title: Clinically significant behavior problems among young children 2 years after the Great East Japan Earthquake.
abstract: BACKGROUND
  On March 11, 2011, a massive undersea earthquake and tsunami struck East Japan. Few studies have investigated the impact of exposure to a natural disaster on preschool children. We investigated the association of trauma experiences during the Great East Japan Earthquake on clinically significant behavior problems among preschool children 2 years after the earthquake.
  
  
  METHODS
  Participants were children who were exposed to the 2011 disaster at preschool age (affected area, n = 178; unaffected area, n = 82). Data were collected from September 2012 to June 2013 (around 2 years after the earthquake), thus participants were aged 5 to 8 years when assessed. Severe trauma exposures related to the earthquake (e.g., loss of family members) were assessed by interview, and trauma events in the physical environment related to the earthquake (e.g. housing damage), and other trauma exposure before the earthquake, were assessed by questionnaire. Behavior problems were assessed by caregivers using the Child Behavior Checklist (CBCL), which encompasses internalizing, externalizing, and total problems. Children who exceeded clinical cut-off of the CBCL were defined as having clinically significant behavior problems.
  
  
  RESULTS
  Rates of internalizing, externalizing, and total problems in the affected area were 27.7%, 21.2%, and 25.9%, respectively. The rate ratio suggests that children who lost distant relatives or friends were 2.36 times more likely to have internalizing behavior problems (47.6% vs. 20.2%, 95% CI: 1.10-5.07). Other trauma experiences before the earthquake also showed significant positive association with internalizing, externalizing, and total behavior problems, which were not observed in the unaffected area.
  
  
  CONCLUSIONS
  One in four children still had behavior problems even 2 years after the Great East Japan Earthquake. Children who had other trauma experiences before the earthquake were more likely to have behavior problems. These data will be useful for developing future interventions in child mental health after a natural disaster.
authors.affiliation: Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Fujiwara
authors.affiliation: Department of Neuropsychiatry, Iwate Medical University, Iwate, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Yagi
authors.affiliation: Miyagi Prefectural Comprehensive Children's Center, Miyagi, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Homma
authors.affiliation: Department of Neuropsychiatry, Fukushima Medical University, Fukushima, Japan.
authors.forename: Hirobumi
authors.initials: H
authors.lastname: Mashiko
authors.affiliation: Nagao Mental Clinic, Mie, Japan.
authors.forename: Keizo
authors.initials: K
authors.lastname: Nagao
authors.affiliation: Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Makiko
authors.initials: M
authors.lastname: Okuyama
mesh_terms: D017028:Caregivers / Q000523:psychology; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology* / Q000473:pathology; D002675:Child, Preschool; D055866:Earthquakes; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011795:Surveys and Questionnaires