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Longitudinal Study of the Stress Responses of Local Government Workers Who Have Been Impacted by a Natural Disaster

We conducted 4 times surveys starting from June 2011 and continuing through February 2013, in order to check up stress response of local government workers who suffered The Great East Japan Earthquake (Higashi Nihon Daishinsai) with K6 and Comprehensive Stress Response Inventory (CSI). Our study has three aims. First, we will organize the chronological pattern of stress responses. Second, we will examine how the initial disastrous condition and attributes of survey participants relate to the chronological pattern of subsequent stress responses. Third, we will examine how the current stress responses interplay with the chronological pattern of stress responses. Result of this study show that (1) chronological patterns of stress response are classified into 8 clusters (no-stress response maintaining group, low-stress response maintaining group, low-stress response to no-stress response slow improvement group, middle-stress response to high-stress response slow deteriorated group, middle-stress response to low-stress response slow improvement group, low-stress response to no-stress response rapid improvement group, high-stress response to low-stress response rapid improvement group, severe-stress response maintaining group ――13.55% of local government workers remained at a high level of stress 15 months after the earthquake), (2) damage of domicile and living outside their domiciles relate to stress response of local government workers, (3) two factors of CSI (stress response to a disaster and autonomic symptoms) relate with state at the outset of disaster and other two factors of CSI (anxiety / tense and displeasure / anger) relate with recent conditions. We mainly discussed two themes about point of attention in mental health care for local government workers at a natural disaster and points of attention in assessment of PTSD-like response.


Introduction
This study is primarily designed to examine The types of stressful conditions that are experienced by public servants in the locations impacted by the disaster are grouped into three categories as described below (Wakashima & Noguchi, 2013): (1) Public servants themselves were victims of the disaster: In the early time period following the earthquake and tsunami, some local government workers could not find their own family members, and yet they dedicated their time and effort to supporting their community and its residents. Some workers had lost their homes and family, and yet they served others who had been impacted by the disaster. However, it is considered that even though those service workers may have been mentally hurt, they preferred to continue their activities to serve others instead of becoming inactive and disheartened as victims of the disaster. (2) The increased workload due to the increased needs of victims and public expectations concerning the restoration of towns and cities: From the perspective of the long-term influence on the public servants, the increased workload is one of the most difficult and important issues. When the mental health of the local government workers is considered, the question of how quickly those workers will be able to achieve the restoration of the town while they also maintain the same amount of workload as before the incident should be discussed. (3) The increase amount of complaints/concerns received from residents: Due to the consciousness of their professional responsibilities as public servants, there is the potential risk that local government workers may lose themselves in the significance in their jobs because of the constant complaints and demands that are continuously received from residents, and this may cause them to lose confidence in themselves.
Under the stressful conditions described above, local government workers have been playing a central role in the recovery and restoration of their towns. In this regard, the purpose of our study is to focus on those workers as our subjects and to examine their responses to stressors in following the occurrence of a natural disaster in chronological order. Our study is also aimed at clarifying several aspects.
First, we will organize the chronological pattern of stress responses. Second, we will examine how the initial disastrous condition and attributes of survey participants relate to the chronological pattern of subsequent stress responses. Third, we will examine how the current stress responses interplay with the chronological pattern of stress responses.

Results
For the purpose of organizing the stress response patterns in a chronological order, we placed the values of "communication with co-workers," "asleep condition," and "scores of K6" that were collected from the 1st investigation through the 3rd investigation into categorical variables and conducted a cluster analysis in accordance with the Ward method.
Severe-stress response maintaining group (n=42). In order to explain the foundation of naming each cluster, particular features of each cluster are described in Table 2, and descriptive   statistics are shown from Tables 3 through   Table 5, followed by the profile of each cluster in Figure 1.
In regard to naming clusters, we referred classification of Wakashima, Kozuka, Noguchi et al. (2012). In this study, we took score of K6 as the criterion of severity of stress response. A range of 0 to 3 is defined as "no-stress response", 4 to 9 is defined as "low-stress response", 10 to 12 is defined as "middle-stress response", and not lower than 13 is defined as "high-stress response" or "severe-stress response". Initial expression of each cluster mentions degree of stress response at 1 st investigation. Depending on changes over time, we added to corresponding words (maintaining, improvement, or deteriorated). Furthermore, "rapid" and "slow" indicate the moment when severity of stress response changed. "Rapid" means that changes resulted between 1 st investigation and 2 nd investigation. "Slow" means that changes resulted between 2 nd investigation and 3 rd investigation. Table12. Descriptive Statistics about CSI and K6 (Mean of Rank) Note: The number framed by circle indicate the time of investigation."General-stress response" means sum of "Anxiety / tense", "Displeasure / anger" and "Autonomic symptom". In this regard, we conducted multiple comparisons of those dependent variables in accordance with the Mann-Whitney U-test (the Type I error rate was 5%).  In particular, C1 indicates the significantly lower mean value than C3, C7, C2, and C5.
Furthermore, the mean values of C6 and C3 are also significantly lower than C2 and C5.
In terms of multiple comparisons involving displeasure/anger in CSI, the mean values of the no-stress response maintaining group (C1), the low-stress response to no-stress response rapid improvement group (C6), the low-stress response to no-stress response slow improvement group (C3), the high-stress response to low stress response rapid improvement group (C7), the middle-stress  In particular, the mean value of C1 is significantly lower than that of C3. Similarly, In terms of general-stress response (sum of "anxiety / tense", "displeasure / anger", and "autonomic symptom) and PTSD-like response (sum of four factors), severe-stress response maintaining group (C8) and middle-stress response to high-stress response slow deteriorated group (C4) are worst, and low-stress response maintaining group (C2) and middle-stress response to low-stress response slow improvement group (C5) indicate relatively high score. The order of score is common in both clusters. This common point means that the score of general-stress response is able to drive up the score of PTSD-like response. Result in this study suggests that the upthrust might make expertise "PTSD develops late" too much.

General overview
First, one of the risk factor in disaster which is able to threat mental health relates circumstances in the aftermath of the disaster