Projects for Alcohol-Related Problems in FY 2018

Section II

Research Reports &Other Manuscripts

1. Research Report
2. What we have learned from our support of a hikikomori-An example of continued support prompted by health surveys
3. What we have learned from the Tagajo Disaster Survivors HealthSupport Project
4. Parent-Child Survivors Camping Project
5. Study of Longitudinal Support of Children Born After the Great
East Japan Earthquake and their Families
6. Report on My Observations Regarding the Korean Ferry Disaster
Support Facilities
7. The Effects of Disaster on Children and Medium-Term Mental Health Care

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Research Report

Research Report
Endowed Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine1
Department of Psychiatry, Tohoku University Hospital2
Department of Psychoneurology, Tohoku University Graduate School of Medicine3
Department of Human Science, Faculty of Liberal Arts, Tohoku Gakuin University4

Shusaku Chiba1, Wataru Shoji1,4, Hitomi Usukura1, Yoko Kunii1, Ikki
Ueda3, Atsushi Sakuma2, Kazunori Matsumoto1,3
At the Endowed Department of Preventive Psychiatry, we engage in support and research activities that will
be of use to disaster survivors alongside the Tohoku University Department of Psychoneurology and the
Tohoku University Hospital Department Psychiatry as an arm of the Tohoku University Department of Psychiatry. In FY 2018, we collaborated with the Miyagi Disaster Mental Health Care Center and affiliated organizations on research activities whose results we report below.
1. Research on the mental health of supporters in disaster-affected regions and on support methods(1) Problems and objectives
A great many individuals from different specialties participate in post-disaster recovery and reconstruction efforts. Previous research examining the mental health of individuals working in the aftermathof a disaster focused primarily on professional rescue workers who are active in the emergency phase(JSDF troops, firefighters, policemen, etc.). On the other hand, municipal workers, medical officials,
social welfare servicemen, educators, and other individuals in public sector jobs play an equally important role as supporters in the recovery and reconstruction processes that take place after the emergency phase. Most of these individuals live in the area affected by the disaster; in addition to the stressof the disaster itself, they are also exposed to the stress inherent in post-disaster support work, placing
them at high risk of developing mental health problems. However, research on the long-term mental
health of these individuals remains insufficient. Thus, starting from the year after the disaster, we administered health surveys to municipal employees, SWC members, and nursing employees from regions
affected by the Great East Japan Earthquake. While offering these individuals psychiatric support, weclarified the state of their health and conducted longitudinal research to help them better receive thesupport they require.
Reconstruction work continues, even as the disaster event recedes into the past. The nature of thiswork eventually comes to include the resumption of normal work as well, and it changes from year toyear. Finally, as supporters from around the country slowly leave, local support systems are also constantly in flux. In this report, we will use the results of health surveys conducted among welfare council
employees and nurses to examine the long-term mental health of supporters who work in disaster-affected regions; determine the factors that contribute to declines in mental health, and consider whatsorts of policies would best protect the mental health of individuals participating in long-term support
activities in the post-disaster recovery and reconstruction period.
(2) Research methods
Our subjects were SWC members living in the disaster-affected coastal regions of Tohoku. Between
September 2017 and February 2018 we administered surveys to 265 individuals living in Miyagi Prefecture and collected usable data from 252 (95.1%) of them (data analysis was done in FY 2018, andresults were reported to SWC members in various regions between April and June 2018).
Surveys were self-administered. Survey items were as follows: The status of your current work andthe extent to which the disaster is affecting you; current health status; a depression/anxiety disorders
screening questionnaire (Kessler Psychological Distress Scale: K6)1-3; evaluation of depressive symptoms and their severity using a mental and physical health questionnaire (Patient Health Questionnaire:
PHQ-9)4,5; a three-item easy post-traumatic stress disorder screening test (PTSD-3)6; and a simple
workplace stress assessment7 related to stress factors at work; and social support.

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FY 2018 Bulletin, Issue 7

The freedom to participate was stated clearly on the questionnaire, and to ensure that they would not
be read by workplace superiors or colleagues, responses were collected only after they had been sealedin envelopes by the participants themselves. As a post-survey consideration, individuals who expressed
an interest in therapy were allowed to receive counseling from a clinical psychologist or a psychiatriccare nurse. This option was available even to individuals who did not submit a questionnaire response.
The research was carried out with the approval of the Tohoku Graduate School of Medicine Ethics Review Board.
(3) Research results
Results of the health survey of SWC members
We administered a survey to multiple SWCs in coastal disaster-affected regions of Miyagi Prefecture.
Of the 252 respondents that returned usable survey forms, 24.0% were male, and 75.0% were female(unknown 1.0%), and their average age was 49.2 years. The results of our self-administered survey are
as follows: In FY 2017, 6.1% were K6 high-risk individuals, 9.9% were PHQ-9 high-risk individuals,
and 4.8% were PTSD- 3 high-risk individuals. Changes in the percentages of K6 and PHQ-9 high-risk
individuals from FY 2012 to FY 2017 are shown in Figure 1.
20.0%
18.0%

18.0%

FY 2012FY 2013

16.0%
14.0%

FY 2014

12.0%

FY 2015

10.0%

FY 2016

8.0%

FY 2017

6.0%
4.0%
2.0%
0.0%

K6 (score: ≥13)

PHQ‐9 (score: ≥10)

Figure 1. Percentages of K6 and PHQ-9 High-Risk SWC Members(4) Discussion
If do a chronological comparison of the results of this year’s cross-sectional survey of SWCs with thosedone in the last 5 years, we see that the percentages of K6 high-risk individuals changed thus: 8.4%→ 7.9%
→ 8.7%→ 8.0% → 11.6% → 6.1%. A large decrease occurred this year, giving us the smallest percentage
seen since the survey was first administered. However, this value is still greater than Miyagi Prefecture’s total
average before the disaster (FY 2005 survey of the whole prefecture: 5.5%). A similar decrease was seen in
the percentage of PHQ-9 high-risk individuals, which has changed thus: 13.1% → 13.7% → 14.9% → 13.7%→ 18.0% → 9.9%. To evaluate the severity of PTSD symptoms, we administered the PTSD checklist (PCL)
up until FY 2015; PCL high-risk patients changed thus: 4.1% → 4.1% → 3.7% → 3.3%, i.e., declining gradually. However, since FY 2016, we have used the PTSD-3 scale, whose percentages have changed thus:
6.8%→ 4.8%. Here, again, a decline is seen. However, the fact remains that this number is significantly higher
than it was during the 12-month long prevalence of PTSD in Japan, 0.4%8.
In comparison to FY 2016, there was a decrease in the number of individuals with mental instability in FY
2017. Indeed, the values obtained were the lowest they have been in the last six years. While it is not that easy
to compare data across the years, as the SWC members polled have not always been the same, the results we
see here suggest that, in the seven years that have passed since the disaster, the number of staff members that
present with psychological stress, depression, PTSD, and other mental instabilities has fallen. No drastic improvement in the mental health of mental health and welfare workers in disaster-affected areas has been seen
over the last six years, but it may well be the case that the long-term mental health initiatives of SWCs andother organizations are beginning to bear fruit. Nevertheless, the rate observed here is still considerably higher
than the national average, and it remains to be seen whether or not this downward trend will continue.
It was not uncommon for the staff that visited us for counseling, to express in follow-up interviews, thedifficulties they faced in their workplace relationships, and communication. While how this stress contributes
to mental health is still quantitatively unclear, such an effect is highly plausible.

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Research Report

In light of this reality, we believe SWCs and municipalities must promote initiatives that prevent mental
instability from occurring. For example, in addition to an individual noticing their stress and seeking
out their self-care, managers and supervisors ought to also take quick notice of stress-related changes
in their employees and refer them to organizations that can teach them self-care techniques. To achieve
such a system, countermeasures such as training sessions and workshops that focus on improving workplace environments to reenergize inter-employee communication may be effective at improving mental
health.
2. Research on positive examples of school-mental health and welfare collaboration(1) Problems and objectives
The number of young people who are also psychiatric patients is on the rise. It has been reported thatabout 75% of people with mental illness develop it by 24 years of age and that the onset of mental illness
in young people leads to great losses to society. Therefore, early detection and early intervention are
required, but in practice, there are often long periods between onset and treatment. Adolescence andyoung adulthood are periods in life when one must confront a host of physical and social changes, which
can lead to mental instability. At the school level, this kind of instability can surface as truancy, hikikomori, bullying, violence, delinquency, developmental disorders, child abuse, self-harm, problematicsexual behavior, drug abuse, and internet-use problems. It is usually the case that secondary disorders
such as mental illness or developmental disorders underlie these symptoms, meaning that the appearanceof such issues often hides the real threat to mental health.
Mental health countermeasures at the school level are necessary for early detection of, and interventionin, cases of mental instability in adolescents and young adults. Unfortunately, school mental health policies in Japan are simply not sufficient. Very few individuals specialize in youth mental health issues. Not
just that, but youth mental health issues are often also complicated and idiosyncratic, leading to the needfor varied professionals—like school officials and medical personnel—to collaborate on a solution. Regrettably, schools, and mental health and welfare organizations, rarely work together in such ways.
Recently, several mental health countermeasures have been proposed for youths in Miyagi Prefecture
as well. While efforts to strengthen mental health infrastructure in schools, including suicide countermeasures, are underway, most of these initiatives are isolated from, and independent of, each other. At
the big-picture level, it is not clear what other types of efforts may be necessary, and information on the
topic has not been neatly compiled. The barriers to mental health initiatives in Japanese schools can be
attributed to a lack of knowledge on the part of most school administrations and limited cross-institutional
collaboration—both of which could compensate for such a lack of expertise.
Employees of mental health and welfare institutions need to understand school culture and collaborate
with educational specialists—something that can only happen if they build good relationships with education officials first. Initiatives that allow medical professionals to intervene appropriately in school environments—i.e., “good examples of school-mental health and welfare collaboration,”—must be analyzed, and the essence of this relationship must be identified. Following the Great East Japan Earthquakeof March 11, 2011, worries about children’s healthy mental development in Miyagi Prefecture has increased. Educators and doctors must work together on this issue, and measures to strengthen efforts at
collaboration between these organizations are necessary.
By analyzing the issues that these different cases deal with, we expect to be able to discover the fundamental issues at play in collaboration between schools and mental health and welfare. Thus, in thisreport, we have collected examples of good practices of such school mental health initiatives. We will
examine what sort of interventions and policies are possible if such collaboration is present.

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FY 2018 Bulletin, Issue 7(2) Methods
Our target cases comprise schools in Miyagi Prefecture (elementary, middle, high, and vocational
schools) as well as initiatives involving the students of t schools. Of these, we have specifically listed
those in which education officials and employees of mental health and welfare institutions have collaborated (through case study conferences, case consultations, and individual counseling for students andfaculty by medical professionals, etc.). The targets of our questionnaire and interview surveys are representative of each case or have been designated as such in their stead. We did not target school counselors,school social workers, or their efforts, i.e., things that have already been systematized at the national
level. The survey was carried out according to steps ① to ④ below.
① Collecting information on “good” cases: We collected information on good examples of youth
mental health measures in Miyagi Prefecture, that accounted for collaboration between schools
and mental health and welfare institutions. In addition to publicly available documents, wefound information on best practices by approaching specialists involved in mental health welfare activities at Miyagi Prefecture schools and by gathering information on normal regional
mental health activities.
② Sending out surveys (questionnaires): We requested survey targets to come interview with us; we also
sent them a questionnaire on their school mental health work ahead of time. The surveyed items wereas follows: responder information (age, sex, attributes, profession, job title, participation in the activities in question) and activity-related information (activity objective, activity support target, activity
participants and their professions, activity period, activity overseer, source of funding, current issues,
activity results).
③ Interview survey: The questionnaire results were used as an interview guide, based on which
we asked the survey targets specific details about their work. Interviews were recorded using
an IC recorder and transcribed verbatim.
④ Based on the content of the interviews, we categorized cases by activity content; support targets;the number of activity participants; activity location; activity period and frequency; activity
overseer; source of funding; activity results; and activity issues. This research initiative was approved by the Ethics Committee of the Tohoku University Graduate School of Medicine.

(3) Results

So far, we have interviewed five people about school-mental health and welfare collaboration in
Miyagi Prefecture, and we have collected the following six cases/practices (Table 1).
① A case study conference where mental health care workers visited schools (Happy Mind Plan).
② School visits and individual counseling by mental health and welfare institution employees, as one ofmany regional support activities (Miyagi Disaster Mental Health Care Center resident support counseling support project [MDMHCC Counseling Project]).
③ Psychology education implemented collaboratively at schools by employees of local mental healthand welfare institutions (Mental Health and Medical Welfare Liaison Conference [Working] within
Kesennuma jurisdiction).
④ A joint case study conference and study session organized by education officials and employees ofmental health and welfare institutions (Kesennuma Child Development Study Group).
⑤ A one-stop, counseling/home visit support project for local children and youths (Ishinomaki WideArea Child/Youth Support Consortium [CYSC]).
⑥ A youth support collaboration where administrative agencies and private organizations stand on an
equal footing (Ishinomaki Regional Truancy/Hikikomori Support Network [Ishinomaki Network]).
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What we have learned from the Tagajo Disaster Survivors Health Support Project
Table 1: List of Cases Exemplifying Good Collaboration Between Schools and Mental Health and Welfare Institutions
activity objective① Happy Mind Plan

support targets
activity participants
activity location
activity content② MDMHCC Counseling Project
Post-disaster regional counseling・Greater mental healthknowledge and capacity of mid- support in disaster-affected regions
dle-school faculty to respond to (Kesennuma)
crises・Improved collaboration between hospitals and externalorganizations③ WorkingMental health awareness activities among youths in disaster-affected regions (Kesennuma)(countering the negative effectsof the disaster, and isolationism)④ Child Development Study Group
Development of a regional network ofprofessionals that work with children⑤ CYSC⑥ Ishinomaki Network

Students attending the target
schoolStudents (aged 10-22) from Kesennuma elementary school and to college, and their guardians

High-school students attending
schools in disaster-affected areas

Youths from school-age to early adulthood

Youths aged 0-39 in the Ishinomaki
Metropolitan Area (Higashimatsushima, Ishinomaki, Onagawa)Youths (from elementary school students to 45-year-olds) supported byeach organization

Less than 10 per session including the[school] principal, vice-principal; nursing teachers; SC; SSW;
homeroom teachers; coordinating faculty; etc.
[Specialists] Doctors; PSWs;
administrative PHNs

The individuals themselves, school
faculty (homeroom teacher,headteacher, nursing teacher, etc.);
parents; Miyagi Disaster Mental
Health Care Center staff, etc.

Public middle school

School or Miyagi Disaster Mental
Health Care Center

Agencies and professions: Miyagi Faculty of special support schools; pub- Consortium staff (PSWs, career con- [5 core organizations]: Ishinomaki
Disaster Mental Health Care Cen- lic health nurses; SCs; SSWs; orphan- sultants, faculty); college student
NOTE; Ishinomaki Support-Stay;ter; Health and Welfare Office;age staff; physicians from regional hos- volunteers; other agency staff (from Japanese Association of Social
prefectural mental health andpitals; medical residents; NPO staff;
rehabilitation/caregiving, education, Workers in Health Services; Eastern
welfare center; municipal Social Miyagi Disaster Mental Health Careemployment, medical, health/welJapan Health and Welfare Office;Welfare, Health Promotion, and Center staff
fare, NPOs, SWC, and other resident Eastern Japan Education Office
Health and Welfare Divisions;(all of these people work with school- organizations)Child Student Mental Health Supsupport center for the disabled;
age children)
port Team
hospitals[Observer]: Board of Education, etc.
(Ns, PHN, PSW, administrative
staff, etc.)
Meeting rooms inside schools
Local school or community center
Base: TEDIC
Meeting rooms, etc., in variousand Health and Welfare offices
Activities were held at offices,
organizations, and the Healthhomes, etc.
Care Center

1. Case study conference
2. Mental health lecture forstudents
3. Joint student-targeted lecture with homeroom teachers
4. Training workshops for faculty

1. Conference: Based on the issue athand, participants would share information, etc.
2. School visits (case consultation,
information sharing)
3. Individual interviews / joint interviews (support target, family, etc.)

・Regional information gatheringand case management
・Working on cases that schools cannot handle, as a form of outreach・Create space where each organization can operate on equal terms, divide their work, and promote support for youth
・Support for private organizations
from the prefectural mental healthcenteractivity period and frequency
activity overseer

1. Short skits (performances that
communicate the importance ofcounseling)
2. Introduction to counseling organizations
3. Management of working(meetings, etc.)

1. Case study conference
1. “Free school” (a non-school-like
2. Introduction of work duties by partic- facility for truant children)
ipants
2. A place for children to spend the
3. Secondary activity via participant ex- night (they provide dinner, organizechange (visits to schools, NPOs, hospi- study sessions, transportation, etc.,
tal psychiatrists)
for children from poor families)
4. Collaborations (school-NPO, school- 3. Outreach (support via home vispublic health nurse, school-child coun- its, etc.)
selor, etc.)
4. Telephone counseling, Web coun5. Creation of a mailing list (manageselingment consultation, posting of opinions, 5. Walk-in counseling (Three conprovision of training information, etc.) sultations, then a conference involving an external SVer and thenconsider referrals/follow-ups)

Management meetings by the coreorganizations (decide activities incollaboration with the needs ofprivate organizations)Symposium (16 organizations
participated, shared their support
work and issues)
Projects with the entire network
Creating and updating the support
map
Establishing a free counseling service for participating organizations at
the symposium (FY 2016)

・Activity period: April 2015 to
the present
・Activity frequency: Once yearly(meetings: 5-6 times yearly)

・Activity period: June 2013 to the present
・Activity frequency: Regular(approximately once monthly)・Activity period: July 2018 to June
2021 (4 years)
・Activity frequency: Continuous

・Activity period: June 2013 to thepresent
・Activity frequency: Irregular (atleast 3 times a year)

Working Group on Measures
Miyagi Disaster Mental Health Care Administrators: Miyagi Disasterfor Youth Suicide Countermeas- Center
Mental Health Care Center;ures Emergency Project
Health care center・Core members included teachers at lo- Ishinomaki Wide-Area Child/Youthcal special support schools and doctors Support Consortium (3 groups:
Switch, TEDIC, Sanaburi Fund)at the Miyagi Disaster Mental HealthCare Center (total: 4-5 people)

・No parent organization or headquarters established (five core organizations)

Miyagi Prefecture

Miyagi Disaster Mental HealthCare Center budget

No funding (requested 500 yen fromeach participant to arrange light refreshments)

Funding from the various organizations

The expected improvement inmental health knowledge andresponsiveness among involved facultySpecialist results: knowledgeof the school environment andrelationships with schools

1. Possibility that community mem- 1. Raising mental health awarebers now understand that there is one ness among high school students
more place they can go for counsel- (through collaboration with SC,
ing
SSW, faculty, etc.)
2. Possibility that this program can 2. Improvement in awareness of,take on “gray” issues (cases with dif- and desire to use, regional counficult to name disorders or problems) seling agencies (from question3. It provides a space for targets tonaire results)
receive counseling outside of
3. Opportunity to meet and bework/school hours and on holidays come acquainted with mental
health and welfare specialists
4. Strengthening of the network
between participating specialists

・ Activity period: April 2014 to ・Activity period: April 2012 to theApril 2017present
・Activity Frequency: Irregular・Activity frequency: Regular(respond as cases come in)(approx. once monthly)

funding
activity results
activity issues

1. Case study conference at1. Because this program operates
tendees’ list was inflexible, so
according to the community’s
non-participating faculty could needs, it is approaching certain limno participate/be reacheditations (overtime work, securing
2. Instability of the group due to places for interviews, personnel
shortages, etc.)
faculty change (currently, theprincipal and VP have changed, 2. The fact that only the Miyagi Disso the program has concluded) aster Mental Health Care Center is
3. Difficulty consulting when an working closely with educational inattending physician was present stitutions is a problem. Health carecenters, the city itself (Health Pro(something we would like themotion Division, Social Welfare Dischool to understand)vision, Child Support Division), and
4. Incomplete achievement ofchild counseling centers, etc., must
objectives (program might bealso get involved.
more reliable if we limit it tonursing teachers and SCs andfocus on skill improvement)

Health care center budget andMiyagi Disaster Mental HealthCare Center budget

1. Budget issues (music, etc.,
make short skits expensive)
2. Whether or not activity oversight can be smoothly transferred from the Miyagi Disaster
Mental Health Care Center toother regional organizations(working participants, etc.)

・Miyagi Prefecture “Child/YouthSupport System Strengthening Project”
・Great East Japan Earthquake Reconstruction Support Foundation“Child Support Fund”
1. Strengthening collaborations withTeam outreach became possible
psychiatrists (connected to visits to psy- (could protect against false or insufchiatrists, etc.)
ficient information; information be2. Improvement of collaborative ability came easier to collect)inside the community (professionals
Responding to difficult cases befrom separate organizations can be in- came possible (can offer to counsel
troduced to each other)to cases that get shunted around; can
3. Origin of independent activities
refer these individuals to the appro(even without the founders, doctors
priate organizations)from the Miyagi Disaster Mental
Health Care Center, it continues to beheld)

1. Impression that professional skills
such as information gathering abilities;
interpersonal support technology; anddecision-making ability have not been
improved
2. Budget issues (after the funding has
been exhausted, eliciting participationfrom doctors will prove difficult)
3. Would like younger people (especially doctors) to participate
4. Management issues due to facultychanges (passing the project on, etc.)
5. Because this is a volunteer initiative, it must meet outside of worktimes

1. Impression that it became easierto refer cases to others by developing face-to-face relationships and interacting with them regularly
2. Ability to work with educational
institutions
3. Creation of support map (established and usable at Health care center; used to respond to supporter
needs)
4. By having the administration participate in a horizontal, non-hierarchical manner, the hurdles that private organizations face in requesting
things from them are lowered (PR,etc.)
1. Insufficient collaboration with
1. Organization member change:
medical professionals and doctors:
Becomes difficult to maintain conMore doctors need to participate (es- tinuous management
pecially child psychiatrists)(the issue is that change in de2. Issues finding caseworkers, psy- sire/motivation to participate causes
member switch-out, accompanied bychologists, and student volunteers
3. Difficulty providing support to re- changes in organizational needs)
gions with poor social resources (no 2. Differences in expectations: Issuebase of operations, so it is difficult to with the impartiality of the administration.
operate)3. Barriers with education: PR, etc.,
are difficult (principals refuse opportunities for private organizations to
introduce their work)*Notes: SC = school counselor, SSW = school social worker, PHN = public health nurse, PSW = psychiatric social worker, PR = public relations－ 101 －

FY 2018 Bulletin, Issue 7(4) Discussion
Of the six cases we looked at, only one was rolled out because of administrative policy (case ①). The
others were rolled out after the Great East Japan Earthquake in disaster-affected areas (cases ②-⑥). We
also observed activities that were funded by disaster aid grants (case ⑤). Mental health and welfare
activities that began as disaster reconstruction measures can ultimately strengthen collaboration between schools on the one hand, and the mental health and medical welfare field, on the other.
These initiatives—their objectives and content—appear to have been responsive to the needs of theparties involved and the phase of activity. We believe that this kept these initiatives exciting and inspiring, and leading to their prolongation (cases ②-④). Any program that strengthens the collaborative
relationship between schools and mental health and welfare institutions, stands to benefit from a systemthat facilitates and maintains mutual communication. This allows stakeholders to rethink the content
and nature of their programs as they respond to each other’s needs.
Their work has resulted in the construction of regional supporter networks and the strengthening ofcollaborative bonds (case ①-⑥). On the other hand, some noticeable issues were preventing them fromcontinuing their activities like financial hurdles, for example, which led to hiatuses/terminations in theiractivities. Organizational restructuring due to member flux, and the need to come in on weekends orwork overtime to participate in these efforts were some of the other difficulties that they faced (cases①-④, ⑥).
Currently, to the state of school-mental health and welfare collaboration in Miyagi Prefecture, it appears that education officials and employees of mental health and welfare institutions are well aware of
the major problems and the continued need to collaborate. However, such collaborations suffer from thedisparity between the educational administration’s and health and welfare administration’s purviews,
and public support or efforts to create a framework for it is essentially non-existent. To achieve collaboration, further resource investment, and the creation of a methodology for effective collaborative practice, are both needed.
3. Interventional research examining the feasibility of a health promotion support program for community residents using an ICT-based cognitive behavioral therapy approach(1) Problems and objectives
In recent years, there has been an increase in the number of patients examined at medical institutions
for mental illnesses such as depression, anxiety disorder, schizophrenia, and dementia. According to
Health Japan 21, which is a set of government guidelines to promote the health of Japanese citizens,countermeasures that protect community residents’ mental health include early intervention in mental
illnesses such as depression; countermeasures against suicide; improved ability to cope with stress orenrichment of support, and adjustment of one’s social environment to reduce stressors. The scope of theGreat East Japan Earthquake was vast enough and horrible enough that even though it has been eight
years since it occurred, the deteriorating state of people’s mental health is still a concern. This is why
initiatives that protect and enhance community mental health and seek to prevent the onset of mental
illnesses are necessary. Given the fact that Japan is aging at a globally unmatched rate, we must focus onelderly individuals, who make up a large chunk of the populace, and come up with an effective systemof support.
One effective approach to treating mental health issues is cognitive-behavioral therapy. Cognitivebehavioral therapy is an effective treatment for depression and a variety of other mental illnesses and is
widely used even outside clinical settings. Combining it with PCs, internet media, and another ICTs has
made effective mental health and medical services accessible to large numbers of people. ICTs’ capacity
to contribute to the primary prevention of mental illness is highly anticipated; such applications are stillin development. Proven use cases involving elderly people are quite rare.
In light of the dangers that accelerated aging and depopulation pose to the mental health of community
residents, especially those living in areas affected by the Great East Japan Earthquake, this study will
examine the feasibility of a health promotion support program (prototype), based on cognitive-behavioral theory and practice, that uses smart-device ICTs.
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What we have learned from the Tagajo Disaster Survivors Health Support Project(2) Research methods
Our targets were elderly individuals, who worked or lived (alone) in Miyagi Prefecture. We advertised
this study in newspapers, etc., and enrolled individuals that met our eligibility criteria into the program.
The survey period extended from September 2017 to April 2019.
After first piloting our survey on a small group of individuals (3-4), we will carry out a before-and-after(non-randomized) comparison study of 6-12 participants. Over four weeks, when they are at home, research participants will either use a robot (name: PaPeRo-i), or a tablet, capable of the following: activity
record and monitoring system; behavioral activation training; and providing health information. To examine the effects of our intervention, on top of requesting subject background information (birth date, age,sex, treatment history for physical and mental illness, current medications, and current state of health),
we will evaluate participants a total of two times (before and after the study) on the following items using
the following metrics: positive emotions (Environmental Reward Observation Scale, EROS), loneliness(Japanese version of the UCLA Loneliness Scale), subjective happiness (Philadelphia Geriatric Center
Morale Scale), self-esteem (Rosenburg self-esteem scale), social capital (12-item questionnaire developedby the Aichi Gerontological Evaluation Study (AGES)), and mental health (General Health Questionnaire,GHQ-30). After they complete the program, we will interview the subjects, and ask them their opinions
about having used it (Did it harm your mood?; How easy was it to use?; What did you feel was usefulabout it?; What can we improve? etc.) This study has received the approval of the Tohoku University
Graduate School of Medicine’s Ethics Committee.
(3) Progress
We recruited for our preliminary trial via our PR magazine, and regional health and welfare project
managers. Between March and October 2018, we were able to enroll three women (mean age 65.0, SD
2.7) as preliminary trial subjects for our health promotion support program. We upgraded our system
based on their feedback, after 4-months of use. Of the items that were mentioned in post-intervention
interviews, one feature that we implemented was a delete function for activity record entries on the tablet
device.
Afterward, we carried out recruitment using our PR magazine (Figure 2) and began the main trial in
November 2018. By April 2019, we had implemented our intervention in 10 cases and had completedintervention in a total of 9 cases (one individual withdrew). Now, we will endeavor to analyze the data
we have obtained.

Figure 2. A Sample Recruiting Advertisement We Used for This Trial

4. Survey interview of experiences receiving disaster preparedness support from the social welfare council(1) Problems and objectives
In disaster situations, acceptance of volunteers and responsibility for regional health and welfare fall
disproportionately to SWCs. This is why SWCs are chronically overworked in the immediate aftermathof a disaster, and many members and employees come down with mental health (MH) issues. Over the
past year, we of the Tohoku University Endowed Department of Preventive Psychiatry have provided
MH support for SWCs in disaster-affected areas. Here, we report what we have learned from interviews
with supervisors looking back on their work, about what sort of support SWCs need, and what sort of
support-receiving systems must be built to streamline the process.

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What we have learned from the Tagajo Disaster Survivors Health Support Project(2) Methods
We interviewed six SWC members from disaster-affected areas in Miyagi Prefecture on the following
topics: ① the MH support they received in various post-disaster period phases (acute phase, subacutephase, medium-term), ② the advantages and disadvantages thereof, ③ the MH support required in eachperiod, and ④ the systems necessary to effectively use MH support. The data was anonymized and organized. Participants were provided with a description of the study before participating; we obtained
written consent to publicize the results.
(3) Results and discussion
Many of the subjects had identified the need for MH support in the wake of the disaster but had had
trouble receiving it. Factors contributing to this difficulty included organizational and occupational
quirks (they were already short-handed, and any breaks taken would mean that work would just pile up;
they were being looked to by residents and citizens, and they couldn’t take time off to receive support).
Additionally, the fact that their usual “peacetime” labor-management policies did not make any allowances for MH countermeasures was raised. We, therefore, believe that support receivers should, in peacetime, promote MH countermeasures as a preventive measure, and support providers should proactively
back such efforts.
References
1) Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, Walters EE, & Zaslavsky AM.
(2002) Short screening scales to monitor population prevalences and trends in non-specific psychologicaldistress. Psychological Medicine. 32: 959-976.
2) Furukawa TA, Kessler RC, Andrews G, & Slade T. (2003) The performance of K6 and K10 screening scales
for psychological distress in the Australian National Survey of Mental Health and Well-Being. Psychological Medicine. 33: 357-362.
3) Furukawa TA, Kawakami N, Saitoh M, Ono Y, Nakane Y, Nakamura Y, Tachimori H, Iwata N, Uda H,
Nakane H, Watanabe M, Naganuma Y, Hata Y, Kobayashi M, Miyake Y, Takeshima T, & Kikkawa T.
(2008) The performance of the Japanese version of the K6 and K10 in the World Mental Health Survey
Japan. International Journal of Methods in Psychiatric Research. 17(3): 152- 158.
4) Muramatsu K, Miyaoka H, Kamijima K, Muramatsu Y, Yoshida M, Otsubo T, & Gejyo F. (2007) The patient
health questionnaire, Japanese version: validity according to the mini-international Neuropsychiatric interview-plus. Psychological Report. 101: 952-960.
5) Kumiko Muramatsu, Kuniyoshi Kamijima (2009) Primary Care Practice and Evaluation Tool for Depression Screening: Patient Health Questionnaire-9 Japanese version of “Kokoro and Body Questionnaire” Diagnosis and Treatment. 97: 1465-1473.
6) Norihito Kawakami, Hisaaki Tatemori, Yuki Shimoda, Kiyomi Sakata, Kotaro Otsuka, Ruriko Suzuki, Yukari Yokoyama, Kenji Kawano, Ryo Yamashita, Keisuke Shirakami, Rouka Otsuki (2014). Examination of
the validity of the mental health survey in the affected area of Iwate prefecture. 2013 Ministry of Health,
Labor and Welfare Grant-in-Aid for Health, Safety and Crisis Management Countermeasures Project“Large-Scale Cohort Study in Iwate Prefecture of Survivors of the Great East Japan Earthquake and Tsunami.”
7) Teruichi Shimomitsu (2009). A Manual for Understanding Stress Condition Using a Simple Workplace
Stress Survey: More Effective Measures for Improving the Workplace Environment. 2002-2004 Ministryof Health, Labor and Welfare Grant-in-Aid for Occupational Health and Safety Research. Research on Mental Health Measures for Improving Workplace Environments.
8) Kawakami, N, Takeshima, T, Ono, Y, Uda, H, Hata, Y, Nakane, Y, Nakane, H, Iwata, N, Furukawa, T, &Kikkawa, T. (2005). Twelve‐month prevalence, severity, and treatment of common mental disorders incommunities in Japan: preliminary finding from the World Mental Health Japan Survey 2002–2003. Psychiatry and clinical neurosciences, 59(4): 441-452.
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