# 5739
Nearly 5 months after the triple horrors of a deadly 9.0 earthquake, a series of massive coastal tsunamis, and an ongoing nuclear crisis, the lives and futures of millions of Japanese remain disrupted and uncertain.
In a matter of a few hours more than 20,000 lives were lost, hundreds of thousands of survivors became refugees, families were separated, entire towns were destroyed, and uncounted businesses and individual livelihoods wiped out.
Added to that, millions of residents have endured scores of strong aftershocks, rattling both previously damaged infrastructures and already raw nerves.
And so stories, such as the one that appeared yesterday on the Voice of America's website about the fears of a rise in post-disaster suicides have become fairly common in the media.
Fears of Suicide Surge in Japan's Tsunami Zone
Henry Ridgwell | Sendai, Japan
Photo: VOA
These people care for their infant, and are among more than 430,000 forced into emergency shelters after the earthquake and tsunami struck Japan on March 11 of this year, in Sendai, Japan, August 2011
Months after Japan's devastating earthquake and tsunami, mental health experts say the psychological effects of the disaster might only now be coming to the surface. Phone counseling services are building up their presence along Japan's northeast coast for fear of increased suicides and other mental health problems.
Japan, somewhat notoriously, was already known for having one of the highest rates of suicide in the world. Not the highest, as many media stories have suggested (Lithuania, Kazakhstan, and Belarus all reportedly surpass Japan’s rate), but very high nonetheless.
According to the Japanese government, more than 30,000 citizens took their own lives in 2010. Differences in international reporting make exact comparisons between countries difficult to make.
Historically, Japan’s suicide rate has been closely tied to its economy, jumping more than 30% following their severe economic downturn in the late 1990s. Suicides often peak in May, during a period called “gogatsu byo” or “May Sickness” – a time of increased stress that coincides with end of the corporate year in Japan.
While exact numbers in the wake of Japan’s tragedy are hard to come by, according to a report appearing in The Australian newspaper last June, suicide rates have risen markedly.
Suicide rates are increasing in Japanese regions most effected by the tsunami and nuclear disasters
Richard Lloyd Parry, Asia Editor June 17, 2011
The country already has one of the highest suicide rates in the world, but new figures show that the number of deaths has risen almost a fifth compared with a year ago. In Miyagi, the region worst hit by the March 11 tsunami, the figures are especially alarming, with suicides up 39 per cent.
Many of these reports are anecdotal in the turmoil following Japan’s disaster, and it will probably be years before the full psychological impact of this national rauma can be fully assessed.
Studies from previous disasters around the world have provided mixed, and sometimes confusing, results.
In 1999 a 7.3 earthquake struck in Chi-Chi, Nantou county in central Taiwan killing more than 2,300 people.
A study that subsequently appeared in the Taiwan Journal of Medicine (Disease-specific Mortality Associated with Earthquake in Taiwan Hsien-Wen Kuo, Shu-Jen Wu, Ming-Chu Chiu) found `a considerable increase in the number of suicides after the earthquake’.
Among their findings:
. . . the psychological effect of the earthquake in the disaster areas was far greater for women than for men. For men and women, suicide mortality rates were highest in the 25 to 39 year age group. Suicide rates among the 22 townships in the disaster areas varied markedly and were significantly correlated to severity of damage (number of injuries and number of collapsed/ partially collapsed buildings) within the township.
But another study, this time following California’s 6.7 magnitude Northridge earthquake in 1994, found exactly the opposite. The rate of suicide actually dropped in the three years following that disaster.
Suicides in Los Angeles County in Relation to the Northridge Earthquake
Kimberley Shoaf,DrPH; Cary Sauter,MPH; Linda B. Bourque, PhD;Christian Giangreco,MPH; Billie Weiss,MPH
Conclusion: It does not appear that suicide rates increase as a result of earthquakes in this setting. This study demonstrates that the psychological
impacts of the Northridge earthquake did not culminate in an increase in the rates of suicide.
Adding to the confusion, we’ve seen conflicting reports on suicide rates following the devastation of New Orleans from Hurricane Katrina.
While some sources have cited a 3-fold increase in suicide in the months following that disaster (see CNN report New Orleans' suicide rate nearly triples) a Harvard Study released in the summer of 2006 came to a different conclusion.
Mental illness and suicidality after Hurricane Katrina.
Ronald C. Kessler, Sandro Galea, Russell T. Jones, Holly A. Parker, and Hurricane Katrina Community Advisory Group
Funded by the National Institute of Mental Health, the study surveyed 1,043 survivors. They found:
- More than 11% were diagnosed with a serious mental illness following the storm. This compares to just over 6% before the hurricane.
- 9.9% had mild-moderate mental illness, compared to 9.7% before Katrina.
- They estimated 200,000 people facing serious mental problems, such as PTSS (Post Traumatic Stress Syndrome) and depression, in the three states most affected.
Despite this doubling of serious mental health issues, they found that fewer people expressed thoughts of committing suicide.
They concluded:
Despite the estimated prevalence of mental illness doubling after Hurricane Katrina, the prevalence of suicidality was unexpectedly low. The role of post-traumatic personal growth in ameliorating the effects of trauma-related mental illness on suicidality warrants further investigation
In 2002 (and updated in 2005) Fran H. Norris of the Dartmouth Medical School and National Center for PTSD released a comprehensive review of the mental health impact of 132 different disasters between 1981 and 2004.
Range, Magnitude, and Duration of the Effects of Disasters on Mental Health: Review Update 2005
The following slides come from an HHS presentation on Research on the Mental Health Consequences of Disaster by Ferris Tuma, Sc.D.
While there appears to be much variability in the levels of stress created by different disasters (exacerbated by both the severity and duration), cultural attitudes towards suicide, and in the effectiveness of individual coping skills, there seems little doubt that major disasters can cause both temporary and long-term mental health problems.
The CDC’s website contains a number of resources devoted to coping with disasters.
Coping With a Disaster or Traumatic Event
Trauma and Disaster Mental Health Resources
The effects of a disaster, terrorist attack, or other public health emergency can be long-lasting, and the resulting trauma can reverberate even with those not directly affected by the disaster. This page provides general strategies for promoting mental health and resilience. These strategies were developed by various organizations based on experiences in prior disasters.
Information for Individuals & Families
- Coping with Traumatic Events
Provides general information regarding common reactions to expect after disasters.- Video: Coping with a Traumatic Event
- Preventing Violence after a Natural Disaster
- Tips for Talking about Disasters
Provides information that can be used by teachers, children, adults, families and response workers.- Maintain a Healthy State of Mind
Developed in partnership with the American Red Cross this site provides information for parents and caregivers, middle school students, high school students, adults and seniors.- Helping Families Deal With the Stress of Relocation After a Disaster
Helping family members deal with relocation stress from ATSDR.- Helping Parents Prepare for a Disaster
- Helping Parents Cope with a Disaster
And from the National Center For PTSD, some resources - including videos - on how to provide Psychological First Aid.
Psychological First Aid: Field Operations Guide
For disaster responders
Developed jointly with the National Child Traumatic Stress Network, PFA is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism: to reduce initial distress, and to foster short and long-term adaptive functioning. It is for use by first responders, incident command systems, primary and emergency health care providers, school crisis response teams, faith-based organizations, disaster relief organizations, Community Emergency Response Teams, Medical Reserve Corps, and the Citizens Corps in diverse settings. The 5th appendix consists of Handouts for Survivors (PDF).
Online training on how to provide Psychological First Aid is available from http://learn.nctsn.org/, and you can view a series of videos about the process that are available on the PFAOnlinevideos Channel of Youtube.
Lastly, while the psychological impact of a major disaster cannot be fully prevented, individual, family, and business preparedness can go a long ways towards reducing the impact of any disaster.
Those that follow FEMA’s, and Ready.gov’s advice to Have A Plan, Make A Kit, and Be informed will be better equipped to deal with any eventuality.
September is National Preparedness Month, but being ready to deal with an emergency – large or small – should be a year-round endeavor.
Finally, a couple of my (many) blogs on that subject include:
In An Emergency, Who Has Your Back? An Appropriate Level Of Preparedness
