Tsuboya Toru, Aida Jun, Hikichi Hiroyuki, Subramanian S V, Kondo Katsunori, Osaka Ken, Kawachi Ichiro
Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, USA; Tohoku University Graduate School of Dentistry, Department of International and Community Oral Health, Sendai, Japan.
Tohoku University Graduate School of Dentistry, Department of International and Community Oral Health, Sendai, Japan.
Soc Sci Med. 2016 Jul;161:47-54. doi: 10.1016/j.socscimed.2016.05.026. Epub 2016 May 20.
We sought to investigate prospectively the association between exposure to disaster (the 2011 East Japan Earthquake) and change in depressive symptoms among community-dwelling older adult survivors. We used two waves of data from the Japan Gerontological Evaluation Study (JAGES), an ongoing population-based, prospective cohort study in Japan. A unique feature of our study was the availability of information about mental health status pre-dating the disaster. Our sample comprised community-dwelling survivors aged 65 and older, who responded to surveys in 2010 (i.e. one year before the disaster) and in 2013 (n = 3464). We categorized disaster exposure according to three types of experiences: loss of family/friends, property damage, and disruption in access to medical service. Our main outcome was change in depressive symptoms, measured by the 15-item geriatric depression scale (GDS). Among the participants, 917 (26.5%) reported losing a family member to the disaster, while a further 537 (15.5%) reported losing a friend. More than half of the participants reported some damage to their homes. After adjusting for demographics and baseline mental health, people whose homes were completely destroyed had significantly elevated depressive symptom scores three years later (+1.22 points, 95%CI: 0.80, 1.64, p < 0.0001). Disruption of psychiatric care was also associated with change in GDS scores (+2.51 points, 95%CI: 1.28, 3.74, p < 0.0001). By contrast, loss of family/friends was no longer associated with GDS after 3 years; +0.18 points (95%CI: -0.018, 0.37, p = 0.08) for loss of family, and -0.045 points (95%CI: -0.28, 0.19, p = 0.71) for loss of friends. Three years after the disaster, survivors of the 2011 earthquake and tsunami appeared to have recovered from loss of loved ones. By contrast, property loss and disruption of psychiatry care were associated with persistent adverse impact on mental health.
我们试图前瞻性地调查灾难暴露（2011年东日本大地震）与社区居住的老年成年幸存者抑郁症状变化之间的关联。我们使用了来自日本老年学评估研究（JAGES）的两波数据，这是一项正在进行的基于人群的前瞻性队列研究。我们研究的一个独特之处在于可获取灾难发生前的心理健康状况信息。我们的样本包括65岁及以上的社区居住幸存者，他们在2010年（即灾难发生前一年）和2013年回复了调查问卷（n = 3464）。我们根据三种经历类型对灾难暴露进行了分类：失去家人/朋友、财产损失以及医疗服务获取中断。我们的主要结果是抑郁症状的变化，通过15项老年抑郁量表（GDS）进行测量。在参与者中，917人（26.5%）报告在灾难中失去了一名家庭成员，另有537人（15.5%）报告失去了一位朋友。超过一半的参与者报告其房屋有一定程度的损坏。在对人口统计学和基线心理健康进行调整后，房屋被完全摧毁的人在三年后抑郁症状得分显著升高（+1.22分，95%置信区间：0.80，1.64，p < 0.0001）。精神科护理中断也与GDS得分变化相关（+2.51分，95%置信区间：1.28，3.74，p < 0.0001）。相比之下，三年后失去家人/朋友与GDS得分不再相关；失去家人的得分变化为+0.18分（95%置信区间：-0.018，0.37，p = 0.08），失去朋友的得分变化为-0.045分（95%置信区间：-0.28，0.19，p = 0.71）。在灾难发生三年后，2011年地震和海啸的幸存者似乎已从失去亲人的痛苦中恢复过来。相比之下，财产损失和精神科护理中断与对心理健康的持续不利影响相关。
