Our research after TMI and Chernobyl found no psychiatric, social, academic, or cognitive differences between exposed children and controls as toddlers (TMI) [49], at age 11 (TMI and Chernobyl) [26, 50] and at age 19 (Chernobyl) [51]. Other international studies of Chernobyl-affected groups who immigrated to other countries also found no relationship of radiation exposure and neuropsychiatric functioning [42]. On the other hand, local studies have produced findings showing impairments in highly exposed children, and northern European studies without direct data on radiation exposure have also suggested that Chernobyl had a neuropsychological impact (for review, see [42]). Since the highest exposure of Chernobyl children was lower than the lowest exposure of young A-bomb survivors who developed cognitive impairments, it seems unlikely that meaningful decrements associated with radiation exposure would exist. The discussion, however, remains open.

Risk perception research has shown that exposure to radiation accidents and events, whether actual or perceived, is among the most feared and pernicious of risk perceptions. As noted earlier, at the 20th anniversary of the Chernobyl accident, the Chernobyl Forum concluded that the mental health impact was the biggest public health effect of the accident [2]. Previously, after the TMI accident, the President’s Commission on the Accident at Three Mile Island had come to the same conclusion [1]. It is already becoming evident that mental health is a major component of the public health impact of Fukushima as well [52]. It is also likely that the effects will be long lasting given the devastation of the triple disaster. The evacuation zone covered 50,000 people living within 20 km of the facility and other communities found to have high levels of contamination. Thus, the relative and absolute magnitude of the psychological impact of the Fukushima nuclear plant accident cannot be overstated.

The World Health Organization (WHO) defined health as a state of complete physical, mental and social well–being and not merely the absence of disease or infirmity. The WHO estimates that disorders like depression, anxiety, and PTSD, which occurred after these nuclear power plant accidents, will be the second leading cause of disability in the industrialized world in the year 2020 [3]. After World War II, when epidemiology shifted its focus from infectious diseases to chronic physical and mental disorders, a large number of population-based studies were conducted that consistently showed that poor mental health leads to increased mortality, medical morbidity, and impaired quality of life [3]. The implications for the design of effective intervention and prevention programs are obvious. Health-care providers need to be knowledgeable about both medical and psychiatric conditions, and integrated treatment programs are critical. It is noteworthy that each event – TMI, Chernobyl, and Fukushima – occurred in regions where integrated care was not the norm and mental health was barely acknowledged as a co-occurring diagnostic condition worthy of treatment.

TMI families moved back to their homes. Chernobyl families were resettled in other cities. The early adjustment period was fraught with difficulties stemming from stigma toward the evacuees, fear by local residents and local medical providers that the evacuees were contaminated, resentment by local residents who had waited for years to move into the new apartments given to the evacuees, and special benefits accorded to evacuees. Eventually, however, the evacuees, especially their children, became integrated into their new communities. The situation in Japan is more complex, given the stigma expressed toward A-bomb survivors that became redirected toward evacuees [53] and Fukushima plant workers [47]. The triple catastrophe occurred during a difficult economic period in Japan. Some evacuees wish to return to Fukushima after their villages are decontaminated, but jobs in these communities are scarce. Some evacuee families are separated because husbands’ jobs are far from home. Still other evacuees prefer not to return to their villages and towns, particularly younger people who more easily found jobs in their new communities. Others fear moving back because of lingering concerns about radiation and distrust of official safety reports [54].

Many elderly people in nursing homes died during the evacuation and in the first 9 months after the disaster started [55]. The rates of alcoholism and suicide in older residents of Fukushima are higher than in other parts of Japan [52], though the suicide rate was higher even before March 2011. Unfortunately, after TMI and Chernobyl, there were no English-language publications on the psychological and alcohol sequelae among older people. There are anecdotal reports that some older people have moved back into the exclusion zone around Chernobyl, but no hard data about this population. Thus, there is little guidance about what to expect in the longer term after Fukushima.

Consistent with TMI and Chernobyl, mothers of young children are emerging as one of the most vulnerable populations [56]. It is important that obstetrician/gynecologists and pediatricians be aware of the signs of psychological distress in mothers and given basic tools for managing these symptoms and referral sources if the problems persist. Since many women do not spontaneously talk about mental health concerns, it is important for their medical physicians to ask about mental health directly. Even a short symptom questionnaire administered in the waiting area would alert the physician to co-occurring psychological issues that need to be addressed during the visit. In our Chernobyl sample, the association between distress severity and number of diagnoses (anemia, cataracts, thyroid, immune system problems, arthritis) among mothers was .42 (p < 0.001). Together, mental and physical health problems are also more strongly associated with disability than either one alone.

Mental health literacy extends beyond physicians, however. Raising awareness about and destigmatizing mental health problems need to be done at the level of the general population and community leaders and officials. Shortly after the Fukushima accident, Japanese psychiatrists asked organizations like the World Psychiatric Association to provide information about psycho-education and treatment for the psychological sequelae of traumatic events [57]. To the extent that medical professionals, particularly non-psychiatrist physicians and nurses, interact with local community leaders and residents around these issues, rather than doing so through mental health specialists, the messages will be more readily received. At the conclusion of our Chernobyl research, we held a “town hall meeting” with all of the participants where we presented the findings and addressed their questions. It was striking that the highlight of the event was the report by the hematologist in our research group. Even though the findings were contrary to local rumor, the community perceived him as “on their side” and trusted that he was not engaging in more of the misinformation that had been gone on for years. Physicians have little to no experience in these kinds of settings. It is therefore important that they learn the skills they need to make such presentations and handle questions and answers and communicate more effectively to large groups. Communication is a dialogue. Physicians are trained to deliver information. Learning to handle challenging questions from informed, and sometimes misinformed, community members and journalists, is a critical skill in the twenty-first century and in post-disaster circumstances. Indeed, communication has become a pivotal issue for physicians and scientists as a result of Fukushima [58].

Long-term mental health research can provide critical information for identifying high-risk populations and for targeting interventions. Suggestions for developing and implementing such studies include: