{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T22:31:36Z","timestamp":1777501896038,"version":"3.51.4"},"reference-count":25,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T00:00:00Z","timestamp":1632873600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the National Health Fund for Children and Adults Affected by the Nuclear Incident","award":["not applicable"],"award-info":[{"award-number":["not applicable"]}]},{"name":"the Program of the Network-type Joint Usage\/Research Center for Radiation Disaster Medical Science","award":["not applicable"],"award-info":[{"award-number":["not applicable"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Cardiovascular disease (CVD) and mental distress have been suggested to be associated with post-traumatic stress disorder (PTSD), but the effect of their combination on PTSD is unknown. We reviewed the synergistic effects of the history of CVD and mental distress on the possibility of PTSD among residents in Fukushima after the Great East Japan Earthquake. This cross-sectional study was conducted among 38,392 participants aged 40\u201374 years in the evacuation area who applied for the Fukushima Health Management Study in Fiscal Year 2011. Relative excess risk due to interaction (RERI), attributable proportion (AP), odds ratio (OR), and 95% confidence interval (CI) were calculated to investigate the combined effect of history of CVD and mental distress on PTSD. We identified 8104 probable cases of PTSD (21.1%). History of CVD, mental distress, and their combination were positively associated with probable PTSD: the multivariable ORs (95% CIs) were 1.44 (1.04, 2.01), 20.08 (18.14, 22.22), and 26.60 (23.07, 30.67), respectively. There was a significant increase in RERI: the corresponding RERI (95% CI) and AP were 6.08 (3.16, 9.00) and 22.9%. Gender-specific analyses showed similar associations. Thus, we found a supra-additive association of history of CVD and mental distress with probable PTSD after the disaster.<\/jats:p>","DOI":"10.3390\/ijerph181910283","type":"journal-article","created":{"date-parts":[[2021,9,30]],"date-time":"2021-09-30T00:03:42Z","timestamp":1632960222000},"page":"10283","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Synergistic Effect of History of Cardiovascular Disease and Mental Distress on Post-Traumatic Stress Disorder after the Great East Japan Earthquake: The Fukushima Health Management Survey"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7874-8081","authenticated-orcid":false,"given":"Kazuhide","family":"Tezuka","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Disease Prevention, Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka 536-0025, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuhiko","family":"Kubota","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Disease Prevention, Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka 536-0025, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4532-7165","authenticated-orcid":false,"given":"Tetsuya","family":"Ohira","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan"},{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3783-2914","authenticated-orcid":false,"given":"Hironori","family":"Nakano","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan"},{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaharu","family":"Maeda","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan"},{"name":"Department of Disaster Psychiatry, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2668-129X","authenticated-orcid":false,"given":"Hirooki","family":"Yabe","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4715-2840","authenticated-orcid":false,"given":"Seiji","family":"Yasumura","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7755-1888","authenticated-orcid":false,"given":"Mayumi","family":"Harigane","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuji","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Disease Prevention, Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka 536-0025, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeo","family":"Okada","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Disease Prevention, Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka 536-0025, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiko","family":"Kiyama","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Disease Prevention, Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka 536-0025, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Kamiya","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan"},{"name":"Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8553, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on behalf of the Fukushima Health Management Survey Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1093\/epirev\/mxi003","article-title":"The epidemiology of post-traumatic stress disorder after disasters","volume":"27","author":"Galea","year":"2005","journal-title":"Epidemiol. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Dai, W., Chen, L., Lai, Z., Li, Y., Wang, J., and Liu, A. (2016). The incidence of post-traumatic stress disorder among survivors after earthquakes: A systematic review and meta-analysis. BMC Psychiatry, 16.","DOI":"10.1186\/s12888-016-0891-9"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1001\/archgenpsychiatry.2011.127","article-title":"Prevention of posttraumatic stress disorder by early treatment: Results from the Jerusalem Trauma Outreach And Prevention study","volume":"69","author":"Shalev","year":"2012","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Chang, J.-C., Yen, A.M.-F., Chen, H.-H., Chen, S.L.-S., Chiu, S.Y.-H., Fann, J.C.-Y., and Lee, C.-S. (2017). Comorbid diseases as risk factors for incident post-traumatic stress disorder (PTSD) in a large community cohort (KCIS no.PSY4). Sci. Rep., 7.","DOI":"10.1038\/srep41276"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1097\/01.psy.0000162254.61556.d5","article-title":"Depression, the autonomic nervous system, and coronary heart disease","volume":"67","author":"Carney","year":"2005","journal-title":"Psychosom. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"263","DOI":"10.31887\/DCNS.2011.13.2\/jsherin","article-title":"Post-traumatic stress disorder: The neurobiological impact of psychological trauma","volume":"13","author":"Sherin","year":"2011","journal-title":"Dialogues Clin. Neurosci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1590\/S1516-44462011000400009","article-title":"Predictors of PTSD symptoms in brazilian police officers: The synergy of negative affect and peritraumatic dissociation","volume":"33","author":"Maia","year":"2011","journal-title":"Rev. Bras. Psiquiatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"375","DOI":"10.2188\/jea.JE20120105","article-title":"Study protocol for the Fukushima Health Management Survey","volume":"22","author":"Yasumura","year":"2012","journal-title":"J. Epidemiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"57","DOI":"10.5387\/fms.2014-1","article-title":"Psychological distress after the Great East Japan Earthquake and Fukushima Daiichi Nuclear Power Plant accident: Results of a mental health and lifestyle survey through the Fukushima Health Management Survey in FY2011 and FY2012","volume":"60","author":"Yabe","year":"2014","journal-title":"Fukushima J. Med. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/0005-7967(96)00033-2","article-title":"Psychometric properties of the PTSD Checklist (PCL)","volume":"34","author":"Blanchard","year":"1996","journal-title":"Behav. Res. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Iwasa, H., Suzuki, Y., Shiga, T., Maeda, M., Yabe, H., and Yasumura, S. (2016). Psychometric evaluation of the Japanese version of the Post-traumatic Stress Disorder Checklist in community dwellers following the Fukushima Daiichi Nuclear Power Plant Incident: The Fukushima Health Management Survey. SAGE Open, 6.","DOI":"10.1177\/2158244016652444"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Suzuki, Y., Yabe, H., Horikoshi, N., Yasumura, S., Kawakami, N., Ohtsuru, A., Mashiko, H., Maeda, M., and Mental Health Group of the Fukushima Health Management Survey (2017). Diagnostic accuracy of Japanese post-traumatic stress measures after a complex disaster: The Fukushima Health Management Survey. Asia Pac. Psychiatry, 9.","DOI":"10.1111\/appy.12248"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1001\/archpsyc.60.2.184","article-title":"Screening for serious mental illness in the general population","volume":"60","author":"Kessler","year":"2003","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1002\/mpr.257","article-title":"The performance of the Japanese version of the K6 and K10 in the World Mental Health Survey Japan","volume":"17","author":"Furukawa","year":"2008","journal-title":"Int. J. Methods Psychiatr. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1002\/mpr.1349","article-title":"Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization","volume":"21","author":"Prochaska","year":"2012","journal-title":"Int. J. Methods Psychiatr. Res."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Maruyama, K., Sato, S., Ohira, T., Maeda, K., Noda, H., Kubota, Y., Nishimura, S., Kitamura, A., Kiyama, M., and Okada, T. (2008). The joint impact on being overweight of self-reported behaviours of eating quickly and eating until full: Cross sectional survey. BMJ, 337.","DOI":"10.1136\/bmj.a2002"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1515\/em-2013-0005","article-title":"A tutorial on interaction","volume":"3","author":"VanderWeele","year":"2014","journal-title":"Epidemiol. Methods"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1097\/00001648-199209000-00012","article-title":"Confidence interval estimation of interaction","volume":"3","author":"Hosmer","year":"1992","journal-title":"Epidemiol. Camb. Mass"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/0306-4530(87)90017-5","article-title":"Sustained urinary norepinephrine and epinephrine elevation in post-traumatic stress disorder","volume":"12","author":"Kosten","year":"1987","journal-title":"Psychoneuroendocrinology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1023\/A:1024400628342","article-title":"Twenty-four-hour ambulatory blood pressure and heart rate monitoring in combat-related posttraumatic stress disorder","volume":"11","author":"Muraoka","year":"1998","journal-title":"J. Trauma. Stress"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s10484-010-9141-y","article-title":"Heart rate variability (HRV) and posttraumatic stress disorder (PTSD): A pilot study","volume":"36","author":"Tan","year":"2011","journal-title":"Appl. Psychophysiol. Biofeedback"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1001\/archpsyc.1993.01820160036003","article-title":"Abnormal noradrenergic function in posttraumatic stress disorder","volume":"50","author":"Southwick","year":"1993","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1097\/PSY.0000000000000313","article-title":"Differential autonomic nervous system reactivity in depression and anxiety during stress depending on type of stressor","volume":"78","author":"Hu","year":"2016","journal-title":"Psychosom. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1093\/ije\/31.1.248","article-title":"Psychological distress as a risk factor for coronary heart disease in the Whitehall II Study","volume":"31","author":"Stansfeld","year":"2002","journal-title":"Int. J. Epidemiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1097\/PSY.0000000000000775","article-title":"Anger expression and the risk of cardiovascular disease among urban and rural Japanese residents: The Circulatory Risk in Communities Study","volume":"82","author":"Tezuka","year":"2020","journal-title":"Psychosom. Med."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/19\/10283\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:07:30Z","timestamp":1760166450000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/19\/10283"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,29]]},"references-count":25,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["ijerph181910283"],"URL":"https:\/\/doi.org\/10.3390\/ijerph181910283","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,29]]}}}