Skip to main content Accessibility help

Gender-Based Risk and Protective Factors for Psychological Distress in the Midterm Recovery Period Following the Great East Japan Earthquake

  • Aya Ishiguro (a1) (a2), Machiko Inoue (a3) (a4), Jane Fisher (a1), Mariko Inoue (a5), Shoko Matsumoto (a5) (a6) and Kazue Yamaoka (a5)...



Women and men might experience psychological distress differently during a disaster. This study investigated gender differences in the factors associated with psychological distress among working-age people 1 to 2 years after the Great East Japan Earthquake.


A cross-sectional household survey of victims who remained living in their homes was conducted between May and December 2012 in Ishinomaki City, Japan. Psychological distress was defined as a Kessler Psychological Distress Scale ≥5, and gender differences were examined using a logistic regression analysis.


Data were obtained from 2593 individuals, and 1537 participants were included in the analyses. Psychological distress was observed in 28.0% of the participants. Living in a household without a salaried income and a low frequency of leaving the house were associated with psychological distress among women. Young age, lack of occupation and no informational support were associated with psychological distress among men. Income change due to the disaster and health complaints were associated with psychological distress in both genders.


For women, stable household income and frequently leaving the house can be protective factors. For men, intervention focusing on young people, occupational support, and informational support may be useful. Income change after the disaster and health complaints may be risk factors in both genders.


Corresponding author

Correspondence and reprint requests to Aya Ishiguro, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan (e-mail:


Hide All
1. Norris, FH, Friedman, MJ, Watson, PJ, et al. 60,000 disaster victims speak, I: an empirical review of the empirical literature, 1981-2001. Psychiatry. 2002;65(3):207239.
2. Lavie, P. Sleep disturbances in the wake of traumatic events. N Engl J Med. 2001;345(25):18251832.
3. Matsumoto, S, Yamaoka, K, Inoue, M, et al. Implications for social support on prolonged sleep difficulties among a disaster-affected population: second report from a cross-sectional survey in Ishinomaki, Japan. PLoS One. 2015;10(6):e0130615. doi: 10.1371/journal.pone.0130615
4. Pietrzak, RH, Van Ness, PH, Fried, TR, et al. Trajectories of posttraumatic stress symptomatology in older persons affected by a large-magnitude disaster. J Psychiatr Res. 2013;47(4):520526. doi: 10.1016/j.jpsychires.2012.12.005
5. Tang, B, Liu, X, Liu, Y, et al. A meta-analysis of risk factors for depression in adults and children after natural disasters. BMC Public Health. 2014;14:623. doi: 10.1186/1471-2458-14-623
6. Suzuki, Y, Tsutsumi, A, Fukasawa, M, et al. Prevalence of mental disorders and suicidal thoughts among community-dwelling elderly adults 3 years after the Niigata-Chuetsu earthquake. J Epidemiol. 2011;21(2):144150.
7. Montazeri, A, Baradaran, H, Omidvari, S, et al. Psychological distress among Bam earthquake survivors in Iran: a population-based study. BMC Public Health. 2005;5:4. doi: 10.1186/1471-2458-5-4
8. Pan, A, Rexrode, KM. Psychological distress as a risk factor for death from cerebrovascular disease. CMAJ. 2012;184(13):14531454. doi: 10.1503/cmaj.121288
9. Nakamura, K, Kitamura, K, Someya, T. Psychological recovery 5 years after the 2004 Niigata-Chuetsu earthquake in Yamakoshi, Japan. J Epidemiol. 2014;24(2):125131. doi: 10.2188/jea.JE20130097
10. Pietrzak, RH, Tracy, M, Galea, S, et al. Resilience in the face of disaster: prevalence and longitudinal course of mental disorders following hurricane Ike. PLoS One. 2012;7(6):e38964. doi: 10.1371/journal.pone.0038964
11. Phifer, JF, Norris, FH. Psychological symptoms in older adults following natural disaster: nature, timing, duration, and course. J Gerontol. 1989;44(6):S207S212. doi: 10.1093/geronj/44.6.S207
12. The United Nations Secretariat for International Strategy for Disaster Reduction. Sendai Framework for Disaster Risk Reduction 2015-2030. Published 2015. Accessed May 31, 2016.
13. Neumayer, E, Plümper, T. The gendered nature of natural disasters: the impact of catastrophic events on the gender gap in life expectancy, 1981-2002. Ann Assoc Am Geogr. 2008;97(3):551566. doi: 10.1111/j.1467-8306.2007.00563.x
14. Nakahara, S, Ichikawa, M. Mortality in the 2011 tsunami in Japan. J Epidemiol. 2013;23(1):7073.
15. Ishiguro, A, Yano, E. Tsunami inundation after the Great East Japan Earthquake and mortality of affected communities. Public Health. 2015;129(10):13901397. doi: 10.1016/j.puhe.2015.06.016
16. Enarson, E, Chakrabarti, PGD. Women, Gender and Disaster: Global Issues and Initiatives. New Delhi: SAGE India; 2009.
17. Norris, FH, Friedman, MJ, Watson, PJ. 60,000 disaster victims speak, II: summary and implications of the disaster mental health research. Psychiatry. 2002;65(3):240260. doi: 10.1521/psyc.
18. Amaratunga, CA, O’Sullivan, TL. In the path of disasters: psychosocial issues for preparedness, response, and recovery. Prehosp Disaster Med. 2006;21(3):149155. doi: 10.1017/S1049023X00003605
19. Phillips, BD. Disaster Recovery. New York: Taylor & Francis Group; 2009.
20. Wisner, B, Adams, J. Environmental health in emergencies and disasters: a practical guide. World Health Organization website. Published 2002. Accessed December 20, 2015.
21. Japan National Council of Social Welfare. Report on Disaster Volunteer Center, Great East Japan Earthquake and Tsunami [in Japanese]. Published 2011. Accessed December 10, 2015.
22. Cabinet Office, Government of Japan. White Paper on Disaster Management 2011. Published 2011. Accessed February 24, 2016.
23. National Police Agency of Japan. Damage Situation and Police Countermeasures Associated With 2011 Tohoku District - Off the Pacific Ocean Earthquake. Published 2013. Accessed May 31, 2016.
24. Harada, N, Shigemura, J, Tanichi, M, et al. Mental health and psychological impacts from the 2011 Great East Japan Earthquake Disaster: a systematic literature review. Disaster Mil Med. 2015; 1(1):17. doi: 10.1186/s40696-015-0008-x
25. Statistics Bureau, Ministry of Internal Affairs and Communications. 2010 Population Census. Accessed May 31, 2016.
26. Oyama, M, Nakamura, K, Suda, Y, et al. Social network disruption as a major factor associated with psychological distress 3 years after the 2004 Niigata-Chuetsu earthquake in Japan. Environ Health Prev Med. 2012;17(2):118123. doi: 10.1007/s12199-011-0225-y
27. Yokoyama, Y, Otsuka, K, Kawakami, N, et al. Mental health and related factors after the Great East Japan earthquake and tsunami. PLoS One. 2014;9(7):e102497. doi: 10.1371/journal.pone.0102497
28. Chen, C-H, Tan, HK-L, Liao, L-R, et al. Long-term psychological outcome of 1999 Taiwan earthquake survivors: a survey of a high-risk sample with property damage. Compr Psychiatry. 2007;48(3):269275. doi: 10.1016/j.comppsych.2006.12.003
29. Cao, X, Jiang, X, Pang, S, et al. The prevalence and risk factors for psychological distress in older men and women affected by the Wenchuan, China earthquake. Australas J Ageing. 2014;33(3):E20E26. doi: 10.1111/ajag.12039
30. Seplaki, CL, Goldman, N, Weinstein, M, et al. Before and after the 1999 Chi-Chi earthquake: traumatic events and depressive symptoms in an older population. Soc Sci Med. 2006;62(12):31213132. doi: 10.1016/j.socscimed.2005.11.059
31. Kiliç, C, Aydin, I, Taşkintuna, N, et al. Predictors of psychological distress in survivors of the 1999 earthquakes in Turkey: effects of relocation after the disaster. Acta Psychiatr Scand. 2006;114(3):194202. doi: 10.1111/j.1600-0447.2006.00786.x
32. Teramoto, C, Matsunaga, A, Nagata, S. Cross-sectional study of social support and psychological distress among displaced earthquake survivors in Japan. Jpn J Nurs Sci. 2015;12(4):320329. doi: 10.1111/jjns.12071
33. Ishiguro, A, Togita, Y, Inoue, M, et al. Identification of disaster-vulnerable communities by use of census data prior to the Great East Japan Earthquake. Disaster Med Public Health Prep. 2015;9(01):1928. doi: 10.1017/dmp.2014.164
34. Brekman, LF, Kawachi, I. Social Epidemiology. New York: Oxford University Press; 2000.
35. Inoue, M, Matsumoto, S, Yamaoka, K, et al. Risk of social isolation among Great East Japan Earthquake survivors living in tsunami-affected Ishinomaki, Japan. Disaster Med Public Health Prep. 2014;8(4):333340. doi: 10.1017/dmp.2014.59
36. Statistics Bureau, Ministry of Internal Affairs and Communications. Data of East Pacific Ocean coast region and data related to disaster [in Japanese]. Published 2013. Accessed December 20, 2015.
37. Muto, S. Zaitaku Iryokara Ishinomakino Fukkoni Nozonda 731 Nichikan (731 Days of the Challenge to Reconstruct Ishinomaki by Home-Visit Medical Care) [in Japanese]. Tokyo, Japan: Nikkei BP; 2013.
38. Matsumoto, S, Yamaoka, K, Inoue, M, et al. Social ties may play a critical role in mitigating sleep difficulties in disaster-affected communities: a cross-sectional study in the Ishinomaki area, Japan. Sleep. 2014;37(1):137145. doi: 10.5665/sleep.3324
39. Furukawa, H, Takeuchi, T, Yano, E, et al. Factors influencing psychological distress after the Great East Japan Earthquake and Tsunami. J Community Psychol. 2015; 43(5):521526. doi: 10.1002/jcop.21695
40. Kessler, RC, Andrews, G, Colpe, LJ, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959976. doi: 10.1017/S0033291702006074
41. Furukawa, TA, Kawakami, N, Saitoh, M, et al. The performance of the Japanese version of the K6 and K10 in the World Mental Health Survey Japan. Int J Methods Psychiatr Res. 2008;17(3):152158. doi: 10.1002/mpr.257
42. Sakurai, K, Nishi, A, Kondo, K, et al. Screening performance of K6/K10 and other screening instruments for mood and anxiety disorders in Japan. Psychiatry Clin Neurosci. 2011;65(5):434441. doi: 10.1111/j.1440-1819.2011.02236.x
43. World Economic Forum. The Global Gender Gap Report 2015. Accessed December 21, 2015.
44. Gender Equality Bureau, Cabinet Office. Learning From Adversity. Published 2014. Accessed January 13, 2016.
45. Backhans, MC, Hemmingsson, T. Unemployment and mental health -who is (not) affected? Eur J Public Health. 2012;22(3):429433. doi: 10.1093/eurpub/ckr059
46. Fujita, K, Fujiwara, Y, Kumagai, S, et al. The frequency of going outdoors, and physical, psychological and social functioning among community-dwelling older adults. Japanese J public Heal. 2004;51(3):168180.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Disaster Medicine and Public Health Preparedness
  • ISSN: 1935-7893
  • EISSN: 1938-744X
  • URL: /core/journals/disaster-medicine-and-public-health-preparedness
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary materials

Ishiguro et al. supplementary material
Ishiguro et al. supplementary material 1

 Word (21 KB)
21 KB


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