Although the immediate psychological aftermath of the disaster could not be examined because of the confusion in our university hospital, we were able to study the long-term effects of the earthquake on glycemic control and psychological stress. The GHQ was used as a screening instrument to detect possible psychiatric problems or disorders. This questionnaire has been widely used in various countries and different settings, including general practice and the community.7- 8 Higher GHQ scores in patients with insulin-dependent diabetes than in control subjects were described previously,9- 10 but, to our knowledge, the effects of life-threatening disasters such as earthquakes on diabetes mellitus have not been reported. The diabetic patients in Kobe were found to have significantly higher GHQ scores than those in Osaka, who had scores near the cutoff values for the general population in Japan. Significant differences were observed in somatic symptoms, sleep disturbances and anxiety, and social dysfunction, which could affect patients' compliance behaviors in ways that lead to difficulties in metabolic control. Although the earthquake did not substantially increase the occurrence of severe depression, this might be due to patients being in the heroic stage,11 as noted in other Kobe citizens when the GHQ was administered (M.U., unpublished data, 1997). These results suggest a serious psychological effect on diabetic patients. A significant, albeit small, elevation of HbA1c levels after the earthquake might be the sum of the mixed results as observed in short-term psychosocial stress. There is no essential difference in the results between patients with non–insulin-dependent diabetes and those with insulin-dependent diabetes (A.I., unpublished data, 1997). It has yet to be determined whether persons such as those with type A behavioral patterns5 may be at risk for having greater metabolic responses to psychosocial stress. Although the increase of HbA1c levels is likely related to other factors such as the inevitable disruption of lifestyle, diet, and access to medication, a high GHQ score, suggesting psychosocial stress, indicates an association between chronic stress and glycemic control. Follow-up studies demonstrate that this is especially the case for the patients who suffered severe damage to their houses and/or who had relatives killed or injured. The number of cases of acute myocardial infarction increased within the first 3 weeks after the earthquake.12 Therefore, the Kobe earthquake appears to have induced emotional stress of both acute and chronic natures, and the chronic stress might be of more importance for glycemic control in diabetic patients.