Review
Natural disasters and suicidal behaviours: A systematic literature review

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Abstract

Background

Various consequences including suicidal behaviours can arise in the aftermath of natural disasters. The aim of the present review was to systematically analyse the existing literature on the potential impact of natural disasters on suicidal behaviours.

Methods

A systematic search of English-language articles indexed in electronic databases was conducted. The current review covers 42 papers containing empirical analyses of the relationship between natural disasters and suicidal behaviours.

Results

In total, 19 papers analysed suicide mortality and 23 non-fatal suicidal behaviours. The effects of earthquakes on suicidal behaviours are the most frequently studied among natural disasters (n=20), followed by hurricanes (n=11). Further, there were four papers about tsunamis, three about floods, three about heat waves and drought, and one investigating the effects of multiple natural disasters. The studies show different directions in suicide mortality following natural disasters. Nevertheless, there seems to be a drop in non-fatal suicidal behaviours in the initial post-disaster period, which has been referred to as the ‘honeymoon’ phase. A delayed increase in suicidal behaviours has been reported in some studies. However, other factors increasing the risk of suicidal behaviours after natural disasters have been reported, such as previous and current mental health problems. Furthermore, contributing factors, such as economic conditions, should also be considered.

Limitations

The exclusion of non-English articles.

Conclusions

In light of the various methodological limitations observed, there is a need for further studies using proper designs. Mental health and suicidal behaviours should continue to be monitored for several years after the disaster.

Introduction

Recent high magnitude earthquakes in Japan and New Zealand and floods and tsunamis in Australia and other countries have been widely reported in the news, and it seems that the number of natural disasters around the world is increasing. Indeed, the International Disasters Database shows an increase in the number of natural disasters around the world between 1975 and 2010 (EM-DAT www.emdat.be/Database, 2011). Despite a reduction in the number of the people killed, the number of affected people is rising.

Research distinguishes between several phases in the behavioural and psychological responses to natural disasters. Pasnau and Fawzy (1989) presented five phases: (1) the impact phase or actual onset of the disaster is described by fear and confusion; (2) the heroism (also called rescue) phase—time of altruism, including intervention activities from different organisations; (3) the honeymoon (remedy) phase—people collaborate actively for the collective good, communities pull together, and there is hope and elation; (4) disillusionment: in this phase people are disappointed in resource allocation, and sense injustice—some seem to be more fortunate, distress rises, and there is potential for mental health problems; and (5) the reorganisation (also called reconstruction and recovery) phase—people start to rebuild and depend on themselves, but failure to do so may cause long-term bitterness and animosity.

There is a growing body of empirical literature on the psychological problems brought about by natural disasters. An empirical review of the disaster literature between 1981 and 2001 by Norris et al. (2002a) included 160 studies. They analysed different outcomes, including specific psychological problems (e.g., PTSD, major depression), non-specific distress (stress-related psychological and psychosomatic symptoms), health problems and concerns (measured by self-reported somatic complaints or checklists of medical conditions), chronic problems in living, psychosocial resource loss (e.g., loss of social support or optimism), and problems specific to youth. Samples were more likely to be impaired when experiencing disasters of mass violence (e.g., terrorist attacks) compared to technical and natural disasters. However, the effect of natural disasters in developing countries was more severe than other types of disasters in developed countries (Norris et al., 2002a, Norris et al., 2002b). Indeed, different cultures have different understandings of natural disasters, which have evolved throughout their history (Reser 2004). As indicated by Reser (2004), the origin of natural disasters is perceived differently in Western compared to non-Western cultures, especially in some more traditionally oriented communities (e.g., Indigenous Australians). This indicates a need, in these cultures, for different types of intervention than those used in Western models.

There are several characteristics that make some victims more vulnerable to disaster effects. Broadly, vulnerability factors include: pre-existing factors such as cultural, social, and economic background, but also psychopathology and psychological resources; natural disaster-related factors, such as type of event, magnitude of event, threat to the life, and extent of loss; and post-disaster factors, such as social support, coping skills, and secondary stressors (e.g., becoming unemployed) (Lindsay, 2003, Norris et al., 2002a, Norris et al., 2002b, Ursano et al., 2007). Furthermore, research has identified particular vulnerable groups, including children, the elderly, women, and single parents (Norris et al., 2002a, Ursano et al., 2007).

There are several studies in suicide research which analyse adverse life events as triggers to suicide, but also as factors which influence suicidal behaviours later in life. Environmental exposure, including disasters, is an important component in several theoretical models, such as the stress-diathesis model of suicidal behaviours (Mann, 2002), and the stress-vulnerability model (Wasserman, 2001). In line with existing disaster and suicide research, we would expect an increase in suicidal behaviours after the honeymoon period. Nevertheless, there is a lack of studies specifically analysing suicidal behaviours that are the consequence of natural disasters (Rezaeian, 2008). Therefore, the aim of the present review was to systematically analyse the existing literature on the potential impact of natural disasters on suicidal behaviours and possible vulnerability factors.

Section snippets

Classification of natural disasters

There are several classifications of man-made and natural disasters, which seem to overlap to a certain degree (UNEP/GRID-Europe, 2004). However, only major natural disasters, such as climatic and tectonic catastrophes, were incorporated into this review. Following UNEP/GRID-Europe (2004), included in the climatic category are cyclones (hurricanes), droughts, floods, heat waves, and landslides; earthquakes, tsunamis, and volcanic eruptions belong to the category of tectonic disasters.

Literature search

A

Results

It is important to note that not all of the papers included in the current review specifically analyse suicidal behaviours. However, suicide or non-fatal suicidal behaviours were included in several studies analysing different types of mortality or mental health problems.

Discussion

Various social, political, economic, and health-related consequences can arise in the aftermath of natural disasters, and these include suicidal behaviours. The aim of the current paper was specifically to review the literature on suicidal behaviours as a potential corollary of natural disasters. The results of the different studies seem to vary. This might be partly explained by different methodological limitations, such as varying study types, the use of diverse comparison or control groups,

Role of funding source

We would like to acknowledge financial support form the Australian Commonwealth Government, Department of Health and Ageing.

Conflict of interest

No conflict declared.

Acknowledgments

We would like to acknowledge Delaney Skerrett for his thorough linguistic revision of the manuscript.

References (60)

  • J.M. Bertolote et al.

    A global perspective on the magnitude of suicide mortality

  • J.M. Bertolote et al.

    Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey

    Psychological Medicine

    (2005)
  • L.B. Bourque et al.

    Psychological distress following urban earthquakes in California

    Prehospital and Disaster Medicine

    (2002)
  • T. Caldera et al.

    Psychological impact of the hurricane Mitch in Nicaragua in a one-year perspective

    Social Psychiatry and Psychiatric Epidemiology

    (2001)
  • Y.-J. Chou et al.

    Suicides after the 1999 Taiwan earthquake

    International Journal of Epidemiology

    (2003)
  • F.H.-C. Chou et al.

    Epidemiologic psychiatric studies on post-disaster impact among Chi–Chi earthquake survivors in Yu-Chi, Taiwan

    Psychiatry and Clinical Neurosciences

    (2007)
  • H.-L. Chuang et al.

    A re-examination of the suicide rates in Taiwan

    Social Indicators Research

    (2007)
  • D. De Leo

    Australia revises its mortality data on suicide

    Crisis

    (2010)
  • EM-DAT: The OFDE/CRED International Disaster Database, 2011. Université Catholique de Louvain, Brussels, Belgium....
  • K.H. Gordon et al.

    The impact of the 2009 Red River Flood on interpersonal risk factors for suicide

    Crisis

    (2011)
  • Z.-X. He

    A suicide belt in China: the Yangtze Basin

    Archives of Suicide Research

    (1998)
  • K. Hyodo et al.

    Long-term suicide mortality rates decrease in men and increase in women after the Niigata-Chuetsu Earthquake in Japan

    Tohoku Journal of Experimental Medicine

    (2010)
  • K.B. Johannesson et al.

    Impact of exposure to trauma on posttraumatic stress disorder symptomatology in Swedish tourist tsunami survivors

    The Journal of Nervous and Mental Disease

    (2009)
  • K.B. Johannesson et al.

    Tsunami-exposed tourist survivors. Signs of recovery in a 3-year perspective

    The Journal of Nervous and Mental Disease

    (2011)
  • N. Kar

    Psychosocial issues following a natural disaster in a developing country: a qualitative longitudinal observational study

    International Journal of Disaster Medicine

    (2006)
  • N. Kar

    Suicidality following a natural disaster

    American Journal of Disaster Medicine

    (2010)
  • R.C. Kessler et al.

    Mental illness and suicidality after Hurricane Katrina

    Bulletin of the World Health Organization

    (2006)
  • R.C. Kessler et al.

    Trends in mental illness and suicidality after Hurricane Katrina

    Molecular Psychiatry

    (2008)
  • E.G. Krug et al.

    Retraction: suicide after natural disasters

    The New England Journal of Medicine

    (1999)
  • R. Larrance et al.

    Health status among internally displaced persons in Louisiana and Mississippi travel trailer parks

    Annals of Emergency Medicine

    (2007)
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