The Great East Japan Earthquake, a magnitude 9.0 quake that occurred on March 11, 2011, left more than 20,000 killed or missing and resulted in more than 400,000 people being displaced. The Fukushima Nuclear Power Plant accident released large amounts of radioactive material into the air. Among the victims of this combined disaster were many pregnant and parturient women, and this study aimed to determine post-disaster anxiety among this specific population and measures for the future. Participants were 259 women (mean age 33.02 ± 4.79 years) who gave birth around the time of the earthquake in Miyagi Prefecture, one of the disaster areas. Sixteen months after the earthquake, we administered survey questionnaires on anxiety. We transcribed questionnaire responses, coded raw data by context, and categorized these codes by commonality. After extracting subcategories of anxiety-related factors, we categorized them into more abstract concepts. Among the participants, 126 (48.6%) reported having no available professionals with whom they could consult about childrearing. Participants reported anxiety in the following 12 categories: “radiation,” “child’s physical and mental growth/development,” “recurrence of earthquake and tsunami,” “financial issues,” “childrearing environment,” “living environment,” “maternal employment,” “stigma,” “familial issues,” “maternal health,” “childrearing,” and “the future”. A beneficial way to reduce maternal anxiety in the 12 areas identified would be to develop support systems that provide continuous support for children’s mental health care needs, psychological guidance, community support for maternal empowerment, outreach for individual support, and professional consultation for mothers who have high anxiety about radioactivity.
The Great East Japan Earthquake, a magnitude 9.0 quake that occurred on March 11, 2011, was centered offshore of Sanriku in Miyagi Prefecture, northeastern Japan [
This study reports the results of a survey on post-disaster anxiety administered 16 months after the Great East Japan Earthquake to mothers in Miyagi Prefecture who had delivered a child around the time of the earthquake in order to investigate various sources of anxiety in their lives and determine the most appropriate means of support.
Study participants were mothers who had delivered a child less than one month before the Great East Japan Earthquake that occurred on March 11, 2011, and pregnant women who had received a “Maternal and Child Health Handbook,” the handbook issued by Japanese municipal governments in accordance with Article 16 of the Maternal and Child Health Law for pregnant women who report their pregnancy to a municipal office. We contacted 26 medical institutions in Miyagi Prefecture and asked them to explain the purpose of this study to their patients who gave birth during the period from February 2011 through September 2011. We administered the survey in July 2012.
Approval to conduct this research was obtained from the Graduate School of Medicine, Tohoku University and hospitals and government offices in Tohoku, Japan that agreed to participate after receiving an explanation of the study. We informed the participants that the content of the investigation would be used for research only and that they could withdraw from the study at any time. We also explained that their participation would be kept confidential. Before starting the investigation, we obtained signed informed consent forms from all participants.
The survey questionnaire included open-ended questions asking participants to describe their anxieties. After collecting basic demographic information, the questionnaire began with the general question, “What is causing you anxiety?” to which participants could freely express their responses.
We transcribed the questionnaire responses, coded anxiety-related raw data by context, and categorized these codes by commonality. We then extracted subcategories of these anxiety-related factors and further categorized them into more abstract concepts. We used ATLAS. ti. 7.0 software (Scientific Software Development GmbH, Berlin) for data analysis. We chose this analytical method because it feeds appropriately into a concept analysis rather than a qualitative theory [
Among 886 women who initially agreed to participate, the final sample comprised 259 women who returned their questionnaires. The mean age of participants was 33.02 ± 4.79 years. Most participants (179, 69.1%) were in their 30 s. Among all participants, 99 (38.2%) were primiparae and 160 (61.8%) were multiparae. In addition, 49 (18.9%) had to move to another residence after the earthquake, most of whom (17, 34.7%) moved to rental housing provided by the prefecture followed by 6 (12.2%) who moved to temporary housing. As for their general health condition since the earthquake to the present time, 179 (69.9%) reported they were “healthy,” 61 (23.8%) reported that they “became ill, but recovered,” and 16 (6.3%) reported that they were “still ill.” In addition, 126 (48.6%) reported the unavailability of childrearing professionals (e.g., physicians or public health nurses) with whom they could consult (
We classified 454 codes for maternal anxiety into 66 subcategories. We then classified these subcategories into 12 higher level categories: “radiation,” “child’s physical and mental growth/development,” “recurrence of earth- quake and tsunami,” “financial issues,” “childrearing environment,” “living environment,” “maternal employment,” “stigma,” “familial issues,” “maternal health,” “childrearing,” and “the future.”
Characteristic | n | % |
---|---|---|
Current residence | ||
No change | 210 | 81.1 |
Temporary housing | 6 | 2.3 |
Rental housing | 17 | 6.6 |
Own parent’s house | 5 | 1.9 |
Husband’s parents’ house | 2 | 1 |
Other | 19 | 7.1 |
Employment | ||
Yes | 107 | 41.3 |
No | 152 | 58.7 |
Type of employment | ||
Side job | 2 | 0.8 |
Part time | 25 | 9.7 |
Full time | 57 | 22 |
Self-employed | 7 | 2.7 |
On maternity leave | 5 | 1.9 |
Other | 11 | 4.2 |
None | 152 | 58.7 |
Health condition after the earthquake | ||
Healthy | 179 | 69.1 |
Became ill, but recovered | 61 | 23.6 |
Still ill | 16 | 6.2 |
No answer | 3 | 1.2 |
No. of children | ||
1 | 99 | 38.2 |
2 | 110 | 42.5 |
3 | 39 | 15.1 |
4 | 5 | 1.9 |
5 | 4 | 1.5 |
6 | 1 | 0.4 |
No answer | 1 | 0.4 |
Currently pregnant | ||
Yes | 14 | 5.4 |
No | 245 | 94.6 |
Have someone I can consult about children’s issues | ||
Definitely yes | 169 | 65.3 |
Somewhat yes | 72 | 27.8 |
Somewhat no | 13 | 5 |
Definitely no | 4 | 1.5 |
No answer | 1 | 0.4 |
Have someone I can consult about childrearing (e.g., professionals such as physician and public health nurse) | ||
Definitely yes | 59 | 22.8 |
Somewhat yes | 73 | 28.2 |
Somewhat no | 71 | 27.4 |
Definitely no | 55 | 21.2 |
No answer | 1 | 0.4 |
Category | Subcategory |
---|---|
Radiation | Food safety |
Outdoor safety | |
Influence on an unborn child | |
Influence on children | |
Influence of radiation on the human body | |
Financial damage | |
Distrust of public announcements | |
Child’s physical and mental growth/development | Mental impact of disaster experience |
Mental impact of parents’ instability | |
Developmental delay and issues | |
Illness | |
Future health condition | |
Weight loss or gain | |
Recurrence of earthquake and tsunami, and aftershocks | Ability to protect children |
Evacuation | |
Recurrence | |
Anxiety during the time apart from one’s own child | |
Anxiety during husband’s absence | |
Lifelines | |
Financial issues | Housing loan issues caused by the earthquake |
Financial damage caused by the earthquake | |
Money for the future | |
Living expenses | |
Reserve for child’s education | |
Consumption tax increase | |
Low income due to a single parent household | |
Childrearing environment | Playground |
New neighborhood | |
Daycare center | |
Child’s making friends | |
Mother’s making friends | |
Shortage of pediatricians | |
Future life after childbirth | |
New school | |
Living environment | Unable to find permanent housing |
Remaining in a disaster area | |
Life in temporary housing | |
Reconstruction | |
Crimes | |
Maternal employment | Returning to work |
Daycare for children while working | |
Balance between work and childrearing | |
Child’s becoming ill | |
Job search | |
Responsibilities at the workplace | |
Sense of guilt over sending child to daycare center | |
Sense of guilt about maternity leave |
Stigma | Being stigmatized as a disaster victim |
---|---|
Being stigmatized by other disaster victims | |
Familial issues | Health condition of parents and relatives |
Relationship with parents and relatives | |
Husband’s employment and health condition | |
Relationship with husband | |
Maternal health | Fatigue |
Poor conditions | |
Mental issues | |
No physical energy | |
Currently pregnant | |
Childrearing | No available professionals to consult |
Discipline | |
How to communicate with children | |
Weaning | |
Meals | |
Sleep | |
Future | Future life |
Future of Japan |
The total number of fatalities in Miyagi prefecture was 10,449 (
Respondents also expressed anxiety about their “child’s physical and mental growth/development”. Catastrophic disasters such as earthquakes and war cause tremendous physical and mental damage [
Another characteristic finding of this study is anxiety about radiation, which is equal to the fear of earthquakes or tsunamis. Miyagi Prefecture, where our hospital is located, is in eastern Japan, ~68 km (~42.5 miles) southeast of the Fukushima nuclear power plant (Geospatial Information Authority of Japan). While the prefecture was not designated a mandatory evacuation zone, many mothers with young children were concerned about radioactive contamination of food and playgrounds. The prefectural government assessed radiation in agricultural and fishery products, and quarantined any food that contained radiation levels with higher than normal background values. They also assessed radiation levels of playground soil and deployed decontamination procedures on ground where radiation levels were abnormal. Nevertheless, this study showed that mothers were not completely reassured by these efforts.
A wide range of support systems should be provided to reduce maternal post-disaster anxiety. For example, continuous support programs in local communities are needed such as the “Mental-Health-Care Team for Children,” “Children’s Mental Health Counseling,” and “Children’s Mental Health Counseling Health Checkup,” all of which were provided by other areas outside the disaster zones. Also, accurate information should be provided about the physical and mental development of children who have lived through disasters. This could entail psychological guidance or counseling mothers to encourage and empower each other. Support providers should not be limited only to professionals such as clinical psychologists, public health nurses, midwives, and nurses, but ideally would also include radiation specialists who can help those experiencing high levels of anxiety about radiation, as revealed in this study. It would appear feasible to provide periodic local support programs for parents with preschoolers in facilities such as daycare centers, kindergartens, and local child centers because these are sites that host periodic health check-up clinics. Also, we can address the issue of the unavailability of professionals with whom mothers can consult about childrearing, as reported by over half of this study’s participants, by establishing outreach support systems where mothers are treated individually with a “high-risk approach” that helps strengthen their resilience.
A beneficial way to reduce maternal anxiety in the 12 areas identified would be to develop support systems that provide continuous support for children’s mental health care needs, psychological guidance, community support for maternal empowerment, outreach for individual support, and professional consultation for mothers who have high anxiety about radioactivity.
Because this study did not employ a control group, we cannot compare our findings with mothers who reside in non-disaster areas.
This study was funded by a Health and Labour Sciences Research Grant: 2012-Next Generation-designated-006 (Restoration; Kunihiro Okamura, Principal Investigator) on the theme “Study of health care for pregnant and parturient women in disasters: Public health issues”.