Post-disaster mental health and psychosocial support in the areas affected by the Great East Japan Earthquake: a qualitative study

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Abstract

Background Few studies exploring the actual practices implemented for long-term mental health and psychosocial support after a natural disaster have been published. This study aimed to reveal (1) the types of activities that were actually provided as mental health and psychosocial support (MHPSS) in the long-term phase after the Great East Japan Earthquake (GEJE) and (2) the problems that must be addressed to provide post-disaster MHPSS activities. Methods An open-ended questionnaire was sent to organizations in the Iwate, Miyagi and Fukushima prefectures that were potentially involved in providing MHPSS to communities affected by the GEJE. The organizations were asked to describe their activities and the problems that needed to be addressed to provide these support activities. The collected statements were analysed using content analysis with NVivo11. Results The support activities conducted to provide MHPSS in the long-term phase after the catastrophe were diverse and classified into 7 major categories, namely, (1) one-on-one support for individuals in need of assistance, (2) support for collective activities, (3) support around living conditions and income, (4) increasing public awareness about mental health, (5) human resource development to improve response capabilities for MHPSS, (6) support for MHPSS providers, and (7) facilitating collaborations among the MHPSS activities provided to affected communities. Problems with human resources and funding were the most frequently mentioned concerns among the organizations participating in the survey. Conclusions The establishment of systems to collect and share sufficient and relevant knowledge and to coordinate organizations for long-term post-disaster postventions would be desirable. Electronic supplementary material The online version of this article (10.1186/s12888-019-2243-z) contains supplementary material, which is available to authorized users.

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Most cited references 23

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Counting codes makes qualitative content analysis a controversial approach to analyzing textual data. Several decades ago, mainstream content analysis rejected qualitative content analysis on the grounds that it was not sufficiently quantitative; today, it is often charged with not being sufficiently qualitative. This article argues that qualitative content analysis is distinctively qualitative in both its approach to coding and its interpretations of counts from codes. Rather than argue over whether to do qualitative content analysis, researchers must make informed decisions about when to use it in analyzing qualitative data.

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How best to plan and provide psychosocial care following disasters remains keenly debated. To develop evidence-informed post-disaster psychosocial management guidelines. A three-round web-based Delphi process was conducted. One hundred and six experts rated the importance of statements generated from existing evidence using a one to nine scale. Participants reassessed their original scores in the light of others' responses in the subsequent rounds. A total of 80 (72%) of 111 statements achieved consensus for inclusion. The statement 'all responses should provide access to pharmacological assessment and management' did not achieve consensus. The final guidelines recommend that every area has a multi-agency psychosocial care planning group, that responses provide general support, access to social, physical and psychological support and that specific mental health interventions are only provided if indicated by a comprehensive assessment. Trauma-focused cognitive-behavioural therapy (CBT) is recommended for acute stress disorder or acute post-traumatic stress disorder, with other treatments with an evidence base for chronic post-traumatic stress disorder being made available if trauma-focused CBT is not tolerated. The Delphi process allowed a consensus to be achieved in an area where there are limitations to the current evidence.

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This study examined the prevalence of posttraumatic stress disorder (PTSD) and depression 14 months after the earthquake in Turkey in 2 randomly selected samples from the epicenter (n = 530) and a suburb of Istanbul 100 km from the epicenter (n = 420). The rates of PTSD and depression comorbid with PTSD were, respectively, 23 and 16% at the epicenter and 14 and 8% in Istanbul. The strongest predictor of traumatic stress symptoms was fear during the earthquake, whereas predictions with female gender, past psychiatric illness, damage to home, participation in rescue work, past trauma, and loss of close ones were significant but weak. Our findings suggest that devastating earthquakes have long-term psychological effects. Psychological interventions reducing fear may improve PTSD in survivors.