Long-term Trends in Mental Health Disorders After the 2011 Great East Japan Earthquake and Tsunami

Importance: Posttraumatic stress symptoms (PTSS) and depressive symptoms are common among survivors of a major disaster, yet few longitudinal studies have documented their long-term persistence at the community level. Objective: To examine the trajectories of PTSS and depressive symptoms for as long as 5.5 years after the 2011 Great East Japan earthquake and tsunami. Design, Setting, and Participants: This cohort study used data from 2781 participants in 3 waves of the Iwanuma Study (2010, 2013, and 2016), a cohort of community-dwelling older adults (≥65 years in August 2010) in Iwanuma, Japan, who were directly affected by the 2011 disaster. The baseline assessment of mental health predated the disaster by 7 months, and survivors were followed up for 5.5 years after the disaster. Data analysis was performed from October 2019 to February 2020. Exposures: The March 11, 2011, Great East Japan earthquake and tsunami. Main Outcomes and Measures: PTSS were measured by 9 questions on the Screening Questionnaire for Disaster Mental Health, while depressive symptoms were measured by 15 items on the Geriatric Depression Scale short form. Results: The analytic samples for trajectories of PTSS and depressive symptoms included 2275 and 1735 respondents, respectively. In the study population at baseline, there were slightly more women (1262 of 2275 [55.5%] and 882 of 1735 [50.8%]), and most participants were aged 65 to 74 years (1533 [67.4%] and 1224 [70.5%]) and married (1664 [76.2%] and 1319 [77.7%]). Overall, there was a 13.6% (95% CI, 11.7%-15.6%) incidence of depression among individuals who did not have depression before the disaster, while a further 11.1% (95% CI, 9.8%-12.4%) reported PTSS after the disaster. By 5.5 years of follow-up, approximately half of the survivors with new depressive symptoms in 2013 (85 of 168 [50.6%]) and PTSS (147 of 253 [58.1%]) had recovered. The prevalence of depression in the community remained remarkably stable (between 504 participants [29.0%] and 506 participants [29.2%]) comparing predisaster and postdisaster data. Conclusions and Relevance: In this study, mental illness symptoms persisted for more than 5 years among half of disaster survivors, but the community-wide prevalence of depression remained stable, suggesting that the community itself was resilient.