Summary: This study presents two cases of late-onset Post-Traumatic Stress Disorder (PTSD) among survivors of the 2011 Great East Japan Earthquake, tsunami, and nuclear disaster. These cases were observed in Minamisoma City, Fukushima Prefecture, which experienced multiple subsequent disasters, including floods (2019), major earthquakes (2021-2022), and the COVID-19 pandemic (2020-2021). The region underwent mandatory evacuation for over a year following the nuclear disaster, significantly disrupting community structures and social support systems. The cases were documented through clinical observations at a psychiatric practice established in 2016 in Minamisoma City, located within 20km of the Fukushima Daiichi Nuclear Power Plant. Both patients were followed longitudinally from their initial presentation through the recognition and treatment of their PTSD symptoms. Detailed clinical interviews and psychological assessments were conducted throughout the treatment period. Both patients provided written and verbal consent to present their cases in academic settings and publications. Both cases exhibited a pattern of initial over-adaptation during the first few years post-disaster, actively participating in community recovery efforts and displaying apparent resilience. Subsequently, they developed depressive symptoms, leading to psychiatric intervention. Despite receiving treatment, their conditions fluctuated significantly. Several years of therapeutic engagement were required before patients recognized their trauma-related memories and associated symptoms. Retrospective analysis revealed that their initial over-adaptation to post-disaster community needs potentially masked underlying PTSD pathology, complicating early diagnosis and intervention. These cases highlight the importance of recognizing delayed-onset PTSD in disaster survivors, particularly when initial over-adaptation may obscure underlying trauma. The study proposes preventive strategies and screening protocols for similar mental health issues in future disaster scenarios, emphasizing long-term monitoring.
Arinobu Hori (Sun,) studied this question.