Camp Project for Parents and Children in Disaster-Affected Areas

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Camp Project for Parents and Children in Disaster-Affected Areas

FY 2019 Bulletin, Vol. 8
Source:FY 2019 Grant-in-Aid for Scientific Research (Basic Research (B)) “Study of longitudinal support for children born after the Great East Japan Earthquake and their families” Symposium for Community Development that Supports the Raising of Children: What We Have Learned from the Michinoku Children's Cohort– Practical Report (2019)

Symposium for Community Development that
Supports the Raising of Children:
What We Have Learned from theMichinoku Children's Cohort

Practical Report

Date: February 11, 2020 (Tuesday, a holiday)
Place: TKP Garden City, Sendai, Kotodai, 2F, Hall 1--121 -

FY 2019 Bulletin, Vol. 8Part 1: Research ReportMichinoku Child Cohort Background
Junko Yagi
Department of Neuropsychiatry, Iwate
Medical University
Iwate Child Care Center

Our Results Thus Far
Naoki Matsuura
Mie University, Faculty of Education, Special Support Education, Special Support (Medical) Field

General moderator: (Research member, Miyagi Prefecture
survey manager)
Naru Fukuchi, Miyagi Disaster Mental Health Care Center--122 -

FY 2019 Bulletin, Vol. 8

Michinoku Child Cohort Background
Presenter – Junko Yagi
Department of Neuropsychiatry, Iwate Medical University
Iwate Child Care Center
Principal Investigator, MiCCaJEGE

In the next 30 minutes, we would like to provide a short overview of the Michinoku Child Cohort study
and discuss our progress thus far.
(Slide 2) The Great East Japan Earthquake
The Great East Japan
Earthquake
was an unprecedented major disaster with
3.11.201115,896 dead
2:46 PMnearly 20,000 people dead in its wake. Com2,537 people missing
Magnitude 7, maximum
19,575 disaster-associatedrunup height: 40.1 m
pared to the population in 2010, for example indeaths(as of 9/2017)
Otsuchi Town, Iwate Prefecture, 8.4% of the
Dead + missing / 2010 population
population died, which represents a major disIwate Prefecture,
Otsuchi
8.4％
aster and it is no wonder that the impact has
Rikuzentakata 7.8％
Yamada4.5%
lasted for a long time. (Slide 3). As I mentioned
Miyagi Prefecture,
Onagawa
8.7％
Minamisanriku 4.8%
in the previous greeting, we discussed this about
Yamamoto
4.3%
Fukushima Prefecture, Kawauchi
3.2％
five years after the earthquake. At that time, we
Namie
2.7%
thought, “While there are children, families, andcommunities who will recover, grow and develop, there are parents and children whose paNow that more than 5 years have passed since thethology will deepen over time.”
disasterFor example, there are cases where trauChildren, families, and communities have begun to recover, grow, and develop
matic grief becomes insidious and symptomatic
As time progresses, parents and children’s pathologies worsen
within a few years. Especially in Fukushima,
ambiguous loss and other such problems have
As time progresses, parents and children’s pathologies worsen
Latent progression of traumatic grief -> symptoms appear several years later
affected the mental health of the family. A few
Ambiguous loss and family mental health -> stop going to school several years later
years after the earthquake, some children beEmergence of weakening of family foundations caused by the disaster – intergenerational pathologies
came maladapted to school. Directly after the
As years pass, gaps in community and individual
earthquake, they were fine, but now some years
reconstruction and recovery will widen
later, they are not attending school. The fragilityof their family base became apparent after theearthquake. How does a child grow up in thenormalization of an emergency, or does the pathology between generations affect the child's development?
This question arose among people supporting the community, and I believe is being asked here also. Thus,
disparities in the degree of reconstruction and revitalization of the community and individuals widened witheach passing year (Slide 4). Therefore, we will introduce and report on “Michinoku Children's Cohort study
after the Great East Japan Earthquake,” which we refer to with the acronym “MiCCa.” Although this is a
bit of a nickname, it led to the idea of this research.

--123 -

FY 2019 Bulletin, Vol. 8(Slide 5) Allow me to explain the background behind this situation schematically. At the site where we
provide support and clinical practice, the Great East
Japan Earthquake caused a drastic change in the environment, which caused a great deal of psychologicalstress. In situations where these effects were protracted over time, we began to hear from supporters in
the field such as nursery teachers, kindergarten teachers, and public health nurses about children who wereborn after the earthquake. During the turmoil, infants
were restless, unfamiliar with group behavior, and hadparents with possible mental health issues. The sup- Research background: Feelings in support and clinical practice
Severe environporters expressed concern about these issues. Since
mental changes
Enormous psychological stressthe earthquake, I have visited Iwate prefecture'sGreat East Japan
Passage of time
Earthquake
coastal areas every week, and continue to do. I realized
Protraction of effects
that the situation was precisely as described by theChildren born after the disaster, and were infants
during the period of turmoil
people in the field. We confirmed that the issues are
Voices from the field
Unfamiliar
more prominent in severely damaged areas, as we
Restless
with group
Parents’ menbehavior
tal health isshared with Professor Masuya, who supports Fukuof concern
Mostclearly observed in severely
shima, and Professor Fukuchi, who supports Miyagi.
damaged areas(Slide 6) In terms of the current situation in disaster areas, Tohoku suffered from a chronic shortage of
Research background: Feelings in support andclinical practiceprofessionals. The supporters grew weary, and living
Great East Japanin an extraordinary situation became the norm. In thisEarthquake
Current status of disasterway, things such as problem awareness graduallyareas, 5 years later
Normalization of the abfaded. What is the current situation / actual situation?
Chronic lack ofSupporter exnormal, fading of issues
specialists
haustion
We believe that developing a firm understanding of
the present and advancing an appropriate support plan
will help future disasters. With the idea that our first
Planning and continuing
urgent task should be to investigate the actual situaappropriate supporttion, I conceptualized this study's idea.
(Slide 7) Currently we are pursuing a basic reLongitudinal study in 3 prefectures
search Grant-in-Aid with a particular group (B),Michinoku Child Cohort: the idea for the MiCCaGEJE“Study of longitudinal support for children born after
the Great East Japan Earthquake and their families.”
This research explores the mental health problems ofchildren born after the Great East Japan Earthquake
and their families. Our two primary goals are toclosely track and investigate the long-term effects the
Basic Research Grant-in-Aid (B) “Study of longitudinal support for children born after the Great East Japandisaster has on children's neurological development.
Earthquake and their families”(Slide 8) In sum, we follow the growth and development of infants during the turmoil in the long termin selected areas of the three prefectures, and compare
the situation in each prefecture. We collaborate with nursery schools and preschools to continue the necessary support. We will continue to track children until they graduate from junior high school andExplore mental health problems among children born after the Great East Japan Earthquake and their families
Investigate the long-term effects of the post-disaster period on the neurological development of children--124 -

FY 2019 Bulletin, Vol. 8
Study of Longitudinal Support for Children Born After the Great
watch and support the process of their growth and deEast Japan Earthquake and their Families
velopment. We are particular about continuing these efResearch Overview
forts, including “support as needed.”Longitudinally track the growth and development of children born after the disaster that grew up in the chaotic post-disaster period.
(Slide 9) I belong to Iwate Medical University, andSelect severely damaged areas in Iwate, Miyagi, and Fukushima, and understandam the principal investigator for this study. However,the situation there.
Iwate Prefecture's research is managed by the Iwate
Work with nursery schools/preschools to continue follow-up surveys and necessary support.
team. Miyagi Prefecture's research is conducted by the
Follow students until they graduate middle school (approximately 12 years), watchMiyagi team led by Professor Fukuchi. The research ining over and supporting their growth and development.
Fukushima Prefecture was conducted by the Fukushimateam led by Dr. Masuya. Dr. Matsuura of Mie University, who will report mainly on the data analysis results,
joined the group as an analyst. The four of us have
Research Organization
formed a research organization and have been researchIwate Medical University / Iwate Child Care Center – Junko Yagi (Principal Investigator)
ing with local colleagues.
Kenji Yamaie, Yasushi Kichioka, Hiromi Tamayama,(Slide 10) The significance of collecting data in thisMiyagi Disaster Mental Health Care Center – Naru Fukuchi
study is to be able to grasp the physical and mental conTakao Tanno, Shusaku Chiba, Wataru Shoji, Tomohiro Uchida, and othditions of children in the disaster area, to consider necers
Fukushima University/Tokyo Medical University – Jiro Yanagiya
essary medical care and medical care systems, and to be
Tokio Uchiyama, Koki Nomura, Shizuka Nakamura, Keiko Kawashima, and others
able to understand how children born after a significant
Mie University – Naoki Matsuura
disaster grow and develop. I thought that this would be
useful for formulating effective support methods for future disasters. Further, I thought that children's psychiatrists in the three prefectures should support children
The Significance of Data Collectiona
with a common awareness of issues and collect data
We will be able to understand the physical and mental status of these children, and will be able to consider the medical care and healthcare systems
with this in mind.
they may need.
(Slide 11) I will explain the flow of this research—
We will learn how children born after a large-scale disaster grow and
we first mailed questionnaire forms. Subjects completeddevelop, and will be able to propose effective support for future disasters.
and returned them. Next, we met and interviewed parents and children and conducted psychological tests.
Child psychologists from all three prefectures will be able to achieve
We evaluated and returned the results to everyone. Aftera common awareness of this particular issue, and will be able towork together to support children
that, the necessary support is provided to parents andchildren in need. This is a series of events, a discrete set.
Pilot surveys began in 2015, baseline surveys in
Research Flow
2016, and from the following year, annual follow-up
surveys were undertaken to track the same population.
From 2021, we plan to continue monitoring, but via biMailing out quesInterviews of children
Evaluation and reProviding necestionnaires and reand parents / psychoturning of results
sary support
ceiving answers
logical testingennial surveys.
(Slide 12) In terms of our subjects, 223 pairs of parents and children from Iwate, Miyagi, and Fukushima
2017-20192015-20162021 onward
Follow-up surveys
Follow-up surveys
Baseline surveys(every year) Providing(biennial)
participate in this research. Groups are broken down
Providing support
supportFollow-up
thus: Iwate 87 groups, Miyagi 74 groups, Fukushima 62
groups. A total of 223 groups participated in the 2016baseline survey. From that point on, we tracked the supplement rate: how many people continued participating. The year 2018 represents admission to elementary
school. Because of this, the supplement rate--125 -

FY 2019 Bulletin, Vol. 8
ropped slightly less than 80%. Thus, about 80% of thepeople continued to participate. In 2019, it was almost
the same; and the research is continuing with a supplement rate of about 78%.

Target children
Baseline
223 children and their parents
87 from Iwate (male/female = 47/40)
74 from Miyagi (male/female = 39/35)(Slide 13) Next, I would like to share the evaluation scales or questionnaires used so far. As mentioned
here, we use many standardized questionnaires andscales for evaluation. In the 2016 baseline and the second follow-up in 2018, we selected several items fromthe children's cognitive development and intelligencetests, such as the painting vocabulary test, WPPSI, and
K-ABC II. And in the first follow-up survey in 2017,
WISC-IV, an intelligence development test, was conducted on all children. A simple structured interview
for psychiatric disorders called MINI was conductedwith parents. A psychiatrist or psychiatrist asks questions face-to-face with the parents to check for mental
illness (Slide 14). Mental problems such as those listed
here can be identified through MINI.
(Slide 15) We also asked other questions to learn
more about their mental health, family situation, andchild development situation. (Slide 16) As shown inthis photo, we rented a nursery school, and went out
as a team to inspect children, listen to mothers, andprovide them with advice.
(Slide 17) Next, I will discuss the kinds of intervention and support we have provided. First, we sent
back results individually to all parents. I made a “feedback sheet” and gave it to everyone, saying: “The results of your child's development tests were such-andsuch.” Although these were precise results and explanations, we also returned a sheet of results to each person. With the parents' permission, we gave these results to the children’s nursery schools and kindergartens. We discussed with nursery schoolteachers andgarden teachers how to deal with and support children
who concerned us. We provided support by travelingto these sites, sharing results, and giving each otherfeedback. Additionally, we publish a newsletter several times a year and have launched a website that I
would like you to view. Topics are published and updated frequently.

--126 -

62 from Fukushima (male/female = 33:29)
Overall mean age: 58.5 months (SD = 6.52)

First follow-up survey: 212 households
Second follow-up survey: 176 households

Evaluative scales/questionnaires
Evaluation of child development characteristics (2016 baseline / 2018second follow-up)
Picture-vocabulary test
WPPSI <Building blocks> <Picture completion>
WPPSI <Building blocks> <Picture completion>
Goodenough-Harris Drawing-a-Man TestChild cognitive development (2017 first follow-up)
WISC-IV (full-set)
Questionnaires, etc., for educators

Child evaluations, educator mental health, resilience, etc.
Structured interview (parents)
MINI (Simple structured interview method for mental illness)

Structured interview(parents)

Child psychologists and clinical psychologists evaluate mental illness
using a structured interview protocol known as MINI
Major depression

Post-traumatic stress disorder

Dysthymia

Alcohol dependence (mother only)

Risk of suicide

Psychotic disorder

Manic episode

Anorexia nervosa

Panic disorder

Bulimia nervosa

Agoraphobia

Generalized anxiety disorderSocial fear

Antisocial personality disorder

Obsessive-compulsive
disorderQuestionnaires, etc. for educators
Child evaluations, educator mental health, resilience, etc.
Parental PTSD: IES-R
Parental mental health: K6, BDI-II
Parental social relationships (social capital, social networks, social support)
Lifestyle, living environment, financial situation
Happiness (WHO26)
Post-traumatic Growth Inventory (PTGI) (Tedeschi, R.G., & Calhoun, L.G., 1996., Taku, K.,
Calhoun, L. G .., Tedeschi, R. G., Gil-Rivas, V., Kilmer, R. P., & Cann, A., 2007)
Parental Interpersonal Relationship Style: The Relationship Questionnaire (RQ (Bartholomew,
K., & LM (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and SocialPsychology, 61, 226-244 .)))
Child's PTSD evaluation: Created based on Parent Report of the Child ’s Reaction To Stress(Jones, R.T., Fletcher, K., & Ribb D.R., 2002)
Child behavior problems: SDQ (Strength and Difficulty Questionnaire, SDQ) (Goodman R, J Child Psychol)
Psychiatry. 1997; Matsuishi et al, Brain Development, 2008)
Child Behavior Checklist (CBCL) (Achenback, 1991; Toagasaki & Sakano, 1998)
Japanese version of M-CHAT (Infant Autism Checklist)

FY 2019 Bulletin, Vol. 8
And for so-called high-risk children and their parents who have some concerns, as a follow-up, we havemade sure to refer them to specialized agencies according to their conditions. Alternatively, we have connected them to support agencies or directly called themourselves. In this way, we have ensured that our projectis one of interventional research in which no one fails
to receive support, and everyone receives some followup.
(Slide 18) This is the specific flow of our followup support, but it is a flow of creating a “follow-up callsheet” and deciding the level of support according to
the procedure. First, we make follow-up calls to allmothers, set up individual interviews for those who
wish, and for children with special needs, being sure toconnect to the support and treatment mentioned earlier.
That is the flow. (Slide 19) This photo is for Iwate; thesheet steps are followed to make phone calls and provide mothers with counseling as needed.
(Slide 20) From here on, I would like to briefly
convey the highlights of our results. Professor
Matsuura will give a more detailed supplementary explanation after this regarding the detailed analysis results.
(Slide 21) As a result of the 2016 baseline survey,
we examined child development, especially cognitionand vocabulary. Nonetheless, many test results show
half a year to several months of developmental delay(Slide 22). Regarding the mental health of mothers, theresult of the interview for psychiatric evaluation called
MINI, indicated that the percentage of mothers who
were thought to require some sort of mental health support via psychiatric evaluations was 35% on average inthe three prefectures and about 40% for Iwate. (Slide
2). According to the questionnaire that mothers themselves answered, the K6 questionnaire, often used forscreening for anxiety and depression, the percentage--127 -

Newsletter

Interventions/support
Individual feedback
Inform educators of developmental status and provide advice

Nursery school/kindergarten feedback
Share status of high-risk children and possible response methods

Newsletter publication / website management

Biyearly progress report, topical articles
High-risk children / parent follow-up
Referral to specialized institutions or support agencies asneededFeedback sheet

Follow-up flow
Decide support level based on follow-up call sheet

Follow-up calls to
all mothers

Checking the child's adaptation status
Checking the mental health of the motherChildcare concerns

Watch
over

Set up individual interviews with those that request themChildcare consultation for applicantsExplanation of children's cognitive development test results
Mother's mental health consultation
Set up next follow-up callSupport high-needs
mothers and children

Referral to a nursing institution (children)
Referral to a medical institution (mother /child)
Childcare guidance in collaboration withnursery schools and schools
Regular follow-up calls
Check the status in the next survey

FY 2019 Bulletin, Vol. 8
of mothers deemed to be in the so-called clinicalarea, was about 35 to 36%. According to the BDI-II,
a scale for depression, about 35% of mothers are considered to be in the moderate to clinical range, meaning that about one in three mothers is anxious or depressed.
On the other hand, the IES-R is a questionnaire
about trauma. These questions were answered with regards to the earthquake and its effects, and the results
indicated that about 14% of mothers are in the clinicalrange. What can be deduced from the above is that one
in three mothers have general depression and anxiety,but only about 14% have strong traumatic symptoms
due to the earthquake. At this point, rather than many
people having trauma-related symptoms specific tothe earthquake, about one in three residents of thesecommunities live with general depression and anxiety, regardless of the causes thereof. Arguably, depression, anxiety, and general mental health problems
are more serious issues than the earthquake's trauma.
(Slide 24) Next, let's examine the relationship between children's behavioral and emotional problems
and their parents' mental health. The results of the“child behavior checklist” questionnaire and the maternal K6 (anxiety/depression questionnaire) scoresseen earlier, show that the proportion of children with
CBCL scores in clinical and borderline areas is significantly higher for children of mothers whose anxiety
and depression levels are in the clinical area. It is also
clear that children with mentally healthy mothers who
have no anxiety or depression problems have fewer
behavioral problems.
(Slide 25) Now, let us examine the relationshipwith the depression scale BDI-II. In cases of children
with normal behavioral problems, mothers with moderate or severe depression were, as you can see here,
relatively uncommon. On the other hand, when thechild's behavioral issues are in the clinical area,

2016 baseline survey results
Highlights

Child development
Cognition and vocabulary
Iwate

Miyagi

Fukushima

Total

Picture completion
Building block pattern
Counting out loudWord order
Hand movement
Standard score
Picturevocabulary
Correct answers
Tests
Developmental age

Many test results indicate half-year or several-monthdevelopmental delays

Mother mental healthMini-International Neuropsychiatric Interview

Percentage of mothers designated as "needs-support" via psychiatric evaluations across all 3 prefectures: ~35%

Mother mental health
K6 (anxiety/depression), BDI-II (depression), IES-R (trauma)

Approximately 35% of mothers have depression or anxiety (1 in 3)
Approximately 14% of individuals have strong disaster trauma symptoms--128 -

FY 2019 Bulletin, Vol. 8
the proportion of mothers with clinical depression is significantly large, and the percentage of mothers who needsupport relatively high. Therefore, it has become clearthat there is a significant relationship between behavioral
problems in children and depressive symptoms in mothers (Slide 26). Furthermore, we implemented the PVTR,a test that measures the vocabulary development of achild. We examined the relationship between vocabularydevelopment in children and mental illness as identified
by the simple structured interviews mentioned earlier,the MINI. The result was that the children of mothers
who were considered to fall in the above category had adelay in vocabulary development.
(Slide 27) To summarize this baseline survey so far,first of all, 35% of parents had some psychiatric symptoms as identified by MINI. However, most of thesemothers were not connected to any specialized institutions. Notably, most had never consulted anyone. Next,
the cognitive development test of children showed a delay of about one standard deviation on average. Further,
the child's delay in vocabulary development was foundto be significantly related to the result of the mother's
MINI. There is a lot of other data, but the baseline survey
found a significant relationship between the child's behavioral and emotional problems and vocabulary development, and the state of the mother's mental health. That
is why we have been implementing the follow-up flow
mentioned previously. We have watched over these individuals as they receive necessary support, and remain
connected to them.
(Slide 28/29) In the first follow-up survey, we compared cognitive development test results in the first andsecond years. While all the same tests were not performed, we calculated and compared the combined
scores. Thus, while this is not an entirely accurate number, I think a certain tendency can be ascertained. Compared to the first year, a significant increase in the socalled mean IQ is observed in the second year, whichmeans that there was apparent growth. Professor
Matsuura will talk in a little more detail about that after
this.

--129 -

Child behavior/development and parent mental health (1)Association between CBCL and parent K6 scores

Significantly higher proportion of children in the CBCL clinical range among parents in the K6 clinical group
Over 20% of CBCL clinical groups in the K6 clinical groupChild behavior/development and parent mental health (2)scores
Association between CBCL and parent BDI-II scores

In the CBCL clinical area of children, the proportion of mothers with BDI-II moderate / severe is significantly higher.
Parents' depressive tendencies may affect their children's behavior and emotions

Child behavior/development and parent mental health (3)Association between PVTR and parent MINIChildren of mothers
who were identified ashaving some form ofmental illness by MINI
had delayed vocabularydevelopment.

MiCCa Baseline Summary
Baseline survey structured interviews (MINI) showed some psychiatricsigns in 35% of parents. However, few people were connected with medical institutions or specialized institutions.
The results of the cognitive development test of the child showed adelay of about 1 standard deviation on average, and the delay in vocabulary development was significantly associated with the resultof the mother's MINI.
A significant association was found between the child's behavioral
and emotional problems and the mother's mental health status.

FY 2019 Bulletin, Vol. 8(Slide 30) Now, among the things we have learned fromcontinuing follow-up surveys since 2016, I would like tofocus on mothers' social capital and mothers' mental health.
(Slide 31) To understand this social capital, we asked thefollowing questions, the first is: “Do you think your neighbors trust each other?” This was to ascertain how muchtheir mothers trust the community. Green is “I think so,”blue is “I suppose I think so,” yellow is “I suppose I don't
think so,” and deep green is “I don't think so.” In 2016,nearly 70% of the people who “think that their neighbors
trust each other” are almost the same in 2018. In terms of
local trust, we found that some solid social capital has beencultivated. (Slide 32) Now, let's look at it from the perspective of mutual aid with the question, “Do you think the people in your neighborhood help each other?” Nearly 75% of
the respondents said, “I think so,” or “I suppose I think so.”
The trend is almost the same in 2016 and 2018 (Slide33).The significant change is in the percentage of “social
participation.”
When asked, “Do you belong to an organization or
club?” as of 2016, one-third of respondents belonged. In
2018, in the third-year follow-up survey, the number ofpeople who belonged increased to about two-thirds. The
trend for trust in the community and mutual aid did notchange. Nevertheless the percentage of people who started
participating in community gatherings increased. (Slide 34)
Also, if you compare the average scores for depression of
mothers in 2016 and 2018, you can see that they are significantly reduced. (Slide 35) Trauma scale scores also improved.
(Slide 36) We compared the aforementioned social capital with respondents’ anxiety/depression and trauma
scores. The anxiety/depression score of those who answered “yes” to “participating in the community” was low.
Mothers who responded that they did not participate in thecommunity tended to have more anxiety and depression
problems. Moreover, mothers who thought that their communities were trusting and had mutual aid had low mental
health problems and trauma problems, whereas those who
answered that they did not believe so had more mental
health problems. In this way, the results turned out quite
clear and orderly.
(Slide 37) Finally, we compared the children's cognitive development scores in the first and third years with thesame tests and found an increase.

Results of first follow-up surveyChild development

Results of first- and second-year child cognitive
development tests
Average score of combined scores from multiple cognitive test results in the first year (FY 2016)
VS
Average score of FSIQ combined score in the second year (FY 2017)

A significant increase
was observed in the
figures for the second
year compared to thefirst year.

Comparison of 2016-2018 survey results
Mother-child mental health / QOL

Social Capital (community trust)Do you think the people in your neighborhood trust each other?

I think so
I suppose I think so

I think so
I suppose I do notthink soSocial Capital (mutual aid)
Do you think the people in your neighborhood help each other?

I think so
I suppose I think so--130 -

I suppose I do not think so
I do not think so

I suppose I do
not think so
I do not think so

I think so
I suppose I think so

I suppose I do not think so
I do not think so

FY 2019 Bulletin, Vol. 8

Social Capital (social participation)
Are you a member of an organization or club?

Yes

no

Yes

no

Change in BDI-II scores (depression)
Change in mean score

Change in clinical groups
Improved
Worsened
Unchanged

Change in IES-R scores (trauma)
Change in mean score

Change in clinical groups
Healthy group 2018 Clinical group 2018
Healthy group

Clinical group

Association between social Capital and mother mental healthSocial participation

Mutual aid

community trust

Association between social Capital and mother mental healthscore(Slide 38) To summarize what we have learned from theongoing surveys from 2016 to 2018, mothers' mental healthproblems were still serious six years after the disaster. And
there was an average delay of about one standard deviation in
the cognitive development of the child. These are the baseline
results. Here, it was found that there seems to be a clear relationship between the mother's mental health and the behavior
and development of the child.
In the follow-up survey one year later, the average IQ ofchildren improved. However, although not shown in the data
presented here, maternal mental health problems were still
protracted. However, the following year, in the second follow-up survey, child development was further promoted andimproved. Additionally, with the improvement of the environment (omitted from slide) and the increase in community
participation, there were also signs of recovery in maternal
mental health problems. This became clear from the first year
to the third year. We believe again that it is essential to continue this survey and appropriate support in the future.
(Slide 39) Here is our take home message: After a largescale disaster, it is necessary to continue long-term support
for children and their families who have directly experienced
the tragedy and the children (and their families) born in turmoil after the earthquake. We consider it important to continue extensive long-term support for children and their families born in a period of turmoil, that is, those who have notdirectly experienced the disaster.
(Slide 40) This is an example of the Iwate version of thenewsletter in the early days, but we have received manymothers' impressions.
From a mother who was worried about raising her child:
While talking about the child's appearance and my feelings, I was able to realize that “Oh, I was like this” and “Thischild is growing up more than I expected.” After the earthquake, there were so many things that I couldn't afford to
think about something carefully.
I was worried that it might affect my child's mind anddevelopment, but I was relieved in that respect as well. I think
it is imperative to have time to come to terms with yourself
and your child slowly.
I hope that you will continue this activity and research in
the future.

K-ABC II (counting out loud)--131 -

K-ABC II
(counting out loud)

K-ABC II (handmovements)

PVT-R (score)FY 2019 Bulletin, Vol. 8

From a mother who was worried about raising her
child:〇 At first, I thought, “This is going to take a lot of
my time,” But I was grateful that I was able to understand the specific problems that my child was having
and to be taught how to deal with them. I couldn't takethis step on my own, so this was an excellent opportunity for me.
〇 These individuals provided their permission for

Key points of the 2016-2018 survey results
Six to eight years after the earthquake ...
Six years after the disaster, mothers' mental health problems remained serious.
An average delay of about one standard deviation was observed in the cognitive
development of children.
A clear association was found between the mental health of the mother and the behavior
and development of the child.
In a follow-up survey one year later, the average IQ of children was improving, and mothers' mental health problems were still protracted.

In the second follow-up survey, child development was further promoted and improved,
and with improvement in the environment and increased social participation, there weresigns of recovery in the mental health problems of mothers.

It is important to continue the investigation and appropriate support in the future

these examples to be used. Their children have been appropriately diagnosed and are well supported.
In support after a large-scale disaster, it isnecessary to continue long-term support not
only for children and their families who directly experienced the disaster, but also forchildren and their families born in the turmoil after the earthquake.

From a mother who was worried about raising her child:
While talking about the child's appearance and my feelings, I was able torealize that "Oh, I was like this" and "This child is growing up more than I
expected." After the earthquake, there were so many things that I couldn't afford to think about things carefully.
I was worried that it might affect my child's mind and development, but I
was relieved in that respect as well. I think it is very important to have timeto slowly come to terms with yourself and your child.
I hope that you will continue this activity and research in the future.

From a mother who was worried about raising her child:
At first, I thought, "This is going to take a lot of my time," But I was gratefulthat I was able to understand the specific problems that my child was experiencing
and to be taught how to deal with them. I couldn't take this step on my own, so thiswas a good opportunity for me.

From a nursery school teacher that participated:
I am grateful for your cooperation even though many years have passed since
the earthquake. Both children and parents have various problems, and I feel that
it is very important to be able to provide counseling to these parents.
As a member of a nursery school, having the opportunity to consult a doctor
was a great learning experience and encouraged me.

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FY 2019 Bulletin, Vol. 8
From a nursery school teacher who participated:〇 I am grateful for your cooperation even though many years have passed since the earthquake. Bothchildren and parents have various problems, and I feel that it is essential to provide counseling.
As a nursery school member, having the opportunity to consult a doctor was a great learning experienceand encouraged me.
These examples of the kind feedback we received, which encouraged us. We have received further
authorization to continue this research and support.
Now, for the last bit of this presentation, I’d like to advertise a little. As part of our support activities
this year, the “Care Caravan” will be held for parents involved in this research to report on the research
results and further support child-rearing. Our
Feedback and parenting support
team comprising three child psychiatrists, areplanning this project. The session in Miyagi
MiCCa Care Caravan 2020
has already ended, but on January 26 we went
together to Higashimatsushima City and2020
Iwanuma City. The contents included a reJanuary 26 (Sun) Miyagi Higashi Matsushima /search progress report, a mini-lecture on
Research progress report
Iwanuma
Mini lecture about parenting
February 15 (Sat) Iwate Miyako
child-rearing, group work and talk, and aGroup work and talkFebruary 16 (Sun) Iwate Kamaishi
Body checker
stress check with a body checker. The quesMarch 1 (Sun) Fukushima Minamisoma
tionnaire was generally well-received. It will
Encouraging the growth of social capital
be held again on February 15-16 in Miyako
and Kamaishi, Iwate, and on March 1 in Fukushima and Minamisoma.
The mothers who participated in the caravan project adopted the expression “social capital.” We realizethat this kind of opportunity fosters and promotes social capital, where people get together and talk about
things they can't usually talk about, such as their concerns. The mothers who participated also left such
impressions. It was an experience that reminded me that the results obtained from this research and thephenomena that occur overlap in reality. It is vital to make full use of the research results in designingappropriate support. We would like to continue to provide support while firmly conducting this research.
While it was a bit rushed, that concludes my overview of our progress thus far. Thank you for yourattention.

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FY 2019 Bulletin, Vol. 8

The Results We Have Obtained Thus Far
Mie University Faculty of Education Special Support
Education/Special Support (Medical) Field
University of Fukui Children's Mental Development
Research Center
MiCCaJEGE Research Collaborator - Naoki Matsuura

Introduction
This study is a longitudinal study of the mental
health of children and mothers after the earthquake.
Characteristics and originality of this study
Various disasters occur all over the world, but there
are few such studies, rare even from an international
Longitudinal intervention study after the Great Earthquake
perspective. The reason is that “longitudinal interFor both children and mothers
Comprehensive assessment of children's cognitive, behavvention research” can be problematic. “Longitudiioral and emotional issues
nal” means investigating something over time. For
The evaluation of the child is mother + caregiver or teacher
example, even when the earthquake struck, we surExperts are conducting structured interviews
veyed the victims. This is called “cross-sectional reWith the full cooperation of government agencies
search.” “Cross-sectional” can be done by one surWill be supplemented from 3, 4 to 15 years oldvey, but “longitudinal” is quite tricky. It takes timeand money, and the burden is heavy. Those who areinvestigated must cooperate with the investigation many times. Therefore, “longitudinal research” yields
very high-quality data, but is challenging to conduct.
Moreover, this study is an intervention study. Many studies are observations. In other words, observational research involves listening to people who have been damaged by the earthquake and collecting data
while observing them. On the other hand, this study leads to direct, guaranteed intervention for people withneeds (the children and parents).
“Longitudinal research” is conducted worldwide, but “longitudinal research of earthquake disasters” israre. Moreover, there are even fewer studies that intervene rather than observe. I hope I have helped you toappreciate the value of this approach.
Survey Methods
This study targets both children and their parents. It is a comprehensive assessment of children's cognitiveand emotional issues. The evaluation scale is not evaluated by one or two, but by everything. The evaluationof children is conducted from the perspective of both the mothers and the caregivers (teachers). In thesecases, the teachers evaluate the children much more rigorously than the parents. These results in turn, arerigorously evaluated by faculty members nationwide, regardless of the survey. Therefore, it is essential toobtain a proper evaluation from both parties.
For parental interviews, experts conducted structured interviews. Evaluation was performed according to aproper procedure (protocol). We received full cooperation from government agencies in conducting thisresearch.

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FY 2019 Bulletin, Vol. 8
Significance of Longitudinal Design
From the start, we decided that we will track children from 3-4 years old to 15 years old. The assumption is that we would support and intervene if required. Allow me to get a little academic. Humans contract
various illnesses, but we must account for their “encounters with risk factors.” There is also a predisposition
for a “risk factor” from the beginning. In this study, the primary risk factor is the disaster itself. However,the problems of family conflict after the earthquake, community collapse, or economic diffiProspective study on pathogenesis andculties may also be risk factors. For example, if
recovery mechanisms
your mother developed depression or anxiety
disorders, you might have some developmental
problems when you were a child. Some people
Recovery/
Pathology
Risk factor
Relapse/onset/avoidancedevelop some pathology; others do not. What is
encounter
Impairment
the difference other than the risk factors between
those who develop pathology and those who donot? By analyzing that, we can understand the<Exploration of pathoge<Exploration of recovery
mechanism of how pathology is born. Some peonetic mechanisms>
mechanisms>
ple who have had a single illness recover, relapse, or become severe, but if you follow thesepeople, what kind of viewpoint and what kind of mechanism cures them, or turns the condition to serious?
Tracking a specific person longitudinally along the time axis reveals quite a lot.
About Evaluative Scales
I will explain the technical terms. First is the evaluation scale for children, the "cognitive development
index." This index has an average of 10 or 100. The cognitive development index is also called a psychological test, or an intelligence test. This was conducted on a full scale once every two years.
Next is the Child Behavior Checklist (CBCL). This is a survey of children's behavioral and emotional issues
that is used around the world. It evaluates the child's hyperactivity, impulsivity, tantrums, and frequentcrying. "SDQ" evaluates a child's strengths and difficulties. For example, the items "I'm getting along with
my friends," and "I fight with my friends" evaluate the child's social strengths and weaknesses.
I use many other things, but these three are the evaluation scales for children that I will talk about today.
Next is the evaluation of parents’ mental health. "MINI" is a simple structured interview method for mental
illness, in which a psychiatrist or psychiatrist interviews parents one-on-one to evaluate the presence orabsence of mental problems. These scales are used worldwide.
Our questionnaire uses the following evaluation scales:• "WHOQOL26": A test created by the WHO World Health Organization to measure quality of life
(QOL) that includes questions about the factors that determine satisfaction, stability, and well-being.
• "K6": Evaluates anxiety and depression• "BDI": Evaluates depressive tendency• "IES-R": Evaluates trauma and stress
Analysis Results of 2016 Baseline Survey
Regarding cognitive development, we performed two test items from the WPPSI test that measures
overall intelligence and three test items from the test called K-ABC. Ten is the average, but the results
showed that all the items were about 8.5 on average, therefore I was concerned that development might bea little late overall. Next, was the "CBCL," that is, the child behavior checklist with results in the boundary
area = "I'm a little worried" and the clinical area = "If possible, it is better to see a specialist." The proportionof children was about 30% when the three prefectures were combined. The national average rarely exceeds
10%, so we found that the percentage of children with behavioral and emotional problems was above average.

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FY 2019 Bulletin, Vol. 8
According to the "SDQ," children's strength anddifficulty questionnaire, the total of the three prefectures showed that 10% to 15% of children required support.

Child Cognitive Development (2016)
Iwate

Miyagi

Fukushima

Picture completion
Building block pattern
Counting out loudAnalysis Results of 2016 Baseline Survey (Parents)
The evaluation was made in five aspects: physical areas, psychological areas, social areas, environmental
areas, and overall quality of life. All areas were poor.
The "QOL26," is often used in Japan, therefore the average value of the Japanese population is available.
What was the difference between the average Japaneseperson and the mental health of parents in these disasterareas? We carried out these comparisons. However, asa result of implementing the measure in 2017 and 2018,
this will improve. I will talk about it later.
When "K6" was used to evaluate overall anxiety, and"BDI" was used to assess depression, the percentage of
those worried was 35%. Additionally, according to thetrauma stress evaluation scale called "IES-R," it was
found that about 14% of people are suffering fromtrauma or stress caused by trauma, even though it has
been several years since the earthquake.
As you can see, 35% were in a tense situation, but noneof them sought help from a specialized hospital. Perhaps they thought: "There are others that have it
worse," or "I can’t allow myself to get stuck in a hospital."
Analysis Results of 2016 Baseline Survey (Association between Child and Parent Results)
According to CBCL results, about 30% of children
were in the borderline/clinical area. Moreover, about
30% of parents had mental health problems.

Word order
Picture vo- Hand movement
Standard score
cabulary
Correct answers
Tests
Developmental age

Many test results show a delay of about 1 standard deviation
Developmental delay of six months to several months in age
Significant delays in building blocks and word arrangement
A similar tendency was confirmed in the picture vocabulary test

Parental mental health(Some mental problem)
Mini-International Neuropsychiatric Interview, Structured Interview (M.I.N.I. 6.0)

Iwate

Fukushima 3-prefecture
total

MiyagiNot applicable
Applicable

On average, the percentage of parents with some kind of mental illness (mental problem) in the threeprefectures is about 35%, and there is no significant difference between the three prefectures.
There were many alcohol dependence and signs of depression.

Mental health of parents in 3 prefectures (2016)
Use WHO-QOL26 to assess the mental health of parents in the disaster area.
Compared to standard value for Japanese general population 20-29
years old (QOL 3.52 ± 0.46, body 3.54 ± 0.57, psychology 3.53 ±
0.63, society 3.54 ± 0.71, environment 3.48 ± 0.53)
The test is a one-sample t-test
WHO-QOL26 is capable of such comparisons2016 Survey

Psychological areas

Overall• Association with Child Verbal Ability
Social areas
Using 2016 data, we answered the following question:"Is there any relationship between the vocabulary ofPhysical areas
children and the mental health of parents?” In the 2016
Environment
parental structured interview "MINI," 79 people werein the clinical area, and 143 people in the normal area.
There was a significant difference between these twogroups when we examined the vocabulary of the children in the clinical range and those in the normal range.
The causal relationship present here remains unknown. We do not know if there was a problem with thechildren because of their mothers’ mental health problem or if there was a problem with the mothers’ mental
health because the children experienced difficulties. The cause and effect direction is unknown, but it isclear that the two are related.
• Association with Child Behavioral and Emotional Issues
Now let us discuss the mother's mental health and the behavioral and emotional issues of the child. The
mother's "K6" results were analyzed separately for children in the normal range and those of the mother in--136 -

FY 2019 Bulletin, Vol. 8
the clinical range. The results showed that mothers in the clinical range were more likely to have children
with behavioral and emotional problems. The causal relationship here is also unknown. We must take acareful look to determine causality and correlation. Correlation does not equal causation.
• Association with Child Cognitive Development
For each "K6," "BDI," and "IES-R," we analyzed the relationship between mothers in the normal range andmothers in the clinical range and their children's cognitive development. There was no difference in cognitive development.
Analysis results of 2018 Second Follow-Up Survey (Association between Child and Parent Results)
As a result of dividing the results of "K6" and "BDI" into mothers in the normal range and mothers in theclinical range, and analyzing the relationship with the child's cognitive development, no difference wasfound.
From 2016 to 2018, we can see that the traumatic problem seen in "IES-R" affects children's cognitive
development.
Relationship between Child Problems and Parental Mental Health
We tried to determine whether or not child issues affected parental mental health. All of our results indicatedthat a relationship does exist. The result was that as the score for children's problems increased from normal
to borderline to clinical, so did the mother's anxiety score. It's a clean pathological reaction. This is the samefor both depression and traumatic stress. This kind of thing doesn't happen very often. This appears to showthat the children’s problems have something to do with the parents' mental health. However, it is difficult
to say that parents' problems influence the cognitive development of children.
Summary
The cognitive development test results increased from 87 to 93.3 when comparing the first year and thesecond year. Since it is a composite score, there are some variations.
Furthermore, when comparing the first year and the third year, the vocabulary score exceeded 10 points inthe third year. In other words, 10 is the average, so we are catching up with the average. In addition tovocabulary development, many other evaluative items for children in difficult situations have improved
significantly since the earthquake. I am looking forward to the results of the full-scale cognitive development test next year.
Consideration
In both the 2016 and 2018 surveys, maternal psychological indicators did not directly predict child cognitive
development.
On the other hand, behavioral and emotional problems of children directly affect the psychological indicators of mothers. I don't know the causal relationship between them, but it can be said that they are related
to each other. A pathological reaction relationship was observed. Significant improvements have been confirmed in the cognitive development of children. This is a fact that I would like many people to know. It isimperative to continue this work in the future. It is difficult to carry out such large-scale research with sucha small number of people, therefore we hope that at least some of you will become interested in cooperatingwith us or understanding our research. Thank you for your attention.
(This report has been summarized and edited based on the recordings recorded on the day of the symposium.
Editing: Yagi, Tamayama)--137 -

FY 2019 Bulletin, Vol. 8

Question and Answer Period
Fukuchi: Here, I would like to set aside time for questions regarding Professor Yagi and Professor
Matsuura's presentations. If you have any questions, please raise your hand, and the staff will bring the
microphone to you. First, please tell us your affiliation and the content of your question. Any takers?
Q1: I am working at a hospital in Kesennuma City. I would like to ask about two points. When you discussed the second and third years of the first survey, it was first mentioned that a dropout group appeared.
What were the characteristics of the members of the dropout group? I was a little worried about that, andI wonder if there is a possibility that those who have difficulty dropped out. The other point is probably
something that will be clarified in future research, but what are the possible causes of children's recovery? I would like to know.
Matsuura: Regarding the first one, I would like to ask Dr. Yagi, the team leader.
Yagi: Yes, thank you. Regarding the parents and children who dropped out, as Dr. Matsuura said, there aresome cases where more concerning children left the program. However, not all dropped-out parents andchildren were high-risk; for example, some moved, or had family situations that got in the way, such as
divorce. There were various situations, and some said that it would be a little difficult or troublesome toparticipate in the survey, and would therefore refrain from doing so. Also, as Dr. Matsuura mentioned,
some people might have grown distant because the results (of the baseline survey) were not so good.
However, we do know that, for example, the result did not improve (i.e., average scores did not increase)because all the high-risk children were eliminated. Parents and children of various levels left the programfor various reasons.
Matsuura: Regarding the second problem, there are specific improvements in various indicators. However,rather than stating that these children “grew,” my current feeling is that the situation calmed down alittle, and the power that these children already possessed came to the fore. In other words, these children
did not initially have low ability or capability. Instead, the performance we see now is the potential they
had originally, which was cultivated. By the way, thank you for your question. It reminded me to divide
the results into two groups, those who improved and those who didn’t, and to analyze it correctly. Maybe
this will reveal some factors.
Q2: I am from Iwanuma City Hall. Some children from Iwanuma participated in this study, and when I
heard about it, I was extremely grateful for the support you provided them. I was very impressed by thefact that rather than merely leaving the children that were found to be of concern as is, you all made aneffort to refer them to necessary support organizations. While listening to your talk just now, I thoughtthat maybe these children improved because of their support. I would like to ask about the factors. However, you did mention that you are still analyzing them, and I am very much looking forward to thoseresults. Thank you.
Yagi: A little supplement. Earlier, when Professor Matsuura talked about the data, there was a question,"Were maternal or teacher evaluations stricter?" We did not present any detailed data on that point today,
but when evaluating behavioral issues, it's clear that nursery teachers and schoolteachers are harsher.
But when you think about it, relationships between children and mothers are generally one-to-one or
one-to-two. On the other hand, teachers and nursery teachers evaluate children's behavior in a group, so
it is natural that their results will be more severe. In other words, teachers and nursery teachers can moreclearly identify children whose behavioral problems become apparent when they are grouped (even if
they are not as noticeable as problems at home). Previous studies suggest that having children withsignificant behavioral problems may negatively impact the mental health of mothers. I think that the--138 -

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causal relationship will become clear as we proceed with a detailed analysis. Nonetheless, at the very
least, we can state that problems with the mother do not cause problems with the development of thechild, but instead that mothers of children with significant behavioral problems are themselves subject
to specific issues (the psychological burden is heavy). Since the earthquake, this has appeared to be more
prominent, and it is becoming clear that we must provide substantial support to mothers. I think this is
an important point. We weren’t able to mention this today during our presentation, but it is somethingthat we have come to notice in our analyses.
Fukuchi: Thank you to Dr. Yagi and Dr. Matsuura.

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