Mental health of nurses after the Fukushima complex disaster: a narrative review

Nukui, Hiroshi; Midorikawa, Sanae; Murakami, Michio; Maeda, Masaharu; Ohtsuru, Akira

Exposure to disasters is common worldwide, and individuals severely exposed to disasters, particularly artificial disasters, may develop posttraumatic stress disorder (PTSD) or other mental disorders [1, 2] . Certain occupational factors and certain disaster characteristics are strongly associated with psychological distress among disaster responders [3] [4] [5] . The Great East-Japan Earthquake, accompanied by a huge Tsunami on 11 March 2011, was an unprecedented complex disaster that caused more than 18 000 deaths and missing people and was followed by the nuclear accident at the Fukushima Daiichi NPP [6] . The nuclear accident had a large negative impact, and rebuilding of the community of Fukushima has been notably slow over the past 6 years. Although it has been reported that the level of additional external and internal radiation exposure from this nuclear accident was much lower than the minimum dose level that causes direct negative health effects [7] ,the residents' anxiety regarding radiation exposure and health risks is yet to be resolved [5] . A survey of public perception of radiation in Fukushima city conducted in May 2014 revealed that 70-80% of residents had experienced anxiety regarding the health risks of radiation exposure to themselves or their families following the nuclear accident [8] . It has been documented that the Three Mile Island NPP accident in the USA in 1979 and the Chernobyl nuclear accident in the former Soviet Union in 1986 significantly influenced the residents mentally [9] . The decommissioning work at the Fukushima Daiichi NPP is expected to continue for a long time, and, as for the Three Mile Island and the Chernobyl accidents, health-care workers, especially public health nurses and hospital nurses, are often asked by the residents about the health risks of the radiation exposure after the disaster [10] . At the same time, the health-care workers are also residents who have their own concerns regarding radiation exposure and the health risks to themselves and their families, which tends to be a mental burden for them. Although the role of nurses in providing mental health care for disaster victims has been extensively studied, the mental health of the nurses themselves in a disaster area has not been sufficiently considered [11] [12] [13] . As shown in Table 1 , there are a few studies focusing on the mental health of nurses in disaster zones [3, [13] [14] [15] . In this review, we looked at the factors affecting mental health and the narrative stories describing resilience in nurses working in the face of disaster, also reviewing the mental health-related findings for residents who experienced the Fukushima disaster or similar disasters, such as atomic bomb.