Chapter 2

Research Reports＆Other Manuscripts– 103 –

– 104 –Research Report
Department of Preventive Psychiatry, Graduate School of Medicine, Tohoku University1)
Department of Psychiatric Disorders, Tohoku University Hospital2)
Department of Psychiatry, Graduate School of Medicine, Tohoku University3)
Wataru Shoji1), Hitomi Usukura1), Mikika Abe1), Yoko Takahashi1),
Atsushi Sakuma2), Hiroo Matsuoka3), Kazunori Matsumoto1) 3)
The Department of Preventive Psychiatry continuously conducts support and research activities fordisaster areas as one of the psychiatry laboratories at Tohoku University, also including the Department of
Psychiatric Disorders and the Department of Psychiatry. In FY2016, we conducted survey and research
activities as reported below in collaboration with the Miyagi Disaster Mental Health Care Center(MDMHCC) and other relevant institutions.

1. Survey of the Mental Health of Supporters in Disaster Areas and Research Support Methods(1)

Issues and Aims
People of diverse professions are involved in the restoration and reconstruction that follows largescale disasters. Previous studies that have looked at the mental health of people working in disasterareas have primarily been concerned with professional rescuers during the emergency phase. At thesame time, supporters engaged in highly public work, such as local authority staff, medical
professionals, social welfare service workers, and teachers, play an important role in long-term
support activities, which includes the restoration and reconstruction phase that follows the
emergency phase. Most of these people are residents of the disaster-struck area, who are thus not
only subject to stress as disaster victims but continuously receive stress from the long post-disastersupport, which likely leads to a high risk of mental health issues. However, research on the mental
health of such supporters in highly public occupations has been insufficient. Thus, we are conducting
a health survey involving local authority staff and Social Welfare Council (SWC) staff in areas
affected by the Great East Japan Earthquake one year or more after the disaster. We are also doing alongitudinal research study to not only provide support from a psychiatric standpoint, but also toclarify the reality of the health of these staff members and help implement the necessary support.
In particular, restoration work is ongoing long after the disaster hit and its contents are changing
by the year. Moreover, the circumstances of local support is constantly changing, for example
because of the gradual decrease in supporters coming in from all over Japan. This study uses theresults of a health survey involving SWC staff conducted in FY2016 to examine what primaryfactors are relevant to poor mental health, and we wish to investigate what policies are needed toprotect the mental health of people engaged in long-term support activities.

(2)

Research Methods
The survey involved SWC staff from disaster areas along the Tohoku coast. We conducted thesurvey on 608 staff members from several SWCs within Miyagi Prefecture between October 2015
and March 2018 and collected data from 539 (88.7%) of them (We analyzed the data in FY2016 andreported the results to each SWC in June 2016).
The survey used self-administered questionnaires. The survey items included current work
situation and personal disaster situation, current health condition, a questionnaire screening fordepression and anxiety disorders (Kessler Psychological Distress Scale: K6), a questionnaire on– 105 –

mental and physical health (Patient Health Questionnaire: PHQ-9) to assess symptoms of depression
and their severity, and a 17th question with a PTSD Checklist (PCL) to assess PTSD severity.
The questionnaire explicitly stated the optional nature of participation, and the samples werecollected after being sealed by the participants themselves so as to maintain the confidentiality of theresults from bosses and colleagues. After the questionnaire, we offered participants the chance tohave a consultation with a clinical psychologist or a psychiatric certified nurse specialist, and we also
informed people that this would be available even if they did not submit the questionnaire.
Furthermore, this study was conducted after approval by the Ethical Board of the Graduate School of
Medicine, Tohoku University.
(3)

Study Results
We conducted the survey with several SWCs in disaster areas along the coast of Miyagi
Prefecture. The 539 respondents consisted of 26.9% men and 73.1% women with an average age of48 years. The results of the self-administered questionnaire for the 2015 survey showed 8.0% at highrisk on the K6, 13.7% at high risk on the PHQ-9, and 3.3% at high risk on the PCL.
Next, we conducted a longitudinal examination of the primary factors relevant to those at highrisk according to the K6, the PHQ-9, and the PCL. We assigned K6, PHQ-9, and PCL high risk as
the response variable, and the following items as the explanatory variables: “Basic attributes” (age,sex, occupation), “Individual factors” (single household, illness treatment history prior to theearthquake, mental health treatment history prior to the earthquake, lack of sense of local solidarity),“Factors caused by the earthquake” (emergency temporary housing, dead or missing family members,
life-threatening experiences, self-condemnation for actions taken at that time), and “Workplace
factors” (evacuating one’s home, not being able to recuperate, lack of workplace communication,
seemingly unending workload). We then conducted a logistic regression analysis. We conducted asimple linear regression for each item and conducted multiple regressions for those found to besignificant, examining their correlation (Table 1).
The primary factor with the highest odds ratio for those aware of high stress levels of at least 13
points in the K6 was “I have a mental health treatment history after the earthquake.” Those with ahistory were about 9.1 times more likely to be aware of high levels of stress than those without ahistory. Next, those who ticked “I am struggling with workplace human relations” were about 4.4
times more likely to be at risk of being aware of high stress levels than others. Those who ticked “Ifeel I have a seemingly unending workload” were about 2.9 times more likely than others.
Table 1. Primary factors relevant to the mental health of SWC staff 55–60 months
after the earthquake
Primary factors relevant to psychological stress (K6)

I have a mental health treatment history after theearthquake
I am struggling with workplace human relations
I feel I have a seemingly unending workload

Primary factors relevant to symptoms of depression (PHQ)

I had a mental health treatment history prior to theearthquake
I have a mental health treatment history after theearthquake
I have not been able to recuperate
I am struggling with workplace human relations
I feel I have a seemingly unending workload

Primary factors relevant to symptoms of trauma (PCL)

I feel guilt over actions that I took at the time of theearthquake

The primary factor with the highest odds ratio for those requiring special attention with symptoms
of depression of at least 10 points in the PHQ-9 was “I have a mental health treatment history after
the earthquake.” Those with a history were about 4.0 times more likely to exhibit strong symptoms– 106 –

of depression than those without a history. Next, those who ticked “I had a mental health treatment
history prior to the earthquake” were about 3.5 times more likely to exhibit strong symptoms ofdepression than others. Those who ticked “I am struggling with workplace human relations” wereabout 3.4 times more likely than others, those who ticked “I feel I have a seemingly unending
workload” were about 2.2 times more likely than others, and those who ticked “I have not been able
to recuperate” were about 2.1 times more likely than others.
The primary factor with the highest odds ratio for those requiring special attention with PTSD
symptoms of at least 44 points in the PCL was “I feel guilt over actions that I took at the time of theearthquake.” Those who feel so were about 7.9 times more likely to exhibit strong PTSD symptoms
than those who do not. Additionally, while not statistically certain, those who ticked “I am struggling
with workplace human relations” were about 8.3 times more likely to exhibit strong PTSD symptoms
than others. Those who ticked “I have a mental health treatment history after the earthquake” wereabout 3.2 times more likely than others, and those who ticked “I have not been able to recuperate”
were about 3.0 times more likely than others.
The above suggested that workplace factors such as “I am struggling with workplace humanrelations,” “I have not been able to recuperate,” and “I feel I have a seemingly unending workload”
have a considerable impact on mental health. Moreover, we also saw that having a “mental healthtreatment history” prior to and after the earthquake increases the risk of mental health deterioration.
Furthermore, “I feel guilt over actions that I took at the time of the earthquake” had a considerable
impact on PTSD.
(4)

Discussion
A chronological comparison of these SWC survey results and the results of other longitudinalsurveys over a three-year period (FY2012, FY2013, FY2014) shows little change in the proportion of
those with K6 high risk at 8.4%  7.9%  8.7%  8.0%, while it is higher than the level for all of
Miyagi Prefecture before the earthquake (about 6% for the prefecture in the 2010 national census).
Moreover, those with PHQ-9 high risk remained at a high level at 13.1%  13.7%  14.9%
13.7%. Those with PCL high risk showed a downward trend at 4.1%  4.1%  3.7%  3.3%,
but there was no major improvement.
It became clear that SWC staff had a proportion of persons with mental unhealth larger than innormal times to some extent even five years after the earthquake. Normally, the indicators for mental
health should gradually improve as time passes after the earthquake, but the mental health situation
here has not improved significantly since the first survey, suggesting the possibility of plateaued
improvement. The SWC staff are in a position of continuously supporting the weakest victims, and it
is possible that the long duration and difficulties of that support are causing chronically high levels ofstress.
Investigating the primary factors impacting mental health 56 months after the earthquake, we
found that the workplace factors “I am struggling with workplace human relations,” “I have not beenable to recuperate,” and “I feel I have a seemingly unending workload” have a major impact onmental health. In addition to their restoration work, their work to support local welfare is returning topre-earthquake levels, which is placing an excessive burden on the workplace as a whole, and this isthought to be one cause. In order to maintain individual mental health, we believe that initiatives for
improving the working environment as a whole in normal times are more needed than mental healthmeasures adapted to disaster recovery. The former includes improving workplace communication,
creating a working environment that makes it easy to recuperate, and efforts to alleviate work
difficulties and negative feelings.
Furthermore, we also saw that answering “I have a mental health treatment history” before orafter the earthquake increases the risk of mental health deterioration. Moreover, “I feel guilt overactions that I took at the time of the earthquake” had a major impact with regard to PTSD. We see
the need for measures that allow staff to share and talk about struggles relating to their support workwithin the workplace and that let them attend work-related conferences or receive work-related
supervision as a way to help those with risk factors.
– 107 –

2. Studies of Skills for Psychological Recovery in Disaster Areas(1)

Study of the Possibility of Implementing Skills for Psychological Recovery (SPR) to Help Disaster
Victims during the Restoration Phase in Japan<Issues and Aims>
SPR represents the latest in practical psychological support techniques and can be applied to abroad range of mental issues that many disaster victims are likely to experience in the restoration andreconstruction phase. It was developed by the U.S. National Center for PTSD and the U.S. National
Child Traumatic Stress Network and was announced in 2010. A Japanese version was created by the
research team at Hyogo Disaster Mental Health Care Center in June 2011.
After the Great East Japan Earthquake we held study meetings and made DVDs in Miyagi tocommunicate knowledge about SPR and improve skills among specialists in disaster areas. We saw
indications that the spread of SPR-related knowledge and skills had a certain effect, such as thegrowing demand for SPR among specialists providing support to residents of disaster-stricken areas.
At the same time, in order to actually apply SPR in Japan, we need to examine whether this program
can be safely implemented in disaster areas. Thus, this study was conducted in collaboration withlocal governments in disaster areas and constituted an intervention study about applying SPR in
Japan. It involved the actual application of SPR to disaster victims and examined its feasibility.
<Research Methods>
A. Subjects and recruitment
The study involved persons 18 years or over who are aware of their own mental unhealth andeither live or work in Miyagi Prefecture. Persons receiving treatment at mental health institutions or
those suffering from serious mental disorders were excluded. Moreover, they had to be Japanesenative speakers and provide the necessary written consent for participation in the study in person
after understanding the aims and contents of the study. We publicly recruited participants for the
program after exchanging memoranda with the local governments in the disaster areas, and also
solicited participants using leaflets posted with permission in public facilities and non-profit offices.

Figure 1. Study flow chart
B. SPR practitioners (interveners)
All mental health professionals providing support (nurses, public health nurses, psychologists,
doctors, etc.) had received instruction from SPR trainers at the Hyogo Disaster Mental Health Care
Center and conducted SPR under the supervision of those trainers and psychiatrists at the
Department of Psychiatric Disorders, Tohoku University Hospital.
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C. Timing and instances of intervention
We conducted a pre-intervention assessment of all participants meeting the selection criteria after
explaining the meaning of the study and obtaining written consent. The interveners visited theparticipants to conduct interviews taking about 60 minutes once every one or two weeks on a total ofno more than eight occasions. We conducted a post-intervention assessment after the intervention
and a follow-up assessment two months later.
D. Course of the intervention
Figure 1 shows a flow chart for the study. We introduced SPR intervention for 30 persons in orderof application as follows. Excluding those who canceled due to personal reasons or has to delay
intervention, we considered introducing SPR for 22 persons. We conducted assessment interviews
with them, screened them by using a General Health Questionnaire (GHQ-30), and evaluated themaccording to eligibility and exclusion criteria. As a result, we found 14 persons who met the research
criteria. The interveners performed SPR interventions on these 14 persons during every session under
the supervision of their SPR trainers.
Of the 14 persons, 2 canceled midway. 1 was found to be pregnant during the intervention and we
had to cancel her SPR intervention and subsequently lost contact with her (finished after 5interventions). There were 12 persons who completed everything until the follow-up session, andtheir data was used for our analysis.
E. Assessment contents
We set the GHQ4,5) total score as the primary endpoint. We set QOL (SF8 Health Survey: SF-8),6)
PTSD (Impact of Event Scale-Revised: IES-R),7,8) resilience (Tachikawa Resilience Scale: TRS),9)
self-efficacy (Self-Efficacy Scale: SES),10,11) and satisfaction with the program (Client Satisfaction
Questionnaire: CSQ-8J)12) as secondary endpoints. Moreover, we qualitatively surveyed participants’thoughts on the program and each skill as well as their later use of them.
<Study Results>
The average number of SPR sessions was 5.5 times. 12 out of 14 cases completed the intervention(14.3% suspension rate) and the follow-up. The average age of the 12 persons subject to analysis was
45.25 years (SD 10.48) and the sex ratio was 2 men to 10 women, making the majority women. Mostof the subjects lived in areas affected by the Great East Japan Earthquake, so the earthquake hadgreatly impacted them, including damages to home and workplace as well as deaths and persons
missing among people close to them.
The analysis showed significant improvements to GHQ, TRS, and SES by the end of intervention(Figures 2–4). However, we could only confirm improvement for SES when comparing the followup to pre-intervention (Figure 4). We saw no significant difference for other indicators.

<Discussion>
We saw that mental health improved after SPR intervention, which had an effect of increasing
resistance (TRS) and self-efficacy (SES). Self-efficacy is known to suppress depression andresilience is thought to assist recovery from mental difficulties. Thus, the results showing mental
health improvements in parallel with these indicators suggests the possibility that these factors arecorrelated. However, this study could not methodologically verify the effects or investigate interfactor correlation, so any interpretation of the results requires care. Moreover, of the three indicators– 109 –

that improved post-intervention, we could confirm sustained improvement for self-efficacy also at
the follow-up, suggesting the possibility of a sustained effect of intervention.
As the results showed how intervention can improve mental health and resistance, this suggeststhat it may have a positive effect on a wide range of mental health indicators. At the same time, we
could see not sustained improvement effect for mental health and resistance. A possible reason why
the effect was not sustained long-term is that sustained mental health improvement was obstructed byparticipant dispositions and chronic post-earthquake issues. Moreover, it is possible that the lack ofregular meetings with interveners after the end of intervention contributed to the intervention effects
not being sustained.
12 out of the 14 cases that underwent SPR intervention completed the intervention andparticipated in a follow-up survey. The reasons for the 2 canceled cases were pregnancy and workrelated stress, and none of the cases exhibited any serious harmful effects accompanying the SPR.
Furthermore, we saw no indicators worsening pre-intervention, post-intervention, or at follow-up,
showing that SPR is safe to implement in Japan as well.
The results of this study showed that it is safe to implement SPR in Japanese disaster areas andthat it is a useful support program suitable for the restoration and reconstruction phase. Future studies
will need to include comparative research with control groups to check the long-term effects of SPR.
(2)

Study of Mental Exercise Training for General Citizens and Supporters in Areas Affected by the Great
East Japan Earthquake with the Aim of Raising Public Awareness about Cognitive Behavioral Therapy<Issues and Aims>
The coastal areas of Miyagi Prefectures sustained considerable damage from the Great East Japan
Earthquake. Victims suffered physical and mental pressure. Thus, we can expect them to need mental
health care for an extended period of time ranging from years to decades. Past studies have shownthat residents of areas struck by large-scale disasters not only suffer from PTSD, depression, andother mental diseases, but are also likelier to face subsyndromal mental issues that do not go as far as
mental diseases.
Cognitive behavioral therapy is a psychotherapeutic method that aims to increase self-control aswell as improve or solve various problems related to social life by approaching issues bothcognitively and behaviorally. Cognitive behavioral therapy can be applied to a variety of mental
diseases, including depression and anxiety disorders, and is reportedly effective. Moreover, cognitive
behavioral therapy is not only used to treat mental diseases but has also been shown to have an effecton subsyndromal mental issues that are not quite mental diseases; reportedly, it has a preventive
effect on mental diseases as well, which is why it is applied in a broad range of settings, apart frommedical settings. However, compared to other advanced countries, the awareness of cognitive
behavioral therapy has not advanced so far in Japan.
Thus, the National Center for Cognitive Behavior Therapy and Research of the National Center of
Neurology and Psychiatry has been conducting “Mental Exercise Trainings” since 2012 in order todisseminate the basic ideas and skills of cognitive behavioral therapy widely in society (no longer
on-going). The program was developed by the National Center for Cognitive Behavior Therapy andResearch of the National Center of Neurology and Psychiatry to teach the general population thebasic ideas and skills of cognitive behavioral therapy through seminars and experiences so that they
can apply them in stress care in daily life.
We expect that the spread of basic ideas and skills of cognitive behavioral theory can play a majorrole in the prevention of mental issues after large-scale disasters. In the past, we held workshops forthe general population and supporters in disaster areas about everyday stress care based on the basic
ideas and skills of cognitive behavioral therapy as a form of primary prevention. We also conducteda pilot study to verify the efficacy and feasibility of a training program for a general audience(February 2013 to June 2014 in Miyagi Prefecture). We modified the sixth “Mental Exercise
Training” program to make it into a pilot study for 46 members of the general public who had given
consent for the study. The results showed a significant increase in self-efficacy after the training. The
participants rated the program highly and we confirmed its safety. High self-efficacy is correlated– 110 –

with weak depression symptoms and high self-esteem,11) so it possibly helps prevent the kinds ofmental issues that easily occur after large-scale disasters. Thus, this study involved a randomized
controlled trial based on the results of the pilot study.

Figure 5. Overall course of the study<Methods>
A. Study design
Randomized control trial (RCT) design. Participants were randomly divided into two groups: Theintervention group receiving the training first and the control group (standby group) on standby
before receiving the training. The intervention group underwent a training program spread over four
sessions and a post-intervention assessment was done in the final session. The standby group had anassessment at the same time, after which they underwent the same training program.
B. Subjects and recruitment
They should be 18 years or over and 79 years or under as well as members of the general public
in Miyagi Prefecture affected by the Great East Japan Earthquake. They should also wish toparticipate in the study, have understood the meaning of the study, and have consented to participate.
Furthermore, we excluded persons receiving treatment at mental health institutions and persons withserious mental disorders who either had their treatment suspended or had received no treatment. We
publicly recruited participants by handing out pamphlets and having articles published in newspapers
and PR magazines.
C. Contents of the training program
Based on the results of the pilot study, we reduced the number of sessions for the “Mental
Exercise Training” from six to four times and changed it to 90-minute sessions held once a week forfour weeks. We tried to increase the participation rate by reducing the number of sessions. Moreover,
we gave the participants homework after each session to help them learn more experientially (e.g.,
illustrating stress situations experienced in daily life by using the cognitive behavioral therapy
model). We changed the program contents so that it centered on cognitive restructuring and assertion.
D. Assessment contents
We set the primary endpoint as the total score of the Self-Efficacy Scale (SES).10,11) A high senseof self-efficacy is expected to have a preventive effect on post-disaster mental diseases, and paststudies have suggested that it can be improved through a cognitive behavioral approach. We would
consider the program effective if there was a positive significant difference in SES scores pre- andpost-intervention.
We set the respective total scores of the K6 measuring general mental health, 13–15) the GHQ-30
measuring stress-related symptoms,4,5) and the Automatic Thoughts Questionnaire-Revised (ATQ-R)
measuring negative and positive automatic thoughts16,17) as secondary endpoints. Moreover, we also
examined ten original items related to subjective stress and understanding of the training contents.

– 111 –

<Results>
We held the program a total of three times: January–March 2015 in Ishinomaki City, and June–
August 2015 and January–March 2016 in Sendai City. A total of 76 general participants (9 men,
67 women, average age 54.3 ± 12.3 years) took part. Of these, 63 (9 men, 54 women, average age
52.8 ± 12.5 years) were study subjects. These subjects were divided into an intervention group of
32 persons (5 men, 27 women, average age 52.8 ± 12.0 years) and a control group of 31 persons(4 men, 27 women, average age 52.9 ± 13.2 years). The average number of program sessions
participated in was 3.47 (± 0.92) for the intervention group, with 87.5% participating in at least
3 sessions.
In the intervention group, 27 persons participated in at least three sessions and answered the preand post-intervention questionnaires. In the control group, 27 persons answered the pre- and postintervention questionnaires. We used the data of these persons for our analysis of basic attributes,
which showed no significant differences in terms of attribute data (age, sex, education, employment
history, household size, moving due to the earthquake, whether they had deaths or missing persons
among close ones, life-threatening experiences) between the two groups. This demonstrated that the
randomization of the two groups had been done appropriately.
We found no significant difference between the groups before or after intervention for generalself-efficacy, the primary endpoint. We found a significant increase for the secondary endpoint of
positive automatic thoughts according to the automatic thoughts scale in the intervention group.
Among the original items, we also found a significant increase in the score for the item related tosubjective stress (“I feel a lot of stress in daily life”).
<Discussion>
This study is the first randomized controlled trial to show that a training program based on
cognitive behavioral therapy for a general audience following a disaster can help increase positive
automatic thinking. It appears that participating in a program focused on cognitive restructuring canincrease the cognitive capacity to deal with everyday stress and increase positive automatic thoughts.
We know that positive automatic thoughts correlates with depression recovery18) and it is hoped thatit can have a suppressive effect on symptoms of depression.19–23) The kind of training program usedin this study has the potential of being an effective means of intervention for members of the generalpublic after large-scale disasters. Future studies should examine if positive automatic thoughts taught
during training can improve mental health or prevent mental diseases.
We found no significant difference for self-efficacy, for which an effect was suggested in the
preliminary study and which was the primary endpoint of this study, between the intervention groupand the standby group. Since the program in this study consisted of four sessions, a modification of
the pilot study’s six sessions, it is possible that an increase in general self-efficacy, meaning trust in
oneself, was not achieved due to the time required for such skills to be acquired and established.

– 112 –

Moreover, we found an increase in subjective stress, which was one of the original question items.
This was possibly due to an increased awareness of one’s psychological stress through the training,
but neither of the assessment scale K6 and GHQ-30 showed any mental health deterioration, thus
supporting the safety of the program. When implementing this kind of program with members of thegeneral public, there is a need to take into consideration the risk of heightened subjective stress postintervention.
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Camp Project for Children in the Disaster Area
Tomoko Uchida – Nurse
Naru Fukuchi – Director, Doctor
Planning Division, Stem Center, MDMHCC
1.

Introduction
Six years have passed since the Great East Japan Earthquake and the restoration in the disaster areas
have entered the long term. Local emergency temporary housing is progressing to public housing and homerebuilding. However, changes in the living environment and the building of human relations in newcommunities may cause people living in the disaster areas further stress.
The Miyagi Disaster Mental Health Care Center (hereafter, MDMHCC) believes that it is important toprovide parents and children living in such circumstances opportunities to remove themselves from theirstressful situations, even if only for a short while, and to refresh themselves in a more unusual environment.
They conducted the Camp Project for Parents and Children in Disaster Areas (hereafter, the Project), whichaims to raise parents’ and children’s interest in mental health as well as increase their self-care ability byletting the children play freely in nature and releasing the parents from everyday child-rearing. It also aims
to help them develop the ability to deal with stress by working together with various people. The Project
started as part of Tohoku Fukushi University’s disaster area support in FY2011 and has been continued by
the Center since FY2012 on a once-a-year basis. Since FY2016, it has been conducted as part of theChildren’s Mental Health Care Regional Support Base Project commissioned by Miyagi Prefecture.
The following is a report about the Project since it was renewed as part of the Children’s Mental HealthCare Regional Support Base Project in FY2016.
2.

Project Outline(1) Aims
The Project was conducted with the aim of raising parents’ and children’s interest in mental healthas well as increasing their self-care ability by letting the children play freely in nature and releasing
the parents from everyday child-rearing, thus removing them from their stressful situations for at least
a short while. It also aimed to help them develop the ability to deal with stress through working
together with various people.
(2) Date and Location
Date: October 1 (Sat), 2016
Location: Matsushima Outdoor Activity Center(3) Participants
Taking into consideration the changing situation as people are rebuilding homes and moving into
public housing in the inland, the camp was not only for elementary-school children and theirguardians from the coastal areas of Sendai and Natori, but also for those from Matsushima, where thecamp was held. We decided to make 30 the maximum number of participants because of the staff
manpower and camp capacity.
(4) Staff
Table 1 shows the staff composition. Besides staff from the Center, we had a multi-disciplinary
team made up of specialists from external organizations registered with a supporters’ club thatendorses the Center’s activities. In this way, we had about the same numbers of staff and participants– 115 –

to ensure better safety. We also received planning and management support from Sendai District, Boy
Scouts Miyagi Prefectural Association, whose activities aim to contribute to the healthy training ofyoung men and who are experts in camping and other outdoor activities.
Table 1. Staff composition
Center staff, 17 persons

1 doctor, 2 public health nurses, 1 nurse, 9 psychiatric social workers, 2clinical psychologists, 2 office workers

External helpers, 7 persons

1 doctor, 1 public health nurse, 1 psychiatric social worker, 1 clinicalpsychologist, 1 yoga instructor, 2 boy scouts(5) Methods
 Questionnaires
We conducted a questionnaire survey by mail about one month before and after the Project,asking participating children and guardians how the earthquake had affected them and how theirmental and physical states had changed.
a. Children’s pre-camp questionnaire
We used the PTSS-15 (Post-Traumatic Stress Symptoms for Children 15 items),1) which isused to assess PTSD symptoms in children during disasters, as well as an original questionnairecreated for this study. The questionnaire had several multiple-response questions. The question“Why did you decide to participate in the camp?” had six answers to choose from: having
participated in the past, I myself wanted to participate, recommended by family, invited by friends,
the program seemed fun, and other. The question “Which part of the program interests you?” hadsix answers to choose from: bus travel, cooking, the recreation, learning about the mind, making
new friends, and other. The question “Is there anything you feel anxious or worried about?” hadseven answers to choose from: riding a bus, participating in the camp, being with staff I don’tknow, being with friends I don’t know, program contents, Learning about the Mind, and other.
There was also a freeform question, “What is on your mind before camp?”
b. Children’s post-camp questionnaire
We used the PTSS-15 and an original questionnaire. The questionnaire had several multipleresponse questions. The question “How was it to participate?” had three answers to choose from:fun, normal, and not fun. The question “Did you feel that Learning about the Mind was helpful?”
had two answers to choose from: yes and no. The question “What part of the program was fun?”had eight answers to choose from: the bus rides, the orientation, lighting a fire, making lunch, therecreation, Learning about the Mind (yoga), final session, and other. There were also the freeform
questions, “What were your impressions from Learning about the Mind?” “Did something at thecamp make you feel anxious or unhappy?” and “Write freely about your impressions from taking
part in the camp.”
c. Caregivers’ pre-camp questionnaire
We used the Kessler Psychological Distress Scale (K6),2) which is a six-item scale formeasuring and assessing symptoms of depression and anxiety in the past one month, as well as an
original questionnaire. The K6 was developed by Kessler and the Japanese version by Furukawa
et al.,3) and its reliability and validity have been verified. The questionnaire had the multipleresponse question, “How would you like the program for guardians to be?,” with five answers tochoose from: an opportunity to talk about child-rearing and everyday troubles, a program forrelieving one’s own stress, really doing a lot of physical activities with my child, taking it easy bymyself, and other. There was also the freeform question, “Is there anything that your or your childfeels worried about?”
Moreover, we also asked the guardians to fill in an original questionnaire about their child’ssituation during the disaster. The question “Where were they during the earthquake?” had three
answers to choose from: at home, at school, and other. The question “Who were they with?” hadfour answers to choose from: family, friends, alone, and other. The question “How badly damaged– 116 –

was your home?” had five answers to choose from: the house and the furniture were not reallydamaged, the house was not damaged but the furniture was scattered, both the house and thefurniture were damaged but we could still live there, both the house and the furniture were sodamaged we could no longer live there, and the house was gone. There were also the yes/noquestions “Were they in any life-threatening situations?,” “Were they actually hurt?,” “Did they
see anybody who was hurt?,” “Did any relative or friend pass away?,” “Did they lose anything
precious (toy, etc.)?,” “Did they see the tsunami with their own eyes?,” “Did they have any
difficult experience prior to the earthquake?,” “Do they have a history of physical disease or
hospitalization?,” and “Have they been treated with psychiatric care or psychosomatic medicine?”
There were two freeform questions, “Is there anything you worry or feel anxious about as a
guardian?” and “What was your address at the time of the earthquake?”d. Caregivers’ post-camp questionnaire
We used the K6 as well as an original questionnaire. There were the freeform questions “Whatwere your impressions from your child’s participation?,” “If a similar event is held in the future,what kind of contents would make you want to have your child participate?,” “If there were a
program for guardians, what kind of contents would make you want to participate?,” “If there
were a program for guardians, what kind of conditions would make you want to participate?,” and“Do you have any other comments or suggestions?”e. Staff post-camp questionnaire
There were three freeform questions, “Did you notice anything about the participating
children?” “Did you notice anything about the planning, management, or composition?” and“What are your impressions from participating?” This time, we only included items relating to thechildren in the results.
2. Program
Taking into consideration the wider area of eligible addresses in two cities and one town since
FY2016 and the resulting burden in terms of guardians driving the children, we set up a meeting
point at Sendai Station as
Program for those meeting up at Program for those meeting up
well as on-site and split up Sendai Station
on-sitesome parts of the children’s 8:00 Assembly
8:50 Assembly
program. This is shown in 8:30 Bus departs
9:00 Handicraft (making a
9:20 Bus arrives
welcome board)
Figure 1.
9:20
Welcomingthe bus, theDuringrecreation,thegroups meet up
children have fun doing
9:30 Orientation
physical exercises, either 10:20 Making a fire, cooking lunch
working together in teams or 11:30 Lunch
all participants taking part at 13:00 Recreation
Groups are balanced inonce. After recreation, we 15:10 Final session
terms of age and sex
had a session titled “Learning 16:00 Tidying up (cleaning)
about the Mind,” which
consisted of yoga centered on 16:30 Bus departs
16:30 Seeing friends off
16:40 Going homebreathing techniques taught 17:30 Going homeby an instructor who has
Figure 1. Program overview
conducted psychotherapy totreat traumas at a national medical research institute since August 2011 and has led a yoga programat the wards of a national hospital. This allowed the children to settle down after the spirited
recreation and aimed to teach them a way to calm down when something bad has happened or they
are agitated.
As regards the FY2016 program for guardians, we decided to plan the contents based on the
results of the pre-camp questionnaire. Since the most common answer was “I want to take it easy
by myself” (9 out of 15 responses), we decided not to organize a program for guardians so thatthey could refresh themselves at their own pace using their time freely away from everyday life.
– 117 –

Photo 1. Outdoor recreation

3.

Results(1)

Participation
The number of participating children in FY2016 was 10 boys and 10 girls, making a total of 20
children. They came from 15 households and their average age was 9.35 years. 12 out of the 20
children had previously participated in the Project. Moreover, since we took into consideration thechanging situation as people are rebuilding homes and moving into public housing inland by
expanding the areas with eligible addresses, we received applications from five children in new areas(one canceled). All of them had moved from disaster areas to rebuild their homes elsewhere. All
guardians from the 15 households filled in the pre-camp questionnaire and helped drive the children.
The participating staff were 17 persons from the Center and 7 external supporters, making a totalof 24 persons. By profession they consisted of two child psychiatrists, three public health nurses, one
nurse, nine psychiatric social workers, one social worker, three clinical psychologists, one yoga
instructor, two boy scouts, and two office workers.

(2)

Questionnaire results Children’s pre-camp questionnaire
We received responses from all 20 participating children (100% response rate). In response to
the question “Why did you decide to participate in the camp?” 40.0% responded “I haveparticipated in the past,” 55.0% responded “I myself wanted to participate,” 50.0% “My family
recommended it,” 20.0% “I was invited by friends,” and 20.0% “The program seemed fun.” In
response to the question “Which part of the program interests you?” 31.6% responded “Bustravel,” 78.9% “Cooking,” 68.4% “Recreation,” 21.1% “Learning about the Mind,” and 31.6%“Making new friends.” In response to the question “Is there anything you feel anxious or worried
about?” 5.0% responded “Riding in a bus,” 5.0% “Participating in the camp,” 5.0% “Being withstaff I don’t know,” and 30.0% “Being with friends I don’t know.” For the freeform question, we
had responses like “I’m worried if I’ll get used to the new friends,” “Will I be able to make newfriends? Worried,” “Yoga seems difficult so I’m not confident,” and “I hope I can make somegood friends.”– 118 –

 Children’s post-camp questionnaire
We received responses from 18 out of 20 participating children (90% response rate). In
response to the question “How was it participating?” 88.9% responded “It was fun” and 11.1% “It
was normal.” In response to the question “What part of the program was fun?” 11.1% responded“The bus rides,” 16.7% “The orientation,” 72.2% “Lighting a fire,” 55.6% “Making lunch,”
72.2% “The recreation,” 38.9% “Learning about the Mind (yoga),” 16.7% “The final session,”and 5.6% “Other (eating curry).” In response to the question “Did you feel that Learning about theMind was helpful?” 88.9% responded “Yes” and 11.1% “No.” In response to the question “Didsomething at the camp make you feel anxious or unhappy?” 44.4% wrote “Nothing” and 55.5%
did not write anything. In response to the freeform question “What were your impressions from
Learning about the Mind?,” they wrote things like “It was fun,” “It felt good,” “I thought it would
difficult in the beginning but it was surprisingly easy,” “It was really educational to move thebody freely,” and “I want to do it again.” Under “Write freely about your impressions from taking
part in the camp,” they wrote many positive responses, such as “It was fun getting to know newfriends. I want to participate again,” “I’m happy I could make new friends,” “I was a bit worriedat the start, but everybody was kind; so it was fun,” “I made many friends. We got along when we
worked together,” and “It was fun lighting a fire.” Caregivers’ pre-camp questionnaire
We received responses from all 15 guardians (100% response rate). In response to the question“How would you like the program for guardians to be?,” 30.0% responded “I want an opportunity
to talk about child-rearing and everyday troubles,” 20.0% “A program for relieving one’s own
stress,” 10.0% “I want to really do a lot of physical activities with my child,” and 80.0% “I wantto take it easy by myself.” In response to the freeform question “Is there anything that your or
your child feels worried about?,” they wrote things like “That they won’t be able to initiate
conversations with new friends,” “I think they are sometimes persevering without letting theiremotions out,” and “I want them to have the ability to handle difficult situations, but don’t know
how to guide them.” Caregivers’ post-camp questionnaire
We received responses from 13 out of 15 guardians (86.7% response rate). In response to thequestion “What were your impressions from your child’s participation?” they wrote things like “Ihaven’t been able to relax like this in a while” and “I got to do something out of the ordinary.”
About their children, they noted positive changes, writing things like “I felt they had goodexperiences participating by themselves,” “I feel the one-day camp made them stronger,” “Theyhaven’t participated much since starting the upper grades, but it looks like they had fun as there
were more things they could do and others would rely on them,” and “They looked a bit worriedin the morning, but I was happy to see them come home with a smile on their face and talking
about how much fun it was.” They also wrote positive responses such as “They don’t usually hangout with kids from other schools or cook, but it seems they had fun despite some nervousness,” “Itseems they could really build confidence,” “Since the children participated by themselves, I think
it really allowed them to express themselves without any worries,” and “I’m happy you let themtry out a variety of things.” In response to the question “If a similar event is held in the future,what kind of contents would make you want to have your child participate?” they wrote responsesuch as “It’s fine as it is,” “River and mountain activities,” “Activities where you move your bodyto your heart’s content,” “Learning about our relation to water,” and “Overnight stay.” Moreover,in response to the question about the program for guardians and “themes you would like to see,”they wrote things like “How to praise and reprimand a child,” “Mindset for raising a child,” and“How to deal with child psychology based on cases and by different patterns.” As for “conditions
that would make you participate,” they responded with things like “I want it to be while thechildren are at day camp,” “On a Saturday,” and “It would be good if we could participate rightafter dropping the children off.” Staff post-camp questionnaire
We received responses from 18 persons out of a total of 21, consisting of the 17 Center staff aswell as 1 doctor, 1 public health nurse, 1 social worker, and 1 clinical psychologist from external– 119 –

organizations (85.7% response rate). In response to the question “Did you notice anything about
the participating children?,” they wrote responses that hinted at the children’s growth, such as“Children who looked worried when we first gathered were brimming with confidence as theywent home,” “As they worked together in groups, they became able to talk to other children andto staff as well,” “I was surprised how children who previously had been uncomfortable in theteams became engaged as they helped their juniors,” “I saw children who had participated several
times giving way to and helping children here for the first time,” “Children who had been here
before had grown tremendously and I saw many instances throughout the day where the children
helped each other or showed consideration for younger ones,” and “I saw children who had been
here before take leadership.” They also wrote about the children during the yoga, such as “I was
surprised by the relaxing effect of the yoga as there were some children sleeping,” “I was amazedby how the children immediately became quiet and focused on their breathing,” “There were kids
who said the yoga was the most fun,” and “It seems the yoga had a relaxing effect as it looked likethey felt good.”(3)

The children’s disaster stress responses
Figure 2 shows the result of the PTSSC-15 conducted with the children before and after the day
camp. We had 18 effective respondents who responded both before and after the day camp. The
average value for the pre-camp PTSSC-15 was 12.2 (SD = 11.5) and the average post-camp was 17.6
(SD = 13.8), both of which were considerably lower than the average for children in regular families(29.1).4) We conducted a corresponding t-test to investigate the change in PTSSC-15 score after the
day camp, which showed a significant difference (t(17) = 1.35, p > .10).

N = 18score

Pre-camp

Post-camp

Figure 2. Before/after comparison of participating children’s PTSSC scores (SD)(4)

The guardians’ general mental health
Figure 3 shows the results of the K6 conducted with the guardians before and after the day camp.
We had 13 effective respondents who responded both before and after the day camp. The averagevalue for the pre-camp K6 was 3.54 (SD = 2.69) and the average post-camp was 1.23 (SD = 1.48),
both of which were lower than the standard score for K6 general groups (5 points).5) We conducted acorresponding t-test to investigate the change in K6 score after the day camp, which showed the postcamp score to be significantly lower than the pre-camp score at a significance level of 1% (t(12) =3.53, Δ = .86, p < .01).

– 120 –

Figure 3. Before/after comparison of guardians’ K6 scores (SD)4.

Discussion
In terms of the effect on the children, they were able to develop their ability to communicate with eachother and build relations with others through the team discussions and team activities to reach goals they set
themselves, which likely reduced the worries they had before the camp. Moreover, results from thechildren’s questionnaire like “It was fun getting to know new friends,” “I’m happy I could make newfriends,” “I made many friends. We got along when we worked together,” and “It was fun lighting a fire”
indicate that they had a sense of accomplishment and improved confidence. The children’s impressions from
Learning about the Mind, such as “It was fun,” “It felt good,” “It was really educational to move the bodyfreely,” and “I want to do it again,” as well as results from the staff post-camp questionnaire, such as “I was
surprised by the relaxing effect of the yoga as there were some children sleeping,” “I was amazed by how
the children immediately became quiet and focused on their breathing,” and “It seems the yoga had arelaxing effect as it looked like they felt good,” indicates that it had a relaxing effect. Moreover, responses
like “I was surprised how children who previously had been uncomfortable in the teams became engaged asthey helped their juniors,” “I saw children who had participated several times giving way to and helping
children here for the first time,” “Children who had been here before had grown tremendously and I saw
many instances throughout the day where the children helped each other or showed consideration foryounger ones,” and “I saw children who had been here before take leadership” show that many staff
members felt the children’s growth as repeaters actively helped first-timers, demonstrating autonomy. Thismight be because the children found their role through the activities and came to have a stronger awarenessof being seniors.
The value for the PTSSC-15 conducted with the children pre-camp was extremely low, and while thepost-camp score was higher, they were both lower than the PTSCC-15 average score of 29.5 for children in
regular families as measured in a study by Tominaga et al.4) This was six years after the earthquake and thechildren were young at the time of the disaster, so it might be necessary to reevaluate future questionnaire
contents, assessment methods, and subject ages.
The pre-camp K6 value for the guardians was lower than the standard score for general groups (5points),5) and the post-camp value was even lower. This might have to do with the time they had to refreshas individuals, being able to remove themselves from daily life for the first time in a long time and spend
time as they wished, as indicated by questionnaire results like “I haven’t been able to relax like this in awhile” and “I got to do something out of the ordinary.” Moreover, responses like “I was happy to see themcome home with a smile on their face and talking about how much fun it was” and “I’m happy you let themtry out a variety of things” show that it made the guardians themselves happy. Responses like “I feel [it]made them stronger” and “It seems they could really build confidence” also suggest that it could alleviate
some of their worries about child-rearing and have a positive effect on their mental health, which thenhelped reduced their K6 value.

– 121 –

The above suggests that continuing this camp project for parents and children in disaster areas will havethe effect of assisting the children’s healthy growth, reducing the parents’ and children’s psychologicalstress, and provide mental stability. In addition, the guardians gave suggestions like “How to praise andreprimand a child,” “Mindset for raising a child,” and “An opportunity to get tips and learn concretely aboutchild-rearing,” which confirmed that there is a strong interest in child-rearing, so that is something we wantnext year’s program for guardians to reflect.
5.

Summary
The Project was conducted with parents and children living in disaster areas with the aim of raising theirinterest in mental health as well as increasing their self-care ability and ability to deal with stress byremoving them from their stressful situations even for a short while and allowing them to refresh themselvesin an environment out of the ordinary.
We saw an increase in the children’s PTSSC15 results after the camp, but it was lower than the averagescore of 29.1.4) The results of the self-completion questionnaire showed that as many as 88.9% wrote “It
was fun,” and we received many positive responses to the freeform questions.
The results of the guardians’ K6 were lower than the average score (5 points) both pre- and post-camp,with the post-camp score showing a considerable reduction. We received many responses to the selfcompletion questionnaire and we were able to confirm the requests that the guardians might have for future
day camps.
Moreover, many of the staff perceived that the children had grown, and we believe that continuing thiscamp project for parents and children in disaster areas will have the effect of assisting the children’s healthy
growth, reducing the parents’ and children’s psychological stress, and provide mental stability. We hope tocontinue the project while reconsidering the eligible areas and ages, so that we can keep providing
opportunities for socializing and refreshing to parents and children starting new lives in different areas.
References
1) Masahide Usami, Yoshitaka Iwadare, Kyota Watanabe, Masaki Kodaira, Hirikage Ushijima, Tetuya
Tanaka, Maiko Harada, Hiromi Tanaka, Yoshinori Sasaki, Seiko Okamoto, Keisuke Sekine, andKazuhiko Saito. Prosocial Behaviors during School Activities among Child Survivors after the 2011
Earthquake and Tsunami in Japan: A Retrospective Observational Study. November 21, 2014,
https://doi.org/10.1371 /ajournal.pone.0113709
2) R. C. Kessler, G. Andrews, L. J. Colpe, and E. Hiripi. Short Screening Scales to Monitor Population
Prevalences and Trends in Non-Specific Psychological Distress. Psychological Medicine, Volume 32,
Issue 6, August 2002, 959–976.
3) Toshi A. Furukawa, Norito Kawakami, Mari Saitoh, Yutaka Ono, Yoshibumi Nakane, Yosikazu
Nakamura, Hisateru Tachimori, Noboru Iwata, Hidenori Uda, Hideyuki Nakane, Makoto Watanabe,
Yoichi Naganuma, Yukihiro Hata, Masayo Kobayashi, Yuko Miyake, Tadashi Takeshima, and Takehiro
Kikkawa. 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, Volume 17, Issue 3, 2008,
152–158.
4) Yoshiki Tominaga, Satoshi Takahashi, Ryuzo Yoshida, Katsuhiko Sumimoto, and Nobuo Kajikawa.
Development and Validity of a Post-Traumatic Symptoms Scale for Children (PTSSC15): Child Abuse
and Bullying. Journal of Human Development and Clinical Psychology, Volume 8, 2002, 29–36.
5) Norito Kawakami and Ayumi Takano. Techniques for Surveying the Mental Effects of Trauma on
General Residents. Integrated Research Project on Disability Policy and Integrated Research Project on
Disability Policy (Mental Disabilities) funded by the MHLW. Research to Gather Information, Verify
Intervention Effects, and Improve Intervention Techniques for Mental Disabilities in Disaster Areas.
AY2014 General and Assigned Research Report (Yoshiharu Kim), 2015, 93–118.

– 122 –

Report on Activities to Support Victims of the Great East Japan
Earthquake in Tagajo City: Collaboration between Multiple
Organizations and Supporters of Many Different Professionals
Yuko Kashihara – Clinical Psychologist
Yukie Oba – Assistant Manager, Public Health Nurse
Minori Oizumi – Psychiatric Social Woker
Mikika Abe - Nurse
Iku Amakasu – Manager, Public Health Nurse
Naru Fukuchi – Director, Doctor
Community Support Division, Stem Center, MDMHCC
1. Background
The Miyagi Disaster Mental Health Care Center (hereafter, MDMHCC) was established in December
2011 to work in the field of mental health following the Great East Japan Earthquake. A characteristic of theCenter is that it has been conducting support projects as a point of contact mainly for local governments’
health and welfare departments and staff working with disaster victims since the very beginning.
Victim support in Tagajo started with an outreach project following up on mental unhealth high-risk
individuals (hereafter, the Outreach Project) after a present-state survey of disaster victim households in
Tagajo in the fall of 2011. Tagajo is a commuter town of about 60,000 residents adjacent to Sendai. The
disaster caused 156 deaths (including related deaths), 1,746 completely destroyed houses, 1,634 houses
destroyed to a large extent, and 2,096 partially destroyed houses. In Tagajo, there were many more withprivate rental housing (1,402 households) scattered across town than with prefab temporary housing (373households). Thus, the post-survey Outreach Project involved support activities from not only twoorganizations commissioned by Tagajo City (Office A, Medical Institution B) but also a health care centerand the Center.
Since everyone had different approaches to support when the project started, it was necessary toundertake collaborative efforts. This report is intended to help us think about how to conduct support in the
future by looking back on initiatives taken by Tagajo City and the Center as they engaged in support for
high-risk individuals in collaboration with other organizations and people of various professions.
2. Methods
We aggregated FY2012–FY2015 data by year to extract from the Center’s records those initiatives thatlikely facilitated collaboration between multiple organizations and supporters of many different professions.
3. Ethical Considerations
These data are a reuse of Tagajo disaster victim support project data and were presented at the 15th
Japanse Society for Traumatic Stress Studies Conference. We used the data after Memoranda Relating toData Provision of Disaster Victim Projects were exchanged between Tagajo City and the Center.
4. Results(1) Support recipients
Present-state questionnaires were distributed to households in Tagajo whose houses were at least
partially destroyed, asking about living and health conditions. Moreover, a prefectural health survey
for private rental housing has also been conducted since FY2012. The number of persons receiving
support for each fiscal year is shown in Table 1. In FY2011, Office A was commissioned by Tagajo
City to visit all households after the disaster victim present-state survey, and it was those individuals
for whom a second visit was deemed necessary that received support in FY2012. Since FY2013,– 123 –

support has been given to those to whom the indicators of “K6 score of 13 or more,” “Drinks alcoholfrom the morning or noon,” or “Suspended treatment” apply.
Table 1(persons)

Fiscal year

FY2012FY2013

FY2014FY2015

Support recipients

200

496

381

350

(2)

Supporters’ affiliations and professions
Office A : Before the earthquake, they were primarily tasked with providing guidance to company
staff after health checkups.
Two certified dieticians, two public health nurses, and two nurses providing support
twice a week.
Hospital B : Psychiatric hospital. One psychiatric social worker and one nurse provide support
twice a week.
Health care center: Municipal health care center in Tagajo. One to three public health nurses
provide support once a month.
Center: A doctor provides support once a month. Two clinical psychologists, two public healthnurses, two psychiatric social workers, and two nurses provide support thrice a week.

(3)

Initiatives
Table 2 shows initiatives that likely facilitated collaboration.
Table 2. Number of initiatives (times)

Fiscal year

1. Case meetings

2. General meetings

3. Discussions

4. Study meetings

Total

FY2012

19

7

3

2

31

FY2013

35

20

4

1

60

FY2014

37

15

11

2

65

FY2015

43

21

8

3

75

1. Case meetings were held for supporters to discuss cases where assessment was difficult. A
doctor gave advice once a month.
Typical cases included depression, suicidal thoughts, suspected PTSD, alcohol-related issues,and sleeplessness.
2. General meetings were held for everyone involved in the support to share feedback about thepresent situation and discuss the future direction of the support.
3. Discussions were held between responsible persons and the Center as needed in preparation forcase meetings and general meetings.
4. Study meetings were doctor-led opportunities to learn about the following 17 mental symptoms
so that all supporters could carry out accurate assessments of mental health conditions.
1) Feeling depressed 2) Loss of interest or happiness 3) Fatigability and low energy4) Suicidal thoughts 5) Feelings of guilt or worthlessness6) Reduced ability to concentrate or make decisions 7) Sleeping disorders
9) Grief
10) Social withdrawal 11) Re-experiencing
8) Loss of appetite
12) Avoidance 13) Hyperarousal. 14) Negative cognitive or mood changes due to trauma15) Symptoms of mental disease (apparent)16) Reduced cognitive functions, etc.
17) Excessive alcohol consumption and related issues– 124 –

5．Discussion
The number of case meetings has increased each year, likely because it has become possible to discussdifficult assessments with everyone on a day-to-day basis. As a result, we surmise that we have been able torecognize the features of the different organizations and supports of various professions, thereby conducting
the support while compensating for each other’s deficiencies. Moreover, thanks to the doctor giving advice
at study and case meetings once a month, we believe that the supporters have become able to conductmental health assessments accurately and effectively. Supporters alternate at the different support offices, so
we will continue to hold general and study meetings centering on the case meetings.

– 125 –

Soberity Activities in Natori City: Setting up a
Health Salon and Their Effect
Hiroyuki Sasao – Psychiatric Social Worker
Masako Kamiya – Psychiatric Social Worker
Iku Amakasu – Manger, Public Health Nurse
Community Support Division, Stem Center, MDMHCC
1. Introduction(1) Initiatives against alcohol-related issues in Natori
Natori City is located on the Pacific coast of Miyagi Prefecture. Most of its coastal areas were
washed away by the tsunami following the Great East Japan earthquake, causing almost 1,000 deaths
and an unprecedented disaster. We started noticing alcohol-related issues in prefab temporary housing
and private rental housing where some would repeatedly consume alcohol in excessive amounts withnegative effects on health and social life as well as being diagnosed with addiction and receiving
treatment at specialized hospitals. Causes are likely to include the death of friends and family and theloss of a job for middle-aged men, but this became more apparent as supporters gained insight into
what happens in prefab temporary housing. Thus, relevant organizations (the NPO Miyagi Sobriety
Association, Tohokukai Hospital, MDMHCC, and other relevant organizations in Natori) came
together to start a sobriety society in the Sennan area. In June 2015, they organized a lecture meeting
titled “Society for Hearing the Stories of Those Who Quit Drinking,” not only for addicts but for all
people who want to drink less, as well as starting meetings as a society with the same name (hereafter,“the Sobriety Society”) once a month.
Participants in the abovementioned Sobriety Society were not only persons with alcohol use
disorder (hereafter, “persons concerned”) but also family members, persons who consume a lot of
alcohol, and supporters. It was run as a normal sobriety society, but few persons concerned
participated (0–3 persons), so it never got off the ground. Initially, there were participants whowanted to drink more moderately, but since the stated goal was to quit drinking, it became difficult forthem to participate and they tended to stop coming. Because of this, supporters started expressing theneed for initiatives to reduce drinking and a society for moderate drinking to prevent alcohol use
disorder.
(2) Initiatives for moderate drinking
There are very few societies for moderate drinking in Japan. Thus, supporters first underwent BIs(brief internships) and training in the Happy Program, discussing matters with the heavy drinkers who
were the main target group. As a result, they decided to start a society not only for moderate drinking,but with the aim of supporting the mental and physical health of middle-age men and supporting
moderate drinking within that context. More concretely, they organized a lecture meeting titled“Lecture Meeting for a Good Relationship with Alcohol” (Natori Municipal Health Care Center)aimed at local citizens. This led to the full-scale opening of the Health Salon (also known as theSociety of Moderate Drinking) in December 2015. In addition, they also conducted the Happy
Program and mini health lectures with the help of the Iwanami Branch of Shiogama Health Care
Center.
2. The Health Salon initiative(1) Health Salon participants
As shown in Figure 1, those invited were the participants of the abovementioned lecture meeting
as well as citizens who previously had had contact with supporters and had an interest in moderatedrinking. They should also fulfill the following two criteria.
– 126 –

1) Residents of Natori City or men middle-aged or older who experienced the disaster inNatori City.
2) Heavy drinkers and persons thought to be at risk of alcohol use disorder. (However, thisexcludes those already diagnosed with alcohol use disorder and who need to quit drinking
as well as those judged by supporters to be extremely close to having alcohol use disorder.)The participants included disaster victims who had been visited by the MDMHCC, persons in needof less drinking and mental or physical health measures under the dedicated guidance of Natori
Municipal Health Care Center, persons already having supporter contact through societies for disastervictims and their families, and persons invited by supporters. Subsequently, participants started
inviting their friends. By age, they included four persons in their 60s, four persons in their 70s, andfour persons in their 80s, the majority being retired.

Figure 1. Pathways for joining the society(2) Contents of the Health Salon
Figure 2 shows initiatives at the Health Salon for the first half-year.
The contents had a two-part structure. The first part was for everyone and consisted mainly ofsocializing to become friends by working together and gaining knowledge about alcohol consumption
and health. This was done in the kitchen of the Health Care Center and elsewhere, and it was
managed by the MDMHCC and the Natori Municipal Health Care Center. More concretely,
participants socialized through mini health lectures (diabetes, blood pressure, sleep, and alcohol for
mental and physical health, etc.), making lunch together, watching cultural performances, hiking, andso forth. The mini health lectures by public health nurses and others were especially popular, andthere were many questions. Participants received health information through the mass media, but asthey had a variety of questions, it was important that they had somewhere they could easily ask
questions and get good answers.

– 127 –

Health Salon event contents and number of participantsParticipants

Mini lectures, discussions

6

First
sessionNovember
26
December
10

SecondsessionJanuary
14

9

Third
sessionFourthSessionFebruary
11
March 17

7

Fifth
SessionApril 148

Healthy use of store
lunchboxes
Discussing the society’s
management andregulations
Reading health checkup
results and designatedhealth guidance
The HAPPY Program andalcoholHigh blood pressure andsalt (on day trips to hot
springs)
Exercises and stretching,alcohol and sleep

Preparation

8

7

Cooking, working
togetherChoosing store
lunchboxes
Cooking watercelery hot pot

HAPPY

Cooking seafood
hot pot

Applications
BasicsCooking curry
Trying nonalcoholic beers

Results andevaluation
Results andevaluation

Lunchboxes forflower viewing

Graduation
BasicsBasics

9/9/2016. National Convention of the Japanese Society of Alcohol-Related Problems

Figure 2. Events at the Health Salon for the first half-year
The second part was an optional program for those who wanted to drink more moderately (theHAPPY Program).
Since participation in the second part was optional, the first session was attended by only four
people, half of those there that day. However, the number gradually increased with each session, sothat almost everyone came to join the second part, excluding non-drinkers. This was likely because of
the improved group dynamic resulting from working together in the first part and because most newparticipants already wanted to drink more moderately.
(3) The HAPPY Program
The HAPPY Program is normally held over a total of three sessions, and each session is expected
to be relatively short. The HAPPY Program at the Health Salon was led by a public health nurse at the
Iwanuma Branch of Shiogama Health Care Center, who was also responsible for each session. We
issued a graduation certificate to the participants who completed a course of three sessions, but since
there were those who joined midway through the year as well, we basically repeated the course
program every three sessions. By having graduates continue to attend, they could also give advice andprovide support to new participants as their seniors. It is also likely that the graduates themselves
could increase their own motivation to drink moderately by repeatedly hearing the same lectures andgiving advice to new participants.
3. Results from the Health Salon
The participants of the HAPPY Program were asked to record their daily alcohol intake and report it as adrinking diary. Figure 3 shows changes in alcohol intake and Figure 4 changes in the number of days off
drinking. The participants’ average alcohol intake was almost halved from 7 to 3.5 drinks after four monthsof participating in the HAPPY Program. Moreover, participants whose alcohol intake did not change somuch started taking one day off drinking when they had never done so before the intervention. The results
can be seen in the values from health checkups shown in Figure 5. Compared to one year before, the values
for blood pressure, neutral fat, and γ-GPT had all become normal.
We explained to the participants the ethical considerations with regard to privacy that applied to thecontents of the drinking diaries and the health checkup values.

– 128 –

Figure 3. Changes in alcohol intake for HAPPY Program participants

Figure 4. Changes in number of days off drinking for HAPPY Program participants

Figure 5. Changes in participants’ examination results– 129 –

4. Summary
We believe these activities were effective.
 There was an effect in terms of moderate drinking as the number of HAPPY Program participants
increased and their alcohol intake was halved.
 Participants socialized well regardless of how the earthquake had affected them, and their bonds
deepened.
 Their interest in health issues became stronger and their checkup results improved.
 They developed awareness about contributing to helping other people with their health issues.
 Initially just formally connected to a public health nurse or a supporter, members would socialize andhelp each other as well as take part in the society’s planning and management.
 The checkup results show that it fulfilled the function of a tool to be used after designated healthguidance.
 More citizen volunteers participated as supporters.
These events and results were reported in a discussion at the 38th National Convention of theJapanese Society of Alcohol-Related Problems in Akita in collaboration with the Iwanuma Branch of
Shiogama Health Care Center and Natori Municipal Health Care Center.

– 130 –

Longitudinal Study of Support for Children Born after theGreat East Japan Earthquake and Their Families: Reportof Baseline Survey Results from a City, Miyagi Prefecture
Naru Fukuchi – Director, Doctor 1)
Moe Seto – Clinical Psychologist 2)
Shizuka Oguchi – Psychiatric Social Worker 3)
Chizuru Ainai – Psychiatric Social Worker 2)
Reira Onuma – Psychiatric Social Worker 1)
Mebuki Sasaki – Psychiatric Social Worker 1)
Yuko Ito – Office 2)
1) Community Support Division, Stem Center, MDMHCC
2) Planning Division, Stem Center, MDMHCC
3) Higashimatsushima City
1. BackgroundChildren’s living environment, starting with the mother-child relationship in infancy, is important for
their emotional development. Past studies have shown that traumas in infancy have an effect on children’s
mental and physical development.1), 2) Following the Great East Japan Earthquake in 2011, several follow-up
surveys of children with direct experiences of the disaster were conducted, the results of which have beenreported.3) At the same time, as we have been providing local support, we have also consulted many children
born after the disaster and without direct experiences of it. We are increasingly hearing from kindergarten
teachers and administrative staff in disaster areas about children born after the disaster who “have trouble
staying still” or “have difficulties with group activities.” We feel that this tendency is more apparent incoastal areas that were greatly affected by the disaster and where restoration is taking time and support
continues to be insufficient. Although a number of factors are plausible, we do not possess expertise that canclearly identify what support is needed, as no studies involving assessments of child development and parent
mental health following large-scale natural disasters or long-term longitudinal intervention studies onchildren and their families have been conducted. Against this background, we realized the need for a longterm follow-up survey of children born after the disaster, which was incorporated in this study.

2. Aims
This study was conducted with the aim of understanding the mental and physical health condition ofchildren born after the earthquake in City A, which sustained considerable damage, and of providing longterm support to high-risk families. Furthermore, we would like to add that the outcomes of this study arepart of the Longitudinal Support Research on Children Born after the Great East Japan Earthquake and the
Their Families, which is being conducted in collaboration with Iwate Children’s Care Center, Iwate Medical
University, and the Children’s Mental Health Support Project Promotion Office, Fukushima University.
3. Methods(1)

Participants
Eligible participants included four-year-old children at kindergartens and nurseries in City A,
Miyagi Prefecture, as of April, FY2016, and their guardians or teachers who provided consent to– 131 –

participate in the survey. Children who moved to the area from a disaster area at least two years after
the earthquake and who belong to a respective kindergarten were excluded.
(2)

Procedures for the survey
We explained the survey to kindergartens and nurseries in the city and asked for their cooperation
via the competent authorities in City A. At kindergartens and nurseries where we obtained consent,
we distributed explanations of the survey and consent forms to the families of their respective classes,
thereby soliciting participants. At this point, we explained that participation was voluntary and thatconsent could be withdrawn at any time. Moreover, since the survey would continue even after thechildren enter primary school, we also obtained consent from the Board of Education in City A inadvance.

(3)

Survey duration
We conducted a pilot survey at two nurseries in February–March 2016. We conducted the main
survey at nurseries that had applied in July–September 2016. The parent survey across threeprefectures started in October 2015 and was planned to run until all participants finish compulsory
education at age 15 (March 2027). In order to see chronological changes, the 12-year survey is to be
conducted annually for the first three years and then biennially.

(4)

Survey methods and feedback
We asked consenting guardians and children to fill out a questionnaire and participate in aninterview as well as have nursery teachers fill out a questionnaire (Table 1). On the day of the survey,
we had the parents and children come to the nursery, where the children underwent an individual
cognitive function examination and the parents an individual interview. After the survey, we
provided feedback on the results of the nursery as a whole to the nursery and feedback on individual
results to each family. We held individual consultations with families deemed to require support aswell as case meetings at the nursery.

(5)

Ethical considerations
The study has been approved by the ethical boards of the School of Medicine, Iwate Medical
School, and of Fukushima University. We ensured that private information was sufficiently protected.

– 132 –

4. Results(1)

Basic attributes of the participating families
Out of 128 eligible children at five nurseries in City A, we obtained cooperation from 30 families(17 boys, 13 girls, 23.4% consent rate). The children’s average age in months at the time ofinterviews was 53.2 months (± 4.51 SD). 83% of these families had suffered damage to their houses
because of the earthquake and tsunami, 33% had lost family or relatives, and 10% had co-habiting
family members who had died or gone missing.

(2)

Results of the children
 Questionnaire results (Figure 4)a. CBCL / TRF
The total score of the child behavior checklist (CBCL) completed by the guardians showed thatsix children (20.0%) were borderline and four children (13.3%) were in the clinical range. At thesame time, the total scores of the teacher’s report form (TRF) completed by the teachers showedthat seven children (23.3%) were borderline and eight children (26.7%) were in the clinical range.
b. SDQThe TDS (total difficulties score) of the children’s Strengths and Difficulties Questionnaire(SDQ)5) showed that one child (3.3%) was in “high need” (of support) according to the guardianassessment, and one child (3.3%) was in “some need” (of support) and one in “high need”
according to the teacher assessment.
c. M-CHAT
The total 23-item assessment of the Modified Checklist for Autism in Toddlers (M-CHAT)
completed by the guardians showed that two children (6.7%) were in the clinical range.
 Development test results (Figure 5)
The raw scores of all test items were converted into assessment scores, aggregating them as
average 10 and standard deviation ± 3. As a result, the average assessment score for each test was
average or below average. We found no difference between the tests.

– 133 –

(3)Results of the caregivers
It was primarily the mothers who responded to the questionnaires and participated in theinterviews, but the fathers of two families responded.
 Questionnaire results (Figure 6)
We used the Kessler Psychological Distress Scale (K6)7) to screen general mental health, the Beck
Depression Inventory-Second Edition (BDI-II)8) to assess depression, and the Impact of Event ScaleRevised (IES-R)9) to assess PTSD. The results showed seven persons (23.3%) in the K6 clinicalgroup (cut-off point at 13 points), three persons (10.0%) suffering from light depressive symptoms
and three persons (10.0%) suffering from intermediate depressive symptoms according to the BDI-II,
and three persons (10.0%) in the IES-R clinical group (cut-off point at 23 points).
 Interview results (Table 2)
The assessment using the Mini-International Neuropsychiatric Interviews (MINI) showed that one
person had previously suffered a major depressive episode, one person a manic episode, two persons
alcohol addiction, and two persons alcohol overconsumption, and one person was deemed to sufferfrom generalized anxiety disorder. Moreover, two persons were deemed to have light suicide risk.
Table 2 clinical diagnoses by MINI (overlap)(4)

Major depressive episode (past)

1 person

Manic episode (past)

1 person

Suicide risk (light)

2 persons

Alcohol addiction

1 person

Alcohol addiction + generalized anxiety
disorder1 person

Alcohol overconsumption

2 personsChildren requiring follow-up
Based on a comprehensive assessment of the baseline survey, we set criteria for high-risk children(families) using the questionnaire and interview results, by which criteria 11 families were deemed torequire follow-up. We provided individual consultations with a child psychiatrist and case meetings
at the nursery. We also provided support for guardians if we deemed it necessary and helped connect
them with help organizations.

5. Discussion
This study involved a baseline study on the basis of obtaining consent and registering 30 families living
in City A, Miyagi Prefecture, which allowed us to build a foundation for a continuous long-term
longitudinal survey. The baseline survey yielded criteria for families requiring follow-up based on acomprehensive assessment of questionnaires and interviews. This resulted in 11 families requiring follow-up.
Furthermore, this survey was part of a larger survey across three prefectures and surveys were also
conducted in parallel in three other cities in Miyagi Prefecture, but the results of those surveys are notincluded in this report, as they were not available at the time of writing.
We conducted a cognitive function assessment of the children, consisting of a behavioral assessment
using questionnaires and psychological tests. The behavioral assessment showed that 33.3% of the children
were either borderline or in the clinical range according to the guardians’ CBCL assessment, and this figure
reached 50.0% according to the teachers’ TRF assessment, which is a high proportion. The proportion ofchildren requiring some form of support according to SDQ was 6.7% and thus not high. At the same time,
the child development assessment showed no major difference from the general population. Since this study
only involved 30 persons, it is difficult to verify that there were statistically significant differences, but itsuggests that attention should be paid to the children’s behavior overall.
With regard to the guardians, the BDI-II showed that 10.0% had intermediate depressive symptoms and
IES-R that 10.0% were in the clinical range, while there were also guardians who fulfilled the MINI clinical– 134 –

diagnosis. Again, despite the small sample, the results suggest that there is a need for comprehensive
support that includes not only children but also guardians, as there are many in need of consideration.
This study suggested the possibility that prolonged stressful life after a disaster can have an effect on thedevelopment of children born after the disaster. The plan is to continue regular longitudinal surveys fromnext year to understand the reality and changes of children’s and guardians’ mental health in the aftermathof disaster lifestyle and the Great East Japan Earthquake as well as keeping up comprehensive interventions
for families requiring follow-up.
References
1)

Perry, B. D., Polland, R. A., Blacklay, T. L., et al. (1995). Childhood Trauma, the Neurobiology of
Adaptation, and “Use-Dependent” Development of the Brain: How “States” Become “Traits.” Infant
Mental Health Journal, 16(4): 271–291.

2)

Felitti, V. J., Anda, R. F., Nordenberg, D., et al. (1998). Relationship of Childhood Abuse andHousehold Dysfunction to Many of the Leading Causes of Death in Adults. The Adverse Childhood
Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4): 245–258.

3)

Fujiwara, T., Yagi, J., Homma, H., et al. (2014). Clinically Significant Behavior Problems among
Young Children 2 years after the Great East Japan Earthquake. i, 9(10): e109342.

4)

Itani, T., Kanbayashi, Y., Nakata, Y., et al. (2001). Developing the Japanese Version of the Child
Behavior Checklist/4-18. Psychiatria et Neurologia Paediatrica Japonica, 41: 243–252. [in Japanese]

5)

Matsuishi, T., Nagano, M., Araki, Y., et al. (2008). Scale Properties of the Japanese Version of theStrengths and Difficulties Questionnaire (SDQ): A Study of Infant and School Children in Community
Samples. Brain & Development, 30(6): 410–415.

6)

Kamio, Y., and Inada, N. (2006). Preliminary Study on the Early Detection of Pervasive
Developmental Disorders in the Health Checkup at 1 Year 6 Months. Journal of Psychiatry, 48(9):981–990. [in Japanese]

7)

Furukawa, T.A., Kawakami, N., Saito, M., et al. (2008). The Performance of the Japanese Version of
the K6 and K10 in the World Mental Health Survey Japan. Int J Methods Psychiatr Res, 17(3): 152–
158.

8)

Hiroe, T., Kojima, M., Yamamoto, I., et al. (2005). Gradations of Clinical Severity and Sensitivity to
Change Assessed with the Beck Depression Inventory-II in Japanese Patients with Depression.
Psychiatr Res, 135(3), 229–235.

9)

Asukai, N., Kato, H., Kawamura, N., et al. (2002). Reliability and Validity of the Japanese-Language
Version of the Impact of Event Scale-Revised (IES-R-J): Four Studies of Different Traumatic Events.
J Nerv Ment Dis, 190(3): 175–182.

10) Otsubo, T., Tanaka, K., Koda, R., et al. (2005). Reliability and Validity of Japanese Version of theMini-International Neuropsychiatric Interview. Psychiatry Clin Neurosci, 59(5): 517–526.

– 135 –

“Meetings” in aMunicipality as Measured by a Questionnaire
Survey: With a Focus on Male Participation
Ishinomaki Regional Center, Miyagi Disaster Mental Health Care Center (MDMHCC)1)
Kunimidai Hospital, Seishinkai Medical Association2)
Tomoko Arashi,1) Nobuhiko Harada2)

1. Introduction
Following the Great East Japan Earthquake, a diverse variety of “meetings”*1 were held in disaster areas,
and a variety of styles of initiatives were also conducted in Municipality A, where we are located. However,participating residents and supporters have commented on these initiatives by saying things like “It would
be great if more people could join in” and “It would be good with more male participants”; this is more orless the same in different areas. In addition, there were also those worrying that men would be isolated orrisk physical and mental unhealth if they did not participate in such “meetings.” Furthermore, since we had
the same worry, we conducted a questionnaire survey in Municipality A to grasp the current state of these“meetings,” and we report the results by adding a discussion from the perspective of “male participation.”
2. Survey methods and survey participant breakdown
We distributed a questionnaire consisting of 12 questions on four pages (including a demographic
question sheet) by post. Completed questionnaires were collected by post (some participants delivered themin person). The participants were chief administrators in all administrative divisions of Municipality A(including temporary housing societies) as well as temporary support staff, making a total of 50 persons.
Table 1 shows a breakdown of the respondents.
Table 1. Respondent breakdown (N = 24)
Job title

Chief administrator
Temporary support staff
No response

6 persons (25%)
17 persons (71%)
1 person (4%)

Age

30s
40s
50s
60s
70s
80s
No response

2 persons (8%)
0 persons (0%)
3 persons (13%)
8 persons (33%)
7 persons (30%)
2 persons (8%)
2 persons (8%)

【Chief administrators】

Years of experience

Under 1 year
1 year or over, under 3 years
3 years or over, under 5 years
5 years or over, under 10 years
10 years or over, under 15 years
15 years or over, under 20 years
20 years or overUnknown

1 person (4%)
4 persons (17%)
5 persons (21%)
1 person (4%)
1 person (4%)
0 persons (0%)
1 person (4%)
4 persons (17%)

【Temporary support staff】– 136 –

Under 1 year
1 year or over, under 3 years
3 years or overUnknown

0 persons (0%)
1 person (4%)
5 persons (21%)
1 person (4%)

3. Survey duration and response rate
We dispatched the questionnaires in March 2016 with a deadline at the end of May 2016. We had a
response rate of 50%.
4. Ethical considerations
We explained the following in writing when distributing the questionnaires.
(1) Answering the questionnaire is voluntary. Declining to answer it has no disadvantageousconsequences.
(2) The survey results will be made publicly available.
Furthermore, we specified that returning the questionnaire would be considered providing consent.
5. Questions and answers
First, we divided the answers collected in the study into five categories according to type of “meetings”
during aggregation. The following is a breakdown of the categories.
Physical health : Activities aiming to improve physical health through exercises, etc.
Mental health : Activities aiming to improve mental health through creative activities andother forms of exchange
Local activities : Activities to improve local connections (building and maintaining
community)
Events: Activities to enjoy concerts and events themselves
Other: Activities that do not belong to the above categories(1)

Question 1
We asked about “meetings” regularly held in the local area where the respondents live (that they
are in charge of), ※2 both providing multiple choices and allowing freeform answers. The multiple
choices included representative “meetings” held in many areas and “meetings” that we were aware of.
The results clearly showed that a diversity of “meetings” were regularly held.
※1 This study defines “meetings” as all activities where several people gather for a period oftime, regardless of objective.
※2 Since we distributed questionnaires to both chief administrators and temporary support staff,
we used the two expression “live” and “in charge of.”(2)

Question 2
We asked about “meetings” irregularly held in the local area where the respondents live (that they
are in charge of), allowing freeform answers. Between Question 1 and Question 2, the number of“meetings” for physical health and “meetings” for mental health are reversed.

(3)

Question 3
We asked about “meetings” independently held in the local area where the respondents live (thatthey are in charge of), allowing freeform answers. These were mainly activities performed by local
people for the benefit of local people, such as cleaning.
Questions 1–3 are summarized in Figure 1.

– 137 –

(4)Question 4
We asked what percentage of locally resident men participated in the “meetings” identified in
Questions 1–3. The result was 【 80%–100% 】 for local events, sports events, festivals, etc.;【50%–70%】 for training trips; 【20%–40%】 for preventive care projects, karaoke, and teamaking sessions; and 【10% or less】 for lectures, cooking classes, etc.
The participation rate was high for cleaning events, festivals, local social gatherings, etc.

(5)

Question 5
We asked the respondents about what reasons there might be for a high male participation rate forsome events and what reasons there might be for a low rate in other cases.
【 Reasons for a high participation rate 】 Very interested in the contents; matching physicalconditions (on a day off); personally invited; involves
the whole district; an awareness or role that makes
them feel indispensable【Reasons for a low participation rate】 Not very interested in the contents; many women, making it
difficult to join in; physical conditions (on aweekday); no habit of joining groups
The reasons 1) interest in the contents and 2) physical conditions (what day it is) appear importantas they were common to both. Moreover, it seems that having a role also helps determine maleparticipation.

(6)

Question 6
We asked the respondents whether they would like men in their areas to participate more in the“meetings.” The result was 16 “Yes” (70%) and 5 “No” (22%). This shows that they see maleparticipation as an issue.
Furthermore, the reasons for answering “Yes” included health-related matters (lack of exercise,diseases related to physical inactivity, disuse syndrome, etc.) and preventing isolation(communication with neighbors). Meanwhile, the reasons for answering “No” had to do witheveryone pursuing their own interests and enjoyment.
About 2/3 answered “Yes,” which shows that many men are not participating. Moreover, there
are worries that their non-participation can lead to physical or mental unhealthy.

– 138 –

(7)Question 7
We asked about the positive aspects of male participation. The following are the answers we
received.
 Men can fulfill certain functions (physical work, etc.) that make the meetings happen.
 Meetings become livelier if both men and women participate. Perhaps both men and women
become more active when interacting with the other sex.
 We can talk about the sea while having a drink
 You get some peace of mind by seeing each other regularly (local crime prevention, checking
each other’s well-being, working together in case of a disaster, etc.)
 They can live more active lives by spending time with different people and getting to know newpeople besides family and work colleagues
It seems that male participation can lead to livelier meetings as well as more activity on the local
and individual levels.

(8)

Question 8
We asked if they plan and hold men-only events in the areas they live (if yes, what the content is).
The result was 16 “No” (70%) and 4 “Yes” (17%). The content was cooking classes, mah-jongg, teamaking sessions, karaoke, business activities, and New Year’s lion dances.

– 139 –

(9)Question 9
We asked those who answered “Yes” to Question 8 what events were popular, to which they
responded cooking classes, mah-jongg, and tea-making sessions.
Two answered cooking classes and both said they were popular. This might be because family
structures have changed due to the disaster and men now have to cook for themselves.

(10)

Question 10
We asked the respondents whether they thought it necessary to create new “meetings” where maleparticipation is easier and, if yes, what kind of contents they should have. The result was 8 “Yes”(35%) and 7 “No” (31%), or about half–half. We also asked them to give their reasons for either
answer.
【Good contents according to those who answered yes】
 Opportunities to talk (about local topics, society as a whole, etc.)
 Get-togethers with topics to discuss Cooking classes
 Don’t know, but considering it【Reasons for answering no】
 They are active in everything and there are already many events
 It’s been five years, so it might be difficult to join in at this point
More or less the same number of respondents answered “Yes” and “No.” While some believe it isnecessary, there are also those who think it would be difficult for them to participate in a new setting
after five years. This suggests that it is important to consider whether a “meeting” is easily accessible
to men before starting it.

(11)

Question 11
We asked whether there are those who do not participate in local “meetings” but who are doing
well in all other ways. The result was 16 “Yes” (73%) and 2 “No” (9%). The following answers
show what concrete activities supported their wellbeing.
 Radio calisthenics by themselves
 Walking, strolling (individually or in a group of friends)
 Working in the fields“Walking” was the most common answer by far. A likely reason for this is that it requires no
special equipment and can be started without trouble.

– 140 –

(12)Question 12
As the converse to Question 11, we also asked what whether they worried about persons whoneither participated in “meetings” nor seemed to live particularly active lives as well as about what
they worried. The result was 14 “Yes” (68%) and 4 “No” (20%). The following were the worries of
those who answered “Yes”.
 No interactions with neighbors
 Problems with alcohol (almost always drinking at home) Old age (issues of dementia, etc.)
 Already in bad mental or physical health Isolation leads to bad health in the form of physical unhealth, weak legs, and lack of mental
energy Isolation makes it difficult to know their state and that is worrying
Most answers were worries about the fact that they were isolating themselves and theconsequences of that.

6. Discussion
The questionnaire results show that while a variety of “meetings” are organized in the various areas,
male participation is quite limited. Moreover, there appears to be a need to create “meetings” that are either
more attractive or accessible to men, considering that the number of respondents wanting more maleparticipation was more than three times higher than that of respondents not thinking so. Additionally, this is
a problem that is not unique to Municipality A but is common to many municipalities. Moreover, they arepaying attention to male participation and are implementing initiatives to ensure the wellbeing of local
men.1–3) Based on such initiatives and our questionnaire results, it might be that male participation in“meetings” not only benefits men’s health, but might also be meaningful for community vitalization.
Ogawa4) divides diseases related to physical inactivity into “the three types of I. those that affect thewhole body, II. those that occur in one part of the body, and III. those that occur in the mind or nerves.”
Based on this, “it is easy to just think of (2) one part of the body, but in reality, I. easily getting tired becauseof reduced heart and lung function or III. depressive tendencies and reduced cognitive function (looks
similar to dementia) are important as well.” In fact, we received questionnaire responses worrying that theymight incur physical and mental unhealth by not participating in the “meetings.” In addition, Ogawa writes
that, “Diseases related to physical inactivity are 1. ‘restricted social participation’ that causes 2. ‘reduced
lifestyle movement’ and 3. ‘leads to reduced physical and mental functions,’” which agrees with thecontents of the questionnaire. This suggests that creating opportunities for men to go outside is important
both for their physical and mental health and to help them live every day with energy. However, as shownby the results of our questionnaire, the reality is that men often tend not to participate, which is why wemust not forget to ask the question, “What kind of contents will make it easier for men to participate?” Yet,
since the questionnaire received quite a number of responses along the lines of “There are those who
maintain their physical and mental health without participating in ‘meetings,’” we also should add that we
also cannot forget the perspective that participating in “meetings” is not the only way to contribute tophysical and mental health.
Characteristic of the initiatives discussed above1–3) is that opportunities are created for men to meet. The
questionnaire results and the idea that “It is difficult to join in when there’s a lot of women,” which also
facilitated the creation of the above initiatives,1–3) provide useful hints about how to create “meetings” thatare accessible to men and that men might want to attend. The questionnaire results here did not go as far as adetailed, concrete examination of what kind of “meeting” would be attractive to men, but this is something
we would like to explore if given the chance.
Finally, we would like to express our sincere thanks to everyone who helped us with this questionnaire
as well as everyone at Municipality A.

– 141 –

References
1) Life Support Center (CLC), 36: 3–5. [in Japanese]2) Great East Japan Earthquake Joint Support Network (2013). Great East Japan Earthquake Joint
Support Network (2013). Local Mutual Support Information Editorial Committee. Local Mutual
Support Information. Community Life Support Center (CLC), 16: 3–8. [in Japanese]3) Great East Japan Earthquake Joint Support Network (2013). Local Mutual Support Information
Editorial Committee. Local Mutual Support Information. Community Life Support Center (CLC), 33:
3–4. [in Japanese]4) Great East Japan Earthquake Joint Support Network (2013). Local Mutual Support Information
Editorial Committee. Local Mutual Support Information. Community Local Mutual Support
Information Editorial Committee. Local Mutual Support Information. Community Life Support Center(CLC), 12: 14. [in Japanese]5) Ogawa, Y. (2013). People Get Sick if They “Don’t Move”: What Are Diseases Related to Physical
Inactivity? Kodansha Gendai Shinsho: 209. [in Japanese]– 142 –