Chapter 2

Research Report
And Manuscripts Contributed to Other Journals

Research Report

Yoko Takahashi1), Atsushi Sakuma2), Ikki Ueda3), Ayami Nagao1), Mikika Abe1), Hiroo Matsuoka3),
Kazunori Matsumoto1)
1)

Tohoku University Graduate School of Medicine Department of Preventive Psychiatry
2)
3)

Tohoku University Hospital Department of Psychiatry

Tohoku University Graduate School of Medicine Department of Psychiatry

At the Tohoku University Graduate School of Medicine Department of Preventive Psychiatry, theTohoku University Psychiatry class including the Tohoku University Graduate School Department of Psychiatry
and the Hospital Psychiatry Department continuously conducts support activities and research activities to help
the stricken areas. In FY2014, the research activities reported below were conducted in cooperation with the
Miyagi Disaster Mental Health Care Center and related organizations.
1.

In research on the mental health of supporters in disaster-stricken areas and research on support methods

In the case of a large-scale disaster, it was found that people of various occupations are involved in the emergency,
recovery, and reconstruction phases. Research that focuses on the mental health of people working after suchdisasters, mainly on police officers and firefighters who provide support as occupational rescuers in theemergency, has been conducted in past disasters, and it has been reported that depression and symptoms
equivalent to PTSD persist in the long term1)2).
However, after a disaster, long-term support activities are necessary not only in the emergency period
but also in the recovery and reconstruction period, especially with individuals engaged in high public welfare
jobs. These occupations include municipal staff, healthcare professionals, social welfare service staff, andteachers; many of whom continue to live in the affected areas as victims, hence requiring support activities in thelong-term. Many of these people have continued their support activities since the disaster. In addition to theirstress as disaster victims, they are expected to feel more stress related to post-disaster support therefore increasing
their risk of developing mental health problems. However, the mental health of supporters working in these local
public welfare jobs has not been studied well.
Therefore, we conducted health surveys for local government officials, Councils of Social Welfare
officials, and nursing officials in the stricken areas of the Great East Japan Earthquake. They were provided
support from a psychiatric perspective, and a longitudinal research study was conducted to clarify the actual
situation to provide the necessary support.
In this report, we will show the results of indicators related to mental health in each occupational area,
including the results of surveys conducted in FY2014 and those of the longitudinal analyses conducted
continuously from FY2013. We will also examine and report on the factors related to mental health issues.
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( 1 ) Research Methods
The research subjects were: ① local government employees, ② employees of Social Welfare Councils,and ③ nursing staff in the affected areas of the Tohoku coast. The survey in ① was conducted for 1,888 people

from August to September 2014 for multiple local government employees in Miyagi Prefecture, and data wascollected from 1,288 (68.2%) people. The survey in ② was conducted from November 2013 to January 2014 formultiple Social Welfare Council employees in Miyagi Prefecture, and out of the 870 targets, data was collectedfrom 779 (89.5%) people. The survey in ③ was conducted for nursing staff at multiple hospitals in Miyagi
Prefecture from August to December 2014 for 485 people, and data was collected from 392 (80.8%).
The survey was conducted using a self-administered questionnaire. The survey items were current work
status, personal injury status, current health status, a screening questionnaire for depression and anxiety disorders(Kessler Psychological Distress Scale: K6), and the Patient Health Questionnaire (PHQ-9). The post-traumaticstress disorder checklist (PTSD Check List: PCL) was used to evaluate the symptoms of depression and its
severity, and to evaluate the severity of PTSD by asking 17 questions.
The questionnaire indicated the voluntary nature of the cooperation and was collected in a sealed form sothat the results could not be disclosed to supervisors and colleagues at work. As a post-survey consideration,
applicants were advised by a psychiatrist, clinical psychologist, or psychiatrist that they could consult with themwithout submitting a questionnaire. This survey was conducted with the approval of the Ethics Committee of the
Tohoku University Graduate School of Medicine.
( 2 ) Research Results① Survey on local government officials

This survey targets local government officials in two regions (local government A and local

government B), and we will report the results of each municipality.
Subjects of local government A were 36% male and the average age was 45 years. In the FY2014
survey, 16% of staff were aware of high stress with a total score of 13 points or higher for K6, an index
of overall mental health status. 16% of staff members with a total score of 10 or higher for PHQ-9 wereat high risk for depression. The percentage of staff with a PCL total score of 44 or higher were at ahigh risk of PTSD was 4%.
The subjects of local government B were 61% male and the average age was 45.3 years. In the
FY2014 survey, 13% of staff were aware of high stress with a total score of 10 points or higher for
K6, an index of overall mental health status. 14% of staff members had a total score of 10 or higher for
PHQ-9 and were therefore at high risk for depression. Besides, 5% of those who had a PCL total scoreof 44 or higher were at a high risk of PTSD.
To clarify the factors related to the risk of mental illness, the local government B divided theemployees into 2 categories: regular staff and temporary staff. They used a chi-square test to determine
the factors associated with high-risk PTSD symptoms, general mental health status, and depression. As- 102 -

a result, for regular employees, “worsening of symptoms,” “not enough support from family andfriends,” “feel responsible for my behaviors after the earthquake,” and “not being able to get enoughrest due to work,” “feeling mentally distressed due to being criticized by residents,” and “feelingmentally distressed due to being criticized by work-related individuals” were some of the factors.
Factors specific to the degree of PTSD symptoms (PCL) included, “I have a physical illness that has
been treated since before the disaster,” “moving houses after the disaster,” “missing family and deaths
due to the disaster,” which were found to be associated with the worsening of PTSD symptoms. Factors
specific to the degree of depressive symptoms (PHQ-9) included, “I feel that the people in the area do
not trust each other.” Regarding the degree of mental health problems (K6) and the degree of depressive
symptoms (PHQ-9), “not enough support from supervisors” and “not enough support from colleagues”
are associated with worse symptoms.
Regarding dispatched staff, poor overall mental health (K6) was reported, with factors such as "notenough support from friends and family," "not being able to get enough rest due to work," and “being
criticized by work-related individuals and feeling mentally distressed,” “not enough support fromcolleagues,” and “the work I am doing is different from what I was expecting,” and a correlation could
be seen with poor overall mental health. Regarding the degree of depressive symptoms (PHQ-9), there
was an association between "I was worried about my health before I was assigned to work" and theworsening symptoms.
② Survey on Social Welfare Council staff
26.2% were males and the average age was 46.8 years. In the FY2014 survey, K6 high-risk persons
made up 7.9%, PHQ-9 high-risk persons 13.7%, and PCL high-risk persons 4.1%. Besides, thelongitudinal analysis was conducted for 610 persons who answered in both the FY2013 and FY2014
surveys. There were some switches between high-risk individuals with depression and those with PTSD
symptoms. Approximately half of those with high-risk depressive symptoms and half of those with PTSD
symptoms in FY2013 remained at high-risk in FY2014. Besides, some who were at low risk in FY2013
became high risk in FY2014. It became clear that some had chronic mental issue symptoms while some
had later onsets.
Next, we used a multivariate logistic regression analysis to clarify factors related to the risk of mental
illness. According to the FY2014 survey, K6 (overall mental health) high-risk persons showed the highest
odds ratio for “bad communication at work,” followed by “I feel that I can’t see the future for lots ofwork” which also had a high odds ratio and showed a correlation. Other factors included “I feel likeblaming my actions at the time of the earthquake,” and “I have not been able to trust my neighbors.”
PHQ-9 (depressive symptoms) high-risk persons showed the highest odds ratio for “I feel that I can’t see
the future for lots of work” followed by “have a history of mental health treatment from before theearthquake” which also had a high odds ratio and showed a correlation. Other factors that showed acorrelation were “bad communication at work,” “not being able to get rest” “single household,” “age.”- 103 -

PCL (PTSD symptoms) high-risk persons showed the highest odds ratio for “bad communication atwork” followed by “I feel like blaming my actions at the time of the earthquake” which also had a highodds ratio and showed a correlation. Other factors that showed a correlation were “house is completely
or almost destroyed.”③ Survey on nursing staff
99.0% were females, with an average age of 43.3 years. The percentage of PTSD high-risk persons(persons with a total PCL score of 44 or higher) was 4.2%. The proportion of people at high risk for
depressive symptoms (PHQ-9 total score of 10 or higher) was 17.4%. K6 was not used in this study.
Next, a longitudinal analysis was conducted on 296 persons who answered in both the FY2012 andFY2014 surveys. Some high-risk persons with PTSD and some with depressive symptoms switched tothe other. Regarding PTSD, among those who were at high risk in FY2012, 70% improved in FY2014,
but 30% remained at high risk. Besides, although there were a small number of people who were in thenormal range in FY2012, there were some who newly became high risk in FY2014. Regarding depression,
60% of those who were at high risk in FY2012 improved, but 40% remained at high risk. Besides, among
those who were in the normal range in FY2012, just under 10% were newly at high risk.
Furthermore, to clarify the factors related to change of PTSD and depressive symptoms at two
points, in FY2012 and FY2014, the analysis was performed using a generalized estimating equation(GEE). As a result, regarding PTSD symptoms, changes in PCL total points and PTSD risk; people who
answered, “I feel responsible for the time of the earthquake” and “feeling mentally distressed due tobeing criticized by residents,” had a higher chance of having higher scores and risk, than those who didn’t.
Regarding depressive symptoms, people who answered, “I feel responsible for the time of the earthquake”
and “not receiving enough support from family,” were more likely to have higher PHQ-9 total scores.
Regarding depressive symptoms, people who answered, “I feel responsible for the time of the earthquake,”“not receiving enough support from supervisors at work,” and “working in a temporary location due tothe impact of the disaster,” had a higher risk of developing depressive symptoms compared to people
who didn’t.
( 3 ) Considerations
The local government staff survey revealed that the risk of depression and PTSD for staff in thestricken areas remained high even after more than three years since the earthquake. It also revealed that
more staff members were at risk for depression than PTSD. The municipalities in the stricken areas
continue to perform enormous reconstruction operations in addition to their usual operations from before
the disaster. The high workload remains persistent, which could also be associated with depressive
symptoms. In the future, we will examine what factors are affecting them and conduct longitudinal
analyses to clarify the factors related to the high risk of mental health issues in more detail.
According to a survey conducted by employees of the Social Welfare Council, many of them arecontinuously working close to the affected people at work while maintaining their mental health, while- 104 -

some of them continue to provide support while coping with mental health issues. There was no change
in the proportion of high-risk persons with psychiatric symptoms between FY2013 and FY2014. Looking
at the switches, there were individuals with chronic mental health symptoms and those whose mental
symptoms worsened later. Considering the factors, although the effects of the disaster itself are graduallydiminishing overall, attention was deemed necessary for employees who suffered a great deal of damage,such as losing their families, losing their homes and property, and suffering long-term mental healthissues. Besides, human relationships at the workplace and connections with the community after theearthquake have also continuously affected mental health, suggesting the importance of communities,
such as improving workplace communication and deepening connections with the community.
A survey of nursing staff revealed that while the overall mental health was improving, some highrisk people switched, and the proportion of people at high risk for chronic depression increased.
Examination of the factors indicated that feelings of responsibility during the disaster hindered therecovery of both PTSD and depression. This suggests that it is necessary to consider ways to intervenewith this feeling of responsibility that remains over time. Besides, the decline in social support is also a
related factor and so, it was considered important to work to maintain and improve connections withpeople at home and work.
2. Research on psychological support methods in disaster-stricken areas( 1 ) Psychological Support Methods for Disaster Relief Victims Research on the spread of Skills for
Psychological Recovery (SPR) and its feasibility in Japan
Skills for Psychological Recovery (hereinafter referred to as SPR) is a practical psychologicalsupport method that can be widely applied to a variety of mental health problems that many victims
experience during the period of disaster recovery and reconstruction and was developed by the National
Center for PTSD and the National Child Traumatic Stress Network in the United States in FY2010. In
June 2011, the Hyogo Prefecture Mental Health Care Center research group created a Japanese version
which is the latest psychological support technique. SPR, a specialized support program for the recovery
phase of disasters, has been used after some overseas disasters but has not yet been fully applied in Japan.
Therefore, we decided to research training for professionals to spread SPR and research on the feasibilityof SPR in Japan.
① Research on training for professional staff to spread SPR
a. Purpose of Research

Mental health care professionals who are involved in support in the stricken areas of the Great East
Japan Earthquake received SPR training and applied it to actual disaster victims. This was considered tohave practical significance as a mental health measure in these areas. However, although training forspecialized skills is necessary for psychological support, the training method is not well established. The
purpose of this study was to provide SPR training to specialists engaged in mental health care in affected- 105 -

areas, to conduct questionnaires and qualitative surveys to clarify the significance and problems of SPR
training, and to clarify the possibility and problems of its use in Japan.
b. Research Methods
SPR workshops were held for experts engaged in mental health care in the affected areas on thefollowing schedule. The lecturer requested was Tomoko Osawa (a clinical psychologist) from one of
the mental health care centers in Hyogo Prefecture who had acquired the SPR trainer qualification. As
basic training, lectures on SPR and training through workshops were conducted over two days. It was
implemented four times by FY2013, and the fifth was implemented in Sendai City in June 2014. Besides,
as follow-up training, a case study of SPR utilization cases was conducted for those who wished toparticipate in the basic training. This training was conducted three times by FY2013 and was conductedin Sendai City in October 2014.
Before and after the basic training and after the follow-up training sessions, a questionnaire survey
was conducted on the contents of the training and SPR. Besides, the data was converted to an ID that
could be anonymous so that the data could be traced from basic training to follow-up training. After thebasic training, if the trainees provided support to the victims using SPR in their fields, they wererequested to record them in the skills implementation log and submit them at the follow-up training. The
contents of the skill implementation log were the techniques used in the support i.e. the support time,
the number of times support was given, the contents of support, and problems. At the follow-up
workshop, group discussions were held to examine the feasibility and problems in utilizing SPR, andthe details were recorded in the meeting minutes. Participation in the training and consent wasdifferentiated, and the research was conducted only for those who provided consent. This study has been
approved by the Ethics Committee of the Tohoku University Graduate School of Medicine.
c. Research Results
The number of participants in the basic training session for the fifth training held in FY2014,
comprised 52 people, bringing the total to 151 from the previous year. The fourth follow-up training wasattended by 19 participants, bringing the total to 56 people. Of the participants, only individuals who
consented to the study were included in the study. The number of valid responses in the basic training
questionnaire survey (5 times) was 137, and the number of valid responses in the follow-up training
questionnaire survey (4 times) was 41. The first response was used for those who attended the followup training more than once. As a result, the number of valid responses to be tracked in the basic
training and follow-up training was 35.
The features of the participants at the basic training sessions were as following; male to female ratio= 23:114, 18% were in their 20’s, 35% in their 30’s, 26% in their 40’s, 15% in their 50’s, 5% in their60’s and 1% didn’t answer. Of the total, 29% of participants were psychologists, 13% were psychiatricsocial workers, 19% were public health nurses, 18% were nurses, 6% were psychiatrists, and 15%
represented other occupations. 12% said they did not have experience in disaster/trauma support, 62%
said they had some experience, 20% said they had experienced, and 5% said they were very experienced.
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According to the questionnaire results after basic training, about 90% of the respondents answered,"strongly agree" or "slightly agree" to the question, "Do you think this is related to your current job?"
About 90% of the respondents answered, "strongly agree" or "slightly agree" when asked if they werewilling to try it in their work. When asked, “Do you have confidence in using SPR?” “strongly agree"
and “slightly agree” were as low as just under 40%. Respondents who had experience in assisting patientswith post-disaster trauma showed significantly higher confidence in using SPR. After basic training andfollow-up training, follow-up subjects (N = 35) were questioned on their interest in SPR, difficulty,
relevance to work, willingness and confidence to use it, and the usefulness of SPR skills in aquestionnaire; but no major changes were observed.
In the group discussion of the follow-up training, with regards to “the usefulness of SPR in your work,”
participants said that it could also be used in “consultations” and “health classrooms or in other groupsettings.” Additionally, “the idea that individuals in need of help can solve their problems on their own
is a good way to lower the burden on supporters who feel as though they ‘must solve their problems’.”
Concerning “I have used SPR before or have wanted to,” while not many used it in their sessions, someused it in essence. Concerning “difficulties/changes/challenges of using SPR in your work, peoplecommented saying that “the idea of thinking together is important because the teaching of skills is notfamiliar in Japanese culture,” “it is necessary to use it flexibly according to the TPO instead of according
to the manual,” “a step to change the expressions in the manual to match yourself is required,” and “whenthe use of skills isn’t successful, you need to be able to change them.” Concerning “What kind of training
system or SV (supervision) system would make it easier to use SPR?”, people answered saying that “casestudies” and “timely supervision” would help.
d. Considerations
The results of the questionnaire survey after basic training revealed that, although the interest in SPR
and the motivation to try it was high, the confidence was low. From the follow-up surveys, it could beseen that follow-up training increased the participants’ level of understanding and that providing
examples increased the motivation to practice SPR but did not lead to confidence.
Based on the above results, although SPR training has a certain significance, there is a limit to training(consisting of basic training and one follow-up training session. As discussed in the group discussion, it
became clear that it was necessary to repeat case studies and establish an SV system. Besides, a modeling
function was considered necessary to spread it as a support method.
Based on the results, a demonstration DVD on SPR utilization scenes was created and distributed tothe trainees along with a questionnaire for viewing. In the future, we plan to analyze the feedback resultsof the DVDs and consider methods to spread SPR.
② Study on the feasibility of SPR in Japana. Purpose of Research
To apply SPR in Japan, it is necessary to consider whether this program can be implemented in theaffected areas. Therefore, the purpose of this study was to cooperate with the municipalities in the disaster- 107 -

areas, apply SPR to the victims, and examine the feasibility of the application.
b. Research Methods

The participant targets were those living or working in District A of the Miyagi prefecture and who
were 18 years or older with an awareness of mental health issues. Those excluded were individuals who
were receiving treatment at a psychiatric institution or had severe poor mental health symptoms. Besides,
participants were native Japanese speakers, who understood the purpose and contents of this study, andwho consented in writing. A memorandum of understanding was exchanged with the municipality ofDistrict A, and residents were jointly recruited to participate in the “Post-disaster Stress Recovery Program.”
There were 15 target participants.

All psychiatric health care workers (nurses, public health nurses, psychologists, physicians, etc.) who
have received training have been trained by SPR trainers at a mental health care center in Hyogo
Prefecture. SPR was conducted under the supervision of the trainer and psychiatrists of the Tohoku
University Hospital Department of Psychiatry. Participants who met the selection criteria were given a
pre-intervention assessment after explaining the intent of the study and obtaining written consent. The
instructor conducted a total of five interviews with the participants for about one hour, once every
one/two weeks. After the intervention, post-intervention evaluations and 2-month follow-up evaluations
were conducted.
The primary endpoint is the overall score on the GHQ Mental Health Questionnaire (GHQ-30).
Secondary endpoints were QOL (SF-8), post-traumatic stress symptoms (IES-R), resilience (TRS), selfefficacy (SE), and program satisfaction (CSQ-8J). Remarks on the program, each skill, and theirsubsequent utilization were evaluated by qualitative content analysis.
This study was conducted under the guidance of the municipality in charge of District A, which is anarea of intervention, and under appropriate cooperation. In each interview, the interventionist assessed
the subject's overall mental status (including suicidal thoughts). Besides, if we became aware of any
serious adverse events or problems related to this study, we included necessary measures and support incooperation with the division in charge of District A, such as referrals to related organizations including
medical institutions. This study was performed with the approval of the Ethics Committee of the Tohoku
University Graduate School of Medicine.
c. Research Results

We began recruiting participants in July 2013. As of March 2015, the number of applicants had
reached 24. Of these, 3 did not meet the requirements, 7 canceled before the intervention, and 1 postponed,leaving 13 participants to start the intervention. Of these, four had prior interventions, one did not meetthe study eligibility criteria, so the total number studied was eight. No adverse events have been reported
in any of the 13 patients, including prior interventions, by March 31, 2015. Of the 13 participants whostarted the intervention, nine completed the final session by March 31, 2015. After examining the preand post-intervention assessments of the nine completed preliminary analyses, the primary endpoint, theGHQ Mental Health Questionnaire (GHQ-30), had lower total scores after the intervention than before.
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d. Considerations
This study has not yet reached the target number of cases. Therefore, at the time of this report, wehave not reached the stage of verifying the feasibility of the program. However, no adverse events wereobserved at the present stage in the 13 cases in which intervention was started. Preliminary analyses showthat the GHQ-30 value of the 9 cases in which the intervention was completed was lower than that of before
the intervention. This suggests that SPR may be a safe and effective program in Japan at this time.
In the future, the number of case subjects will be increased, and when the target number of subjects
is reached, the transition of each endpoint will be analyzed to verify the feasibility of the program.
3. Research on mental exercise training for general citizens and supporters in the affected areas of the Great
East Japan Earthquake to spread awareness on cognitive behavioral therapy( 1 ) Purpose of Research
Cognitive-behavioral therapy (CBT) is a psychotherapy that enhances self-control through bothcognitive and behavioral approaches to improve and resolve various social life issues. CBT has indications
for various mental disorders such as depression and anxiety disorders, and its effectiveness has beenreported3)4). It is effective not only for mental illnesses but also to prevent depressive symptoms that are notyet considered to be mental illnesses and have been widely applied in fields other than for medical practices5).
In Japan, the spread of CBT is slower than in other developed countries, and effective training
methods must be established to spread it throughout society. In this study, from the perspective of primaryprevention, a workshop on stress care in daily life was conducted for the general public and supporters in
the disaster areas based on the basic concept and skills of CBT. The significance and problems of the training
were examined by conducting surveys using questionnaires. The purpose of this study was to clarify the
future of CBT and the possibilities and issues with spreading awareness of this method.
( 2 ) Research Methods
In FY2013, training was held four times in Iwanuma City, Sendai City, and Ishinomaki City for thegeneral public, and the fifth training was held in Ishinomaki City from May to June 2014.
A questionnaire was conducted after each training session to obtain feedback on the degree ofunderstanding and remarks of the training program. Before and after the entire training program, participantslearned about (i) the characteristics of participants, (ii) questions to clarify their understanding and retentionof the training, (iii) SF-8 as a scale to measure the quality of life (QOL). A self-efficacy scale was used todetermine whether self-efficacy was enhanced by learning and utilizing CBT. In conducting the training,
we received technical guidance from Dr. Hiroshi Ohno (Director of the Center for Cognitive Behavioral
Therapy at the National Center of Neurology and Psychiatry) and Professor Miyuki Tajima (Director of theClinical Technology Department Office at the National Cognitive Behavioral Therapy Center of the
National Research Center of Neurology and Psychiatry). This study was performed with the approval of the
Ethics Committee of the Tohoku University Graduate School of Medicine.

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( 3 ) Results
The first to fifth training sessions have been conducted in Iwanuma City, Sendai City, and Ishinomaki City thus
far. The total number of participants was 180, consisting of 19 males (10.6%) and 161 females (89.4%). The average
age was 45.53 ± 14.27 years (range: 22-91 years).
Questions to measure the understanding of the training sessions and self-efficacy scale (SES) were conducted
before and after the training sessions for 46 people (2 males, 44 females, average age 47.8 ± 13.7 years) who attended
at least 5 times out of the 6 sessions.
Self-efficacy was compared before and after interventions using the Wilcoxon signed-rank test. Self-efficacy
significantly improved from 69.2 before training to 73.4 after training (p <0.01, z = 2.73).
Seven questions were asked about their understanding of the training, and scores before and after theintervention were compared by using the Wilcoxon signed-rank test. A 5-point scale from 0 (not applicable) to 4
(applicable) was used, and a significant change before and after the intervention was observed for the four following
items, “I know the habits of the way I think,” “I know what kind of thinking makes me feel depressed and anxious,”“I can recognize the ideas that hurt me, and I know how to change what I think about,” and “ I carefully evaluate how
the situation changes after implementing the solution.”
Participants were satisfied with the training and commented saying that they were able to enjoy learning while
experiencing the exercises.

( 4 ) Considerations
Although the results should be interpreted with caution, as it is a preliminary pre- and post-survey with nocontrols, it was suggested that this training program would help improve the self-efficacy of the disaster victims. Our
trials have revealed that there is a need to learn the cognitive-behavioral approach and use it in disaster-stricken areas
and that training programs can be implemented to respond to this. In the future, it will be necessary to try the practicein even more regions, revise the program, and train program implementers.
Based on the above, the program was revised with a focus on cognition, focusing on the assertion(communication) of cognitive reconstruction methods in cognitive behavioral therapy skills. At the end of FY2014,
we conducted a workshop to spread the skills of CBT for the general public in the stricken areas and started arandomized controlled trial. We plan to verify the effectiveness of the training in the future.

References
1. Perrin MA, DiGrande L, Wheeler K, Thorpe L, Farfel M, Brackbill R. Differences in PTSD prevalence andassociated risk factors among World Trade Center disaster rescue and recovery workers. Am J Psychiatry,
164, 2007, 1385-94
2. Hiroshi Kato, Nozomi Asukai. Psychological effects of a disaster rescuer: From a large-scale survey offirefighters working in the Great Hanshin-Awaji Earthquake. Traumatic Stress, 2(1), 2004, 51-9 [InJapanese]
3. American Psychiatric Association Practice guideline for the treatment of patients with major depressive

disorder (Revision). American Journal Psychiatry, 157(4), 2000, 1-45
4. Hiroshi Ohno. Progressive Psychotherapy of Treatment. Japanese Clinical, 65(9), 2007, 1650-1653[in Japanese]- 110 -

5. Central Occupational Accident Prevention Association. Mental Health. Return to work support guide[Explanations and case studies], 2005. [in Japanese]

Assistant

Yoko Takahashi (Nurse)

Assistant Professor

Atsushi Sakuma (Psychiatrist)

Graduate Student

Ikki Ueda (Psychiatrist）

Education and research supporter

Ayami Nagao（Psychologist）

Education and research supporter

Mikika Abe（Nurse）

Professor
Associate Professor

Hiroo Matsuoka（Psychiatrist)
Kazunori Matsumoto（Psychiatrist)

As of March 31st, 2014

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