Introduction: Adolescents affected by disasters need mental health support because they tend to be at risk of developing psychiatric disorders and stress as grown-ups. However, it is difficult to develop and validate a support system for adolescents affected by disasters because it is unknown when and where disasters occur, and there is inadequate data related to this in Japan. Methods: To address these issues, we present a mental health support system for high school students affected by the Great East Japan Earthquake. We hypothesized that mental health support could be provided by classroom teachers and school nurses, who are familiar with high school students. We investigated the psychological state of the affected high school students for three years after the earthquake, and the students in psychological crises received interventions from their class teachers and school nurses. Results: The intervention resulted in improvements in depression and post-traumatic stress reaction (PTSR). Conclusion: These results suggest that our high school-based intervention is a feasible solution for mental health support for adolescents affected by the disaster.

1. [1] L. Morgan et al., “The Aberfan disaster: 33-year follow-up of survivors,” Br. J. Psychiatry, Vol.182, No.6, pp. 532-536, 2003.
2. [2] W. Yele et al., “The long-term psychological effects of a disaster experienced in adolescence: I: The incidence and course of PTSD,” J. Child. Psychol. Psychiatry, Vol.41, No.4, pp. 503-511, 2000.
3. [3] D. Bolton et al., “The long-term psychological effects of a disaster experienced in adolescence: II: General psychopathology,” J. Child. Psychol. Psychiatry, Vol.41, No.4, pp. 513-523, 2000.
4. [4] A. K. Goenjian et al., “Posttraumatic stress disorder 23 years after the 1988 Spitak Earthquake in Armenia,” J. Trauma Stress, Vol.31, No.1, pp. 47-56, 2018.
5. [5] R. M. Hiller et al., “Research review: Changes in the prevalence and symptom severity of child post-traumatic stress disorder in the year following trauma – a meta-analytic study,” J. Child. Psychol. Psychiatry, Vol.57, No.8, pp. 884-898, 2000.
6. [6] O. Udwin et al., “Risk factors for long-term psychological effects of a disaster experienced in adolescence: predictors of post traumatic stress disorder,” J. Child. Psychol. Psychiatry, Vol.41, No.8, pp. 969-979, 2000.
7. [7] V. Khachadourian et al., “Loss and psychosocial factors as determinants of quality of life in a cohort of earthquake survivors,” Health Qual. Life Outcomes, Vol.13, pp. 740-741, 2015.
8. [8] M. Uemoto et al., “Kobe earthquake and post-traumatic stress in school-aged children,” Int. J. Behav., Vol.19, No.3, pp. 243-251, doi: 10.1007/s12529-011-9184-3, 2012.
9. [9] H. Kaye-Kauderer et al., “Narratives of resilience in medical students following the 3/11 triple disaster: Using thematic analysis to examine paths to recovery,” Psychiatry Res., Vol.292, Article No.113348, doi: 10.1016/j.psychres.2020.113348, 2020.
10. [10] F. Hayashi et al., “Changes in the mental health status of adolescents following the Fukushima Daiichi nuclear accident and related factors: Fukushima Health Management Survey,” J. Affect. Disord., Vo.260, pp. 432-439, doi: 10.1016/j.jad.2019.09.045, 2020.
11. [11] J. Okuyama et al., “School-Based Interventions Aimed at the Prevention and Treatment of Adolescents Affected by the 2011 Great East Japan Earthquake: A Three-Year Longitudinal Study,” Tohoku J. Exp. Med., Vol.242, No.3, pp. 203-213, doi: 10.1620/tjem.242.203, 2017.
12. [12] Y. Kunii et al., “Severe Psychological Distress of Evacuees in Evacuation Zone Caused by the Fukushima Daiichi Nuclear Power Plant Accident: The Fukushima Health Management Survey,” PLoS One, Vo.11, No.7, Article No.e0158821, doi: 10.1371/journal.pone.0158821, 2016.
13. [13] M. Usami et al., “Prosocial behaviors during school activities among child survivors after the 2011 earthquake and Tsunami in Japan: a retrospective observational study,” PLoS One, Vol.9, No.11, Article No.e113709, doi: 10.1371/journal.pone.0113709, 2014.
14. [14] S. Funakoshi et al., “Factors associated with the psychological impact of the Great East Japan earthquake on high school students 1 year and 4 months after the disaster,” Seishin Shinkeigaku Zasshi, Vol.116, No.7, pp. 541-554, 2014.
15. [15] W. Tang et al., “Impact of earthquake exposure, family adversity and peer problems on anxiety-related emotional disorders in adolescent survivors three years after the Ya’an earthquake,” J. Affect. Disord., Vol.273, pp. 215-222, doi: 10.1016/j.jad.2020.04.044, 2020.
16. [16] W. Wang et al., “Moderating role of social support in the relationship between posttraumatic stress disorder and antisocial behavior in adolescents after the Ya’an earthquake,” Psych. J., Vol.9, No.3, pp. 350-358, doi: 10.1002/pchj.343, 2020.
17. [17] X. Zhou et al., “Self-esteem and hope mediate the relations between social support and post-traumatic stress disorder and growth in adolescents following the Ya’an earthquake,” Anxiety Stress Coping, Vol.31, No.1, pp. 32-45, doi: 10.1080/10615806.2017.1374376, 2018.
18. [18] W. Tang et al., “Mental health problems among children and adolescents experiencing two major earthquakes in remote mountainous regions: A longitudinal study,” Compr. Psychiatry, Vol.72, pp. 66-73, doi: 10.1016/j.comppsych.2016.09.004, 2017.
19. [19] E. B. Thordardottir et al., “Development and predictors of psychological outcomes following the 2008 earthquake in Iceland: a longitudinal cohort study,” Scand. J. Public Health, Vol.47, No.2, pp. 269-279, doi: 10.1177/1403494818771444, 2019.
20. [20] W. W. Kung et al., “Posttraumatic stress disorder in the short and medium term following the World Trade Center attack among Asian Americans,” J. Community Psychol., Vol.46, No.8, pp. 1075-1091, doi: 10.1002/jcop.22092, 2018.
21. [21] S. Ravindran et al., “Crossing barriers: Role of a tele-outreach program addressing psychosocial needs in the midst of COVID-19 pandemic,” Asian J. Psychiatr., Vol.53, Article No.102351, doi: 10.1016/j.ajp.2020.102351, 2020.
22. [22] W. Tang et al., “Prevalence and correlates of PTSD and depressive symptoms one month after the outbreak of the COVID-19 epidemic in a sample of home-quarantined Chinese university students,” J. Affect. Disord. Vol.274, pp. 1-7, doi: 10.1016/j.jad.2020.05.009, 2020.
23. [23] T. Serikawa et al., “Spatial Distribution of Causes of Death in the 2011 Tohoku Tsunami at Ishinomaki City, Miyagi Prefecture,” J. Disaster Res., Vol.15, No.7, pp. 943-958, 2020.
24. [24] S. Seto, “Classification of tsunami deaths by modifying ICD-10 categories in the 2011 Tohoku earthquake tsunami – A case study in Miyagi prefecture,” Int. J. Disaster Risk Reduct., Vol.50, Article No.101743, 2020.
25. [25] M. Orgilés et al., “Coping Behaviors and Psychological Disturbances in Youth Affected by the COVID-19 Health Crisis,” Front. Psychol., Vol.12, doi: 10.3389/fpsyg.2021.565657, 2021.
26. [26] N. Nakaya et al., “Prospect of future housing and risk of psychological distress at 1 year after an earthquake disaster,” Psychiatry Clin. Neurosci., Vol.70, No.4, pp. 182-189, 2016.
27. [27] N. Tsuchiya et al., “Impact of social capital on psychological distress and interaction with house destruction and displacement after the Great East Japan Earthquake of 2011,” Psychiatry Clin. Neurosci., Vol.71, pp. 52-60, 2017.
28. [28] N. Nakaya et al., “Effect of tsunami drill experience on evacuation behavior after the onset of the Great East Japan Earthquake,” Int. J. of Disaster Risk Reduction, Vol.28, pp. 206-213, 2018.
29. [29] K. Matsumoto, “Mental health care systems and provisions in the immediate and acute phase of the Great East Japan Earthquake: situational and support activities in Miyagi Prefecture,” Seishin Shinkeigaku Zasshi, Vol.116, No.3, pp. 175-188, 2014.
30. [30] M. Kurosawa et al., “Support of psychiatric care at Great Earthquake of Eastern Japan and a workshop for reconstructive measures (1),” Seishin Shinkeigaku Zasshi, Vol.113, No.8, pp. 749-772, 2011.
31. [31] J. Okuyama et al., “Mental health and school-based intervention among adolescent exposed to the 2011 Great East Japan Earthquake and tsunami,” Int. J. of Disaster Risk Reduction, Vol.24, pp. 183-188, 2017.
32. [32] J. Okuyama et al., “Longitudinal characteristics of resilience among adolescents: A high school student cohort study to assess the psychological impact of the Great East Japan Earthquake,” Psychiatry Clin. Neurosci., Vol.72, No.11, pp. 821-835, 2018.
33. [33] A. J. Rush et al., “The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression,” Biol. Psychiatry, Vol.54, No.5, pp. 573-583, 2003.
34. [34] D. Fujisawa et al., “Development of the Japanese version of the self-administered brief depression scale (QIDS-SR),” Stress Science, Vol.25, pp. 43-52, 2010.
35. [35] W. W. Zung et al., “The comorbidity of anxiety and depression in general medical patients: a longitudinal study,” J. Clin. Psychiatry., Vol.51, pp. 77-80, 1990.
36. [36] H. Okamura et al., “Reliability and Validity of the Self-Rated Anxiety Scale (SAS),” Psychiatric Diagnosis., Vol.2, pp. 113-119, 1991.
37. [37] M. Horowitz et al., “Impact of Event Scale: a measure of subjective stress,” Psychosom. Med., Vol.41, No.3, pp. 209-218, 1979.
38. [38] N. Asukai, “Anxiety disorders, posttraumatic stress disorder (PTSD),” J. of Clinical Psychiatry, Vol.28, pp 171-177, 1999.
39. [39] A. K. Langley et al., “Bounce back: Effectiveness of an elementary school-based intervention for multicultural children exposed to traumatic events,” J. Consult. Clin. Psychol., Vol.83, No.5, pp. 853-865, 2015.
40. [40] C. M. Chemtob et al., “Psychosocial intervention for postdisaster trauma symptoms in elementary school children: a controlled community field study,” Arch. Pediatr. Adolesc. Med., Vol.156, No.3, pp. 211-216, 2002.
41. [41] L. Wolmer et al., “Teacher-mediated intervention after disaster: A controlled three-year follow-up of children’s functioning,” J. Child Psychol. Psychiatry, Vol.46, No.11, pp. 1161-1168, 2005.