the relationship between the frequency of
Trust
is a coreincomponentof socialcooperationand depressive
collective actionin theThey
face foundof adversity
and enabling survivors
to remain
resilient.
Residential
stability
is an important
prerequisite
participation
exercise groups
andcohesion,
the time facilitating
spent walking
per day, withsymptoms.
that post-earthquake
participationin exercisegroupsincreasedby an averageof 1.9 days
per yearoftrusting
relations
among
members.
However, little isInknown
about whether
thethemovementof internallydisplaced
persons (IDPs)
after awere
disastermightHowever,change community
anddeveloping
walking time
per day
increasedby 1.3community
minutes compared
to pre-earthquake.
both activities,
the morenumber increased,
the morethe depressive
symptoms
alleviated.
there was a
relations.
Gero et al. (2020)
explored
perceivedchanges insymptoms
trust after theGreat
East JapanorEarthquake
and Tsunami
among 3250
nonrelocatedof Iwanuma
City.theTheamount
results showthat eachpositive relationshipbetweenthe worseningof depressive
and2011"loss ofemployment
leave of absence"and "damage
to house."
Based onresidents
the results,
we estimatedof exercise
andstandard
deviation
inﬂux of ofinternallydisplaced
persons(1 SDwith= 11damage
IDPs) within
m ofresident'sifhome
associatedwith higher odds
of aandecrease
the resident's
walking required
to increase
alleviate inthetheworsening
depressive
symptoms
associatedto the250
house.
Fora example,
peopleaddress
whose washouseswere "half-destroyed"joinedexerciseingroupﬁve or six
particularizedfrom thesame
community)
generalized
trust
from othercommunities).
to “partial
avoid theerosion of social cohesion after a disaster, it may be crucial
times a month(trustingor walkedpeople
75 minutes
a day,
theirdepressiveand
symptoms
wouldbe (trusting
alleviatedpeople
to the samelevel asthose whoseTherefore,houses haddamage."to provide opportunities for social interaction between old and new residents of communities.
19
15

0.05

0.02
15

15.5

0.00
12.4

-0.02
10
-0.04
-0.06
5
-0.08
-0.100
-0.12

-0.04
7.9

7.4

No change

Became worse-0.14 Change in subjective economic circumstances

No damageby the earthquake Increased walking time per day-0.12

Destroyed

information)* Tooth loss: Fewer numbers of teeth in responses from 2013 than2010
* Subjective economic deterioration and housing damage due to thedisaster were signiﬁcantly associated with tooth loss after adjusting forsex, age, education, income, pre-disaster health status, post-disastermental stress, and loss of loved ones.

Matsuyama Y, Aida J, Tsuboya T, Hikichi H, Kondo K, Kawachi I, Osaka K: Are lowered socioeconomic
Hikichi H, Aida
J, Matsuyama
Y, Tsuboya
Kondoexperiment
K, KawachiInvolving
I: Community-levelsocialcircumstances
causally
related to toothloss? AT,natural
the 2011 GreatEast
capitalEarthquake.
and cognitiveafter
a natural
disaster: A naturalexperiment from the 2011
Japan
Am J decline
Epidemiol.
2017
Jul 1;186(1):54-62.
doi:10.1093/aje/kwx059.
Great East Japan Earthquake and tsunami. Soc Sci Med. 2018 Sep:111981. doi:
10.1016/j.socscimed.2018.09.057.

Housing damage

Community Social Ties

We examined prospectively whether community-level social capital can mitigate the adverse effects of natural disaster on cognitive decline in the aftermath of the 2011 Great East Japan Earthquake andATsunami.
study byThe
Matsuyama
et al.
older people
severelysevenaffectedby theearthquake
wereinmore
likelyoftoolder
lose theirteeth. Housing damage
andlived
worsening
economic
conditions
due80
to thebaseline forour(2017)
naturalfoundexperimental
studywho
waswereestablishedmonthsbeforethe disastera survey
community-dwelling
adults who
in Iwanuma
City, Japan,
locatedkm
disasterwere
the risk Two
factors.
study
analyzedand post-disasterdata(2010 and2013,ofNsurvivors= 3,039)toandshowedthat 8.2%of thestudy
participants
lost theirteeththeafter
the disaster.
Subjective
west of theepicenter.
andThea halfyears
after thepredisaster,
we conducteda follow-up
surveygatherinformation
about
their
individual
experiences
duringdisaster(n = 3560;
82.1%
economicdeteriorationand housing
disaster disability
were associatedwith ontooth
Afterstatisticallyfor sex, age,education,
income,establishedpre-disastertwo
healthstatus, of
post-disasterfollow-up rate).
Our primary
outcomedamage
was thedue
leveltoofthecognitive(measuredan loss.
8-levelscale)
assessedadjusting
within people's
homes.
Factor analysis
subscales
communitymentalsocialstress,loss of loved
ones,(perceptions
subjective economic
deteriorationand housing
damage dueto the disastersigniﬁcantly
associatedwith 8.1%
1.7% increases
in theprobabilityof toothloss,
capital:anda cognitive
dimensionof community
social cohesion)and a structuraldimension(informalweresocializing
and social
participation).
Theandprevalenceof cognitive
declineat follow-up(11.5%)
respectively.
Disaster
were more
likelyOur
to have
poormembershiporal health. Measures
supportoral hygiene,
as distributing
and having spacefor brushingteethandin evacuation
centers,
was three times
highersurvivors
than at baseline(4.2%).
multiple
multilevel tomodelindicatedthat pre-suchversuspost-disastertoothbrushes
increases in community-level
informalsocializing
social participationarewererequired.
associated with lower risk of cognitive decline (coefﬁcient = -0.12, 95% conﬁdence interval: -0.20 to -0.04). In addition, social capital mitigated the risk of cognitive decline due to housing damage(interaction effect coefﬁcient = -0.07, 95% conﬁdence interval: -0.14 to -0.01). Community-level informal socializing and social participation buffers the impact of housing damage on cognitive decline in
the aftermath of natural disaster. Relocating residents together with other community members may help to preserve community social capital and improve the cognitive resilience of older survivors.

Decreased social
capitaland
doeshigher
not explain
post-disasterincreased
depressive symptoms Pre- and Post- Earthquake
symptoms
mortality
on the dayof the disaster19
11 Depressive

The coastal area of Iwanuma City was hit by a massive tsunami
Mortality risk the day after
B: Association between changes
socialsupport/social
capital before
after
the earthquake
aboutinanhour
after the earthquake.
Aidaandet al.
(2017)
summarized
the earthquake
the resultsa study thatfound on the day of the disaster, the risk
andof
depression
in 20131of death was about four times higher for older adults who had
Emotional support fromsevere depression symptoms before the earthquake than for those
Losing relatives
1000 - 1999m
0.83(0.42, 1.65)
3.01(0.56, 16.16)
family and friends
who did not. They analyzed risks of mortality on the day of the
500 - 999m
0.76(0.38, 1.51)
16.88(4.33, 65.84)
disaster and from the next day of the disaster to May 2014 using theInstrumental support from
Losing friends
JAGES Iwanuma data of 860 older adults in the Tamaura area,
0 - 499m
0.84(0.43, 1.68) family and friends
22.66(5.78, 88.84)
Iwanuma city, which was ﬂooded by the tsunami. On the day, 33
Emotional
supportfrom
IncomechangeLiving alone1
1
Householdpeople died (mortality rate-3.8%). The mortality rate on the day of
non-family and friends(Unit: 1 million yen)
the disaster was as high as 12.8% for those who had severe
Co-habiting with others,
1.05(0.54, 2.06)
3.04(0.47, 19.74)
but not parent(s)depressive symptoms before the disaster, and their adjusted risk of
Instrumental support from
Deterioration of subjective
death was about four times higher than for those who did not havenon-family and friends
economic conditions
Living with parent(s)0.45(0.10, 2.12)
6.67(0.83, 53.71)
any depressive symptoms. The mortality risk may have increasedNot
meetingany
friends
1
1
Socialinteractions
Loss of employment
because the evacuation was delayed due to cognitive decline
Social participation(Interacted with friends)
associated with depression, or because people gave up, thinking
Meeting some friends
0.46(0.26, 0.82)
2.06(0.51, 8.23)
that evacuation would not save them. The mortality risk on the day
Loss
of
house
Socialconnections
Normal1
1
Depressive symptomsof the disaster tended to also be higher for those with rich social
0.0
0.5
1.0
1.5
2.0
-0.5
0.0before the-0.5
1.5
2.0 such
2.5
interactions
disaster.1.0
Among suchpeople, actionsasMild
1.39(0.81, 2.38)
0.79(0.29, 2.19)
trying to help a friend may have delayed evacuation from the
Changesin
Depressive
Symptoms(GDS
Scores)2010-2013
Changesin
Depressive
Symptoms(GDS
Scores)2010-2013
Moderate
1.45(0.62, 3.26)
1.14(0.29, 4.50)
tsunami. Additionally, 95 people died the day after the earthquake
in May 2014. During this period, the risk of death for those with richSevere1.91(0.81, 4.50)
3.90(1.13, 13.47)
social interactions was about half that of those who did not. The
Shiba K, Yazawa A, Kino S, Kondo K, Aida J, Kawachi
I: Depressive
symptoms
the aftermath of majordisaster: Empiricaltest ofwith
the social
supportresultsshow
the inimportanceof helping
peoplesevereAdjusted
effects of municipality of residence,
age, gender, education,
1
ActivitiesNote:of dailyliving for theIndependent
1
deterioration model using natural experiment. Wellbeing,
Space and Society.
2020 Jan 1;to
1:100006.
doi: 10.1016/j.wss.2020.100006.
depressive
symptoms
minimizetardiness in evacuation, andincome, IADL, and marital
statusin 2010.
Partially
disabled
2.44(1.30, 4.56)
0.73(0.18, 2.89)
assisting those who are isolated after the disaster.
Disabled
2.97(1.43, 6.14)
0.32(0.04, 2.64)
Depressive symptoms are known to increase among survivors who have experienced trauma after a major disaster. Post-disaster decrease in social capital has been claimed to be one potential cause.
Note: Adjusted for age, sex, medical history, lifestyle, etc. Logistic regression analysis applied for mortality on the day. Analysis for the death from
However,
Shiba et al. (2020) used follow-up data from approximately 3,500 survivors of the 2011 Great East Japan Earthquake and tsunami to investigate whether post-disaster changes in social capitalthe next-day of the disaster, Cox proportional hazard model was applied.
mediates
the association between disaster traumas and increased depressive symptoms using statistically rigorous methods. They found that social capital did not explain the trauma- depression
associations.
Mortality risk the day ofthe earthquake
A: Association between disaster-related experiences and depression
in 2013> 2000m
Distance from coastline
1

symptoms caused due to housing damage?

(re Nof; n ch=2 an,55 ge4)-0.049St(n= rong
40 er
0)
Mu
ch
str
o
(n= nge
34 r
)

-0.06

W
(n= eake
58 r)-0.034-0.04

0.80 0.81

1.20

Depression alleviated

0.75

-0.02

0.92 0.93
Losing family member

0.80

0.89

0.92

Damage to house

0.85

0

0.019

Loss of employment /leave of absence

0.90

Mu
ch
w
(n= eake
12 r
)

0.95

1
1
0.02

(re Nof; n ch=2 an,70 ge
6)

1.00

1.07

0.057

Depression aggravated

1.05

0.04

Trust in people fromHow
yourarea the deterioration of depressive
to mitigate
Decrease in income
Multivariable-adjusted odds ratios

1.10

1.15

Increased walking time

1.15

0.06

Increased frequency ofparticipation in exercise group

Standardized partial regression coefﬁcientMultivariable-adjusted
odds
ratios relevance)(Statisticalindex showing the strengthof relative

1.20(n=3,560)* N = 2,332 (the graph included only those without missing

0.04

Mortality
Decrease inrisksocial
duringsupportdisasterandissocial
four times
capitalhigher
after thefor thosedisasterwith
does
depressive
not explain
symptoms.
the increase in depressive symptoms
Post-disasteramong disastermortality
survivorsrisk reduced by about half through interaction with friends.

Relationships
Changesin community
with changes
relationsin depressive(trust) among
symptoms
nonrelocatedpre- andIwanuma
post-disaster
City residents
0.075

0.06
20

Damage to house

We examined prospectively the association between changes in participation in civic associations and changes in depressive symptoms among older survivors of the 2011 Great Eastern Japan Earthquake.
We analyzed questionnaire-based survey data on pre- and post-disaster participation in civic associations and depressive symptoms compiled for 3567 respondents aged 65 years and above. Changes inAthesestudysymptoms
by Sasakiwere
et al.assessed(2020) foundolder adults
whoDepression
increased Scaleneighborhood
after the disasterless andlikely2013.
to sufferfrom depressive
Anassociations:analysis of data
fromhobby,
a surveyof 3,111
older
usingthata 15-item
Geriatric(GDS) as aties
continuous
variable werefor 2010
We investigatedfoursymptoms.
types of civic
sports,voluntarygroups,adultsin Iwanuma
2010Changes
and 2013
that those
who increased
neighborhoodties after the frequency
earthquake,had 0.39inpoints
worsen depressive
symptoms
the earthquake
thanand seniorcitizens’inclubs.
in showed
participation
were calculated
by subtracting
the participation
measured
2010lessfromlikelythat tomeasuredin 2013. Applying
95%after
conﬁdence
intervals,
wethoseused
whoneighborhood
beforeand after
earthquake.
neighborhoodties may have played standardizeda beneﬁcial rolein the mental
health of GDS
the oldersurvivors
affectedby points
naturalondisasters.
linearhad
regression
modelsties
withimputation
to theestimate
the age-Increased
and sex-adjusted
and multivariate-adjusted
coefﬁcients.
The survivors'scoresincreasedby 0.13average between
the pre-disaster and post-disaster periods. Average changes in the participation frequencies of respondents in each group were respectively +0.36 days/year, −5.63 days/year, +0.51 days/year, and −1.45
days/year. Increased frequencies of participation in the sports and hobby groups were inversely associated with changes in GDS scores (B = −0.003, Cohen's f2 = 0.10, P = 0.01 and B = −0.002, Cohen's f2= 0.08, P = 0.04, respectively). The associations did not differ depending on the experience of housing damage caused by the disaster. In contrast, we did not observe a signiﬁcant association betweenchanges in participation frequencies for voluntary groups or senior citizens' clubs and changes in GDS scores after multivariable adjustment. Depressive symptoms of older adults’ post-disaster may be
mitigated through increased frequency of participation in sports and hobby groups, though civic participation did not mitigate the adverse impact of disaster experiences on mental health.

Trust in people
from other areas
0.08

Percentage of people
Cognitive
who lost
Function
their teeth (%)

DegreePartialof worsening
regression
depression
coefﬁcientsymptoms (points)-0.001
0.1-0.00150-0.0020.15-0.001Pre- and Post- Earthquake

Social ties
Peopleseverely
mitigate
affected
the impact
by theofearthquake
disaster experienceswere moreon
likelypost-disasterto lose their
cognitive
teeth disability

Direction and strength of association with changes in
depression pre- and post-earthquake (n = 3,567)

Reduction of Geriatric Depression Scale (GDS) score

0-0.00050.2

social capital mitigates progression of cognitive disability
Worsening ﬁnancial status increases risk of tooth loss after disaster18 Community-level
10
after a disaster

Iwanuma Project

Aida J, Hikichi H, Matsuyama Y, Sato Y, Tsuboya T, Tabuchi T, Koyama S, Subramanian SV, Kondo K, Osaka K, Kawachi I: Risk of mortality during and after the 2011 Great East Japan
Earthquake and tsunami among older coastal residents. Sci Rep. 2017 Nov 29;7(1):16591. doi:10.1038/s41598-017-16636-3.

20
16

Essayparticipation in exercise and hobby groups help to reduce depressive
Socializing with neighbors post-earthquake reduces depressive symptoms
8 Increased
16
symptoms in disaster survivors

Pre- and Post- Earthquake

Increased participationin exercise
and hobby groups
reduces depressive
symptoms
Relationshipbetween changes
in neighborhood
relationships
and the degreeof severity of depressive symptoms-0.1-0.0025-0.003-0.2-0.0035-0.3-0.004No ➡ Yes(n=257)0.01-0.002*Yes ➡ No
(n=336)Neighborhood relationships
Yes ➡ Yes (Standard)-0.003*(n=2,195)

No ➡ No(n=323)-0.004-0.4-0.0045

Note:* adjusted
for changessigniﬁcantin age, gender, medical treatment, living
p <0.05, statisticallyalone, social participation, smoking habits, drinking habits, subjective
economic status, and walking habits before and after the earthquake, as
Factors considered for statistical impact
well as for the effects of relocation and losing loved ones.
Adjusted
for agesex, educational
attainment,
impaired ADL,
* Indicatesthat there
wasanda statisticallysigniﬁcantassociation.
change in drinking habits, change in smoking status, change injob status, dwelling house damage, death of family members,change in equivalent income, and change in IADL score.

Zhang W, Tsuji T, Yokoyama M, Ide K, Aida J, Kawachi I, Kondo K: Increased frequency ofparticipation in civic associations and reduced depressive symptoms: Prospective study of
Sasaki Y, Tsuji T, Koyama S, Tani Y, Saito T, Kondo K, Kawachi I, Aida J: Neighborhood ties reduced
older Japanese survivors of the Great Eastern Japan Earthquake. Soc Sci Med. 2021 Mar 8;
depressive symptoms in older disaster survivors: Iwanuma study, a natural experiment. Int J Environ
276:11 3827. doi: 10.1016/j.socscimed.2021.113827.
Res Public Health. 2020 Jan 3;17(1):337. doi:10.3390/ijerph17010337.

-0.39*

Change in frequency
Change in frequency
Change in frequency
Change in frequencyof sports groupof hobby groupof volunteer groupof senior citizens'participation
participationclubearthquake
participation
Changes in neighborhood
relationshipsparticipation
before and after the-0.5

affectshelps
socialtorelationships
in areassymptoms
receiving in
displacedsurvivors
Physical activity
prevent depressive
older disastersurvivors
17
9 Relocation

Pre- and Post- Earthquake

p <0.05 Statistically signiﬁcantp < 0.10 Statistically signiﬁcant trend

1.00
0.95
0.90
0.85
0.80
0.75

1

or

1

Gero K, Aida J, Kondo K, Kawachi I: Evaluation of trust within a community after survivor relocation following the Great East Japan Earthquake and tsunami. JAMA Netw Open. 2020 Nov;3(11):e2021166. doi:10.1001/jamanetworkopen.2020.21166.

Walking duration"75 minutes / day"

0.97

(n=3,567)

0.89

Housing damage "1 Stage*"* None / Partial damage /Half-destroyed /Major partial damage/
0.96 Completely
destroyed
0.95

0.90

0.84 in an
For example, if a person with a "half-destroyed" house participates
exercise group ﬁve to six times a month or walks about 75 minutes aday, their depressive symptoms would be alleviated to the same level as
someone with "partial damage" to their house.
St(n= rong
55 er
3)
Mu
ch
str
o
(n= nge
36 r)

0.0251.05

W(n= eake
61 r
)

1.10

1.15

Frequency of participation in
exercisegroups 5-6 times / month"
1.07

Mu
ch
w
(n= eake
12 r
)

1.15

Tsuji T, Sasaki Y, Matsuyama Y, Sato Y, Aida J, Kondo K, Kawachi I: Reducing depressive
symptoms after the Great East Japan Earthquake in older survivors through group exercise
participation and regular walking: a prospective observational study. BMJ Open. 2017 Mar
3;7(3): e013706. doi:10.1136/bmjopen-2016-013706.

IDPs Within 100 m
IDPs Within 250 m

After the disaster, support activities were conducted in many areas to encourage people to exercise and walk to improve the health of those affected by the disaster. However, it was unclear what effect these
activities would have. Therefore, Tsuji et al. (2017) analyzed data from JAGES' surveys of older people in Iwanuma City in 2010 and 2013. The study examined the relationship between the frequency of
Trust
is a coreincomponentof socialcooperationand depressive
collective actionin theThey
face foundof adversity
and enabling survivors
to remain
resilient.
Residential
stability
is an important
prerequisite
participation
exercise groups
andcohesion,
the time facilitating
spent walking
per day, withsymptoms.
that post-earthquake
participationin exercisegroupsincreasedby an averageof 1.9 days
per yearoftrusting
relations
among
members.
However, little isInknown
about whether
thethemovementof internallydisplaced
persons (IDPs)
after awere
disastermightHowever,change community
anddeveloping
walking time
per day
increasedby 1.3community
minutes compared
to pre-earthquake.
both activities,
the morenumber increased,
the morethe depressive
symptoms
alleviated.
there was a
relations.
Gero et al. (2020)
explored
perceivedchanges insymptoms
trust after theGreat
East JapanorEarthquake
and Tsunami
among 3250
nonrelocatedof Iwanuma
City.theTheamount
results showthat eachpositive relationshipbetweenthe worseningof depressive
and2011"loss ofemployment
leave of absence"and "damage
to house."
Based onresidents
the results,
we estimatedof exercise
andstandard
deviation
inﬂux of ofinternallydisplaced
persons(1 SDwith= 11damage
IDPs) within
m ofresident'sifhome
associatedwith higher odds
of aandecrease
the resident's
walking required
to increase
alleviate inthetheworsening
depressive
symptoms
associatedto the250
house.
Fora example,
peopleaddress
whose washouseswere "half-destroyed"joinedexerciseingroupﬁve or six
particularizedfrom thesame
community)
generalized
trust
from othercommunities).
to “partial
avoid theerosion of social cohesion after a disaster, it may be crucial
times a month(trustingor walkedpeople
75 minutes
a day,
theirdepressiveand
symptoms
wouldbe (trusting
alleviatedpeople
to the samelevel asthose whoseTherefore,houses haddamage."to provide opportunities for social interaction between old and new residents of communities.
19
15

0.05

0.02
15

15.5

0.00
12.4

-0.02
10
-0.04
-0.06
5
-0.08
-0.100
-0.12

-0.04
7.9

7.4

No change

Became worse-0.14 Change in subjective economic circumstances

No damageby the earthquake Increased walking time per day-0.12

Destroyed

information)* Tooth loss: Fewer numbers of teeth in responses from 2013 than2010
* Subjective economic deterioration and housing damage due to thedisaster were signiﬁcantly associated with tooth loss after adjusting forsex, age, education, income, pre-disaster health status, post-disastermental stress, and loss of loved ones.

Matsuyama Y, Aida J, Tsuboya T, Hikichi H, Kondo K, Kawachi I, Osaka K: Are lowered socioeconomic
Hikichi H, Aida
J, Matsuyama
Y, Tsuboya
Kondoexperiment
K, KawachiInvolving
I: Community-levelsocialcircumstances
causally
related to toothloss? AT,natural
the 2011 GreatEast
capitalEarthquake.
and cognitiveafter
a natural
disaster: A naturalexperiment from the 2011
Japan
Am J decline
Epidemiol.
2017
Jul 1;186(1):54-62.
doi:10.1093/aje/kwx059.
Great East Japan Earthquake and tsunami. Soc Sci Med. 2018 Sep:111981. doi:
10.1016/j.socscimed.2018.09.057.

Housing damage

Community Social Ties

We examined prospectively whether community-level social capital can mitigate the adverse effects of natural disaster on cognitive decline in the aftermath of the 2011 Great East Japan Earthquake andATsunami.
study byThe
Matsuyama
et al.
older people
severelysevenaffectedby theearthquake
wereinmore
likelyoftoolder
lose theirteeth. Housing damage
andlived
worsening
economic
conditions
due80
to thebaseline forour(2017)
naturalfoundexperimental
studywho
waswereestablishedmonthsbeforethe disastera survey
community-dwelling
adults who
in Iwanuma
City, Japan,
locatedkm
disasterwere
the risk Two
factors.
study
analyzedand post-disasterdata(2010 and2013,ofNsurvivors= 3,039)toandshowedthat 8.2%of thestudy
participants
lost theirteeththeafter
the disaster.
Subjective
west of theepicenter.
andThea halfyears
after thepredisaster,
we conducteda follow-up
surveygatherinformation
about
their
individual
experiences
duringdisaster(n = 3560;
82.1%
economicdeteriorationand housing
disaster disability
were associatedwith ontooth
Afterstatisticallyfor sex, age,education,
income,establishedpre-disastertwo
healthstatus, of
post-disasterfollow-up rate).
Our primary
outcomedamage
was thedue
leveltoofthecognitive(measuredan loss.
8-levelscale)
assessedadjusting
within people's
homes.
Factor analysis
subscales
communitymentalsocialstress,loss of loved
ones,(perceptions
subjective economic
deteriorationand housing
damage dueto the disastersigniﬁcantly
associatedwith 8.1%
1.7% increases
in theprobabilityof toothloss,
capital:anda cognitive
dimensionof community
social cohesion)and a structuraldimension(informalweresocializing
and social
participation).
Theandprevalenceof cognitive
declineat follow-up(11.5%)
respectively.
Disaster
were more
likelyOur
to have
poormembershiporal health. Measures
supportoral hygiene,
as distributing
and having spacefor brushingteethandin evacuation
centers,
was three times
highersurvivors
than at baseline(4.2%).
multiple
multilevel tomodelindicatedthat pre-suchversuspost-disastertoothbrushes
increases in community-level
informalsocializing
social participationarewererequired.
associated with lower risk of cognitive decline (coefﬁcient = -0.12, 95% conﬁdence interval: -0.20 to -0.04). In addition, social capital mitigated the risk of cognitive decline due to housing damage(interaction effect coefﬁcient = -0.07, 95% conﬁdence interval: -0.14 to -0.01). Community-level informal socializing and social participation buffers the impact of housing damage on cognitive decline in
the aftermath of natural disaster. Relocating residents together with other community members may help to preserve community social capital and improve the cognitive resilience of older survivors.

Decreased social
capitaland
doeshigher
not explain
post-disasterincreased
depressive symptoms Pre- and Post- Earthquake
symptoms
mortality
on the dayof the disaster19
11 Depressive

The coastal area of Iwanuma City was hit by a massive tsunami
Mortality risk the day after
B: Association between changes
socialsupport/social
capital before
after
the earthquake
aboutinanhour
after the earthquake.
Aidaandet al.
(2017)
summarized
the earthquake
the resultsa study thatfound on the day of the disaster, the risk
andof
depression
in 20131of death was about four times higher for older adults who had
Emotional support fromsevere depression symptoms before the earthquake than for those
Losing relatives
1000 - 1999m
0.83(0.42, 1.65)
3.01(0.56, 16.16)
family and friends
who did not. They analyzed risks of mortality on the day of the
500 - 999m
0.76(0.38, 1.51)
16.88(4.33, 65.84)
disaster and from the next day of the disaster to May 2014 using theInstrumental support from
Losing friends
JAGES Iwanuma data of 860 older adults in the Tamaura area,
0 - 499m
0.84(0.43, 1.68) family and friends
22.66(5.78, 88.84)
Iwanuma city, which was ﬂooded by the tsunami. On the day, 33
Emotional
supportfrom
IncomechangeLiving alone1
1
Householdpeople died (mortality rate-3.8%). The mortality rate on the day of
non-family and friends(Unit: 1 million yen)
the disaster was as high as 12.8% for those who had severe
Co-habiting with others,
1.05(0.54, 2.06)
3.04(0.47, 19.74)
but not parent(s)depressive symptoms before the disaster, and their adjusted risk of
Instrumental support from
Deterioration of subjective
death was about four times higher than for those who did not havenon-family and friends
economic conditions
Living with parent(s)0.45(0.10, 2.12)
6.67(0.83, 53.71)
any depressive symptoms. The mortality risk may have increasedNot
meetingany
friends
1
1
Socialinteractions
Loss of employment
because the evacuation was delayed due to cognitive decline
Social participation(Interacted with friends)
associated with depression, or because people gave up, thinking
Meeting some friends
0.46(0.26, 0.82)
2.06(0.51, 8.23)
that evacuation would not save them. The mortality risk on the day
Loss
of
house
Socialconnections
Normal1
1
Depressive symptomsof the disaster tended to also be higher for those with rich social
0.0
0.5
1.0
1.5
2.0
-0.5
0.0before the-0.5
1.5
2.0 such
2.5
interactions
disaster.1.0
Among suchpeople, actionsasMild
1.39(0.81, 2.38)
0.79(0.29, 2.19)
trying to help a friend may have delayed evacuation from the
Changesin
Depressive
Symptoms(GDS
Scores)2010-2013
Changesin
Depressive
Symptoms(GDS
Scores)2010-2013
Moderate
1.45(0.62, 3.26)
1.14(0.29, 4.50)
tsunami. Additionally, 95 people died the day after the earthquake
in May 2014. During this period, the risk of death for those with richSevere1.91(0.81, 4.50)
3.90(1.13, 13.47)
social interactions was about half that of those who did not. The
Shiba K, Yazawa A, Kino S, Kondo K, Aida J, Kawachi
I: Depressive
symptoms
the aftermath of majordisaster: Empiricaltest ofwith
the social
supportresultsshow
the inimportanceof helping
peoplesevereAdjusted
effects of municipality of residence,
age, gender, education,
1
ActivitiesNote:of dailyliving for theIndependent
1
deterioration model using natural experiment. Wellbeing,
Space and Society.
2020 Jan 1;to
1:100006.
doi: 10.1016/j.wss.2020.100006.
depressive
symptoms
minimizetardiness in evacuation, andincome, IADL, and marital
statusin 2010.
Partially
disabled
2.44(1.30, 4.56)
0.73(0.18, 2.89)
assisting those who are isolated after the disaster.
Disabled
2.97(1.43, 6.14)
0.32(0.04, 2.64)
Depressive symptoms are known to increase among survivors who have experienced trauma after a major disaster. Post-disaster decrease in social capital has been claimed to be one potential cause.
Note: Adjusted for age, sex, medical history, lifestyle, etc. Logistic regression analysis applied for mortality on the day. Analysis for the death from
However,
Shiba et al. (2020) used follow-up data from approximately 3,500 survivors of the 2011 Great East Japan Earthquake and tsunami to investigate whether post-disaster changes in social capitalthe next-day of the disaster, Cox proportional hazard model was applied.
mediates
the association between disaster traumas and increased depressive symptoms using statistically rigorous methods. They found that social capital did not explain the trauma- depression
associations.
Mortality risk the day ofthe earthquake
A: Association between disaster-related experiences and depression
in 2013> 2000m
Distance from coastline
1

symptoms caused due to housing damage?

(re Nof; n ch=2 an,55 ge4)-0.049St(n= rong
40 er
0)
Mu
ch
str
o
(n= nge
34 r
)

-0.06

W
(n= eake
58 r)-0.034-0.04

0.80 0.81

1.20

Depression alleviated

0.75

-0.02

0.92 0.93
Losing family member

0.80

0.89

0.92

Damage to house

0.85

0

0.019

Loss of employment /leave of absence

0.90

Mu
ch
w
(n= eake
12 r
)

0.95

1
1
0.02

(re Nof; n ch=2 an,70 ge
6)

1.00

1.07

0.057

Depression aggravated

1.05

0.04

Trust in people fromHow
yourarea the deterioration of depressive
to mitigate
Decrease in income
Multivariable-adjusted odds ratios

1.10

1.15

Increased walking time

1.15

0.06

Increased frequency ofparticipation in exercise group

Standardized partial regression coefﬁcientMultivariable-adjusted
odds
ratios relevance)(Statisticalindex showing the strengthof relative

1.20(n=3,560)* N = 2,332 (the graph included only those without missing

0.04

Mortality
Decrease inrisksocial
duringsupportdisasterandissocial
four times
capitalhigher
after thefor thosedisasterwith
does
depressive
not explain
symptoms.
the increase in depressive symptoms
Post-disasteramong disastermortality
survivorsrisk reduced by about half through interaction with friends.

Relationships
Changesin community
with changes
relationsin depressive(trust) among
symptoms
nonrelocatedpre- andIwanuma
post-disaster
City residents
0.075

0.06
20

Damage to house

We examined prospectively the association between changes in participation in civic associations and changes in depressive symptoms among older survivors of the 2011 Great Eastern Japan Earthquake.
We analyzed questionnaire-based survey data on pre- and post-disaster participation in civic associations and depressive symptoms compiled for 3567 respondents aged 65 years and above. Changes inAthesestudysymptoms
by Sasakiwere
et al.assessed(2020) foundolder adults
whoDepression
increased Scaleneighborhood
after the disasterless andlikely2013.
to sufferfrom depressive
Anassociations:analysis of data
fromhobby,
a surveyof 3,111
older
usingthata 15-item
Geriatric(GDS) as aties
continuous
variable werefor 2010
We investigatedfoursymptoms.
types of civic
sports,voluntarygroups,adultsin Iwanuma
2010Changes
and 2013
that those
who increased
neighborhoodties after the frequency
earthquake,had 0.39inpoints
worsen depressive
symptoms
the earthquake
thanand seniorcitizens’inclubs.
in showed
participation
were calculated
by subtracting
the participation
measured
2010lessfromlikelythat tomeasuredin 2013. Applying
95%after
conﬁdence
intervals,
wethoseused
whoneighborhood
beforeand after
earthquake.
neighborhoodties may have played standardizeda beneﬁcial rolein the mental
health of GDS
the oldersurvivors
affectedby points
naturalondisasters.
linearhad
regression
modelsties
withimputation
to theestimate
the age-Increased
and sex-adjusted
and multivariate-adjusted
coefﬁcients.
The survivors'scoresincreasedby 0.13average between
the pre-disaster and post-disaster periods. Average changes in the participation frequencies of respondents in each group were respectively +0.36 days/year, −5.63 days/year, +0.51 days/year, and −1.45
days/year. Increased frequencies of participation in the sports and hobby groups were inversely associated with changes in GDS scores (B = −0.003, Cohen's f2 = 0.10, P = 0.01 and B = −0.002, Cohen's f2= 0.08, P = 0.04, respectively). The associations did not differ depending on the experience of housing damage caused by the disaster. In contrast, we did not observe a signiﬁcant association betweenchanges in participation frequencies for voluntary groups or senior citizens' clubs and changes in GDS scores after multivariable adjustment. Depressive symptoms of older adults’ post-disaster may be
mitigated through increased frequency of participation in sports and hobby groups, though civic participation did not mitigate the adverse impact of disaster experiences on mental health.

Trust in people
from other areas
0.08

Percentage of people
Cognitive
who lost
Function
their teeth (%)

DegreePartialof worsening
regression
depression
coefﬁcientsymptoms (points)-0.001
0.1-0.00150-0.0020.15-0.001Pre- and Post- Earthquake

Social ties
Peopleseverely
mitigate
affected
the impact
by theofearthquake
disaster experienceswere moreon
likelypost-disasterto lose their
cognitive
teeth disability

Direction and strength of association with changes in
depression pre- and post-earthquake (n = 3,567)

Reduction of Geriatric Depression Scale (GDS) score

0-0.00050.2

social capital mitigates progression of cognitive disability
Worsening ﬁnancial status increases risk of tooth loss after disaster18 Community-level
10
after a disaster

Iwanuma Project

Aida J, Hikichi H, Matsuyama Y, Sato Y, Tsuboya T, Tabuchi T, Koyama S, Subramanian SV, Kondo K, Osaka K, Kawachi I: Risk of mortality during and after the 2011 Great East Japan
Earthquake and tsunami among older coastal residents. Sci Rep. 2017 Nov 29;7(1):16591. doi:10.1038/s41598-017-16636-3.

20
16

Essaysocial ties mitigate post-earthquake progression of
12 Individual-levelcognitive disability

Pre- and Post- Earthquake

14 Positive effects on mental health of group relocation into temporary housing
Figure 1 Relationship between relocation methods and social support* p <0.05, ** p <0.01, *** p <0.001

-0.05

-0.10

-0.10***

Hikichi H, Tsuboya T, Aida J, Matsuyama Y, Kondo K, Subramani an SV, Kawachi I: Social capital and cognitive decline
in the aftermath of a natural disaster: a natural experiment from the 2011 Great East Japan Earthquake and tsunami.
Lancet Planet Health. 2017 Jun;1(3): e105-e113. doi:10.1016/S2542-5196(17)30041-4.

-0.15
Improved social ties

Deteriorated social ties

In this natural experiment, the baseline for our study was established 7 months before the 2011 Great East Japan Earthquake and Tsunami in a survey of older community-dwelling adults who lived 80 km
west of the epicentre (59·0% response rate). About 2 and a half years after the disaster, which occurred on March 11, 2011, the follow-up survey collected information about personal experiences ofdisaster as well as incidence of cognitive disability. Our primary outcome was cognitive disability (measured on an 8-level scale) assessed by in-home assessment. We obtained 5058 respondents at thebaseline survey (59·0% response rate) and re-contacted 3594 survivors in the follow-up survey (82·1% follow-up rate). The experience of housing damage was associated with risk of cognitive impairment(coefﬁcient 0·05 [95% CI 0·03 to 0·07]). Factor analysis of our analytical sample (n=3566) established two subscales of social capital: a cognitive dimension (perceptions of community social cohesion) anda structural dimension (informal socialising and social participation). Fixed effects regression indicated that improved informal socialising and social participation mitigated the risk of cognitive
decline due to housing damage (coefﬁcient –0·10 [95% CI –0·14 to –0·05]) and deteriorating informal socialising and social participation aggravated the effect of housing damage on cognitive decline(coefﬁcient 0·04 [0·01 to 0·07]). Improved informal socialising and social participation reduces the risk of cognitive decline due to housing damage in the aftermath of natural disasters. Interventions topromote civic participation should be tried to promote cognitive resilience of older survivors.

Lottery allocation

30%
25%
20%
15%
10%
5%
0%
Receiving social support[if they have someone
who listened to their concerns
and complaints]
n=222

Providing social support[if they listened tosomeone else’s concerns
and complaints]
n=212

3

2.5
1.93

1.5
1

1

1

0.4
0.2

0

0
Receiving social support Providing social support(p = 0.05)(p = 0.21)[if they have someone who[if they listened tolistened to their concerns
someone else’s
and complaints]
concerns and complaints]
The lack of receiving social support increases the risk ofserious psychological distress.

Relocation Method(p=0.36)Thus, the present results suggest thatthe method of resettlement totemporary housing is an important
predictor of access to social support.

Koyama S, Aida J, Kawachi I, Kondo N, Subramanian SV, Ito K, Kobashi G, Masuno K, Kondo K, Osaka K: Social support improves mental health among the victims relocated to temporary housing following the Great East Japan Earthquake and tsunami. Tohoku J Exp Med. 2014 Nov;234(3):241-7. doi:10.1620/tjem.234.241.

The victims of the Great East Japan Earthquake and Tsunami have been forced to live in temporary housing, by two different methods of resettlement: group allocation that preserved pre-existing local social
ties and lottery allocation. Koyama et al. (2014) surveyed the effects of various factors, including the resettlement methods and social support, on mental health. Survivors who underwent group allocation totemporary housing (and were thus living in proximity to people who were their neighbors before the disaster) were signiﬁcantly more likely to report receiving social support than those who underwent lottery
allocation. Moreover, respondents who were receiving social support showed signiﬁcantly lower psychological distress, although the resettlement approach was not signiﬁcantly associated with distress.

15 Review article: Disaster resilience in older populations

In areas with high social participation, the negative health impact of housing damage was reduced

Increasing levels of symptoms of dementia depending on the severity of damage to housing

Change in functional capacity score after the earthquake

0.00

0.8

1.29

0.6

0.5

Relocation to temporary housing together with pre-disaster community
members was signiﬁcantly associated with higher social support.
(Receiving social support p = 0.003 Providing social support p=0.050)

1.4

1

2

1

Group allocation
Lottery allocation

1.2

2.5

13 Community social capital helps to preserve functional independence in older survivors Pre- and Post- Earthquake

Pre- and Post- Earthquake

Community social participation
Lowest tertile
Middle tertile
Highest tertile

-0.05
-0.10

MiyagiEpicenter

Adjusted for individual social capital

-0.15
-0.20

Tokyo

-0.25
-0.30
Gero K, Hikichi H, Aida J, Kondo K, Kawachi I: Associations between
community social capital and preservation of functional capacity in theaftermath of a major disaster. Am J Epidemiol. 2020 Nov 2;189(11):1369-1378. doi:10.1093/aje/kwaa085.

-0.35
-0.40
-0.45

No damagePartial damage

Half destroyed

Mostly destroyed

Destroyed

Severity of housing damage
The strength of social connections in the community ("social capital") is hypothesized to be a crucial ingredient in disaster resilience. Gero et al. (2020) examined whether community-level social capital iscorrelated with the ability to maintain functional capacity among older Iwanuma City residents 2.5 years after the 2011 Great East Japan Earthquake and Tsunami. Functional capacity was measured by theInstrumental Activities of Daily Living scale, evaluating the survivors’ ability to use public transportation, shop for daily necessities, prepare meals, pay bills, and manage deposits and withdrawals at a bankor post ofﬁce independently. Three subscales of community-level social capital were assessed: social cohesion, social participation, and reciprocity. The results show that community-level social participation
was associated with a lower risk of functional decline after disaster exposure. The average level of social participation in the community also mitigated the adverse impact of housing damage on functional
status, suggesting a buffering mechanism.

17

35%

Group allocation

Figure 2 Relationship between social support and serious
psychological distressYes
No
Odds of serious psychological distress

0.00

Association between change in social ties and change in cognitive
disability due to housing damage

Percentage of people without social support

Impact of housing damage on cognitive impairment

0.04*

Pre- and Post- Earthquake

Survivors who underwent group allocation to temporary housing were signiﬁcantly more likely to report receivingsocial support than those who underwent lottery allocation

Social ties mitigate the progression of dementia due to a disaster

0.05

Iwanuma Project

Densely Inhabited Area
(DID) Flooded Area

Kawachi I, Aida J, Hikichi H, Kondo K: Disaster resilience in aging
populations: lessons from the 2011 Great East Japan Earthquake
and tsunami. Journal of the Royal Society of New Zealand. 2020
Feb 4;50(2):263-278. doi:10.1080/03036758.2020.1722186.

Recovery after major disaster poses a unique set of challenges for the older population, including disruption of medical care for pre-existing conditions, functional limitations that impede recovery, andsocial isolation following involuntary resettlement. In this review, we summarize the lessons about disaster resilience that have been learned (so far) from a unique ongoing ﬁeld study based in a communitythat was affected by the 2011 earthquake and tsunami in Japan. In the Iwanuma Study, baseline information about the health status and living conditions of older residents was collected seven months
before the disaster. A follow-up survey was conducted 2.5 years after the disaster, allowing us investigate the risk and protective factors for a range of disaster-related health sequelae, including mental
illness and cognitive disability. A consistent ﬁnding to emerge from our studies is the critical role of social connections (the "social capital" of a community) in protecting against the deleterious after-effectsof psychological trauma and involuntary resettlement following the disaster. In contrast to the emphasis on investing in material infrastructure to prepare for disasters, a review of our studies suggests that
repairing (or at least preserving) the social fabric of people's lives is a crucial ingredient in disaster resilience.

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