Social Science & Medicine 258 (2020) 113108

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Social Science & Medicine

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Long-lasting effects of distrust in government and science on mental health T

eight years after the Fukushima nuclear power plant disaster
Maiko Fukasawaa, Norito Kawakamia,∗, Maki Umedaa,h, Tsuyoshi Akiyamab, Naoko Horikoshic,
Seiji Yasumurac,d, Hirooki Yabee, Yuriko Suzukif, Evelyn J. Brometg
a
Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
b
Department of Neuropsychiatry, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
c
Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295,
Japan
d
Department of Public Health, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan
e
Department of Neuropsychiatry, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima 960-1295, Japan
f
Department of Mental Health Policy, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-higashi, Kodaira, Tokyo, 187-8553,
Japan
g
Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11794, USA
h
Research Institute of Nursing Care for People and Community, University of Hyogo, 13-71 Kitaoji-cho, Akashi City, Hyogo, 673-8588, Japan

A R T I C LE I N FO A B S T R A C T

Keywords: We aimed to explore the effects of erosion of trust in authorities on the long-term mental health of community
Fukushima residents after the 2011 Fukushima nuclear power plant accident in Japan. We investigated the effects of distrust
Nuclear power plant disaster in authorities on mental health in a cohort study following non-evacuee community residents after the 2011
Distrust in government Fukushima nuclear power plant accident. A baseline questionnaire survey was administered five years after the
Mental health
accident for a random sample of 4900 residents outside the evacuation zone in Fukushima. Distrust in the
Longitudinal study
national government and in science were assessed using a four-point single-item scale. Psychological distress was
measured using the K6. Posttraumatic stress symptoms were measured using an abbreviated version of the
Posttraumatic Stress Disorder Checklist-Specific version. Longitudinal associations of distrust in the government
and science at baseline and psychological distress and posttraumatic stress symptoms eight years after the ac-
cident were examined, controlling for the baseline level of distress or symptoms using multivariate logistic
regression analyses. Valid responses were obtained from 927 (18.9%) residents. Distrust in the government at
baseline was significantly associated with posttraumatic stress symptoms at follow-up, albeit controlling for
baseline symptoms. While distrust in the government was also associated with psychological distress at follow-
up, the association became non-significant after controlling for baseline distress. Distrust in science at baseline
was not associated with posttraumatic stress symptoms or psychological distress at follow-up. Distrust in gov-
ernment after a nuclear power plant accident may have adverse effects on mental health in the long-term.

1. Introduction
A disaster poses adverse effects on the mental health of the affected
population. Mental health problems including posttraumatic stress
symptoms, as well as non-specific psychological distress such as de-
pression and anxiety, increase in a community affected by a disaster
(Goldman and Galea, 2014). High prevalence of posttraumatic stress
symptoms and psychological distress were reported after the 2011 Fu-
kushima nuclear power plant accident (Harada et al., 2015; Niitsu et al.,
2014; Oe et al., 2016; Yabe et al., 2014). These mental health problems
may linger as reported after previous nuclear power plant accidents in
Three Mile Island (TMI) and Chernobyl (Bromet et al., 2011; Bromet,
2014).
After the Fukushima nuclear power plant accident, public trust for
the national government and for nuclear experts was lost in Japan
(Ando, 2018). Surveys conducted at seven months to one year after the
accident showed erosion of public trust in the managing bodies of nu-
clear power generation, including electric power companies and gov-
ernment (Tsujikawa, 2016), in organizations responsible for managing
risks of nuclear power plant accidents (Nakayachi, 2015), and in

∗
Corresponding author.
E-mail address: nkawakami@m.u-tokyo.ac.jp (N. Kawakami).

https://doi.org/10.1016/j.socscimed.2020.113108
Received in revised form 21 May 2020; Accepted 2 June 2020
Available online 14 June 2020
0277-9536/ © 2020 Published by Elsevier Ltd.
M. Fukasawa, et al.
science (Arimoto and Sato, 2012). Confusion in the aftermath of the
accident caused by the countermeasures taken by the government, such
as issuing evacuation orders and setting standards for decontamination
and food safety, seems to have damaged the public trust for the national
government and for nuclear experts (Ando, 2018). Scientists sometimes
fueled confusion by proposing divergent recommendations on these
matters (Arimoto and Sato, 2012). The government's poor crisis com-
munications in the aftermath of the accident also contributed to the loss
of trust in the national government (Yilmaz, 2011). The accident itself
inherently damaged the public trust of the government and of the ex-
perts who had strongly disseminated a “safety myth” before the acci-
dent occurred (Ando, 2018).
Loss of trust for authorities among members of the public was also
observed after past nuclear power plant accidents (Dohrenwend et al.,
1981; Dohrenwend, 1983; Goldsteen and Schorr, 1982; Prince-Embury
and Rooney, 1987; Koscheyev et al., 1997). Residents who lived near
the TMI nuclear power plant showed high levels of distrust in autho-
rities, including federal and state officials and utility companies, at one
month after the accident, which remained higher than the national
level five months after the accident (Dohrenwend et al., 1981; Doh-
renwend, 1983). At six months after the TMI accident, a large propor-
tion of residents in the affected area still expressed distrust for public
officials, and that proportion increased one year after the accident
(Goldsteen and Schorr, 1982). A study reported that even four years
after the accident these residents expressed loss of faith in experts more
than residents who moved into the same area at a later time (Prince-
Embury and Rooney, 1987).
Distrust in the government after a nuclear power plant accident may
have negative effects on mental health. A few studies reported asso-
ciations between distrust in government and mental health, or health-
related anxiety or perceptions, after both the Fukushima nuclear power
plant accident and the TMI accident. In a study conducted six months
after the Fukushima accident, Hommerich (2012) reported a positive
correlation between trust in governmental institutions and subjective
well-being. A study conducted after the TMI accident reported that trust
for government officials was negatively associated with the level of
perceived threat at six months after the accident, which increased
psychological distress at six months and 3.5 years after the accident
(Goldsteen et al., 1989). At approximately five years after the Fu-
kushima accident, Murakami et al. (2016) reported that trust in the
central government was associated with lower perceived risk for ra-
diation's health effects. Nakayama et al. (2019) reported that trust in
government ministries and in local government as an information
source on radiation were associated with lower health-related anxiety
for the effects of radiation at 5.5 years after the Fukushima accident.
These previous studies were all cross-sectional (Hommerich, 2012;
Goldsteen et al., 1989; Murakami et al., 2016; Nakayama et al., 2019).
A causal relationship between distrust in the government and poor
mental health has not been explored in a longitudinal study design.
While the previous studies revealed the associations of distrust in the
government with perceived risk or anxiety of radiation (Goldsteen
et al., 1989; Murakami et al., 2016; Nakayama et al., 2019) and worry
about possible radiation exposure was associated with posttraumatic
stress symptoms (Fukasawa et al., 2020), a relationship between dis-
trust in the government and posttraumatic stress symptoms has not
been studied. In addition, while it is known that mental health pro-
blems after a nuclear power plant accident usually remained for many
years (Bromet et al., 2011; Bromet, 2014), all the previous studies were
conducted within about five years after the accident. A longer-term
effect of distrust in the government on poor mental health is still un-
clear.
Therefore, in this study we aimed to examine temporal associations
of distrust in the national government with later mental health issues
after the Fukushima nuclear power plant accident using longitudinal
data. We examined the effects of distrust in the national government
that had been assessed at five years after the accident on psychological
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Social Science & Medicine 258 (2020) 113108
distress and posttraumatic stress symptoms of non-evacuee community
residents in Fukushima prefecture assessed eight years after the acci-
dent. We focused on psychological distress and posttraumatic stress
symptoms because these two types of psychiatric symptoms are the
most popular indicators of mental health status explored in a disaster
setting (Galea, 2014; Norris et al., 2002; Norris and Elrod, 2006). We
focused on the distrust in the national government five years after the
accident because we think the distrust of the affected population could
play a key role in their long-term recovery. Distrust in the government
after five years seems to reflect their confidence in the government's
countermeasures taken since the accident and the future reconstruction
plans. If their confidence in the government at that point was poor, it
might indicate that they feel insufficient attention was given to re-
covery, which could lead to a feeling of being left behind and make
their subsequent recovery more difficult. In our analysis of longitudinal
association between the distrust in the government and later mental
health, we further adjusted for the baseline score of mental health
outcomes to more strictly explore a causal effect of distrust in the na-
tional government on later mental health. In addition, we conducted
corresponding analyses to explore the effects of distrust in science
technology on later mental health, because the public loss of trust in
science was also often reported parallel to loss of trust in the national
government following the Fukushima nuclear power plant accident
(Arimoto and Sato, 2012).
2. Material and methods
2.1. Study design and study population
In this study, we used data obtained in a longitudinal questionnaire
survey administered in 49 municipalities of Fukushima prefecture, ex-
cluding the restricted areas designated by the Japanese government
close to the nuclear power plant. From each municipality, 100 residents
aged 20–80 years old were randomly sampled with double weighting
for residents aged 20–39 years old, which yielded a total of 4900 initial
subjects. The baseline survey was administered from February to April
2016, five years after the Fukushima nuclear power plant accident. The
second survey was conducted approximately one year after the baseline
survey, the target of which was 2037 respondents to the baseline
survey. The details of the baseline survey and the second survey were
previously reported (Fukasawa et al., 2017, 2020). The third survey
was conducted from November 2018 to January 2019, about eight
years after the accident or 33 months after the baseline survey, tar-
geting 1450 respondents to the second survey. In the current study, we
used the data obtained in the baseline survey and the third survey (the
follow-up survey).
3. Study variables
3.1. Psychological distress
Psychological distress was assessed using the K6, a validated six-
item self-administered screening instrument assessing non-specific
psychological distress during the past 30 days (Furukawa et al., 2008;
Kessler et al., 2002). It has been widely used for community residents in
a disaster setting including the Fukushima nuclear power plant accident
as well as natural disasters such as Hurricane Katrina (Yabe et al., 2014;
Galea et al., 2007; Kessler et al., 2006). Items are rated on a five-point
Likert scale from 0 (none) to 4 (all the time), with a total score ranging
from 0 to 24. Higher scores indicate higher distress. The score was di-
chotomized using a cut-off point of 13 based on a previous study
(Kessler et al., 2003) and studies conducted after the Fukushima nu-
clear power plant accident (Yabe et al., 2014; Bromet et al., 2011;
Miura et al., 2017; Suzuki et al., 2015).
M. Fukasawa, et al.
3.2. Posttraumatic stress symptoms
Posttraumatic stress symptoms were assessed using a six-item ab-
breviated version of the Posttraumatic Stress Disorder Checklist-
Specific version (PCL-S) developed and validated by Lang and Stein
(2005). The PCL-S is a widely used questionnaire for people who have
experienced a specific traumatic event (McDonald and Calhoun, 2010;
Suzuki et al., 2017; Wilkins et al., 2011), and has been used for com-
munity residents in a disaster setting including the Fukushima nuclear
power plant accident as well as the World Trade Center terrorist attacks
(Yabe et al., 2014; Jordan et al., 2019). In this study, we specified the
experience of the Great East Japan Earthquake as the traumatic event,
including the earthquake, tsunami, and nuclear power plant accident,
and asked about current symptoms during the past month. The items,
which measure the degree to which respondents are bothered by
symptoms, are rated on a five-point Likert scale from 1 (not at all) to 5
(extremely), with a total score ranging from 6 to 30. Higher scores in-
dicate more severe symptoms. The score was dichotomized using a cut-
off point of 17 based on a previous study (Suzuki et al., 2017).
3.3. Distrust for the national government and for science technology
The level of distrust in the national government and in science
technology were assessed by a questionnaire used in a previous study
without validation (Yamaoka, 2008). We asked the current degree of
confidence in the national government and in science technology on a
four-point Likert scale from 1 (very confident) to 4 (not confident at all),
which we used as a continuous variable. Higher scores indicate a higher
level of distrust.
3.4. Socio-demographic characteristics and disaster damage
The socio-demographic characteristics included in this study were
age, gender, educational attainment, household income in the past
year, marital status, and residential area assessed at the baseline survey.
Household income in the past year was adjusted by the number of
household members and categorized into high, medium, and low-in-
come groups (Fukasawa et al., 2017). When the number of household
members was one or two, household income < 2.5 million yen was
categorized as low, 2.5–5.0 million yen was categorized as middle, and
≥5.0 million yen was categorized as high. When the number of
household members was three, household income < 2.5 million yen
was categorized as low, 2.5–7.5 million yen was categorized as middle,
and ≥7.5 million yen was categorized as high. When the number of
household members was four or more, household income < 5.0 million
yen was categorized as low, 5.0–10.0 million yen was categorized as
middle, and ≥10.0 million yen was categorized as high. Residential
area was divided into eastern coastal area (Hama-dori), central area
(Naka-dori), and western area (Aizu).
Regarding damages by the Great East Japan Earthquake, we asked
about four experiences: 1) injured, 2) family member injured or dead,
3) loss of job or temporary absence from work, and 4) loss of house or
property. Respondents were dichotomized into those who had experi-
enced at least one of these experiences or had not experienced any of
them.
3.5. Statistical analysis
First, we calculated descriptive statistics for socio-demographic
characteristics, disaster damage, and distrust in the national govern-
ment and in science technology of the study subjects at the baseline
survey (Time 1) and their psychological distress and posttraumatic
stress symptoms at the baseline survey and at the follow-up survey
(Time 2). Then, we compared these basic characteristics of our study
subjects with those of the individuals who had participated in the
baseline survey but who were not included in this study because of non-
3
Social Science & Medicine 258 (2020) 113108
participation in the follow-up survey or having missing information
using chi-square tests or t-tests.
Second, we examined bivariate associations of distrust in the na-
tional government and in science technology at Time 1 with psycho-
logical distress and posttraumatic stress symptoms at Time 2 using lo-
gistic regression analyses. After that, we examined their associations
controlling for socio-demographic characteristics and disaster damage
using multivariate logistic regression analyses (Model 1). Furthermore,
we adjusted for psychological distress or posttraumatic stress symptoms
at Time 1 in the respective models (Model 2). Separate logistic re-
gression analyses were conducted for distrust in the national govern-
ment and distrust in science technology.
To explore the bias caused by removing those who did not partici-
pate in the follow-up survey or had missing information, we repeated
the analyses using inverse probability weighting. To estimate the
probability for being included as a study subjects, we developed logistic
regression models including the responses on living arrangement, life-
style habits, social networks, experiences of family problems and al-
cohol problems after the accident, and distrust in national assembly in
the baseline survey, in addition to the study variables reported above.
The c-statistics (95% confidential interval) were 0.6562
(0.6312–0.6812) and 0.6617 (0.6369–0.6865) for the analyses for
psychological distress and posttraumatic stress symptoms, respectively.
All statistical analyses were performed using Stata 15 for Windows
(StataCorp LP, College Station, TX). Statistical significance was set at
.05 and all tests were two-tailed.
4. Results
Among the 2038 respondents to the baseline survey (41.6% of
4900), 1013 individuals participated in the follow-up survey, from
which, in the current study, we used the data from the 927 respondents
with no missing information on socio-demographic characteristics and
disaster damages and having a score on psychological distress or
posttraumatic stress symptoms both at Time 1 and Time 2 (45.5% of the
respondents to the baseline survey, corresponding to 18.9% of the in-
itial target for the baseline survey). The frequency of missing values in
the baseline survey and the Time 2 survey are reported in Supplemental
Table 1. Compared to those removed, our study subjects included more
middle-aged people, more women, more individuals who had grad-
uated from a university or higher, and more married individuals
(Supplemental Table 2). They had slightly higher trust in science
technology, while their level of trust in the national government was
not different from those removed. The disaster damages experienced
and mental health status at the baseline survey did not differ between
the two groups.
Table 1 reports the socio-demographic characteristics, disaster da-
mages, and distrust levels in the national government and in science
technology of our study subjects at Time 1. Individuals who got injured,
whose family members got injured or died, lost jobs or experienced a
temporary absence from work, or lost a house or property in the Great
East Japan Earthquake comprised 32.9% of our study subjects. Re-
spondents who did not trust the national government (i.e., who were
not confident or not confident at all in the national government) ac-
counted for 54.3% and those who did not trust science technology ac-
counted for 21.7% of the respondents.
The proportions of the respondents with psychological distress at
Time 1 and those at Time 2 were 5.0% and 5.9%, respectively. The
proportions of the respondents with posttraumatic stress symptoms at
Time 1 and those at Time 2 were 3.5% and 3.9%, respectively (Table 2).
Table 3 reports the associations of distrust in the national govern-
ment and in science technology at Time 1 with psychological distress at
Time 2, which were explored with 891 respondents with scores of
psychological distress at both Time 1 and Time 2. In bivariate analysis,
distrust for the national government in Time 1 was significantly asso-
ciated with higher psychological distress at Time 2. This significant
M. Fukasawa, et al. Social Science & Medicine 258 (2020) 113108

Table 1 Table 2
Socio-demographic characteristics, disaster damages, and distrust level in na- Mental health of study subjects at Time 1 and Time 2 (n = 927).
tional government and science technology at Time 1 (n = 927).
N %
n % mean SD
Time 1
Age, years Psychological distress
20–39 357 38.5 K6 score ≥ 13 46 5.0
40–64 335 36.1 K6 score < 13 866 93.4
65+ 235 25.4 K6 score missing 15 1.6
Mean (Standard Deviation) 49.1 (16.9) Posttraumatic stress symptoms
Gender PCL-S6 score ≥ 17 32 3.5
Men 414 44.7 PCL-S6 score < 17 878 94.7
Women 513 55.3 PCL-S6 score missing 17 1.8
Educational attainment Time 2
Junior high school 111 12.0 Psychological distress
High school 474 51.1 K6 score ≥ 13 55 5.9
Junior or technical college 192 20.7 K6 score < 13 849 91.6
University or graduate school 150 16.2 K6 score missing 23 2.5
Level of household income adjusted by household Posttraumatic stress symptoms
size PCL-S6 score ≥ 17 36 3.9
Low 366 39.5 PCL-S6 score < 17 860 92.8
Medium 431 46.5 PCL-S6 score missing 31 3.3
High 130 14.0
Marital status Time 1: at the baseline survey, i.e., 5 years after the accident; Time 2: at the
Married 639 68.9 follow-up survey, i.e., about 8 years after the accident or 33 months after the
Separated, divorced, bereaved, unmarried, or 288 31.1 baseline survey.
unknown
Residential area
Eastern coastal area (Hama-dori) 65 7.0 Table 3
Central area (Naka-dori) 514 55.5 Associations between the level of distrust at Time 1 and psychological distress
Western area (Aizu) 348 37.5 at Time 2 (n = 891).
Damages by the Great East Japan Earthquake a
Model 1a Model 2b
Experienced at least one of damages 305 32.9
No 622 67.1
OR 95% CI OR 95% CI OR 95% CI
Distrust (score range: 1–4)
Distrust at Time 1
Distrust of national government
Very confident (1) 37 4.0
Distrust of national 1.83 1.26 2.66 1.58 1.08 2.33 1.31 0.84 2.03
Somewhat confident (2) 387 41.8
government
Not confident (3) 400 43.2
Distrust of science 1.28 0.86 1.90 1.06 0.70 1.61 0.97 0.60 1.58
Not confident at all (4) 103 11.1
technology
Mean (Standard Deviation) 2.6 (0.7)
Distrust of science technology
OR, odds ratio; CI, confidence interval; Time 1, at the baseline survey, i.e., 5
Very confident (1) 135 14.6
Somewhat confident (2) 591 63.8 years after the accident; Time 2, at the follow-up survey, i.e., about 8 years after
Not confident (3) 173 18.7 the accident or 33 months after the baseline survey.
a
Not confident at all (4) 28 3.0 Adjusted for age, gender, educational attainment, household income,
Mean (Standard Deviation) 2.1 (0.7) marital status, residential area, and disaster damage at Time 1.
b
Adjusted for Model 1 + psychological distress at Time 1.
SD, stegandard deviation.
a
Corresponds to any of the following: 1. Injured, 2. Family member injured Table 4
or dead, 3. Loss of job or temporary absence from work, or 4. Loss of house or Associations between the level of distrust at Time 1 and posttraumatic stress
property. symptoms at Time 2 (n = 880).
Model 1a Model 2b
association was maintained after adjusting for socio-demographic
characteristics and disaster damages (Model 1). However, this asso- OR 95% CI OR 95% CI OR 95% CI
ciation did not remain after adjusting for psychological distress at Time
1 (Model 2). On the other hand, distrust for science technology at Time Distrust at Time 1
1 was not significantly associated with psychological distress at Time 2.
Distrust of national 2.09 1.31 3.34 1.94 1.20 3.16 1.98 1.17 3.34
Table 4 reports the associations of the distrust in the national gov- government
ernment and in science technology at Time 1 with posttraumatic stress Distrust of science 1.19 0.72 1.95 1.06 0.64 1.76 1.04 0.62 1.74
symptoms at Time 2, which were explored with 880 respondents with technology
the scores of posttraumatic stress symptoms at both Time 1 and Time 2.
OR, odds ratio; CI, confidence interval; Time 1, at the baseline survey, i.e., 5
In bivariate analysis, distrust for the national government in Time 1 was
years after the accident; Time 2, at the follow-up survey, i.e., about 8 years after
significantly associated with higher posttraumatic stress symptoms at
the accident or 33 months after the baseline survey.
Time 2. This significant association maintained after adjusting for a
Adjusted for age, gender, educational attainment, household income,
socio-demographic characteristics and disaster damages (Model 1), and marital status, residential area, and disaster damage at Time 1.
also maintained after the further adjustment for posttraumatic stress b
Adjusted for Model 1 + posttraumatic stress symptoms at Time 1.
symptoms at Time 1 (Model 2). Distrust for science technology was not
significantly associated with posttraumatic stress symptoms at Time 2. 5. Discussion
We repeated our analyses using inverse probability weighting to
account for the attrition and missing information and gained almost the In this longitudinal study of non-evacuee community residents of
same results (Supplemental Tables 3 and 4). Fukushima prefecture from five to eight years after the nuclear power
plant accident, distrust in the national government at baseline was

4
M. Fukasawa, et al.
significantly associated with posttraumatic stress symptoms at follow-
up, even after controlling for posttraumatic stress symptoms at baseline.
While distrust in the national government at baseline was also asso-
ciated with psychological distress at follow-up, the association atte-
nuated and became non-significant after controlling for psychological
distress at baseline. On the other hand, distrust in science technology at
baseline associated with neither posttraumatic stress symptoms nor
psychological distress at follow-up.
Our study demonstrated that even five to eight years after the
Fukushima nuclear power plant accident, distrust in the national gov-
ernment contributed to developing or sustaining posttraumatic stress
symptoms. This observation is consistent with the findings of previous
studies conducted after the Fukushima nuclear power plant accident
reporting a cross-sectional association of the trust in government with
mental health, health-related anxiety, and risk perceptions for radia-
tion's adverse effects (Hommerich, 2012; Murakami et al., 2016;
Nakayama et al., 2019). The present study adds further evidence to
support a longitudinal association between the two variables. A pre-
vious study after the TMI accident revealed that distrust in authorities,
such as federal and state officials and government, affected psycholo-
gical distress through the perceived threat for TMI and its adverse
health effects (Goldsteen et al., 1989). Hence, the longitudinal asso-
ciation of distrust in the national government with later posttraumatic
stress symptoms observed in the present study might be mediated by
the perceived threat of the nuclear power plant accident. Trust in the
national government and national parliament are positively associated
with people's mental health in a non-disaster setting (Hudson, 2006;
Lindström and Mohseni, 2009). The perceptions of people suffering
from a disaster that the government may not be able to provide correct
information and necessary supports may cause feelings of disappoint-
ment and abandonment, which could affect their mental health. In a
post-disaster setting, community members' lack of trust in the govern-
ment represents a huge loss of resources for their ability to cope with
their difficult situations. A previous study of victims of a ferry disaster
reported that trust in the police and the justice system was associated
with their mental health 26 years after the disaster (Thoresen et al.,
2018). Once it is formed, distrust may remain unresolved for a long
period of time, affecting the mental health of people involved in a
disaster, which was also observed in the present study. In order to
overcome the long-term deterioration in mental health sustained by
people who suffered from a nuclear power plant accident, resolving
distrust or rebuilding trust with the national government may be an
important approach to mitigate this damage. Establishing truthful
communication between the government and community residents
through government disclosure of data and information and continuous
discussion seems necessary to rebuild public trust in the national gov-
ernment.
While distrust in the national government at baseline significantly
predicted psychological distress at follow-up before controlling for
baseline psychological distress, the association became smaller and
non-significant after controlling for psychological distress at baseline.
Distrust in the national government may contribute to later psycholo-
gical distress to some extent, but its impact may be smaller than its
impact on posttraumatic stress symptoms. It has been argued that non-
specific psychological distress (such as depression) and disaster-specific
symptoms (such as posttraumatic stress symptoms) in a post-disaster
setting could have a different nature, for instance, differential risk
factors (Fukasawa et al., 2020; Suzuki et al., 2015, 2017; Lang and
Stein, 2005; McDonald and Calhoun, 2010; Wilkins et al., 2011; Jordan
et al., 2019; Yamaoka, 2008; Hudson, 2006; Lindström and Mohseni,
2009; Thoresen et al., 2018; Cénat and Derivois, 2014; Gigantesco
et al., 2013; Guo et al., 2017; Pietrzak et al., 2012; Tracy et al., 2011).
Distrust in the national government may be more associated with
posttraumatic stress symptoms. This may be reasonable because distrust
in the national government often stems from a fearful experience after
an accident without sufficient support from the national government
5
Social Science & Medicine 258 (2020) 113108
(Fackler, 2011) and posttraumatic stress symptoms may also result from
such an experience. Distrust in the national government contributes to
poor mental health after a nuclear power plant accident, albeit the
extent of its contribution depends on the type of mental health pro-
blems.
Distrust in science technology at baseline did not contribute to
posttraumatic stress symptoms or psychological distress at follow-up.
Science might not be perceived to have a major effect on the lives of
most people, and a loss of trust in science may not have an impact on
their mental health. Our study subjects were community residents who
had lived outside the evacuation zone and the current study focused on
their mental health at eight years after the accident. The effects of
distrust for science on mental health might be different among the
evacuees who were heavily affected by the nuclear power plant acci-
dent, or in the immediate aftermath of the accident when its horrible
effects might be perceived more strongly. Further studies are needed to
confirm the generalizability of our results to different populations or to
a different time phase of a nuclear power plant disaster.
5.1. Limitations
Our study has several limitations. First, the response rate of the
baseline survey was not very high (41.6%), which might have caused a
selection bias. It may be possible that individuals with distrust in the
government or science were less likely to participate in this study be-
cause of their lack of trust in these kinds of surveys. If individuals with
severe psychological symptoms were less likely to participate in the
survey because of its perceived burden, the associations observed be-
tween the distrust in these authorities and psychological symptoms
might have been underestimated. Second, our study subjects were not
fully representative of all respondents to the baseline survey. Although
the proportions of the respondents with psychological distress and
posttraumatic stress symptoms in the baseline survey were not sig-
nificantly different, there were several differences in the socio-demo-
graphic characteristics and the level of trust in science technology be-
tween the current study subjects and those who were removed. To
explore the influence of these differences on our results, we repeated
our analyses using inverse probability weighting to account for the
probability of the attrition and missing, by which we obtained almost
the same results. Therefore, we did not think these differences had
much influence on our results. Third, we could not identify the reasons
for distrust in the national government or in science technology at five
years after the nuclear power plant accident. It is possible that their
distrust had stemmed from other events unrelated to the accident.
Furthermore, concerning the distrust in the national government, at the
wake of the Great East Japan Earthquake in 2011, the Democratic Party
of Japan, which had taken power in 2009, controlled the government.
However, at the time of the baseline survey in 2016, the Liberal
Democratic Party, which had taken power in December 2012, was in
control of the government. It was unclear what the respondents brought
to their mind as a government and whether their political affiliation
had any effects on their level of distrust in government and their mental
health.
6. Conclusions
We examined temporal associations of distrust in the national
government and in science technology with later mental health using
the data obtained in a longitudinal questionnaire survey following a
random sample of non-evacuee community residents five to eight years
after the Fukushima nuclear power plant accident. Distrust in the na-
tional government at baseline contributed to posttraumatic stress
symptoms at follow-up, independently from baseline symptoms.
Distrust in the national government at baseline was associated with
psychological distress at follow-up before controlling for baseline dis-
tress, although the association diminished after controlling for
M. Fukasawa, et al.
psychological distress at baseline. Distrust in science technology did not
contribute to later mental health. Distrust in the national government
may have long-term adverse effects on the mental health of the affected
population after a nuclear power plant disaster. Resolving distrust or
rebuilding trust in the national government after a disaster, as well as
keeping its trust during and in the aftermath of a disaster, are thought
to be important for the long-term mental health of the affected popu-
lation.
Authors’ contributions
MF analyzed the data and wrote the first draft. NK managed the
study. MU, TA, NH, SY, HY and YS developed and revised the ques-
tionnaire and contributed to conducting the survey. EB advised the
study design. All the authors reviewed and approved the final manu-
script.
Declaration of competing interest
The authors declare that they have no conflict of interest.
Acknowledgments
The present study was supported by Research on the Health Effects
of Radiation organized by the Ministry of the Environment, Japan.
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://
doi.org/10.1016/j.socscimed.2020.113108.
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