title: Prevalence of insomnia among residents of Tokyo and osaka after the great East Japan earthquake: a prospective study.
abstract: BACKGROUND
  The Great East Japan Earthquake occurred on March 11, 2011. Tokyo and Osaka, which are located 375 km and 750 km, respectively, from the epicenter, experienced tremors of 5.0 lower and 3.0 seismic intensity on the Japan Meteorological Agency scale. The Great East Japan Earthquake was the fourth largest earthquake in the world and was accompanied by a radioactive leak at a nuclear power plant and a tsunami. In the aftermath of a disaster, some affected individuals presented to mental health facilities with acute stress disorder (ASD) and/or post-traumatic stress disorder (PTSD). However, few studies have addressed mental stress problems other than ASD or PTSD among the general public immediately after a disaster. Further, the effects of such a disaster on residents living at considerable distances from the most severely affected area have not been examined.
  
  
  OBJECTIVE
  This study aimed to prospectively analyze the effect of a major earthquake on the prevalence of insomnia among residents of Tokyo and Osaka.
  
  
  METHODS
  A prospective online questionnaire study was conducted in Tokyo and Osaka from January 20 to April 30, 2011. An Internet-based questionnaire, intended to be completed daily for a period of 101 days, was used to collect the data. All of the study participants lived in Tokyo or Osaka and were Consumers' Co-operative Union (CO-OP) members who used an Internet-based food-ordering system. The presence or absence of insomnia was determined before and after the earthquake. These data were compared after stratification for the region and participants' age. Multivariate analyses were conducted using logistic regression and a generalized estimating equation. This study was conducted with the assistance of the Japanese CO-OP.
  
  
  RESULTS
  The prevalence of insomnia among adults and minors in Tokyo and adults in Osaka increased significantly after the earthquake. No such increase was observed among minors in Osaka. The overall adjusted odds ratios for the risk of insomnia post-earthquake versus pre-earthquake were 1.998 (95% CI 1.571-2.542) for Tokyo, 1.558 (95% CI 1.106-2.196) for Osaka, and 1.842 (95% CI,1.514-2.242) for both areas combined.
  
  
  CONCLUSIONS
  The prevalence of insomnia increased even in regions that were at a considerable distance from the epicenter. Both adults and minors in Tokyo, where the seismic intensity was greater, experienced stress after the earthquake. In Osaka, where the earthquake impact was milder, disturbing video images may have exacerbated insomnia among adults.
authors.affiliation: Health Management and Policy, Department of Public Health, Nara Medical University School of Medicine, Kashihara, Japan. tomomarie@smn.enjoy.ne.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sugiura
authors.forename: Manabu
authors.initials: M
authors.lastname: Akahane
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ohkusa
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Okabe
authors.forename: Tomomi
authors.initials: T
authors.lastname: Sano
authors.forename: Noriko
authors.initials: N
authors.lastname: Jojima
authors.forename: Harumi
authors.initials: H
authors.lastname: Bando
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Imamura
keywords: Web-based survey; disaster; earthquakes; insomnia; nuclear accidents; population surveillance