Part II

Research reports andother journal articles

Research reports
Wataru Shoji 1), Ikki Ueda 3), Ayami Nagao 1), Mikika Abe 1), Yoko Takahashi1), Atsushi Sakuma 2), Hiroo Matsuoka 3), Kazunori Matsumoto 1)
Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine 1）
Department of Psychiatry, Tohoku University Hospital 2）
Department of Neuropsychiatry, Tohoku University Graduate School of Medicine 3）

The Department of Preventative Psychiatry has conducted ongoing work on support and research activities
that are useful for disaster areas as part of the Tohoku University Department of Psychiatry, which includes the
Department of Neuropsychiatry and the Department of Hospital Psychiatry at the Tohoku University Graduate
School of Medicine. For FY 2015, we have conducted investigations and research activity in collaboration with
the Miyagi Disaster Mental Health Care Center and associated institutions, as reported below.
１．Investigations on the mental health of care workers in disaster areas and research on support
methods（１） Issues and objectives
Individuals with various occupations are involved in the restoration and recovery of regions from largescale disasters. Police officers and firefighters Individuals such as police officers and firefighters, whoprovide support primarily as emergency occupational rescue workers, have been the subject of previous
research that focused on the mental health of working individuals following a disaster, which reported
that illnesses resembling depression or PTSD have lingered in these individuals over a long period.
Meanwhile, care workers engaged in works of public interest (e.g., municipal officials, health careproviders, social services staff members, teachers) serve an important role in long-term support activities
during the post-emergency period (including restoration/recovery periods). Many of these people areresidents of the affected area and are thought to be at high risk of having mental health problems due tobeing continuously exposed to long-term stresses involved in post-disaster support in addition to thestresses of being a victim themselves. However, there has been insufficient research on the mental healthof care workers who are engaged in such duties with the high public interest. With this in mind, we
conducted health surveys for municipal officials, Social Welfare Council (henceforth, SWC) staff
members, and nursing staff members in the area affected by the Great East Japan Earthquake one year
after the event. We are conducting longitudinal studies and research to provide support from the academic
perspective of psychiatry, clarify the actual state of staff member health, and provide useful results forproviding necessary support.
Five years on from the earthquake, problems directly facing local care workers qualitatively shift during
the recovery process, going from assuring the reconstruction and use of recovery-period housing,providing support for socially vulnerable individuals such the disaster-affected elderly and those withmental disorders, building communities in temporary housing; to providing support for regions andindividuals that have been left behind due to disparities in recovery and handling problems between
residents which accompany residence relocation. Furthermore, these individuals gradually must take on
their pre-disaster duties in addition to those that are directly related to the earthquake, which is thought tofurther exacerbate the physical and mental stresses imposed on the care worker. The prolonging of therecovery process is connected to the increased stresses in the care worker, so even more than before, it isimportant to prevent the worsening of mental health in these individuals.With this in mind, the results of－ 105 －

the FY 2015 annual report will show the mental health indicators in each region and report oninvestigations on the causes relating to poor mental health. Through these investigations, we will
determine the optimal policies for protecting the mental health of individuals working on long-term
support activities.
（２） Methods
Subjects were ① municipal officials and ② SWC staff members in the coastal Tohoku regions of thedisaster area. Research on ①focused on several municipal officials in the coastal regions of Miyagi
Prefecture, with a total of 1918 individuals from August – September 2015, and data was extracted from1575 individuals (82.1%). Research on ②focused on several SWC staff members in Miyagi Prefecture,with a total of 719 individuals from October 2014 to March 2015, and data was extracted from 631
individuals (87.8%). Data was analyzed in FY 2015 and results were reported to the SWC in each regionin June 2015.
Self-administered questionnaires were used for the research. Research categories included the nature of thecurrent work, personal damage from the earthquake, current health status, the Kessler Psychological Distress
Scale (K6), evaluations of depression symptoms and severity using the patient health questionnaire (PHQ-9) anda PTSD Check List (PCL) for evaluating PTSD severity.
Arbitrary cooperation was recorded in the questionnaires and results were retrieved after the individual placed
them in a sealed envelope to ensure that privacy from workplace superiors or colleagues. Consultations frompsychiatrists, clinical psychologists, or psychiatric nurses were offered to participants who desired them after thesurvey and we offered these services even when questionnaires were not submitted. This research was conductedwith the approval of the Tohoku University Graduate School of Medicine Ethics Committee.
（３） Results① Research on municipal officials
We researched municipal officials (municipality A, municipality B) in two regions. We compared
the research results of each municipality with the mental health status of regular staff members in
disaster-affected municipalities and support staff sent for fixed periods to post-disaster municipalities
from the earthquake to the restoration/recovery period to shore up their labor shortages (e.g., staff fromother municipal organizations working full-time in the affected municipality, fixed-term employees
who directly work in the affected municipality or who are hired by non-affected municipalities anddispatched there and part-time staff members who are hired by the Reconstruction Ministry).
＜ Results for Municipality A＞
Questionnaires were distributed to 1494 officials in Municipality A, with 1154 responses received(77.2% retrieval rate). Subjects were 46.3% male and 53.7% female, with an average age of 44.3 years.
85.9% comprised regular staff members and 14.1% comprised support staff. Investigations in FY 2015
utilizing K6, which is a general indicator of mental health conditions, showed that the percentage ofstaff with stresses above a total score of 13 was 8.5% among regular staff and 3.1% among support
staff, with a total percentage of 7.8%. Those with a total PHQ-9 score of above 10, which indicateshigh depression risk, was 15.9% for regular staff and 3.7% for support staff, with a total percentage of
14.1%. The percentage of staff with a total PCL score of over 44, which indicates high PTSD risk, was
5.0% for regular staff and 0% for support staff, with a total percentage of 4.3%. Across all evaluation
metrics, regular staff had poorer mental health than support staff.
Next, we conducted logistical regression analyses with high K6, PHQ-9, and PCL risk as to theobjective variables; and characteristics related to family, the extent of damage, and work, as the
explanatory variables; to analyze the causes that influence mental health in regular staff members. We
did not conduct analyses on support staff because there were few high-risk individuals for each
symptom. Cases, where the odds ratio (OR) was above one, indicate high risk which can exacerbate－ 106 －

symptoms, and cases, where OR is less than one, indicates causes that alleviate symptoms.
Risk factors that exacerbated symptoms for mental problems measured by K6 included “I have
had poor mental health that has been treated since before the earthquake” (OR = 2.77), “I havereceived criticism from residents, and I am struggling mentally” (OR = 2.38) and “I have a family
member that requires care” (OR = 1.66). On the other hand, categories that reduced the risk of
exacerbating symptoms included “the individuals residing in the region trust one another” (OR =0.45) and “I have support from parents, families, and friends” (OR = 0.38).
The highest risk factor for depression symptoms measured by PHQ-9 was “I have received
criticism from a work associate and I am struggling mentally” (OR = 4.08), with other risk factors
including “I have had poor mental health that has been treated since before the earthquake” (OR =2.77), “I have a family member that requires care” (OR = 2.69) and “I felt like my life was in danger
due to the earthquake, tsunami, and evacuations” (OR = 1.55). Categories that reduced the risk of
exacerbating symptoms included “employment following the disaster” (OR = 0.40), “I have support
from parents, families, and friends” (OR = 0.56), and “the individuals residing in the region trust one
another” (OR = 0.59).
The highest risk factor for PTSD symptoms measured by PCL was “family members died or are
missing” (OR = 4.37), followed by “I have received criticism from residents and I am struggling
mentally” (OR = 3.12) and “I have a family member that requires care” (OR = 2.58), whereas
categories that reduced the risk of exacerbating symptoms included “I have support from parents,
family and friends” (OR = 0.36).
＜ Results for Municipality B＞
Questionnaires were distributed out to 424 officials from Municipality B, with 421 responses
received (99.3% retrieval rate). Subjects were 62.0% male and 38.0% female, with 67.9% comprising
regular staff members and 32.1% comprising support staff and the average age was 44.8 years.
Investigations in FY 2015 with K6, which is a general indicator for a subject’s mental healthcondition, showed that the percentage of staff with stresses above a total score of 13 was 8.2% among
regular staff and 3.7% among support staff, with a total percentage of 6.7%. When all staff members
are evaluated, this is virtually the same level as that of citizens in Miyagi Prefecture according to the2010 census (average level of 6%). However, it cannot be said that the mental health of regular staff
has recovered to that of pre-disaster levels. Those with a total PHQ score of above 10, which indicateshigh depression risk, was 14.5% for regular staff and 3.8% for support staff, with a total percentageof 11.1%. Additionally, the percentage of staff with a PCL score of over 44, which indicates high
PTSD risk, was 5.5% for regular staff and 0.8% for support staff, with a total percentage of 4.0%.
Across all evaluation metrics, regular staff had poorer mental health than support staff.
Next, we conducted χ2tests on the relationships between high risk of K6, PHQ-9, and PCL andcharacteristics related to family, the extent of damage, and work to determine the causes that
influence the mental health of regular staff members. We did not conduct analyses on support staff
members since there were few high-risk individuals for each symptom.
Risk factors that exacerbated symptoms for mental problems measured by K6 included “regional
residents do not trust one another”, “I have no support from my spouse, family, or friends”, “I feelguilt over my words or actions during the earthquake”, “I have received criticism from residents,
and I am struggling mentally” and “I have received criticism from a work associate, and I am
struggling mentally”.
Risk factors that exacerbated symptoms for depression measured by PHQ-9 included “regional
residents do not trust one another”, “I have no support from my spouse, family, or friends”, “I havephysical illnesses since before the earthquake that is still in the process of treatment”, “I have a family
member that requires care”, “I had to relocate due to the earthquake”, “I felt like my life was indanger due to the earthquake, tsunami, and evacuations”, “I feel guilt over my words or actions
during the earthquake”, “I am busy with work and I have not been able to rest enough”, “I have been
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employed since before the earthquake”, “I have received criticism from residents, and I am struggling
mentally and “I have received criticism from a work associate and I am struggling mentally”.
Risk factors that exacerbated symptoms for PTSD measured by PCL included “I live alone”,“regional residents do not trust one another”, “I have no support from my spouse, family, or friends”,“I have physical illnesses since before the earthquake that are still in the process of treatment”,“family members died or are missing”, “I felt like my life was in danger due to the earthquake,tsunami, and evacuations”, “I feel guilt over my words or actions during the earthquake”, “I am busy
with work and I have not been able to rest enough”, “I have been employed since before theearthquake”, “I have received criticism from residents and I am struggling mentally” and “I havereceived criticism from a work associate, and I am struggling mentally”.
② Research on SWC staff members
SWC staff members were 26.3% male and 72.9% female (0.8% unknown), with an average age of
48.0 years. According to the FY 2014 research, 8.7%, 14.9%, and 3.7% were high-risk individuals
according to K6, PHQ-9, and PCL, respectively.
Next, we conducted longitudinal studies to determine the factors associated with high-risk
individuals according to K6, PHQ-9, and PCL. Logistical regression analyses were conducted, with ahigh risk of K6, PHQ-9 and PCL set as target variables; and the categories of “basic attributes (age,gender, occupation)”, “individual factors (single households, pre-disaster illness / mental illness
treatment history)”, “factors influenced by the earthquake (container type temporary housing, decreased
or missing persons within the family, life-or-death experiences, guilt over actions taken at the time ofthe disaster)” and “workplace factors (criticism from residents, excessive work on earthquake-related
activities, increases in earthquake-related work, no leave taken, lack of communication in theworkplace)” set as the explanatory variables.
“Lack of sufficient rest” was the highest OR for individuals with a K6 score above 13 and is awareof his or her high level of stress and were 6.7 times higher than those who had sufficient amounts ofrest. Next, individuals who felt “guilt over the actions they took during the earthquake” and “had a hardtime due to criticism from residents” were approximately 3.2 and 2.6 times, respectively, more likely
to be at risk of high levels of stress than those who did not. “Lack of sufficient rest” was the highest
OR for individuals with a PHQ-9 score above 10 and is at risk of depressive symptoms and were 5.1
times higher than those who had sufficient amounts of rest. Next, individuals who “had a history ofmental health treatment since before the earthquake”, who felt “guilty over the actions they took during
the earthquake” and who “received criticism from residents and had a hard time” were approximately
2.8, 2.7, and 1.9 times, respectively, more likely to be at risk of high levels of depression than those
who did not.
“A history of mental illness treatment since before the earthquake” was the highest OR for
individuals with PTSD symptoms that have a PCL score above 44 and were 7.9 times higher than those
who did not have such a history. Other than this, individuals who felt “guilt over the actions they took
during the earthquake”, who “thought they might die in the earthquake”, who “did not have rest”, andwho “received criticism from residents and are struggling mentally” were approximately 5.9, 5.5, 4.1
and 3.5 times, respectively, more likely to be at high risk for PTSD symptoms.
From the above results, the three factors of “guilt over the actions they took during the earthquake”,“receiving criticism from residents and struggling mentally” and “insufficient rest” were thought to be
negative influences on mental health 44 months following the earthquake. Additionally, the factor of“having a treatment history of mental health since before the earthquake” is thought to greatly influence
depression and PTSD symptoms.

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（４） Discussion① Research on municipal officials
The percentage of individuals in Miyagi Prefecture with a K6 score of higher than 13 points in the2010 census was approximately 6% on average and support staff members in both Municipalities A
and B have averages that are lower than this, whereas regular staff members have percentages above
this. Over time, the percentage of individuals with high stress has decreased, but we can see that there
are many individuals among regular staff members who have continued to work in disaster activities
immediately after the earthquake for long periods who are conscious of their high-stress levels.
The higher levels of chronic stress among regular staff members, as they worked for long periods oftime since immediately after the disaster, is thought to have been a reason for why poor mental healthamong regular staff members is prominent relative to that of support staff members. It is also thoughtthat there are individuals who have received significant damage as residents in a disaster area.
Furthermore, the prolonged duration of the disaster recovery activities may be concentrating larger
stresses on regular staff members.
Analysis of causes relating to the high risk of mental health showed that criticism from residents orwork associates has significant effects on mental health among regular staff members in both
Municipality A and B. Additionally, a history of physical illness treatment or mental illness since before
the earthquake was related to poor mental health. Meanwhile, the fact that residents trust one anotherand that individuals have support from their spouse, family, or friends, have the potential to prevent theexacerbation of mental health. These results correspond with those relating to post-earthquake mental
health1-2) and this highlights that the effects of the disaster still have a large role in mental symptoms,
even four years after the earthquake. It is thought that countermeasures at the workplace level, such as
initiatives to support staff members receiving criticism at work or to support individuals going throughvarious difficulties using workplace teams, to ensure that staff members who are having difficulty due
to criticism do not become isolated.
② Research on SWC staff members
Longitudinal comparisons of prior research results (FY 2012, FY 2013) and current results showedthat the percentages of high-risk individuals as determined by K6 score shifted sideways from 8.4% 
7.9%  8.7% and has been changing at a percentage higher than pre-disaster standards (percentagesin Miyagi Prefecture in the 2010 census was approximately 6%). Additionally, percentages of high-risk
individuals as determined by PHQ tended to increase from 13.1%  13.7%  14.9%. No majorchanges were observed in high-risk individuals as determined by PCL, with shifts from 4.1%  4.1%
 3.7%.
Many staff members who conduct ongoing work alongside victims maintain their mental health whileworking, but it was clear that the higher-than-normal percentage of individuals who continue to provide
support while suffering from some form of poor mental health has continued at a fixed level even four
years after the earthquake. Under normal conditions, mental health indicators should be gradually
improving with time since the disaster, but the mental health situation these past few years has notshown significant change since the time of prior research and it may be the case that improvements
have already reached their zenith. Staff members are in the position of conducting ongoing work withthe most vulnerable victims and the prolonged aspects and difficulties of providing support for these
individuals may be connected to chronically high levels of stress.
Analysis on causes that influence mental health 44 months after the disaster showed that the categories of“guilt over the actions they took during the earthquake”, “receiving criticism from residents and struggling
mentally” and “insufficient rest” were thought to be risk factors that exacerbate a wide range of mental
health aspects. In particular, insufficient rest was correlated to various symptoms, so it is thought that various
initiatives that target the improvement of the overall workplace environment, such as ongoing humanresource support in disaster areas, improvements in workplace communication and the maintenance of easyto-rest workplace environments, are necessary to reduce the risk factors that emerge following a disaster.
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２． Research on psychological support methods in a disaster area
（１） Research on the feasibility of skills for psychological recovery (SPR) for Japanese victims during
disaster recovery periods＜ Issues and objectives ＞
SPR was developed by the US National Center for PTSD and the US National Child Traumatic Stress
Network as a psychological support method that can be widely applied to various mental problems
experienced by victims during disaster restoration and recovery periods. It is a new psychologicalsupport method that was published in 2010 and a Japanese version was created in June 2011 by the
Mental health care center research group in Hyogo prefecture. SPR, which is a support program
specialized for recovery and restoration periods of disasters, has been used in several international
disasters to date but has not been seriously implemented in Japan.
After the Great East Japan Earthquake, we have conducted workshops and created DVDs to raise thepublic awareness of skills for SPR for specialists in the disaster areas of Miyagi prefecture. It is thoughtthat these resulted in the higher demand for SPR among specialists working to support residents inaffected regions and the public awareness of knowledge and skills relating to SPR. Meanwhile, thefeasibility of SPR in disaster areas must first be confirmed for this program to be applied in our country.
With this in mind, in the present research, we collaborated with municipalities in the disaster area toapply SPR to actual victims and conducted intervention research on the application of SPR in Japan.
Below, we report on the intervention research results regarding the feasibility of SPR in Japan.
＜ Methods ＞
A． participants and recruitment
Subjects included individuals who reside or work in Miyagi Prefecture above the age of
18 and those who have poor mental health are receiving treatment from mental medical
institutions or who have serious mental symptoms, were excluded. Additionally, subjects
included those whose native language was Japanese, who understood the purpose and content
of the present research, and had provided the necessary research participation approval inwriting. We exchanged memorandums with affected municipalities and recruited program
participants and sent out flyers in public facilities where flyers were permitted and in nonprofit organization offices to call for participation.
B．SPR practitioners (interveners)
All mental health care staff who provided support (nurses, public health nurses,
psychologists, doctors, etc.) all received training for becoming SPR trainers at the mental
health care center in the Hyogo Prefecture and conducted SPR with the same trainers under
the supervision (SV) of psychiatrists at the Tohoku University Hospital Department of
Psychiatry.
C． Duration and frequency of intervention
Research objectives were explained to participants who met the selection criteria, and a
pre-intervention assessment was conducted following the receipt of written consent.
Interveners conducted visit-based interviews (60 minutes per session) with participants at afrequency of once every one to two weeks, with a maximum of 8 sessions conducted. A postintervention evaluation as well as a follow-up evaluation two months later were conducted
after the end of the intervention.
D． Content of evaluation－ 110 －

The total score of the general health questionnaire (GHQ-30) was selected as the primary
endpoint. QOL (8-item short-form health survey (SF-8)), PTSD symptoms (The impact of
event scale-revised (IES-R)), resilience (Tachikawa resilience scale (TRS)), self-efficacy (SE),and program satisfaction (program satisfaction questionnaire (CSQ-8)) were chosen as thesecondary endpoints. We also conducted qualitative research on the opinions of the programand each skill as well as their subsequent applications.

＜ Results ＞

We started recruiting participants in July 2013. We received a total of 34 applicants byMarch 2016. Of these, seven individuals were excluded, seven canceled before interventions,one postponed, and one individual was before research explanations and intake, so we started
interventions on the remaining 18 individuals. Of these, five individuals were pre-intervention
cases, and 13 were intervention cases after the start of research.
Of the 13 individuals who started intervention, 12 had completed their sessions at present,of these, 10 had completed their follow-up sessions. When we analyzed the pre- and postintervention evaluations as a preliminary analysis, we observed that the primary endpoint of
GHQ score had all decreased during post-intervention relative to pre-intervention. We plan to
conduct detailed analyses once we reach the target number of subjects but we expect to see acertain effect in our results.
＜ Discussion ＞
The present research has not yet reached its target number of subjects. For this reason, we
are not yet at the stage where we can test program feasibility. However, no adverse eventswere observed in the 18 subjects who have started interventions and preliminary analysis
showed that GHQ scores have decreased when post-intervention levels are compared with preintervention levels. At the current stage, this indicates that SPR may be a safe and effective
program for use in Japan.
In the future, we plan to increase the number of subjects, and once we reach this target,
analyze changes in each endpoint and test program feasibility.
（２） Research on raising public awareness around cognitive behavioral therapy and on mental exercise training
for the general public and care workers in disaster areas affected by the Great East Japan Earthquake＜ Issues and objectives ＞
Massive amounts of damage were inflicted on the coastal areas of Miyagi Prefecture as aresult of the Great East Japan Earthquake and victims have experienced heavy physical andmental pressure as a result. For these reasons, victims require long-term mental health care atan annual timescale. Previous research has indicated that subsyndromal mental illnesses that
do not reach the extent of mental illness increases in addition to mental illnesses such as PTSD
and depression among residents in areas affected by a large-scale disaster.
Cognitive-behavioral therapy is a psychological therapy that promotes self-control skills
by addressing both cognition and behavior and seeks to improve or resolve the challenges ofvarious social problems. Cognitive-behavioral therapy has been applied to various mental
illnesses such as depression and anxiety disorders and its effectiveness has been demonstrated.
Additionally, cognitive behavioral therapy is not only a treatment method for mental illness
but also for subsyndromal mental illnesses that do not reach the level of mental illness and has
been reported to affect mental illness prevention. As such, it is widely used in fields other thanhealth care. However, relative to that in other developed countries, the current status in Japanis such that there is not much public awareness of cognitive-behavioral therapy.
－ 111 －Given this environment, the National Center for Cognitive Behavioral Therapy andResearch and the National Center of Neurology and Psychiatry has hosted “mental exercise
workshops” since FY 2012 (now ended) to raise public awareness on basic concepts and skillsof cognitive-behavioral therapy. This program was developed by the two centers to learn thebasic concepts and skills of cognitive-behavioral therapy, by mixing exercises with experienceand to apply stress management in day-to-day activities.
It is thought that the role of raising public awareness of basic concepts and skills in
cognitive behavioral therapy plays a large role in the prevention of mental problems following
a large-scale disaster. With this in mind, the present research conducted workshops on stresscare for daily life activities for general residents and care workers in disaster areas, focusing
on basic concepts and skills in cognitive behavioral therapy from a primary prevention
standpoint and tested the effectiveness and feasibility of the training programs designed forthe general public. Our objective was to raise public awareness of future cognitive behavioral
therapy and to clarify the possibilities and challenges surrounding public awareness.
＜ Pilot study ＞
Until now, we have conducted a “mental exercise workshop” program for general
residents in disaster areas once a week for a total of six times as a pilot study and conductedfive courses in the disaster area. There was a total of 180 participants (19 males, 161 females,
the average age of 45.7± 14.4 years), of which 98 were from the general public.
Research approval was obtained; we posed questions to 46 members of the general public
who attended more than 5 sessions (2 males, 44 females, the average age of 47.8± 13.7) tomeasure self-efficacy, comprehension of the workshops, and attendance rate, and we analyzed
changes before and after the workshops.
Results showed that self-efficacy (score range: 23-115 points, average score: 77.9 ± 13.9
points for men, 75.3 ± 13.4 points for women) significantly increased from 69.2 before theworkshops to 73.4 afterward (Z = 2.73, p < 0.01). Additionally, four out of the seven criteriaof the workshop comprehension scores showed significant increases when pre- and postintervention scores were analyzed with the Wilcoxon signed-rank sum test (“I am aware of mythinking tendencies”, (Z = -3.43, p < 0.01); “I am aware of what thought processes contributeto depression or anxiety”, (Z = -2.08, p = 0.04); “I noticed that I am always making myself
suffer, and I was able to switch my thought process”, (Z = -2.95, p < 0.01); “I carefully examine
how the situation changed once I implemented solutions”, (Z = -2.05, p = 0.04)). Additionally,questionnaires that asked for opinions on the workshop were all favorable, with many saying
they found the overall learning process enjoyable.
＜ Revision of the training program ＞
We reduced the number of mental exercise workshops from 6 to 4 as a result of the pilot
study, changing it to a format where we present content in a weekly 90-minute session over 4
weeks. We sought to increase the research participation rate by decreasing the number of
events. Additionally, we assigned homework for each session so that workshop participants
could learn experientially. The program content was changed to focus on cognitive behavioral
therapy and assertion.

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＜ Methods ＞
Ａ． Study design
The study is a randomized controlled trial (RCT). Subjects were randomly divided into
an intervention group where they received the training beforehand and a control group who is
on standby during this period and received the training over time. The intervention groupconducted four rounds of the training program and we conducted post-intervention evaluations
at the final program round. We conducted evaluations with the control group at the same time
as well and the group subsequently conducted the same training program.
Ｂ． Participants and recruitment
Subjects included those over the age of 18 and under the age of 79 who were victims of
the Great East Japan Earthquake in Miyagi Prefecture and who wished to participate in theseworkshops, understood the research objectives, and provided consent for research participation.
We excluded individuals who were visiting psychiatric medical institutions, whose treatment
was suspended, and who have serious untreated mental symptoms. We recruited research
participants by distributing flyers and publishing articles in newspapers and public relations
magazines.
Ｃ． Training program content
The revised program mentioned above was used.
Ｄ． Evaluation content
The generalized self-efficacy scale (SES) total score was used as the primary endpoint. High selfefficacy is thought to have preventative effects on mental illness following a disaster, and previous
research has shown that this can be improved with a cognitive-behavioral approach. The program
was conducted and this workshop program would be considered effective if significant
improvements in SES score were observed between pre- and post-intervention.
The total scores of K6, which measures general psychological stress; the GHQ mental healthquestionnaire (GHQ-30), which measures stress-related symptoms; and the automatic thoughts
questionnaire-revised (ATQ-R), which measured negative and positive automatic thoughts, wereused as the secondary endpoints.
＜ Results ＞
Programs have been implemented a total of three times: Ishinomaki City from January – March
2015; and Sendai City in June – August 2015, and January – March 2016. There were a total of 86
participants (14 men, 72 women, the average age of 52.5 ± 13.2 years) with a total of 61 researchsubjects (9 men, 52 women, the average age of 52.7 ± 12.7 years). Of these, there were 31 individuals
in the intervention group (5 men, 26 women, the average age of 52.9 ± 11.9 years) and 30 were in
the control group (4 men, 26 women, the average age of 52.5 ± 13.4 years). The average participation
rate in the intervention group was 3.58 times (± 0.67), and the percentage of individuals who attended
at least 3 meetings was 90.3%.
There were a total of 27 individuals in the intervention group who participated in at least 3
sessions and who responded to both pre- and post-intervention questionnaires and there were also 27
individuals in the control group who responded to both pre- and post-intervention questionnaires aswell. Analysis of their basic attributes showed no significant differences in attribute data (age, gender,
education, profession, household size, relocation due to earthquakes, deceased or missing persons
within the family, life-or-death situations) between the two groups, which indicated that the
randomization between the two groups was effective.
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Provisional analyses did not show significant differences in the primary endpoint of generalized
self-efficacy between the two groups but significant improvements in the secondary endpoint of thepositive automatic thoughts in the automatic thoughts list in the intervention group. Since the present
program was changed from 6 sessions in the pilot study to 4 sessions, a certain period was required
for skills to be learned and retained and it was possible that this did not sufficiently improvegeneralized self-efficacy, which is a measure of self-trust. Meanwhile, positive automatic thoughts
are thought to have increased by creating program content that focuses on cognitive behavioral
therapy.
In the future, we intended to analyze the obtained data in detail and report on program
effectiveness and feasibility.
References
１） Asukai, N. Chapter 1: Disasters and mental health – Section 4: Epidemiology – prevalence, risk factors,
defense factors (supervised by Sakai, A., Niwa, S., Matsuoka, H.; edited by Otsuka, K., Kato, H., Kin, Y.,
Matsumoto, K. Mental health in disaster situations), Igaku-Shoin, 2016, pg. 15-20.
２） Kuwahara, Y., Takahashi, S., Matsui, Y. Post-traumatic stress responses in local government officials affectedby the Great East Japan Earth quake , Traumatic stress ，13（2），2015，59-67．

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