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Markedly higher mortality among psychiatric inpatients mandatorily evacuated after the Fukushima Daiichi Nuclear Power Plant accident

Several articles have reported long-term outcomes and factors related to mortality among evacuated hospitalized patients or nursing home residents after the Fukushima Daiichi Nuclear Power Plant accident associated with the Great East Japan Earthquake, but little is known about these outcomes among psychiatric inpatients. After the first hydrogen explosion of the Number 1 reactor in the afternoon of 12 March 2011, the Japanese government issued a mandatory evacuation order for all residents within a 20-km radius of the plant, which included Soso area. Consequently, five psychiatric hospitals, including general hospitals with psychiatry units, were closed in the Soso area of Fukushima Prefecture. Within a few days after that, the psychiatric inpatients completed the transfer via buses and were temporarily housed at a meeting room in Minamisoma city, 26 km northwest of the plant. As a result of the mandatory evacuation order, more than 700 psychiatric inpatients were evacuated within and outside of Fukushima Prefecture. We investigated the long-term outcomes, particularly mortality, of all psychiatric inpatients evacuated from hospitals in the mandatory-evacuation-order area using data owned by Fukushima Prefecture. The target population for analysis was 789 psychiatric inpatients who were evacuated immediately from hospitals located within the government-designated evacuation zone, which included Soso area. We used the data of this population provided by Fukushima Prefecture, including patients’ age, sex, cities they had lived in, hospitals in which they had been during the disaster, prefectures and hospitals where they had been transferred immediately post-disaster, and status (living or deceased) in each year. There was no information, however, about their psychiatric diagnoses. Of the inpatients, 165 were excluded because they had been hospitalized outside the mandatory-evacuation-order area, and one was excluded because of missing data, resulting in 623 inpatients who were the target population for analysis. In this study we examined the standardized mortality ratio (SMR) of inpatients evacuated as a primary outcome. The SMR of all inpatients and dichotomized groups (i.e., inpatients evacuated within or outside Fukushima Prefecture) from 2011 to 2017 were computed and compared. The Japanese Ministry of Health, Labour and Welfare’s 2010 age-specific death rates were adopted as expected mortality rates to calculate SMR. Microsoft EXCEL 2016 was used for calculations. All analyses in this study were conducted anonymously in an unlinkable fashion. The Institutional Review Board at Fukushima Medical University waived the need for patient consent for this retrospective review as all data were anonymized and kept confidential. Figure 1 compares the SMR of the psychiatric inpatients within to those transferred to hospitals outside the prefecture after the accident. The SMR of all psychiatric inpatients in 2011 was seriously high (3.33; 95% confidence interval [CI], 2.53–4.29), particularly for inpatients evacuated within Fukushima Prefecture (5.43; 95%CI, 3.82–7.49) compared with that for inpatients evacuated outside the prefecture (2.02; 95%CI, 1.26–3.05). Furthermore, although the SMR subsequently decreased, high SMR have persisted to the present. The current study is the first report about mortality among inpatients who were evacuated after the Fukushima nuclear accident from psychiatric hospitals or units. Moreover, we have revealed markedly higher mortality among these inpatients, which is consistent with the results of previous reports targeting evacuees who were almost entirely non-psychiatric inpatients or nursing home residents. 4 There are several possible reasons for this shocking result. First, it is assumed from the older ages of the psychiatric inpatients in this study that most of them had some physical complications (ref: mean age of 789 inpatients = 65 20 16 31 years), which were possibly the chief causes of the marked increase in the SMR at least regarding the first post-disaster year. Second, it seems reasonable that the psychological and physical burdens associated with evacuation, including transfer to a distant hospital and separation from families and communities, influenced the SMR of these inpatients, but it is difficult to explain the ratios beyond the first year using these burdens. The ratios might be related to these patients’ low stress tolerance combined with physical complications. Further, several reports have indicated vulnerability among psychiatric patients after the Fukushima disaster. 6 Consequently, we should be particularly cautious about susceptibility of these socially vulnerable people during emergency periods after disasters.