Increased antidepressant prescriptions following the 2018 Japan floods: a longitudinal analysis using the national health insurance database.

Background

Natural disasters are known to affect the mental health of the victims; however, the understanding of their impact on real-world clinical practice remains insufficient.

Objective

This study aimed to evaluate the effects of the 2018 Japan floods, one of the largest disasters in Japan's recorded history, on antidepressant prescriptions over time.Method: Prescription data from the medical insurance claims database covering three prefectures that accounted for 90% of flood damage were analyzed for the years before and after the floods. Participants were categorized as disaster victims or nonvictims based on local government designations. A difference-in-differences analysis compared the trends in antidepressant prescriptions between victims and non-victims during the period surrounding the floods.

Results

Of 5,000,129 participants, 31,235 were disaster victims. Victims were more likely to be prescribed antidepressants after the disaster than nonvictims (p < .001). This trend peaked 2-3 months after the disaster (adjusted Ratio of Odds Ratios [ROR], 1.13; 95% confidence interval [CI] 1.07-1.20) and persisted up to 1 year later (adjusted ROR, 1.20; 95% CI 1.12-1.28). Among antidepressants, noradrenergic and specific serotonergic antidepressants (NaSSAs) and serotonin antagonist and reuptake inhibitors (adjusted ROR 1.47, 1.49; 95% CI 1.21-1.80, 1.22-1.83) were particularly prescribed more frequently among victims. When limited to those who had not used antidepressants before the disaster, NaSSAs (adjusted ROR 2.56; 95% CI 2.14-3.07, p < .001) were conspicuously more prescribed.

Conclusions

The floods were associated with an increase in antidepressant prescriptions, suggesting the development of disaster-related mental health conditions such as depression and post-traumatic stress disorder. The need for care became pronounced 2-3 months after the event and persisted for 1 year. These findings highlight the need for psychiatric drug treatment among disaster victims and emphasize the importance of identifying appropriate timing for such interventions.