Psychiatry and Clinical Neurosciences 2008; 62: 503–507 doi:10.1111/j.1440-1819.2008.01842.

Regular Article

Factors impacting on psychological distress and recovery

after the 2004 Niigata–Chuetsu earthquake, Japan:
Community-based study
Hideki Kuwabara, MD, PhD,1 Toshiki Shioiri, MD, PhD,2* Shin-Ichi Toyabe, MD, PhD,3
Tsuyoshi Kawamura, MD, PhD,4 Masataka Koizumi, MD,5 Miki Ito-Sawamura, BA,5,6
Kouhei Akazawa, PhD3 and Toshiyuki Someya, MD, PhD5
1
Department of Psychiatry, Sagata Mental Hospital, 2Department of Psychopathology, Gifu University Graduate School of
Medicine, Gifu, 4Department of Psychiatry, Takada Nishishiro Hospital, 3Department of Medical Informatics, Niigata
University Medical and Dental Hospital, 5Department of Psychiatry, Niigata University Graduate School of Medical and
Dental Sciences and 6Group of Mental Health, Section of Safety Net of Life, Research Center for Natural Hazards and
Disaster Recovery, Niigata University, Niigata, Japan

Aim: This study was undertaken 5 months after the (iii) lived at home or office after the earthquake; and
2004 Niigata–Chuetsu earthquake in Japan to assess (iv) were injured due to the earthquake or suffered
factors that impacted on psychological distress and from sickness after the earthquake. In contrast, the
its recovery. factors impairing psychological recovery 5 months
after the earthquake were as follows: (i) being with
Methods: Three thousand and twenty-six adult
unfamiliar member(s) during the night after the
victims who lived in temporary shelter and in seri-
earthquake; (ii) serious house damage; (iii) living
ously damaged areas were evaluated by question-
in temporary shelter or at a relative’s home after
naire. The questionnaire queried subject profile,
the earthquake; and (iv) physical illness after the
degree of house damage, health status, and psycho-
earthquake.
logical distress using a 5-point scale before, immedi-
ately and 5 months after the earthquake. Conclusion: Despite differences between disasters,
these results were consistent with those in some pre-
Results: Immediately after the earthquake, 59.3% of
vious studies and may be useful for long-term mental
the subjects had psychological distress. At 5 months
care support.
after the earthquake, however, this percentage
decreased to 21.8%. The psychological distress
Key words: depression, natural disaster, psychologi-
immediately after the earthquake was significantly
cal distress, psychological recovery, post-traumatic
serious in victims who: (i) were female; (ii) felt
stress disorder.
stronger fear of the earthquake and the aftershocks;

CCORDING TO A survey in the USA, 13% of all National Comorbidity Survey, 18.9% of male and
A people suffer from natural or human-generated
disasters during their lifetime.1 Also, according to the
15.2% of female individuals experience a natural
disaster in their lifetime.2 Therefore, disasters are not
rare events.
At 5:56 p.m. on 23 October 2004, a severe earth-
*Correspondence: Toshiki Shioiri, MD, PhD, Department of
quake with a magnitude of 6.8 and a maximum
Psychopathology, Gifu University Graduate, School of Medicine, 1-1
Yanagido, Gifu 501-1194, Japan. Email: [email protected] tremor intensity level of 7 according to the Japanese
Received 14 June 2007; revised 14 February 2008; accepted 16 June 7-stage seismic scale occurred in and around the
2008. Chuetsu Area, Niigata Prefecture. Approximately

© 2008 The Authors 503

Journal compilation © 2008 Japanese Society of Psychiatry and Neurology
504 H. Kuwabara et al. Psychiatry and Clinical Neurosciences 2008; 62: 503–507

100 000 people took refuge (49 killed, 4794 injured), Table 1. Subject details
approximately 120 000 houses were damaged
Age groups (years) Total Male Female
(including 3185 completely destroyed), and the
damage amounted to >¥3 trillion (as of 16 Septem- ⱕ29 59 21 38
ber 2005). Because of the sustained occurrence of 30–39 184 74 110
aftershocks and delayed reconstruction of commu- 40–49 333 142 191
nity lifelines, 9160 people who lost their houses were 50–64 802 426 376
still living in temporary shelter as long as 1 year after 65–79 617 435 182
ⱖ80 65 39 26
the earthquake.3
Total 2060 1137 923
Disasters (e.g. earthquakes, floods, traffic acci-
dents) are traumatic events that many people Note: 16 persons with unknown age group and 23 female
encounter and may cause various psychological or subjects with unknown age were excluded.
physical health problems.4 The impact of the devas-
tating earthquake and subsequent life in an unfamil- (v) very poor. The value assigned to each answer (i–v)
iar environment would cause psychological distress was regarded as a score of the severity of psychologi-
for almost all people affected by the earthquake.5–9 In cal distress. The subjects were also asked to assess
some people, however, severe mental problems such their mental health status before, immediately after
as depression and/or post-traumatic stress disorder the earthquake, and at the time of the survey (i.e.
(PTSD), known risk factors for suicidal thinking,10,11 5 months after the earthquake). Additionally, the
will occur and they may continue to suffer from these following 19 items were selected as factors that
mental disorders for a long time.12–14 may affect psychological distress and its recovery:
In the present study we examined the factors that (1) gender; (2) age; (3) place of residence when
impacted on psychological distress and its recovery the earthquake occurred; (4) occupation; (5) family
after the 2004 Niigata–Chuetsu earthquake in structure; (6) whether the family was separated by the
community-based large-scale samples. earthquake or not; (7) whether being on a pension or
not; (8) whereabouts at the time of the earthquake;
(9) whether being with anyone at the time of the
METHODS earthquake or not; (10) time until family reunion
The subjects were 3026 adult victims consisting of all after the earthquake; (11) behavior after the earth-
those living in temporary shelter and those living quake; (12) whether being with anyone during the
in seriously damaged areas. The latter group was night after the earthquake or not; (13) whereabouts
selected on the basis of house damage assessment during night-time on the day of the earthquake; (14)
(complete destruction, partial destruction, minor fear of the earthquake or aftershocks; (15) degree of
destruction) and standardizing the sampling fre- house damage; (16) time until first contact with
quency by correcting for the population density. rescue staff; (17) whether using temporary shelter or
Five months after the earthquake, a questionnaire not; (18) place of living after the earthquake; and
entitled ‘Opinion Survey Concerning Disaster Relief (19) whether physically ill or injured after the earth-
after Niigata–Chuetsu earthquake’ was distributed quake or not.
and collected by door-to-door survey in cooperation Statistically, comparisons among groups were per-
with the Red Cross of Japan from mid- to late March, formed using c2 test with Bonferroni correction. Also,
2005, and responses were collected from 2083 the factors that impacted on psychological distress
people (1137 male, 946 female) who consented to and its recovery after the earthquake were determined
the survey (return rate: 68.8%). Table 1 shows the on multiple logistic regression (with concomitant use
age and gender distribution of the subjects. This study of the stepwise method). The score of each group was
protocol was approved by the Ethical Review Board, expressed as mean ⫾ SD, and P < 0.05 was regarded
Niigata University School of Medicine. as significant.
The questionnaire consisted of 42 questions ad-
dressed to various situations during and after the
earthquake. Among them, mental health status was
RESULTS
assessed on a 5-point self-report scale: (i) very good; Table 2 presents the changes in subjects with psycho-
(ii) good; (iii) neither good nor poor; (iv) poor; and logical distress before, immediately and 5 months

© 2008 The Authors

Journal compilation © 2008 Japanese Society of Psychiatry and Neurology
Psychiatry and Clinical Neurosciences 2008; 62: 503–507 Psychological distress: Chuetsu earthquake 505

Table 2. Changes in psychological distress

Very good Good Neither good nor poor Poor Very poor
n (%) n (%) n (%) n (%) n (%)

Before earthquake 916 (46.2) 510 (25.7) 341 (17.2) 160 (8.1) 55 (2.8)
Immediately after earthquake 166 (8.4) 207 (10.4) 434 (21.9) 648 (32.7) 528 (26.6)
Five months after earthquake 503 (25.0) 592 (29.4) 479 (23.8) 325 (16.2) 112 (5.6)

after the earthquake. Of all the subjects, 59.3% after earthquake. In contrast, the factors impairing
reported their mental health status as distressed psychological recovery 5 months after the earthquake
(reported ‘poor’ or ‘very poor’) immediately after were as follows: (i) being with unfamiliar member(s)
the earthquake. There was a significant difference in during night-time on the day of the earthquake; (ii)
the ratio of psychological distress between before serious house damage; (iii) living in temporary
and immediately after the earthquake (c2 = 297.6, shelter or a relative’s home after the earthquake; and
P < 0.01). Five months after the earthquake, gradual (iv) physical illness after the earthquake.
improvement was observed.
Table 3 shows the results of multiple logistic
regression of factors that affected psychological dis-
DISCUSSION
tress and its recovery after the earthquake. In this With regard to psychological study of disaster
analysis, the degree of psychological distress was used victims, to the best of our knowledge there is a
as the dependent variable. paucity of large-scale psychological studies of disaster
The psychological distress immediately after the victims involving subjects selected from the general
earthquake was significantly serious in the victims population of an entire disaster-stricken area in con-
who: (i) were female; (ii) felt stronger fear of the sideration of the severity of damage and population
earthquake and the aftershocks; (iii) lived at home or density.15 In the present study, factors that affected
office after the earthquake; and (iv) were injured due psychological distress and its recovery in victims after
to the earthquake or suffered from physical illness a devastating earthquake were evaluated in more

Table 3. Multiple logistic regression with degree of psychological distress as dependent variable

Independent variable B SE P Exp(B)

Immediately after Female gender 0.410 0.123 0.001 1.508

earthquake Place of residence (Nagaoka City) -0.598 0.174 0.001 0.550
Place of residence (Koshiji Town) -0.552 0.221 0.012 0.576
Fear of the earthquake 0.812 0.173 <0.001 0.444
Fear of the aftershocks 1.170 0.265 <0.001 0.310
Living at home after the earthquake 0.924 0.448 0.039 2.518
Living at office after the earthquake 0.618 0.171 <0.001 1.855
Injury after the earthquake 0.652 0.223 0.004 1.918
Physical illness after the earthquake 0.672 0.196 0.001 1.958

Five months after Being with unfamiliar member(s) during night-time 0.853 0.380 0.025 2.346
earthquake on the day of the earthquake
Serious house damage 0.512 0.079 <0.001 0.596
Living at relative’s home after the earthquake 0.863 0.287 0.003 2.370
Living at temporary shelter after the earthquake 0.493 0.179 0.004 1.637
Physical illness after the earthquake 0.669 0.226 0.002 1.951

Note: The ‘injury’ score was 0 for no injury, 1 for injury not requiring hospitalization, and 2 for injury requiring hospitalization.
The ‘physical illness’ score was also 0 for no illness, 1 for illness not requiring hospitalization, and 2 for illness requiring
hospitalization.

© 2008 The Authors

Journal compilation © 2008 Japanese Society of Psychiatry and Neurology
506 H. Kuwabara et al. Psychiatry and Clinical Neurosciences 2008; 62: 503–507

than 2000 community-based samples. Consequently, These are consistent with previous reports mentioned
we found some factors that impacted on psychologi- here. Interestingly, the present results showed that
cal distress immediately and 5 months after the both history of living in a temporary shelter or at a
earthquake. relative’s home after the earthquake and ‘fear of the
In the present study, factors significantly associated earthquake and the aftershocks’ affected psychologi-
with psychological distress immediately after the cal distress. The former factors were not reported in
earthquake were female gender, fear of the earth- previous studies and the latter may be in line with the
quake and aftershocks, living at home or office after report by Chen et al., indicating that ‘personality
the earthquake, and injury or physical illness after the characteristics of nervousness’ affected psychological
earthquake. Moreover, factors that impaired psycho- distress after the earthquake.18 Further studies are
logical recovery 5 months after the earthquake were needed to evaluate those matters.
being with unfamiliar member(s) during night-time Shinfuku, who had the rare experience as a
after the earthquake, serious house damage, living in medical doctor of being both a victim and an
a temporary shelter or at a relative’s home after the observer of a major disaster in the Hanshin–Awaji
earthquake, and physical illness after the earthquake. earthquake, indicated that good physical health
Lima et al. examined the relationship between depended greatly on good mental health, and that
disaster and psychological problems 2 months fol- good mental health depended on a sound social
lowing the 1987 earthquake in Ecuador and found environment, including housing and community.28
some risk factors that affected emotional disturbance Moreover, he stressed the importance of long-term
as follows: (i) not being married; (ii) reporting physi- and wide-ranging programs for victims, including
cal or emotional health problems; and (iii) having housing, employment, and financial support.28 Our
ill-defined physical complaints.16 Sharan et al. also results confirm his indications.
indicated that the degree of destruction of house and Several potential limitations should be taken into
property was significantly associated with the severity account in the interpretation of this study. First, the
of psychiatric morbidity.17 Recently, Chen et al. inves- questionnaire used to assess mental health status
tigated the psychiatric morbidity and post-traumatic included retrospective evaluation about ‘before’ and
symptoms among survivors in the early stage follow- ‘immediately after’ the earthquake. There might be
ing the 1999 earthquake in Taiwan and found that some problems about the accuracy of scores that
factors significantly associated with high psychiatric were made retrospectively. Second, in Japan the
morbidity were female gender, serious destruction of female population is usually larger than that of men
property and housing, and personality characteristics in older age, but not in the present study (male >
of nervousness and obsessiveness.18 More recently, female). This discrepancy must have been due to
Ohta et al., who provided support for the mental sampling bias, because there is a similar tendency
health of evacuees from the volcanic eruption of Mt to Japan in Nagaoka City, which also experienced
Unzen for 44 months indicated that recovery from severe damage from this earthquake (male,
psychological distress was more difficult in middle- 137 906 < female, 144 308; 2007 data). Therefore, it
aged and older evacuees than in younger evacuees.19 is possible that these results may not reflect other
There have been a number of studies on PTSD. areas in Japan, although we could not find the cause
For example, women are more likely than men to of the discrepancy.
have PTSD after natural disasters,20,21 and low social We hope that our results will be used effectively
support is associated with a higher likelihood of by administrative organizations of countries that
PTSD.22–25 A greater degree of exposure to a disaster are frequently stricken by natural disasters including
is also consistently associated with the likelihood of Japan.
PTSD.25–27 It is very interesting that the same factors
are associated with PTSD and psychological distress
after a disaster, despite considerable differences in
ACKNOWLEDGMENTS
severities and pathologies between them. This study was supported by grants from the Japan
According to our results, some factors such as Society for the Promotion of Science (JSPS) (No.
female gender, serious house damage, and injury or 19203031) and the Research Center for Natural
physical illness after the earthquake were indicated to Hazards and Disaster Recovery, Niigata University,
affect psychological distress after the earthquake. Japan.

© 2008 The Authors

Journal compilation © 2008 Japanese Society of Psychiatry and Neurology
Psychiatry and Clinical Neurosciences 2008; 62: 503–507 Psychological distress: Chuetsu earthquake 507

15
REFERENCES Kokai M, Fujii S, Shinfuku N, Edwards G. Natural disaster
and mental health in Asia. Psychiatry Clin. Neurosci. 2004;
1
Burkle FM Jr. Acute-phase mental health consequences of 58: 110–116.
16
disasters: Implications for triage and emergency medical ser- Lima BR, Chavez H, Samaniego N et al. Disaster severity
vices. Ann. Emerg. Med. 1996; 28: 119–128. and emotional disturbance: Implications for primary
2
Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. mental health care in developing countries. Acta Psychiatr.
Posttraumatic stress disorder in the National Comorbidity Scand. 1989; 79: 74–82.
17
Survey. Arch. Gen. Psychiatry 1995; 52: 1048–1060. Sharan P, Chaudhary G, Kavathekar SA, Saxena S. Prelimi-
3
Toyabe S, Shioiri T, Kuwabara H et al. Impaired psychologi- nary report of psychiatric disorders in survivors of a severe
cal recovery in the elderly after the Niigata-Chuetsu Earth- earthquake. Am. J. Psychiatry 1996; 153: 556–558.
18
quake in Japan: A population-based study. BMC Public Chen CC, Yeh TL, Yang YK et al. Psychiatric morbidity and
Health 2006; 6: 230. post-traumatic symptoms among survivors in the early stage
4
Norris FH, Friedman MJ, Watson PJ, Byrne CM, Diaz E, following the 1999 earthquake in Taiwan. Psychiatry Res.
Kaniasty K. 60,000 disaster victims speak: Part I. An empiri- 2001; 105: 13–22.
19
cal review of the empirical literature, 1981–2001. Psychiatry Ohta Y, Araki K, Kawasaki N, Nakane Y, Honda S, Mine M.
2002; 65: 207–239. Psychological distress among evacuees of a volcanic erup-
5
Montazeri A, Baradaran H, Omidvari S et al. Psychological tion in Japan: A follow-up study. Psychiatry Clin. Neurosci.
distress among Bam earthquake survivors in Iran: A 2003; 57: 105–111.
20
population-based study. BMC Public Health 2005; 5: 4. Carr VJ, Lewin TJ, Webster RA et al. Psychosocial sequelae
6
Carr VJ, Lewin TJ, Webster RA, Kenardy JA. A synthesis of the of the 1989 Newcastle earthquake: I. Community disaster
findings from the Quake Impact Study: A two-year investi- experiences and psychological morbidity 6 months post-
gation of the psychosocial sequelae of the 1989 Newcastle disaster. Psychol. Med. 1995; 25: 539–555.
21
earthquake. Soc. Psychiatry Psychiatr. Epidemiol. 1997a; 32: Caldera T, Palma L, Penayo U et al. Psychological impact of
123–136. the hurricane Mitch in Nicaragua in a one-year perspective.
7
Carr VJ, Lewin TJ, Kenardy JA et al. Psychosocial sequelae of Soc. Psychiatry Psychiatr. Epidemiol. 2001; 36: 108–114.
22
the 1989 Newcastle earthquake: III. Role of vulnerability La Greca AM, Silverman WK, Vernberg EM et al. Symptoms
factors in post-disaster morbidity. Psychol. Med. 1997b; 27: of posttraumatic stress in children after Hurricane Andrew:
179–190. A prospective study. J. Consult. Clin. Psychol. 1996; 64: 712–
8
Carr VJ, Lewin TJ, Webster RA, Kenardy JA, Hazell PL, Carter 723.
23
GL. Psychosocial sequelae of the 1989 Newcastle earth- Vernberg EM, La Greca AM, Silverman WK et al. Prediction
quake: II. Exposure and morbidity profiles during the first of posttraumatic stress symptoms in children after Hurri-
2 years post-disaster. Psychol. Med. 1997c; 27: 167–178. cane Andrew. J. Abnorm. Psychol. 1996; 105: 237–248.
9 24
Kenardy JA, Webster RA, Lewin TJ, Carr VJ, Hazell PL, Carter Kwon Y, Maruyama S, Morimoto K. Life events and post-
GL. Stress debriefing and patterns of recovery following a traumatic stress in Hanshin-Awaji earthquake victims.
natural disaster. J. Trauma Stress 1996; 9: 37–49. Environ. Health Prev. Med. 2001; 6: 97–103.
10 25
Blumenthal SJ. Suicide: A guide to risk factors, assessment, Wang X, Gao L, Shinfuku N et al. Longitudinal study of
and treatment of suicidal patients. Med. Clin. North Am. earthquake-related PTSD in a randomly selected community
1988; 72: 937–971. sample in North China. Am. J. Psychiatry 2000; 157: 1260–
11
Haynes MA. Suicide prevention: A US perspective. In: Gold- 1266.
26
bloom RB, Lawrence RS (eds). Preventing Disease: Beyond The Goenjian AK, Najarian LM, Pynoos RS et al. Posttraumatic
Rhetoric. Springer-Verlag, New York, 1990; 129–136. stress disorder in elderly and younger adults after the 1988
12
Ollendick DG, Hoffmann M. Assessment of psychological earthquake in Armenia. Am. J. Psychiatry 1994; 151: 895–
reactions in disaster victims. J. Community Psychol. 1982; 10: 901.
27
157–167. Goenjian AK, Molina L, Steinberg AM et al. Posttraumatic
13
Murphy SA. Status of natural disaster victims’ health and stress and depressive reactions among Nicaraguan adoles-
recovery 1 and 3 years later. Res. Nurs. Health 1986; 9: 331– cents after Hurricane Mitch. Am. J. Psychiatry 2001; 158:
340. 788–794.
14 28
Rubonis AV, Bickman L. Psychological impairment in the Shinfuku N. To be a victim and a survivor of the great
wake of disaster: The disaster–psychopathology relation- Hanshin-Awaji earthquake. J. Psychosom. Res. 1999; 46:
ship. Psychol. Bull. 1991; 109: 384–399. 541–548.

© 2008 The Authors

Journal compilation © 2008 Japanese Society of Psychiatry and Neurology