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Rates of suicide increased most dramatically in the second year after a disaster, after many postdisaster mental health assistance programs expire.

Credit: iStock.com/Nastco

By Kimberly M. S. Cartier 12 hours ago

Content warning: This article discusses suicide and potential risk factors of suicide.

Natural disasters can continue to cause pain long after homes have been rebuilt and businesses reopened. According to a recent U.S.-based study, rates of suicide increase somewhat during the first 3 years postdisaster.

“These are, in a sense, preventable deaths.”

“These are, in a sense, preventable deaths, because there should be opportunities for people to get assistance with these mental health problems after disasters,” said lead author Jennifer A. Horney, an epidemiologist at the University of Delaware in Newark. After a disaster has passed, one third to one half of people affected by it experience mental health problems, including post-traumatic stress disorder (PTSD), depression, anxiety, and substance use disorders. Severe cases of these issues are risk factors for suicide if untreated. “If people have access to treatment for anxiety and depression and PTSD following a disaster, as much as they need and for as long as they need, then we should not see the rates of suicide that we’re seeing in the subsequent years following the disaster.”

A Growing Public Health Problem

Climate change has increased the frequency and severity of natural disasters. So, too, has people’s understanding of the risk factors, warning signs, and precursors of suicide grown in recent years. For governments, relief organizations, and communities to provide effective postdisaster support, everyone must better understand how disasters influence the long-term mental health of people in harm’s way, Horney said.

“The impacts of a natural disaster persist much longer than the storm or the shaking. The impacts also include the psychosocial response to the disaster.”

Horney and her team gathered county-level data on natural disaster occurrences and fatal suicide rates in the United States from 2003 to 2015. In counties that experienced a single natural disaster during that time, the researchers found that suicide rates rose by 23% in the first 3 years postdisaster compared with 3 years predisaster (from 16.3 to 20.1 per 100,000 people). Severe storms led to the largest postdisaster rise in suicide rate, followed by floods, hurricanes, and severe ice storms. These results were published in Crisis in October 2020.

“The impacts of a natural disaster persist much longer than the storm or the shaking. The impacts also include the psychosocial response to the disaster,” said Ben Beaglehole, who was not involved with this research. The calculated increase in suicide rates is not statistically significant, but that’s not unusual in studies like this. “Although mental illness and psychological distress increase following disasters, this is predominantly in the mild-moderate severity group,” rather than severe cases that can lead to suicidality, Beaglehole explained. “Suicide is so rare, there would need to be a large increase for any increase to be statistically significant.” Still, he added, this is a “good study design” to isolate the influence of a single disaster. Beaglehole is a senior lecturer in psychological medicine at the University of Otago and an inpatient psychiatrist at Hillmorton Hospital in Christchurch, New Zealand.

Highlighting a Need for Policy Change

Because the study considers only counties with one disaster from 2003 to 2015 (slightly more than 9% of all U.S. counties), the reported rise in suicide rate is likely underestimated, Horney said. Areas that experience natural disaster year after year may have much higher suicide rates after a disaster than rates in areas where disasters are rare. “We know that there’s a cumulative effect of repeated exposure,” she said.

The trends are “highlighting policy changes I think that need to happen.”

“The other thing that we don’t know about is nonfatal suicide attempts. And there’s also the complex [role] that social support plays in the mitigation of the mental health impacts of disasters.” Future research will seek to understand these complexities.

Policies addressing postdisaster mental health likely also played a role in how suicide rates changed after disasters. Many U.S. disaster relief programs offer mental health support for up to a year after a disaster. “I think it’s really important that we know from this study that the largest increases [in suicide rate] seem to happen in the second year after disasters,” Horney said. By year 3, suicide rates fell nearly to predisaster levels.

The trends are “highlighting policy changes I think that need to happen,” Horney said. “There are programs in place to provide mental health assistance to people who’ve been impacted by disasters, and we would like policies to change [and] to expand people’s opportunities to receive that assistance, both through providing more assistance and also providing it for longer.”

—Kimberly M. S. Cartier (@AstroKimCartier), Staff Writer

If you or someone you know is in crisis, please reach out to a prevention network for help. The U.S. National Suicide Prevention Lifeline is 1-800-273-TALK (8255) (En Español, Nacional de Prevención del Suicidio es 1-888-628-9454). You can reach the Crisis Text Line by texting HOME to 741741 (United States and Canada), 85285 (United Kingdom), or 50808 (Ireland) and also through Facebook Messenger.