Skip to main content Accessibility help
×
Home

Trauma Signature Analysis of the Great East Japan Disaster: Guidance for Psychological Consequences

  • James M. Shultz (a1), David Forbes (a2), David Wald (a3), Fiona Kelly (a4), Helena M. Solo-Gabriele (a5), Alexa Rosen (a1), Zelde Espinel (a1), Andrew McLean (a6), Oscar Bernal (a7) and Yuval Neria (a8)...

Abstract

Objectives

On March 11, 2011, Japan experienced the largest earthquake in its history. The undersea earthquake launched a tsunami that inundated much of Japan's eastern coastline and damaged nuclear power plants, precipitating multiple reactor meltdowns. We examined open-source disaster situation reports, news accounts, and disaster-monitoring websites to gather event-specific data to conduct a trauma signature analysis of the event.

Methods

The trauma signature analysis included a review of disaster situation reports; the construction of a hazard profile for the earthquake, tsunami, and radiation threats; enumeration of disaster stressors by disaster phase; identification of salient evidence-based psychological risk factors; summation of the trauma signature based on exposure to hazards, loss, and change; and review of the mental health and psychosocial support responses in relation to the analysis.

Results

Exposure to this triple-hazard event resulted in extensive damage, significant loss of life, and massive population displacement. Many citizens were exposed to multiple hazards. The extremity of these exposures was partially mitigated by Japan's timely, expert-coordinated, and unified activation of an evidence-based mental health response.

Conclusions

The eastern Japan disaster was notable for its unique constellation of compounding exposures. Examination of the trauma signature of this event provided insights and guidance regarding optimal mental health and psychosocial responses. Japan orchestrated a model response that reinforced community resilience. (Disaster Med Public Health Preparedness. 2013;0:1-14)

Copyright

Corresponding author

Address correspondence and reprint requests to James M. Shultz, MS, PhD, Center for Disaster and Extreme Event Preparedness (DEEP Center), University of Miami Miller School of Medicine, 251 174 St, #2319, Sunny Isles Beach FL 33160 (e-mail: jshultz1@med.miami.edu).

References

Hide All
1. Office for the Coordination of Humanitarian Assistance. Japan Earthquake and Tsunami, Situation Report 1; March 11, 2011. http://reliefweb.int/node/391666. Accessed February 20, 2012.
2. Center for Excellence in Disaster Management and Humanitarian Assistance. Japan earthquake and tsunami update, Monday, March 12, 2011. http://reliefweb.int/node/391694. Accessed February 20, 2012.
3.Keim, M. The public health impact of industrial disasters. Am J Disaster Med. 2011;6(5):265-274.
4.Boyarsky, I, Shneiderman, A. Natural and hybrid disasters—Causes, effects and management. Top Emerg Med. 2002;24(3):1-25.
5.Shultz, JM, Marcelin, LH, Madanes, SB, Espinel, Z, Neria, Y. The “trauma signature:” understanding the psychological consequences of the 2010 Haiti earthquake. Prehosp Disaster Med. 2011;26(5):353-366.
6.Shultz, JM, Kelly, F, Forbes, D, etal. Triple threat trauma: evidence-based mental health response for the 2011 Japan disaster. Prehosp Disaster Med. 2011;26(3):141-145.
7.Shultz, JM, McLean, A, Herberman Mash, HB, etal. Mitigating flood exposure: reducing disaster risk and trauma signature. Disaster Health. 2012;1(1):1-15.
8.Norris, FH, Friedman, MJ, Watson, PJ, Byrne, CM, Diaz, E, Kaniasty K: 60,000 disaster victims speak: part I. an empirical review of the empirical literature, 1981-2001. Psychiatry. 2002;65(3):207-239.
9.Norris, FH, Friedman, MJ. Watson PJ: 60,000 disaster victims speak: part II. summary and implications of the disaster mental health research. Psychiatry. 2002;65(3):240-260.
10.Norris, FH. Range, Magnitude, and Duration of the Effects of Disasters on Mental Health: Review Update 2005. Hanover, NH: Dartmouth Medical School and National Center for Posttraumatic Stress Disorder.
11.Andrulis, DP, Siddiqui, NJ, Gantner, JL. Preparing racially and ethnically diverse communities for public health emergencies. Health Aff (Millwood). 2007;26(5):1269-1279.
12.Shultz, JM, Espinel, Z, Galea, S, Reissman, DB. Disaster ecology: implications for disaster psychiatry. In: Ursano RJ, Fullerton CS, Weisaeth L, Raphael B (eds). Textbook of Disaster Psychiatry. Cambridge, UK: Cambridge University Press; 2007:69-96.
13.Shultz, JM, Espinel, Z, Flynn, BW, Cohen, RE, Hoffmann, Y. DEEP PREP: All-Hazards Disaster Behavioral Health Training. Tampa, FL: Disaster Life Support Publishing; 2007.
14.Kessler, RC, McLaughlin, KA, Koenen, KC, Petukhova, M, Hill, ED. The importance of secondary trauma exposure for post-disaster mental disorder. Epidemiol Psychiatric Sci. 2012;21:35-45.
15. Centre for Research on the Epidemiology of Disasters. EM-DAT: The International Disaster Database. http://www.emdat.be. Accessed August 24, 2012.
16. World Association of Disaster and Emergency Medicine (WADEM). Health Disaster Management: Guidelines for Evaluation and Research. http://www.wadem.org/guidelines.html. Accessed August 24, 2012.
17.Kim, Y. Great East Japan Earthquake and early mental-health response. Psychiatry Clin Neurosci. 2011;65:539-548.
18. Emergency Disaster Measures Headquarters, National Police Agency of Japan. Damage situation and police countermeasures associated with 2011 Tohoku district – off the Pacific Ocean Earthquake, July 11, 2012. http://www.npa.go.jp/archive/keibi/biki/higaijokyo_e.pdf. Accessed July 16, 2012.
19.Keim, M. The public health impact of tsunami disasters. Am J Disaster Med. 2011;6(6):341-350.
20. United States Geological Survey. Magnitude 9.0 - Near The East Coast Of Honshu, Japan: Summary. http://earthquake.usgs.gov/earthquakes/eqinthenews/2011/. Accessed February 20, 2012.
21. Wikipedia. 2011 Tōhoku earthquake and tsunami. http://en.wikipedia.org/wiki/2011_T%C5%8Dhoku_earthquake_and_tsunami. Accessed February 20, 2012.
22. CATDAT. Japan Tohoku earthquake and tsunami: CATDAT 41 report (October 2, 2011). http://earthquake-report.com/2011/10/02/japan-tohoku-earthquake-and-tsunami-catdat-41-report-october-2-2011/. Accessed February 25, 2012.
23. World Bank. The recent earthquake and tsunami in Japan: implications for East Asia. http://siteresources.worldbank.org/INTEAPHALFYEARLYUPDATE/Resources/550192-1300567391916/EAP_Update_March2011_japan.pdf?cid=EXTEAPMonth1. Accessed February 20, 2012.
24. United States Geological Survey. Earthquake shaking map: M 9.0, Near the East Coast of Honshu, Japan. http://earthquake.usgs.gov/earthquakes/pager/events/us/c0001xgp/onepager.pdf. Accessed February 20, 2012.
25. United States Geological Survey. M 8.9, Near the East Coast of Honshu, Japan: Aftershock Map—Mainshock and 726 Aftershocks. Last Updated: 23 March 2011, 17:39:53 UTC. http://earthquake.usgs.gov/earthquakes/aftershocks/?event=c0001xgp&source=us&title=M8.9%20NEAR%20THE%20EAST%20COAST%20OF%20HONSHU,%20JAPAN. Accessed February 20, 2012.
26. Japanese Geotechnical Society. Geo-hazards During Earthquakes and Mitigation Measures: Lessons and Recommendations from the 2011 Great East Japan Earthquake; July 2011. http://www.geosyntheticssociety.org/Uploads/Japan_Earthquake.pdf. Accessed February 27, 2012.
27.Oh, J-H. A Consideration for the better Preparedness against Mega-Disaster: Lessons from the 2011 Great Eastern Japan Earthquake and Tsunami. Buson, South Korea: Pukyong National University. http://www.kf.or.kr/file/kor_1/Panel_1_Jai-Ho_Oh_%EB%B0%9C%ED%91%9C%EC%9A%94%EC%95%BD%EB%AC%B8.pdf. Accessed February 27, 2012.
28.Norio, O, Ye, T, Kajitani, Y, Shi, P, Tatano, H. The 2011 Eastern Japan Great Earthquake Disaster: overview and comments. Int J Disaster Risk Sci. 2011;2(1):34-42.
29. Kyoto University International Environment and Disaster Management Graduate School of Global Environmental Studies. Mega Disaster in a Resilient Society: The Great East Japan (Tohoku Kanto) Earthquake and Tsunami of 11th March 2011. March 25, 2011.
30.Dauer, LT, Zanzonico, P, Tuttle, RM, Quinn, DM, Strauss, HW. The Japanese tsunami and resulting nuclear emergency at the Fukushima Daiichi power facility: technical, radiologic, and response perspectives. J Nucl Med. 2011;52:1423-1432.
31.Becker, SM. Learning from the 2011 Great East Japan Disaster: insights from a special radiological emergency assistance mission. Biosecur Bioterror. 2011;9(4):394-404.
32. Wikipedia. Fukushima Daiichi nuclear disaster. http://en.wikipedia.org/wiki/Fukushima_Daiichi_nuclear_disaster. Accessed February 27, 2012.
33.Kuwabara, H, Shioiri, T, Toyabe, SI, etal. Factors impacting on psychological distress and recovery after the 2004 Niigata–Chuetsu earthquake, Japan: community-based study. Psychiatry Clin Neurosci. 2008;62:503-507.
34.Lau, JTF, Yu, X, Zhang, J, etal. Psychological distress among adolescents in Chengdu, Sichuan at 1 month after the 2008 Sichuan earthquake. J Urban Health. 2010;87(3):504-523.
35.Basoglu, M, Kilic, C, Salcioglu, E. Livanou M: Prevalence of posttraumatic stress disorder and comorbid depression in earthquake survivors in Turkey: an epidemiological study. J Trauma Stress. 2004;17(2):133-144.
36.Kato, H. Posttraumatic symptoms among victims of the Great Hanshin-Awaji earthquake in Japan. Psychiatry Clin Neurosci. 1998;52(suppl):S59-S65.
37.National Center for PTSD. Tsunami and Mental Health: What Can We Expect? Washington, DC: US Department of Veterans Affairs. http://www.ptsd.va.gov/public/pages/tsunami-mental-health.asp. Accessed February 27, 2012.
38.Carballo, M, Heal, B, Horbaty, G. Impact of the tsunami on psychosocial health and well-being. Int Rev Psychiatry. 2006;18(3):217-223.
39.Hollifield, M, Hewage, C, Gunawardena, CN, etal.: Symptoms and coping in Sri Lanka 20-21 months after the 2004 tsunami. Brit J Psychiatry. 2008;192:39-44.
40.Wahlström, L, Michélsen, H, Schulman, A, Backheden, M. Different types of exposure to the 2004 tsunami are associated with different levels of psychological distress and posttraumatic stress. J Trauma Stress. 2008;21(5):463-470.
41.Thienkrua, W, Cardozo, BL, Chakkraband, ML, etal. Symptoms of posttraumatic stress disorder and depression among children in tsunami-affected areas in southern Thailand. JAMA. 2006;296(5):549-559.
42.Souza, R, Bernatsky, S, Reyes, R, de Jong, K. Mental health status of vulnerable tsunami-affected communities: a survey in Aceh province, Indonesia. J Trauma Stress. 2007;20(3):263-269.
43.van Griensven, F, Chakkraband, ML, Thienkrua, W, etal. Mental health problems among adults in tsunami-affected areas in southern Thailand. JAMA. 2006;296(5):537-548.
44.Lommen, MJ, Sanders, AJ, Buck, N, Arntz, A. Psychosocial predictors of chronic post-traumatic stress disorder in Sri Lankan tsunami survivors. Behav Res Ther. 2009;47(1):60-65.
45.Bryant, RA. Recovery after the tsunami: timeline for rehabilitation. J Clin Psychiatry. 2006;67(suppl 2):50-55.
46.MacDonald, R. How women were affected by the tsunami: a perspective from Oxfam. PLoS Med. 2005;2(6):e178.
47.Carballo, M, Heal, B, Hernandez, M. Psychosocial aspects of the tsunami. J R Soc Med. 2005;98(9):396-399.
48.Bhugra, D, van Ommeren, M. Mental health, psychosocial support and the tsunami. Int Rev Psychiatry. 2006;18(3):213-216.
49.Kristensen, P, Weisaeth, L, Heir, T. Psychiatric disorders among disaster bereaved: an interview study of individuals directly or not directly exposed to the 2004 tsunami. Depress Anxiety. 2009;26(12):1127-1133.
50.Neuner, F, Schauer, E, Catani, C, Ruf, M, Elbert, T. Post-tsunami stress: a study of posttraumatic stress disorder in children living in three severely affected regions in Sri Lanka. J Trauma Stress. 2006;19(3):339-347.
51.Armagan, E, Engindeniz, Z, Devay, AO, Erdur, B, Ozcakir, A. Frequency of post-traumatic stress disorder among relief force workers after the tsunami in Asia: do rescuers become victims? Prehosp Disaster Med. 2006;21(3):168-172.
52.Dodgen, D, Norwood, AE, Becker, SM, Perez, JT, Hansen, CK. Social, psychological, and behavioral responses to a nuclear detonation in a US city: implications for health care planning and delivery. Disaster Med Public Health Prep. 2011;5(suppl 1):S54-S64.
53.Slovic, P. Perception of risk from radiation. Radiat Prot Dosimetry. 1996;68(3/4):165-180.
54.Becker, SM. Emergency communication and information issues in terrorist events involving radioactive materials. Biosecur Bioterror. 2004;2(3):195-207.
55.Becker, SM. Communicating risk to the public after radiological incidents. BMJ. 2007;335(7630):1106-1107.
56.Christodouleas, JP, Forrest, RD, Ainsley, CG, Tochner, Z, Hahn, SM, Glatstein, E. Short-term and long-term health risks of nuclear-power-plant accidents. N Engl J Med. 2011;364:2334-2341.
57.Auf der Heide, E. Common misconceptions about disasters: panic, the “disaster syndrome,” and looting. In: O'Leary MR, ed. The First 72 Hours: A Community Approach to Disaster Preparedness. Bloomington, IN: iUniverse; 2004:340-380.
58.Drury, J, Cocking, C, Reicher, S. Everyone for themselves? a comparative study of crowd solidarity among emergency survivors. Br J Soc Psychol. 2009;48(pt 3):487-506.
59.Becker, SM. Protecting public health after major radiation emergencies: nuclear crisis in Japan is a powerful reminder of past lessons. BMJ. 2011;342:717.
60.Chernobyl Forum: 2003-2005. Chernobyl ‘s Legacy: Health, Environmental and Socioeconomic Impacts. Vienna: International Atomic Energy Agency; 2006.
61.Saenko, V, Ivanov, V, Tsyb, A, etal. The Chernobyl accident and its consequences. Clin Oncol (R Coll Radiol). 2011;23(4):234-243.
62.Bromet, EJ, Havenaar, JM, Guey, LT. A 25-year retrospective review of the psychological consequences of the Chernobyl accident. Clin Oncol (R Coll Radiol). 2011;23(4):297-305.
63.Beehler, GP, Baker, JA, Falkner, K, etal. A multilevel analysis of long-term psychological distress among Belarusians affected by the Chernobyl disaster. Public Health. 2008;122(11):1239-1249.
64.Havenaar, JM, de Wilde, EJ, van den Bout, J, Drottz-Sjoberg, BM, van den Brink, W. Perception of risk and subjective health among victims of the Chernobyl disaster. Soc Sci Med. 2003;56(3):569-572.
65.Havenaar, JM, Rumyantzeva, GM, van den Brink, W, etal. Long-term mental health effects on the Chernobyl disaster: an epidemiologic survey in two former soviet regions. Am J Psychiatry. 1997;154:1605-1607.
66.Butler, AS, Panzer, AM, Goldfrank, LR. Institute of Medicine Committee on Responding to the Psychological Consequences of Terrorism Board on Neuroscience and Behavioral Health. Preparing for the Psychological Consequences of Terrorism: A Public Health Approach. Washington, DC: National Academies Press; 2003.
67.Raphael, B, Taylor, M, McAndrew, V. Women, catastrophe and mental health. Aust NZ J Psychiatry. 2008;42:13-23.
68.Kim, Y, Abe, Y, Araki, H, etal. Guidelines for Local Mental Health Care Activities after a Disaster. Tokyo, Japan: National Institute of Mental Health, National Center of Psychiatry and Neurology; 2004. http://www.ncnp.go.jp/nimh/seijin/EnglishDisasterMentalHealth.pdf. Accessed February 25, 2012.
69.Takeda, M. Mental health care and East Japan Great Earthquake. Psychiatry Clin. Neurosci. 2011;65:207-212.
70.Suzuki, Y, Kim, Y. The Great East Japan earthquake in 2011: toward a sustainable mental health care system. Epidemiol Psychiatric Sci. 2012;21:7-11.
71.Shultz, JM, Marcelin, LH, Espinel, Z, Madanes, SB, Allen, A, Neria, YA. Haiti earthquake 2010: psychosocial impacts. In: Bobrowsky P (ed). Encyclopedia of Natural Hazards. New York, NY: Springer Publishing, 2013 (in press).
72.Shultz, JM, Neria, Y, Espinel, Z, Marcelin, LH, Madanes, S. Trauma signature analysis: rapid post-impact/pre-deployment guidance for mental health response. Presented at: International Society for Traumatic Stress Studies (ISTSS) 26th Annual Meeting; November 5, 2010; Montreal, Quebec, Canada.
73.Shultz, JM, Espinel, Z, Kelly, F, Neria, Y. Examining the trauma signature of the Japan tsunami/nuclear crisis. Presented at: Social Bonds and Trauma Through the Life Span: International Society for Traumatic Stress Studies (ISTSS) 27th Annual Meeting; November 4, 2011; Baltimore, MD.
74.Shultz, JM, McLean, AJ, Rosen, A, Youngs, GA, Jensen, J, Neria, Y. A tale of two cities: flooding and effects on community resilience [poster]. Presented at: 2nd International Preparedness and Response to Emergencies and Disasters (IPRED II) Conference; January 16-17, 2012; Tel Aviv, Israel.
75.Shultz, JM, Bueno Ramirez, AM, Espinel, Z, etal. Displaced within borders: Colombia's humanitarian crisis. Presented at: 2nd International Preparedness and Response to Emergencies and Disasters (IPRED II) Conference; January 16-17, 2012; Tel Aviv, Israel.
76.Shultz, JM, Herberman Mash, HB, Rosen, A, Espinel, Z, Kelly, F, Neria, Y. The trauma signature of the 2011 U.S. super tornado outbreak. Presented at: 2nd International Preparedness and Response to Emergencies and Disasters (IPRED II) Conference; January 16-17, 2012; Tel Aviv, Israel.
77.Migline, V, Shultz, JM. Psychosocial impact of the Russian invasion of Georgia in 2008. Presented at: 17th World Congress on Disaster and Emergency Medicine; June 1, 2011; Beijing, China.
78.Shultz, JM, Neria, Y, Espinel, Z, Kelly, F. Trauma signature analysis: evidence-based guidance for disaster mental health response. Presented at: 17th World Congress on Disaster and Emergency Medicine; May 31, 2011; Beijing, China.
79.Shultz, JM, Kelly, F, Espinel, Z, Neria, Y. Rapid evidence-based guidance for post-impact disaster mental health response: Trauma signature (TSIG) analysis. Presented at: Social Bonds and Trauma Through the Life Span: International Society for Traumatic Stress Studies (ISTSS) 27th Annual Meeting; November 2, 2011; Baltimore, MD.
80.Shultz, JM. Trauma signature analysis. Presented at: Innovation and Results: Surviving the Times. The Joint Commission 2012 Accreditation Standards Update; November 16, 2011; Lombard, IL.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed