Correspondence

Suicides after Natural Disasters

N Engl J Med 1998; 338:1851-1852June 18, 1998

Article

To the Editor:

The study by Krug et al. (Feb. 5 issue)1 is unique in having looked for trends in the rates of suicide before and after natural disasters. However, the authors fail to distinguish between the statistically significant increase in the rate of suicide after a disaster and its substantive importance as reflected by the magnitude of the problem. An increase of 13.8 percent in the suicide rate gives one the impression of a serious public health problem. However, if we compare the annualized number of suicides per year before and after a natural disaster, as reported by Krug et al., there are an average of 1.05 excess suicides per year per county after a disaster. The seriousness of this excess number for a community as a whole is questionable.

Viewed in this context, the study by Krug et al. indicates that severe mental health effects are rare, and theirs is one more study that indicates that although it is “possible that some individuals could experience negative psychological consequences [as a result of a disaster],”2 the “magnitude [of the problem] is rather small and could be considered clinically insignificant.”3 Therefore, rather than emphasizing the importance of providing psychological support after disasters, we should focus our efforts on disaster preparedness, mitigation, and response.

Kimberley I. Shoaf, Dr.P.H.
UCLA Center for Public Health and Disaster Relief, Los Angeles, CA 90095-1772

3 References

1. 1

   Krug EG, Kresnow M, Peddicord JP, et al. Suicide after natural disasters. N Engl J Med 1998;338:373-378
   Full Text | Web of Science | Medline

2. 2

   Perry RW, Lindell MK. The psychological consequences of a natural disaster: a review of research on American communities. Mass Emergencies 1978;3:105-115
   

3. 3

   Bravo M, Rubio-Stipec M, Canino GJ, Woodbury MA, Ribera JC. The psychological sequelae of disaster stress prospectively and retrospectively evaluated. Am J Community Psychol 1990;18:661-680
   CrossRef | Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: We agree with Dr. Shoaf that primary-prevention efforts such as disaster preparedness and mitigation are important and deserve more attention. We disagree, however, with Dr. Shoaf's conclusion about the negative psychological consequences of natural disasters and the contention that the magnitude of the problem is small and clinically insignificant. We believe that psychological trauma is a public health problem of sufficient magnitude to deserve postdisaster ministrations.

Suicides represent only a small portion of the disabling psychological trauma that follows natural disasters. Researchers estimate that there are approximately 25 suicide attempts for every completed suicide1 and that about 15 percent of people with depression commit suicide.2 Moreover, the number of disaster-related suicides probably exceeds the number of disaster-related deaths due to physical trauma. The estimated rate of deaths due to physical trauma and attributed directly to natural disasters is 1.5 deaths per affected county per year3 (and Watts A, Federal Emergency Management Agency: personal communication), which is lower than the average rate of 4 suicides per county during the four-year postdisaster period in our study.

Natural disasters inflict both physical and psychological damage. Arguing that prevention or relief of physical damage after a disaster is more important than prevention or relief of psychological damage, or vice versa, is counterproductive. Both approaches are needed, and for each there is an appropriate time and target group.

Etienne G. Krug, M.D., M.P.H.
Centers for Disease Control and Prevention, Atlanta, GA 30341-3724

Kenneth E. Powell, M.D., M.P.H.
Georgia Department of Human Resources, Atlanta, GA 30303-3186

Linda L. Dahlberg, Ph.D.
Centers for Disease Control and Prevention, Atlanta, GA 30341-3724

3 References

1. 1

   O'Carroll PW, Rosenberg ML, Mercy JA. Suicide. In: Rosenberg ML, Fenley MA, eds. Violence in America. New York: Oxford University Press, 1997.
   

2. 2

   Wilson GL. Suicidal behavior -- clinical considerations and risk factors. J Consult Clin Psychol 1991;59:869-873
   CrossRef | Web of Science

3. 3

   Noji EK, ed. The public health consequences of disasters. New York: Oxford University Press, 1997.
   

Citing Articles (1)

Citing Articles

1. 1

   Hayriye Ertem Vehid, Behiye Alyanak, Aysel Eksi. (2006) Suicide Ideation after the 1999 Earthquake in Marmara, Turkey. The Tohoku Journal of Experimental Medicine 208:1, 19-24
   CrossRef