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Soc Psychiatry Psychiatr Epidemiol (2016) 51:1117–1123

DOI 10.1007/s00127-016-1227-2


Does social capital reduce child behavior problems? Results
from the Great East Japan Earthquake follow-up
for Children Study
Junko Yagi1 • Takeo Fujiwara2,3 • Takehito Yambe1 • Makiko Okuyama4 •

Ichiro Kawachi5 • Akio Sakai1

Received: 20 May 2015 / Accepted: 16 April 2016 / Published online: 11 May 2016
Ó Springer-Verlag Berlin Heidelberg 2016

Abstract social capital and child behavior problems was mediated by
Purpose We sought to investigate the association between caregiver’s mental health status.
social capital and child behavior problems in Iwate pre- Results Children of caregivers who perceived higher
fecture, Japan, in the aftermath of the 2011 Great East community social capital (trust and mutual aid) showed
Japan Earthquake. fewer PTSD symptoms. Furthermore, caregiver’s mental
Methods Children and their caregivers were recruited from health mediated the association between social trust and
four nursery schools in coastal areas affected by the tsu- child PTSD symptoms. Social capital had no direct impact
nami, as well as one in an unaffected inland area (N = 94). on child behavior problems.
We assessed the following via caregiver questionnaire: Conclusions Community social capital was indirectly
perceptions of social capital in the community, child associated (via caregiver mental health status) with child
behavior problems (Child Behavior Checklist, Strength and behavior problems following exposure to disaster. Com-
Difficulty Questionnaire), post-traumatic stress disorder munity development to boost social capital among care-
(PTSD) symptoms, child’s exposure to trauma (e.g. loss of givers may help to prevent child behavior problems.
family members), and caregiver’s mental health (Impact of
Event Scale-R for PTSD symptoms; K6 for general mental Keywords Disaster  Child behavior problem  Mental
health). We collected details on trauma exposure by health  Social capital  Post-traumatic stress disorder
interviewing child participants. Structural equation mod-
eling was used to assess whether the association between

In the aftermath of natural disaster, a significant proportion of
& Takeo Fujiwara children exhibit mental health problems, such as depression, post-traumatic stress disorder (PTSD) symptoms, or behavior
problems. For example, after the 2004 Indian Ocean earth-
Department of Psychiatry, Iwate Medical University,
Morioka, Iwate, Japan
quake and tsunami [1–6], Hurricane Katrina in the USA in
2005 [7–10], and the 2008 Sichuan earthquake in China [11–
Department of Social Medicine, National Research Institute
for Child Health and Development, Setagaya-ku, Tokyo,
14], 6–28 % of children were reported to suffer from
Japan depression or PTSD symptoms. Further, 15–30 % of pre-
Department of Global Health Promotion, Tokyo Medical and
school children who experienced high-intensity trauma dur-
Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, ing the World Trade Center terrorist attacks, such as
Japan witnessing the towers collapse, later showed behavioral
Department of Psychosocial Medicine, National Center for symptoms [15]. Research based on data from the Great East
Child Health and Development, Setagaya-ku, Tokyo, Japan Japan Earthquake Follow-up for Children Study showed that
Department of Social and Behavioral Sciences, Harvard T. 25 % of children had clinically significant behavior problems
H. Chan School of Public Health, Boston, USA even two years after the disaster [16].


The combined total ture. exposure to fire. and as parental/caregiver behavior problems that are internalized (withdrawn mental health can have a positive influence on child mental behavior.e. problems. and 80 symptoms using the self-reported questionnaire. children may feel T scores from the CBCL among Japanese children were more secure and experience less stress. The CBCL measures health after disaster [20. the following esized that community social capital after a disaster may four were used in this study: emotional symptoms. Finally. refers to resources that individuals can access through their including procedure to obtain informed consent from social networks in the community. implemented 2 years after the disaster). anxiety/depression). directly or indirectly.1118 Soc Psychiatry Psychiatr Epidemiol (2016) 51:1117–1123 To address child behavior problems. the primary caregiver and community may have evaluated via both an interview of the child by child had an effect on the development of child behavior prob. in a problems. were selected for this study. ‘Social capital’ at community level Child Health and Development approved this study. community level—might be helpful in reducing child The Research Ethics Committee at the National Center for behavior problems. and (c) the capacity for planned. problems. as child behavior problems via parental mental health. Child behavior problems were assessed using the Child vidual level. Exposure to the following trau- social capital after the Great East Japan Earthquake has a matic events was assessed at interview based on items direct protective effect on child behavior problems or an developed in a previous study [1]: being separated from indirect effect through caregiver’s mental health status. or at work [17]. wit- nessing tsunami waves. children’s exposure to disaster-related trauma was school. and completion of a ques- lems. and is measured by indicators such as: (a) levels of social trust in the community. Thus. conduct reduce child behavior problems. death of a close family member. or someone being swept away by Methods the tsunami. increase the sample size. well as total behavior problems (internalizing and exter- Alternatively. This is different from social capital at indi. and peer relationship through parental mental health. clinical care resources are limited. school. provision of mental caregivers (77 mothers and 3 fathers) agreed to join the health care by child psychiatrists or psychologists would be study. Impact of 123 . death of other relatives or friends. Japan. which were com- social capital exert a protective influence on adult mental pleted by participating caregivers. parents at the time of the earthquake. exter- health. As these children In conjunction with the assessment of PTSD symp- were exposed to the disaster before entering elementary toms. separation from a family member. Of the five SDQ subscales. which refers is similar to social support [19]. calculated [24]. staying at a shelter. or seeing a dead body. and well as one in an unaffected inland area of Iwate prefec. evacuation to a relative’s house. aggressive behavior). either their caregiver responded to the of other community-based assets—such as social capital at questionnaire or the child participated in the interview). damage to the family home (either Four nursery schools within three municipalities affected completely or partially). caregiver’s mental health. for example. Next. The caregiver questionnaire included questions that assessed Sample exposure to the following traumatic events: loss of a family member. from 4–6 years old at the time of the disaster who were affected which 28 items were selected to reduce the burden on by the Great East Japan Earthquake (the assessment was respondents. thought effect on child behavior problems. In this situation. psychiatrists or psychologists. children aged 4–6 years on March 11. From September number of traumatic events was then calculated from the to December 2012. 94 children actually especially after disaster. somatic complaints. (b) norms of reciprocity and mutual Measurements assistance. social capital might also have a protective effect on nalized (rule-breaking behavior. collective action [18]. community social capital might have a direct nalizing behavior problems plus social problems. The purpose of this study is to examine whether tionnaire by caregivers. living in by the Great East Japan Earthquake in the coastal areas as temporary quarters. interview and questionnaire data. Symptoms of PTSD among children child behavior problems. Behavior Checklist (CBCL) [22] and the Strength and Previous studies have shown that communities with high Difficulty Questionnaire (SDQ) [23]. sex-standardized community with high levels of trust. and were also assessed using a caregiver questionnaire. we hypoth. These four subscales were combined and coded We sought to investigate this hypothesis by assessing as ‘difficult behavior’. hyperactivity/inattention. the mobilization participated (i. Siblings of the target children were then added to optimal. 2011 (5–7 years at time of recruitment) (N = 251) were Caregiver’s mental health was assessed for PTSD invited to participate through their caregivers. however. and attention problems). 21]. caregiver and assent from children. the social capital among families with young children aged Parent Report of the Child’s Reaction to Stress [25].

child behavior problems that were assessed by the CBCL and SDQ. This association was mediated by the influence of social capital Table 1 shows the characteristics of the sample.e. PTSD symptoms assessment. this is the first study to report that community social capital can ameliorate child behav- Results ior problems following exposure to disaster trauma. social trust and mutual aid. SDQ. and 19 % showed think that people in your neighborhood trust each other?’’. in the community dren did not experience any of these traumatic events. The number of disaster-related trau- givers that explored their perception of cognitive social matic events experienced was 2.7 %). but not for indicators of child association between social capital indicators.90. caregiver’s mental health.001). p \ 0. were defined as a latent variable determined by CBCL total behavior problems and SDQ difficult behavior. College Station. 21 % of mothers trust was assessed by the following question: ‘‘Do you showed PTSD symptoms on the IES-R. and that both would be directly associated lems. Structural equation modeling (SEM) caregiver’s mental health indicators were also highly pos- was used to determine the association between social itively correlated (p \ 0. Mutual aid was assessed by the following relatively high in the community. p \ 0. although 67 % of chil- capital. We confirmed the following causal model: higher turn would be determined by the number of traumatic social trust decreased maternal mental illness (standard events related to the disaster. and maternal mental illness events experienced by the child was hypothesized to be was directly associated with child PTSD symptoms (stan- associated with caregiver’s mental health. and depression/anxiety participating children in both the measurement of CBCL was assessed using the K6 [27]. i.149. USA) was used for sta. child PTSD symptoms.1. caregiver’s behavior problems. Ages of on improving caregiver’s mental health. ‘‘Somewhat disagree’’. and child behavior problems social trust (standard coefficient 0.001). the IES-R and K6 were also highly positively correlated IES-R. The sample included protective influence of community social capital on adult slightly more boys (58. PTSD symptoms. RMSEA 0. more than 70 % ‘‘Agree’’. Further. which in 0. p \ 0. caregiver’s mental tions. Social Regarding caregiver’s mental health. The number of traumatic coefficient -0. and child behavior prob- the community. upper limit 0. with the same 4-point Likert scale and caregiver’s mental health variables and social capital responses. which in turn were age is directly associated with child behavior problems as associated with child behavior problems (standard coeffi- developmental stages are critical to determining such cient 0. We theorized that mutual aid enhances social trust in health. social capital capital.5 %) than girls.001). lems.e. mental health. TX.001). Mothers perceived social with the following 4-point Likert scale response options: capital after the disaster as high.100.010. As expected. depression or anxiety on the K6. Maternal mental illness was defined as a latent associated with maternal mental illness nor child behavior variable determined by maternal PTSD symptoms (IES-R) problems. CFI problems can be induced by PTSD symptoms. we hypothesized that child behavior lower limit 0. with a mean age A number of previous studies have reported on the of 6 years at the time of study. To the best of our knowledge.956.60. total behavior problems (26.8. between social capital indicators. In addition. and indicators were significantly associated with only care- child behavior problems. p = 0. mental health [28. model. where they lived with their family after the disaster. A conceptual model of the causal giver’s mental health.001). p \ 0.Soc Psychiatry Psychiatr Epidemiol (2016) 51:1117–1123 1119 Event Scale–Revised (IES-R) [26].51.001). Mutual aid was neither directly problems. Chi square [19]: 34.001).. (p \ 0. and child behavior Figure 1 shows the result of SEM for the association problems was developed based on the following assump. question: ‘‘Do you think that people in your neighborhood Table 2 shows Spearman’s correlation between child help each other?’’.048. K6 and social capital indicators were used as con. and the Analysis number of traumatic events were highly positively corre- lated (p \ 0. PTSD symptoms. but mutual aid showed a strong association with and depression/anxiety (K6). pclose 0. Caregiver’s mental health assessed by Scores from the CBCL. Moreover. ‘‘Somewhat agree’’.057. However. child mental health indicators and tinuous outcomes. 29]. child dard coefficient 0. indicators. child PTSD symptoms. The following model was considered: LR test of with caregiver’s mental health and child behavior prob.6 %) and SDQ difficult Social capital was assessed via a questionnaire to care. Discussion tistical analysis.60. Stata 13 SE (StataCorp. and several have reported on the cant behavior problems were found in over 25 % of impact of social capital on adult mental health after disaster 123 . children ranged from 4 to 8 years of age. i. and responded that social trust or mutual aid was either high or ‘‘Disagree’’. Clinically signifi.. behavior (28.

6 Borderline 11 11.1 0 9 Caregiver’s PTSD symptoms IES-R score 15.5 Lost close family member or relative 2 2.6 33 90 Clinical range 25 26.1 5.1 10.7 Borderline 14 14.5 Witnessed tsunami waves 31 33.4 Family members lived in separate places 13 13.1120 Soc Psychiatry Psychiatr Epidemiol (2016) 51:1117–1123 Table 1 Characteristics of Mean or N SD or % Min Max sample (N = 94) Age of child at recruitment Years 5.2 Social trust Low 8 8.0 Witnessed someone being swept away by tsunami 7 7.9 Lived in temporary housing 19 20.1 Lost distant relative or friend 8 8.2 10.33 4 8 Sex of child Male 55 58.80 0 22 K6 4? 18 19.3 Saw a dead body 3 3.5 Female 39 41.6 123 .7 19 82 Trauma experience Home lost or completely damaged 28 29.1 2.8 Home partially damaged 7 7.5 Mutual aid Low 7 7.5 Middle low 16 17.5 Witnessed a fire 4 4.5 Stayed at shelter 14 14.3 Caregiver’s mental health K6 score 3.0 Middle high 47 50.0 Number of these events 2.8 CBCL total behavior problem T score 57.8 Separation from caregiver 23 24.3 0 71 IES-R 9? 20 21.5 Middle low 16 17.0 High 23 24.5 Location Coastal area 66 70.2 Evacuated to relative’s house 37 39.3 15.9 Child PTSD symptoms Parent report of the child’s reaction to stress score 44.7 SDQ difficult behavior Difficult behavior score 12.2 Inland 28 29.0 Middle high 46 48.9 High 25 26.2 Any of these events 31 33.13 4.96 1.8 0 28 Clinical range 27 28.

upper limit 0. in information pre-dating the disaster. the sample size was limited and was not repre- associated with child mental health).04 -0. social capital before the directly associate with children.56*** 0. pclose 0. the mother). can reduce own mental health because in a crisis situation. Our findings are sentative of all children in the affected area after the consistent with the ecological model developed by Bron. 21].05.17** 0.22*** 0. but we did not have peers.06 -0.30*** 0. *p \ 0. such as evokes the attachment system [31].048.956.28*** 0. earthquake might be important. RMSEA 0.04 -0. p = 0. higher social psychiatrists. SDQ difficult behavior score 0.100. strating that social capital had a collateral influence on This study has several limitations.34*** 0.59*** – 7. teachers. IES-R 0. child PTSD symptoms.  p \ 0.057 [20.057. CBCL total behavior problem T score – 2.28*** – 8. caregiver’s mental health is crucial for their experience of traumatic events with others. such as family.Soc Psychiatry Psychiatr Epidemiol (2016) 51:1117–1123 1121 Table 2 Spearman’s correlation coefficient among trauma-related scales and social capital indicators 1 2 3 4 5 6 7 8 1. K6 0.40*** 0. or other public resources. Thus.88*** – * p \ 0. three ways: (1) psychosocial support. capital is beneficial not only for adult mothers. caregiver’s mental health.16** -0.010. Third. and child behavior problems.77*** – 3. child behavior problems were assessed fenbrenner [30]. LR test of model: Chi square [19]: 34. SRMR 0.18** -0. but also for Moreover. 123 . lower limit 0.13* -0. earthquake. (2) the dissemination of health-relevant after disaster. *** p \ 0. Child PTSD symptoms score 0. This study is consistent with these previous addition. younger children depend on caregivers who information though social networks.001 Fig.30*** 0. CFI 0.8.49*** – 4. as this study is child mental health after disaster via their caregiver’s cross-sectional.06 -0.21*** 0. we cannot rule out reverse causation.28*** – 5. **p \ 0. our findings add to the literature by demon. the microsystem (the actors who by the caregiver only. such as stress for the adult. Social trust indicator -0. Number of traumatic events experienced by children 0. That is. mental health (even though social capital was not directly Second.19** -0. First. which to professional mental healthcare and services.29*** 0. and (3) better access are closest to them (in most cases.05. ** p \ 0. 1 Result of structural equation model for causal association between social capital indicators. their children.149.001. the mesosystem (interaction between actors.16** -0. such studies in showing that higher social capital is protective as the relationship between parents and the child’s teacher) for adult mental health. such as sharing one’s For children. Number shows standard coefficient.01. psychologists.51*** – 6. health workers) directly affects child health.47*** 0. Possible pathways to improve and the macrosystem (community or social environment) mental health via higher social capital can be considered in also affect child health indirectly through the microsystem. Fourth.16** -0.1. Mutual aid indicator -0.

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Ran MS.pone.1371/ Conflict of interest Nothing to declare.

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