保健医療科学

2018Vol.67 No.1 p.50－58

Topics: Lessons learned on public health from the Fukushima Daiichi Nuclear Power Plant accident＜ Review ＞
Psychosocial effects of the Fukushima disaster and current tasks:
Differences between natural and nuclear disasters
Masaharu Maeda 1,2), Misari Oe 2,3), Yuriko Suzuki 2,4)
1)

Department of Disaster Psychiatry, School of Medicine, Fukushima Medical University

2)

Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University

3)

Department of Neuropsychiatry, Kurume University School of Medicine

4)

Department of Adult Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry
Abstract
There are substantial differences between natural and nuclear disasters in terms of the psychosocial
impact associated with many factors such as human and material losses, psychological acceptance,
community cohesiveness, stigmas, and media influence. Although the Great East Japan Earthquake andtsunami that occurred in Fukushima, Japan, was a major disaster, the impact of the subsequent nuclear
accident seemed to be even more devastating on residentsʼ mental health. These effects included not only
posttraumatic responses but also chronic psychiatric symptoms such as depression and alcohol abuse, which
can also contribute to self-destructive behavior such as suicide. In addition to these psychiatric problems,
Fukushima residents had to endure public and self-stigma towards the radiation effects. In particular,
negative risk perceptions about the genetic effects of radiation were associated with depressive symptoms
among the evacuees. Significant exhaustion and various types of depressive symptoms have been reported
among relief workers in Fukushima, who require more intensive care and treatment. To maintain anddevelop the current care network in Fukushima successfully, cooperation between different resources
involving outside experts is key.
keywords: nuclear disaster, depression, posttraumatic stress disorder, stigma, suicide(accepted for publication, 21st November 2017)

I．Introduction
As explosions occurred at the Fukushima Daiichi nuclear
power plant (FDNPP) following the huge tsunami in March
2011, very few seemed to be able to predict the current
situation in Fukushima, where over 100,000 people havebeen evacuated, either voluntarily or involuntarily, for an
extended period of time. The Japanese have historicallyexperienced various types of natural disasters, including
earthquakes, typhoons, and tsunamis, and faced manydifficulties, eventually overcoming them with great effort.
However, the Fukushima disaster took on quite a different

appearance from other natural disasters. As described
below in detail, the Fukushima disaster has several uniquefeatures compared with natural disasters, including an
unclear relief process, invisible effects, uncertainty
regarding information, distrust towards various experts
such as the authorities, and ambiguous losses. Thesefeatures seemed to make Fukushima residents experiencestrong anxiety, which induced manifold mental healthproblems (e.g., depression, posttraumatic responses,
and alcohol abuse). In addition, the Fukushima residents
who were evacuated or relocated to other prefecturesoften faced somewhat public stigmas regarding marriage,

Corresponding author: Masaharu Maeda
1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan.
Tel: +81-24-547-1887; Fax: +81-24-547-1892
E-mail: masagen@fmu.ac.jp

50

J. Natl. Inst. Public Health, 67 (1) : 2018

Psychosocial effects of the Fukushima disaster and current tasks
reproduction, and compensation, which are seldom seen innatural disasters. Therefore, Fukushima residents are not
only suffering from psychiatric problems but also enduring
psychosocial problems such as stigma or discriminationfrom the public. With regard to the complicated psychologicalissues in Fukushima, a multifactorial causal relationshipconsisting of posttraumatic and psychosocial responses,
as well as chronic anxiety was observed (Figure 1). These
responses among residents, including evacuees, could
lead to the development of various psychiatric issues,
such as depressive or avoidant symptoms, and even more
destructive behavior such as alcohol abuse and suicide [1].
In this article, we review the various psychosocial
influences on the people of Fukushima caused by the
nuclear accident. Furthermore, we propose future directions
for mental health care for Fukushima residents.

non-disaster areas. Natural disasters are also thought tobe psychologically acceptable as a calamity beyond humanunderstanding. Furthermore, compensation schemes
after a natural disaster are relatively simple and easy tounderstand, and groundless rumors or stigmas among the
public are seldom seen. Many people evacuated becauseof government orders tend to be relocated relatively close
to their home community. In addition, after many natural
disasters, psychological recovery among evacuees isclosely contingent upon the progress of physical relief,
including the reconstruction of lifelines or other important
infrastructures such as hospitals, public offices, and schools.
On the other hand, the impact of the Fukushima nuclear
disaster was largely invisible, which made it difficult toclarify the boundary between disaster and non-disasterareas. In contrast to natural disasters, the impact of nuclear
disasters is more likely to be persistent, which may lead toconstant fear of fallout or radiation exposure among people
living in and around a disaster area. In nuclear disasters,
physical losses due to the disaster itself are unclear, so
it is not easy for many evacuees to accept substantial
losses physically or psychologically. These ambiguous
losses, furthermore, might elicit disappointment and anger
among evacuees and diminish their hopes of returning
to their hometown someday. Many people seemed to bestrongly influenced by the mass media, including social
networks, and often endure groundless rumors or stigmas
from among the public [3]. With regard to the Fukushima

II．Differences between natural and nuclear
disasters
The Fukushima disaster revealed clear differences inmany aspects from past natural disasters. Differences
between major nuclear disasters such as the Fukushimadisaster and natural disasters have been previously
reported [2,3] (Table 1). For example, in general, theonset of a natural disaster is sudden, and its peak impact
is in the earliest phase. Many areas affected by a natural
disaster are visible and can easily be differentiated from

Nuclear accident in Fukushima
Similar experience to the power plant explosion

Fear of fallout

Anxiety in the public
PTSD/PTSR

Avoidance behavior
Separation of family
Separation of community

Worry about being labeled as
someone exposed to radiation

Alternation of self image:self‐stigma

Loss reaction
depression
Self‐destructive behaviors(alcohol abuse, suicide)

Identity crisis

Figure 1 Multidimensional psychosocial reactions inside/outside of Fukushima [3]Three experiences (“similar experience to the power plant explosion”, “fear of fallout”, and“worry about being labeled as someone exposed to radiation”) that led to various reactions amongpeople living inside/outside of Fukushima were considered key to understanding the participants’complex emotional responses. The unique and specific reactions to the nuclear disaster are shownon the right.

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Masaharu Maeda, Misari Oe, Yuriko Suzuki
Table 1 Differences between natural disasters and the Fukushima disasterNatural disasters

Fukushima disaster

Impact of trauma

Acute, instant

Chronic, continuous

Affected area

Visible, clear

Invisible, unclear

Physical loss

Apparent

Ambiguous

Psychological acceptance

Relatively easy

Very difficult

Anger or disappointment

Relatively low

Very strong

Compensation

Simple, limited

Complicated, unsettled

Groundless rumors

Rare

CommonStigma and self-stigma

Rare

CommonInfluence of media

Relatively low

Very strong

Voluntary evacuation

Few

Numerous

Remote evacuation

Few

Numerous

Cohesiveness of community

High

Low

Psychological recovery

Dependent on physical relief

Independent of physical relief

disaster, compared with evacuees from other affected areas,
especially those areas affected by the tsunami, such as
Iwate and Miyagi Prefectures, a much higher proportionof evacuees from Fukushima volunteered to move toremote areas [4]. In general, psychological recovery amongevacuees after a nuclear disaster is often dissociated fromphysical recovery (e.g., rebuilding of infrastructure anddecontamination), which also leads to delays in returning
home.

III．Psychiatric problems
1. Posttraumatic responses
Similar to other natural disasters, many people in
Fukushima who experienced the tsunami or FDNPP
explosion showed symptoms of posttraumatic stressdisorder (PTSD). In the early phase of the disaster, aretrospective survey was conducted on new outpatients
who had visited psychiatric clinics in Fukushima Prefecture[5]. The results of that survey showed that 13.9% of thetotal number of patients (n = 1321) showed symptoms of
PTSD or adjustment disorder, and 17.2% were experiencing
depressive episodes; symptoms in more than 30% of thesepatients were found to be possibly associated with thenuclear accident. Another study [6] performed in the same
early phase that focused on rescue workers near FDNPP
revealed that psychological distress was strongly associatedwith concern about radiation exposure. In addition, otherstudies [7, 8] conducted on Tokyo Electric Power Company

52

plant workers 2–3 months after the accident demonstrated
that high psychological distress was associated withdiscrimination and slurs.
With regard to the general population in Fukushima,
since February 2012, Fukushima Medical University has
been conducting major population-based mental healthsurveys (the Mental Health and Lifetime Survey: MHLS)
involving approximately 210,000 people who had previously
lived in the evacuation area [9]. In these surveys,
questionnaires, which include a version of the PTSD
checklist for specific trauma (PCL-S) [10], are mailed to thetargeted population annually. The findings show that 21.6%of the adults surveyed score above the cutoff value (≥44)
on the PCL-S at 10 months after the accident, which isalmost equal to that of workers after the 9/11 World Trade
Center attacks in the United States using the same cutoff
value for the PCL-S [11]. A 3-year trend survey [12] of thesame cohort indicated that the age-adjusted prevalence of
probable PTSD based on the results of the PCL-S gradually
decreased over time, from 19.0% (10 months) to 17.8% (35months) for men, and from 25.3% (10 months) to 23.3%(35 months) for women. Another study [13] conducted in
Saitama Prefecture on the evacuees from Fukushima at
1 year after the disaster showed that 59.4% of residents
scored ≥30 on the Impact of Events Scale-Revised [14],which is a 22-item self-rating scale for screening posttraumatic stress symptoms. The findings revealed that
PTSD symptoms were also associated with chronic physicaland mental diseases, anxiety about livelihoods, lost jobs and

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Psychosocial effects of the Fukushima disaster and current taskssocial ties, and concerns about monetary compensation [13].
However, these studies have some limitations. First,
there is a lack of control group comparisons between
residents of Fukushima Prefecture and those living in otherareas. Second, there is a lack of information about whichtraumatic event—the earthquake, the tsunami, or the
explosions at the FDNPP—was the strongest. In spite ofthese limitations, it is apparent that many people, especiallyevacuees, are likely to have strong PTSD symptoms,
leading to hesitation in their returning home because of
avoidance. Therefore, to promote the relief of more affectedareas in Fukushima, posttraumatic stress responses amongevacuees should be mitigated through the provision of
psychological interventions, as well as adequate risk
communication.
2. Depression and related issues
In addition to PTSD, the complicated situation in
Fukushima as described above also seemed to lead tochronic psychiatric issues such as depression, suicide, andalcohol abuse. Actually, the results of the MHLS showedthat the prevalence of probable depression among adultevacuees, based on the 6-item Kessler (K6) scale (score≥13), were as follows: 14.6% in 2012, 11.9% in 2013,
and 9.7% in 2014 [12]. Despite a gradual decrease, thesescores were still considerably higher than that of thegeneral population of Japan (3%) [15]. Furthermore, a close
relationship was observed between depressive symptoms
and the perception of individual risk toward radiation. The
MHLS performed in 2012 showed that the respondents
who believed that radiation exposure was very likely
to cause adverse health effects were significantly more
likely to have depressive symptoms compared with other
respondents [16]. In addition, a 3-year MHLS trajectory
analysis revealed that a negative risk perception regarding
the genetic effects of radioactive exposure was strongly
associated with depressive symptoms [17]. From theclinical perspective, considering this close relationshipbetween depressive symptoms and the perception ofradiation risk, one hypothesis can be proposed: people withdepressive symptoms are more likely to be pessimistic
toward the effects of radiation and other common issues(e.g., financial and health problems, and future plans), which
may exacerbate their depressive state and become a vicious
circle. Therefore, it is important to consider the existenceof depressive symptoms among people who continue tohave excessively negative worries about the adverse
health effects of radiation exposure while providing risk
communication.
Another psychiatric problem often seen after natural
disasters is alcohol abuse [18, 19]. The MHLS showedthat changes in alcohol consumption patterns after thedisaster, not only in terms of substantial increases inalcohol consumption but also in terms of abstinence, wereassociated with a high risk of severe psychological distress[20]. It seems that the prevalence of problem drinking
according to CAGE (an acronym for “attempts to Cut backon drinking, being Annoyed at criticisms about drinking,feeling Guilty about drinking, and using alcohol as an Eye
opener”) scores remained relatively high in both males(20.7% in 2013 and 20.4% in 2014; P=0.18) and females(10.5% in 2013 and 10.5% in 2014; P=0.91) [12]. In spite of
the lack of CAGE data from the general population in Japan,
these findings suggest that primary prevention strategies
need to be prioritized for people at increased risk of alcoholabuse and depression.
Given the evoked issues of PTSD, depression, andalcohol abuse after a disaster, increases in suicide should
be a great concern. Kölves et al. [21] reviewed 42 studies
concerning the relationship between suicide cases andnatural disasters occurring before the Great East Japan
Earthquake. Their findings indicated that, in some disasters,
suicide and non-fatal suicide behavior rates increased after
an initial decline. They also hypothesized that a temporary
decrease in the suicide rate after a major disaster might
result from the “honeymoon phase” following disasters[21]. Furthermore, Matsubayashi et al. [22] examined therelationship between suicide rates and the severity of pastnatural disasters occurring in Japan using prefecture-level
panel data from 1982–2010. They found that suicide rates
only decreased after less destructive disasters, while they
were more likely to increase after massive disasters [22].
They considered that this difference in suicide rates could
be the result of weakened social ties between community
members following a major disaster [22].
Actually, in Fukushima Prefecture, 83 cases of suicidein the 5 years after the Fukushima disaster were officiallycertified as disaster-related by the Japanese Police Agency[23], which is much higher compared with other prefectures
such as Iwate and Miyagi, which were mainly affected by
the tsunami [23]. Given this difference, such a substantial
increase in suicide cases in Fukushima could conceivably be
the result of the effects of the nuclear power plant accident,
rather than those of the earthquake or tsunami. In otherwords, the decrease in community resilience in Fukushima
might have caused the increase in suicide cases.
Furthermore, initially, the standardized suicide mortality
ratio (SMR) decreased after the 2011 disaster (108 in 2010,
107 in 2011, 94 in 2012, and 96 in 2013), but then increased
to 126 in 2014, which exceeded pre-disaster levels (thereference of the SMR is the average suicide rate among thegeneral population in Japan) [24]. This pattern, an increase

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Masaharu Maeda, Misari Oe, Yuriko Suzuki
after a short-term drop, is similar to that noted in a review
by Kölves et al. [21].

IV．Psychosocial issues
1. C aregivers’ anxiety and its influence on theirchildren
Af ter the disaster, many residents without clear
prospects or expectations relocated to different placesinside or outside of Fukushima. In fact, the MHLS foundthat 65.7% of the respondents had relocated more than
three times since the disaster, and that 39.2% of families
had been separated [11]. Along with long-term evacuation,family members often had to be separated from eachother because of physical reasons or differences in risk
perception regarding radioactive exposure [3]. Regarding
risk perception after major nuclear power plant accidents
such as those at Three Mile Island or Chernobyl, young
mothers have tended to have more anxious feelings towards
radiation exposure [25, 26]. In addition, a survey [27] inFukushima at the time of the disaster showed that 28% ofpregnant residents had depressive symptoms, which wasthought to be higher than that in the general populationin Japan [27]. A nationwide epidemiological study [28]conducted 1 year after the disaster found that married
couples were more concerned about radiation and foodsafety, and Fukushima residents, particularly those withyoung children, engaged in more preventative behaviors
against radiation [29].
These intense anxieties concerning radiation among
caregivers, especially young mothers, may elicit behavioral
problems among their children. In a small survey [30] of 97
mothers visiting a pediatric clinic in Fukushima City during
the first 5 months after the disaster, 77.2% reported that
their children had different types of behavioral problems,such as hyperactivity, irritability, and withdrawal behavior.
Moreover, 85.1% of the mothers had the idea to relocate
to a less affected area, if possible [30]. These concerns ofcaregivers and the restrictions on their children’s outdoor
activities may have contributed to the higher obesity rates
observed among children in disaster-affected areas [31].
In addition to self-administered questionnaires for
adults, such as the K6 and PCL-S, the MHLS used theStrengths and Difficulties Questionnaire (SDQ) for younger
populations (age <16 years), which should be completed
by caregivers, to identify problematic behaviors among
their children [9]. At around 1 year after the disaster, theprevalence of children having some type of behavioral
problem according to the SDQ (score ≥16) was 24.4% in
those aged 4–6 years, 22.0% in those of primary schoolage (6–12 years), and 16.2% in those of junior high school54

age (12–15 years) [11]. Overall, 21.2% of the children wereidentified as requiring support; this decreased to 15.3% in
the following year [32]. However, this rate was still higher
compared with that in an area not affected by the disaster(9.5% of those aged 4–12 years) [33]. Considering thatmany children were barely able to understand the healthrisks associated with radiation, it is conceivable that thesefindings resulted from substantial worry about caregivers,
thereby indicating close psychological interaction between
caregivers and their children. Therefore, psychologicalinterventions for children showing behavioral problems
should be conducted with adequate psychoeducation andsupport for their caregivers, especially young mothers.
2. Community fragmentation and self-stigma amongevacuees
In general, the bonds and cohesiveness amongresidents tend to become stronger after a natural disaster.
Moreover, natural disasters may enhance the resilienceof communities and reduce mental health problems. A
previous epidemiological study [34] revealed that theprevalence of PTSD was considerably lower among those
who had experienced a natural disaster than among those
who had experienced other man-made incidents or serious
crimes (e.g., motor vehicle accidents, physical assaults,
and rapes). In Fukushima, people seemed to be divided into
many different groups having different opinions regarding
the health risks of radiation exposure, future prospects,
compensation or other financial issues, political beliefs, andso on [35]. These findings suggest that complications anddissension seem to develop among people when they facea certain situation in which a critical decision needs to bemade about relocating, child-rearing, or marriage.
As a result, the following three types of discordancemight be produced, each of which could lead to dissonancewithin both families and the community: 1) family members
having different opinions on the physical risks caused byradiation exposure; 2) interfamilial conflicts caused bydifferences in residential restrictions or compensation; and3) frustration between evacuees and neighboring areas
where large numbers of evacuees are being taken in (e.g.,
Iwaki City) [3]. These types of discordance might reducethe community resilience that existed before the disaster,
leading to increases in a variety of mental health problems
among residents.
Moreover, nuclear disasters are associated with othercomplicated social issues not seen in natural disasters:
radiation and self-stigma. Despite there being few studies
that reveal the features of public and self-stigma among
Fukushima residents, these have been noted in several nonscientific reports. For example, young women in Fukushima

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Psychosocial effects of the Fukushima disaster and current tasks
were afraid that some people viewed them negatively
owing to assumptions regarding the effects of radiation
on future pregnancy or genetic inheritance [3]. Becauseof such misconceptions or worries, when moving to otherprefectures, they often tried to conceal the fact that they
had lived in Fukushima and experienced the nuclear power
plant accident [36].
As described above, the MHLS includes questions
regarding two types of risk perception towards radiation;
one is about delayed health risks (e.g., thyroid cancer or
leukemia), and the other is about genetic effects on thesubsequent generation [31]. Surprisingly, a consistently
larger proportion of respondents have had a high-risk
perception of genetic effects than of delayed health risks[37]. In 2012, the first survey year, over 60% of respondents
had a high-risk perception about genetic effects [16]. While
this proportion has been decreasing annually, it has only
been doing so gradually, and in the latest survey, was stillover 40% [37]. Compared with worries about delayed
effects such as thyroid cancer, negative risk perceptions
about genetic effects tend to be considered as being
associated with reproduction or marriage, which could
induce self-stigma among evacuees. A study of people withchronic psychiatric disorders such as schizophrenia showedthat self-stigma caused by public stigma often made themmore unstable and anxious, and could even reduce selfefficacy/-esteem [38]. It is possible that, when Fukushimaresidents attempt to establish their identity as a community
member from Fukushima, they can also become more
vulnerable to mental health problems such as depression
owing to low self-esteem or social isolation.
This possible self-stigma among Fukushima residents
should be more similar to that experienced by survivorsof the atomic bombs that were dropped on Hiroshima
and Nagasaki than to that experienced by survivors ofnatural disasters. Atomic bomb survivors, especially young
women, also tried to hide their life histories and refused
to talk about their experiences [39]. This tendency among
young female survivors to conceal their experiences was
also associated with more severe psychological symptoms
compared with male survivors [39]. Given the highrisk perception of genetic effects and the existence ofself-stigma among Fukushima residents, a public antistigma campaign involving the mass media, as well as
risk communication or psychiatric interventions, could benecessary.

V．Tasks and challenges
Mental health care resources in Fukushima are
insufficient to be deployed widely in disaster-affectedareas. One reason is that, in spite of a shortage of experts
before the disaster, a number of medical staff who had
been working in Fukushima relocated to other areas after
the disaster, mainly because of worries about the effectsof radiation exposure. On the other hand, fortunately, anumber of professions working outside of Fukushima
showed great concern and thus came to Fukushima toprovide mental health care or treatment. This newfoundcooperation led to the establishment of several new mental
health care facilities and organizations in Fukushima.
For example, one of these major resources is the mental
health support team at Fukushima Medical University,
which consists of 15 medical staff and has been performing
brief counseling by telephone every year. This teamhas been calling approximately 4,000 evacuees at riskof psychiatric disorders such as PTSD or depression
according to the results of the MHLS [40]. Another major
facility (Fukushima Kokoro No Care Center), with about
50 staff members, including psychiatrists, social workers,
clinical psychologists, nurses, and occupational therapists,
has also been implementing mental health intervention
programs since 2012. This center, which has six branches inFukushima, has been providing active outreach services andgroup interventions for evacuees [41], as well as sharing
necessary information with other preexisting mental healthresources, in an attempt to foster good relationships.
Certainly, cooperation between different care resources inFukushima is key to the success of seamless and long-termcare. The current tasks of mental health care providers inFukushima are as follows:•Developing more efficient screening systems or tools to
identify people at risk of psychiatric disorders and related
issues, especially suicidal behavior•Intensive health promotion activities for preventing
lifestyle-related problems such as alcohol abuse, sleep
disorders, and poor dietary and exercise behaviors.
•Fostering good cooperation with different types of healthprofessionals•Elaborating risk communication skills•Carrying out public anti-stigma campaigns involving themass media•Providing intensive mental health care for relief workers,
especially public employees• Sec uring long - t er m fina nc ia l s uppor t from t h egovernment to maintain and develop the current care
network
Although 7 years have passed since the Fukushimadisaster, many difficult tasks remain unsolved in the domainof mental health care. In particular, public employees
working in disaster areas are likely to be considerably
exhausted. In fact, one study [42] revealed that the current

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Masaharu Maeda, Misari Oe, Yuriko Suzuki
prevalence of depression among all workers belonging to
two towns in the coastal area of Fukushima was as high as
17.8%. The provision of adequate psychiatric interventions
and the establishment of an efficient care system for theseworkers are urgently needed. A continuous supply of
mental health professionals and other relief workers is also
crucial for providing further long-term care for Fukushimaresidents. Finally, information about the current situationin Fukushima needs to be positively conveyed to as manyoutside experts as possible to foster cooperation in the
future.

Conflict of interest
There are no conflict of interest.

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J. Natl. Inst. Public Health, 67 (1) : 201857

Masaharu Maeda, Misari Oe, Yuriko Suzuki

福島原発災害による心理社会的影響と現在の課題―自然災害と原子力災害の相違―
前田正治 1,2)，大江美佐里 2,3)，鈴木友理子 2,4)
1)

福島県立医科大学医学部災害こころの医学講座

2)

福島県立医科大学放射線医学県民健康管理センター健康調査部門

3)

久留米大学医学部神経精神医学講座

4)

国立精神・神経医療研究センター成人精神保健研究部

抄録
原子力災害と自然災害との間には，人的・物的損失のありかた，心理的受容，コミュニティの凝集性，様々なタイプのスティグマ，メディアの影響など，数多くの点で大きな相違が存在する．福島においても，東日本大震災による津波・地震の影響は非常に大きなものであったが，引き続いて引き起こされた原子力発電所事故の住民への影響はさらに増して多大であったと考えられる．そうした影響は，
心理的外傷反応にとどまらず，うつ病やアルコール乱用といった慢性的な精神障害をもたらし，それらによって自殺といった自己破壊的行動さえも引きこされている可能性がある．こうした精神医学的問題に加えて，福島の避難者も含めた住民は，放射線の影響に関する一般大衆のスティグマやセルフ・
スティグマにも晒されている．とりわけ遺伝に関する放射線影響についてのネガティブな認知は，避難住民の抑うつ症状と強く関連している．
さらに，福島で復興事業に従事する就労者に強い疲弊と様々なタイプの抑うつ症状が出現していることが報告されており，彼らに対するより密接なケアや治療が現在求められている．現在福島で展開しているケア・システムを維持・発展するためには，県外も含
めた異なる支援資源間の協力が重要である．
キーワード：原子力災害，うつ病，外傷後ストレス障害，スティグマ，自殺

58

J. Natl. Inst. Public Health, 67 (1) : 2018