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Letters to the Editor   |    
The Impact of Internet Coverage of the March 2011 Japan Earthquake on Sleep and Posttraumatic Stress Symptoms: An International Perspective
Eric Bui, M.D., Ph.D.; Rachel F. Rodgers, Ph.D.; Christophe Herbert, M.A.; Debra L. Franko, Ph.D.; Naomi M. Simon, M.D., M.Sc.; Philippe Birmes, M.D., Ph.D.; Alain Brunet, Ph.D.
Am J Psychiatry 2012;169:221-222. doi:10.1176/appi.ajp.2011.11081281
View Author and Article Information
Toulouse, France
Boston
Montreal, Quebec

Dr. Bui is supported by a fellowship from Association Traumapsy and Toulouse University Hospital. Dr. Rodgers is supported by a Fulbright fellowship. Dr. Simon has received research grants from American Foundation for Suicide Prevention, Eli Lilly, Forest Laboratories, GlaxoSmithKline, NARSAD, NIMH, Pfizer, Sepracor, and the U.S. Department of Defense and speaking, CME, or consulting fees from Massachusetts General Hospital Psychiatry Academy, Pfizer, and the U.S. Department of Defense. Dr. Brunet has received a salary award from the Fonds de la recherche en santé du Québec. All other authors report no financial relationships with commercial interests.

Accepted for publication in November 2011.

Copyright © American Psychiatric Association

Accepted November , 2011.

To the Editor: On March 11, 2011, a 9.0 magnitude earthquake and tsunami struck Japan, killing 14,000 people and damaging nuclear and petrochemical plants. The immediate and intense media coverage exposed viewers across the world to disturbing images. While television coverage of a nearby disaster has been found to increase the risk for subsequent psychological distress (1), little is known about the effects of Internet coverage of a distant disaster.

We conducted an online survey simultaneously in France, Canada, and the United States within 2 weeks of the event. Adult participants (N=698; 42.7% from Canada, 44.6% from France, 8.2% from the United States, and 4.5% from “other/unspecified” countries) were contacted through online mailing lists and snowballing procedures (i.e., participants were also asked to circulate the link to the survey among their contacts) and asked to report 1) the time they spent viewing television and Internet coverage of the event during the first week afterward; 2) their immediate reactions after learning the news (i.e., peritraumatic distress [2] and dissociation [3]); and 3) any disruptive nocturnal behavior (i.e., trauma-related sleep disturbances such as nightmares [4]) they experienced during the first 10 days after the event.

After the earthquake and tsunami, most participants (64.9%) had increased their media consumption. The amount of television and Internet viewing correlated both with symptoms of peritraumatic distress and dissociation (r>0.22 and p<0.001 in all cases) and with disruptive nocturnal behavior (r>0.17 and p<0.001 in all cases), while 45% of the participants reported at least one disruptive nocturnal behavior. Being female, knowing someone in Japan, and figuring in the amount of time spent on the Internet each predicted at least one disruptive nocturnal behavior in a logistic regression (Table 1). In the second step, peritraumatic dissociation and distress significantly predicted disruptive nocturnal behavior; however, the time spent on the Internet became nonsignificant, suggesting a mediating effect of peritraumatic reactions. This was confirmed by a multiple mediator analysis revealing that the direct effect of Internet viewing on disruptive nocturnal behavior was not significant, while indirect effects through both peritraumatic distress and dissociation were significant (p<0.05), suggesting that peritraumatic reactions might explain the relationship between Internet exposure and disruptive nocturnal behavior. Replicating the analyses separately by country yielded similar results. As a follow-up, in a subsample reassessed 2 months later (109 individuals who provided their e-mail addresses), similar analyses examining predictors of posttraumatic stress symptoms (5) revealed a significant effect of Internet viewing that was mediated by peritraumatic reaction.

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TABLE 1.

Predictors of the Presence of at Least One Disruptive Nocturnal Behavior in the First Week After the March 2011 Japan Earthquake and of Posttraumatic Stress Symptoms 2 Months Latera

Table Footer Note

a N=698 assessed in the first week; some data are missing. N=109 assessed 2 months later; some data are missing. There were no differences on any variables between those who were reassessed at 2 months and those who were not.

Table Footer Note

b At least one item on the Pittsburgh Sleep Quality Index Addendum for PTSD.

Table Footer Note

c Peritraumatic Distress Inventory score (range 0–52).

Table Footer Note

d Peritraumatic Dissociative Experiences Questionnaire score (range 10–50).

Table Footer Note

e Impact of Event Scale–Revised total score (range 0–88).

Table Footer Note

*p<0.05. **p<0.01. ***p<0.001.

Limitations of this study include the convenience sample, the lack of an assessment of disruptive nocturnal behavior and posttraumatic stress symptoms before the event, an expectedly low level of symptoms, and the possible response bias. However, the results suggest that Internet coverage of a distant disaster may induce sleep disturbances and subclinical psychological symptoms of posttraumatic stress in the general population. Such effects, consistent with previous reports (6, 7) of posttraumatic stress disorder symptoms after trauma exposure, were mediated by peritraumatic reactions.

Ahern  J;  Galea  S;  Resnick  H;  Kilpatrick  D;  Bucuvalas  M;  Gold  J;  Vlahov  D:  Television images and psychological symptoms after the September 11 terrorist attacks.  Psychiatry 2002; 65:289–300
[PubMed]
 
Brunet  A;  Weiss  DS;  Metzler  TJ;  Best  SR;  Neylan  TC;  Rogers  C;  Fagan  J;  Marmar  CR:  The Peritraumatic Distress Inventory: a proposed measure of PTSD criterion A2.  Am J Psychiatry 2001; 158:1480–1485
[PubMed]
[CrossRef]
 
Marmar  CR;  Weiss  DS;  Metzler  TJ:  The Peritraumatic Dissociative Experiences Questionnaire: assessing psychological trauma and PTSD, in  Assessing Psychological Trauma and PTSD . Edited by Wilson  JP;  Keane  TM.  New York,  Guilford, 1997, pp 412–428
 
Germain  A;  Hall  M;  Krakow  B;  Katherine Shear  M;  Buysse  DJ:  A brief sleep scale for posttraumatic stress disorder: Pittsburgh Sleep Quality Index Addendum for PTSD.  J Anx Disord 2005; 19:233–244
[CrossRef]
 
Creamer  M;  Bell  R;  Failla  S:  Psychometric properties of the Impact of Event Scale–Revised.  Behav Res Ther 2003; 41:1489–1496
[PubMed]
[CrossRef]
 
Allenou  C;  Olliac  B;  Bourdet-Loubère  S;  Brunet  A;  David  AC;  Claudet  I;  Lecoules  N;  Roullet  P;  Bui  E;  Birmes  P:  Symptoms of traumatic stress in mothers of children victims of a motor vehicle accident.  Depress Anxiety 2010; 27:652–657
[PubMed]
[CrossRef]
 
Bui  E;  Brunet  A;  Allenou  C;  Camassel  C;  Raynaud  JP;  Claudet  I;  Fries  F;  Cahuzac  JP;  Grandjean  H;  Schmitt  L;  Birmes  P:  Peritraumatic reactions and posttraumatic stress symptoms in school-aged children victims of road traffic accident.  Gen Hosp Psychiatry 2010; 32:330–333
[PubMed]
[CrossRef]
 
References Container
Anchor for Jump
TABLE 1.

Predictors of the Presence of at Least One Disruptive Nocturnal Behavior in the First Week After the March 2011 Japan Earthquake and of Posttraumatic Stress Symptoms 2 Months Latera

Table Footer Note

a N=698 assessed in the first week; some data are missing. N=109 assessed 2 months later; some data are missing. There were no differences on any variables between those who were reassessed at 2 months and those who were not.

Table Footer Note

b At least one item on the Pittsburgh Sleep Quality Index Addendum for PTSD.

Table Footer Note

c Peritraumatic Distress Inventory score (range 0–52).

Table Footer Note

d Peritraumatic Dissociative Experiences Questionnaire score (range 10–50).

Table Footer Note

e Impact of Event Scale–Revised total score (range 0–88).

Table Footer Note

*p<0.05. **p<0.01. ***p<0.001.

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References

Ahern  J;  Galea  S;  Resnick  H;  Kilpatrick  D;  Bucuvalas  M;  Gold  J;  Vlahov  D:  Television images and psychological symptoms after the September 11 terrorist attacks.  Psychiatry 2002; 65:289–300
[PubMed]
 
Brunet  A;  Weiss  DS;  Metzler  TJ;  Best  SR;  Neylan  TC;  Rogers  C;  Fagan  J;  Marmar  CR:  The Peritraumatic Distress Inventory: a proposed measure of PTSD criterion A2.  Am J Psychiatry 2001; 158:1480–1485
[PubMed]
[CrossRef]
 
Marmar  CR;  Weiss  DS;  Metzler  TJ:  The Peritraumatic Dissociative Experiences Questionnaire: assessing psychological trauma and PTSD, in  Assessing Psychological Trauma and PTSD . Edited by Wilson  JP;  Keane  TM.  New York,  Guilford, 1997, pp 412–428
 
Germain  A;  Hall  M;  Krakow  B;  Katherine Shear  M;  Buysse  DJ:  A brief sleep scale for posttraumatic stress disorder: Pittsburgh Sleep Quality Index Addendum for PTSD.  J Anx Disord 2005; 19:233–244
[CrossRef]
 
Creamer  M;  Bell  R;  Failla  S:  Psychometric properties of the Impact of Event Scale–Revised.  Behav Res Ther 2003; 41:1489–1496
[PubMed]
[CrossRef]
 
Allenou  C;  Olliac  B;  Bourdet-Loubère  S;  Brunet  A;  David  AC;  Claudet  I;  Lecoules  N;  Roullet  P;  Bui  E;  Birmes  P:  Symptoms of traumatic stress in mothers of children victims of a motor vehicle accident.  Depress Anxiety 2010; 27:652–657
[PubMed]
[CrossRef]
 
Bui  E;  Brunet  A;  Allenou  C;  Camassel  C;  Raynaud  JP;  Claudet  I;  Fries  F;  Cahuzac  JP;  Grandjean  H;  Schmitt  L;  Birmes  P:  Peritraumatic reactions and posttraumatic stress symptoms in school-aged children victims of road traffic accident.  Gen Hosp Psychiatry 2010; 32:330–333
[PubMed]
[CrossRef]
 
References Container
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