Mental health consequences for survivors of the 2011 Fukushima nuclear disaster: a systematic review. Part 2: emotional and behavioral consequences.

To compile the findings of studies assessing emotional and behavioral changes in the survivors of the 2011 Fukushima nuclear disaster, we performed a systematic review in August 2019 using four literature databases (PubMed, PsycINFO, Psychology and Behavioral Sciences Collection, and ICHUSHI). Peer-reviewed manuscripts, either in English or Japanese, were included in the searches. Sixty-one studies were retrieved for the review. Of these, 41 studies (67.2%) assessed emotional consequences, 28 studies (45.9%) evaluated behavioral consequences, and 8 studies (13.1%) evaluated both emotional and behavioral outcomes. The main research topic in emotional change was radiation exposure-associated risk perception, as reported in 15 studies. This risk perception included immediate health effects (eg, acute radiation syndrome) as well as future health effects (eg, future cancer and genetic effects). Lowered subjective well-being was reported in eight studies. Six studies reported perceived discrimination/stigmatization in the disaster survivors. The most critical behavioral change was an increase in suicides compared with residents in the whole of Japan or affected by the earthquake and tsunami, but not by the nuclear disaster. Increased rate of alcohol and tobacco use was reported, although the effect on one's health was inconsistent. As a conclusion, the Fukushima nuclear disaster survivors suffered issues in risk perception, well-being, stigmatization, and alcohol/tobacco use in the first 8 years after the disaster. The present study is important in order to better understand the emotional and behavioral responses to future nuclear/radiological disasters as well as other "invisible" disasters, such as chemical and biological public health crises.