Suicide after natural disasters

Youth Suicidality in the Context of Disasters

PURPOSE OF REVIEW

The purpose of this review is to summarize the current literature regarding youth suicidality (suicidal ideation, suicidal behavior, and completed suicide) in the context of disasters.

RECENT FINDINGS

There are fewer studies that examine the effect of disasters on suicidality specifically in children and youth than studies that focus on adults or general population. Numerous studies have reported on the effect of disasters on youth mental health in general without zeroing in on suicide risk. Some variables that have shown to increase suicide risk in children and youth after disasters include female gender, age at the time of disaster exposure, dependence on adults, attachments to places and caregivers, family functioning, and vulnerability to mistreatment. Several studies have demonstrated that youth suicidality fluctuates in response to disasters, at times increasing immediately post-disaster and at other times decreasing immediately post-disaster followed by an increase later. Exposure to natural disasters (e.g., earthquakes, typhoons, hurricanes, wildfires, and extremes of temperature and humidity), man-made disasters (e.g., armed conflict, global warming, and pollution), and unique disasters (e.g., the COVID-19 pandemic) have had significant impact on suicidality in children and adolescents. Although there are several promising interventions to mitigate the post-disaster suicide risk among youth, there is no consensus on a single intervention that is superior to others. More research is needed to study youth suicide risk in the context of disasters and develop culturally appropriate and evidence-based interventions.

Using iterative random forest to find geospatial environmental and Sociodemographic predictors of suicide attempts

Introduction

Despite a recent global decrease in suicide rates, death by suicide has increased in the United States. It is therefore imperative to identify the risk factors associated with suicide attempts to combat this growing epidemic. In this study, we aim to identify potential risk factors of suicide attempt using geospatial features in an Artificial intelligence framework.

Methods

We use iterative Random Forest, an explainable artificial intelligence method, to predict suicide attempts using data from the Million Veteran Program. This cohort incorporated 405,540 patients with 391,409 controls and 14,131 attempts. Our predictive model incorporates multiple climatic features at ZIP-code-level geospatial resolution. We additionally consider demographic features from the American Community Survey as well as the number of firearms and alcohol vendors per 10,000 people to assess the contributions of proximal environment, access to means, and restraint decrease to suicide attempts. In total 1,784 features were included in the predictive model.

Results

Our results show that geographic areas with higher concentrations of married males living with spouses are predictive of lower rates of suicide attempts, whereas geographic areas where males are more likely to live alone and to rent housing are predictive of higher rates of suicide attempts. We also identified climatic features that were associated with suicide attempt risk by age group. Additionally, we observed that firearms and alcohol vendors were associated with increased risk for suicide attempts irrespective of the age group examined, but that their effects were small in comparison to the top features.

Discussion

Taken together, our findings highlight the importance of social determinants and environmental factors in understanding suicide risk among veterans.

A Systematic Literature Review of the Impact of Climate Change on the Global Demand for Psychiatric Services

Climate Change (CC) imposes important global health risks, including on mental health (MH). They are related mostly to psychological suffering caused by climate-related events and to the heat-vulnerability caused by psychiatric disorders. This growing burden may press MH services worldwide, increasing demand on public and private systems in low-, middle-, and high-income countries. According to PRISMA, two independent reviewers searched four databases for papers published before May 2022 that associated climate-related events with healthcare demand for psychiatric conditions. Of the 7432 papers retrieved, we included 105. Only 29 were carried out in low- and middle-income countries. Twelve related the admission numbers to (i) extreme events, while 93 to (ii) meteorological factors-mostly heat. Emergency visits and hospitalizations were significantly higher during hot periods for MH disorders, especially until lag 5-7. Extreme events also caused more consultations. Suicide (completed or attempted), substance misuse, schizophrenia, mood, organic and neurotic disorders, and mortality were strongly affected by CC. This high healthcare demand is evidence of the burden patients may undergo. In addition, public and private services may face a shortage of financial and human resources. Finally, the increased use of healthcare facilities, in turn, intensifies greenhouse gas emissions, representing a self-enforcing cycle for CC. Further research is needed to better clarify how extreme events affect MH services and, in addition, if services in low- and middle-income countries are more intensely demanded by CC, as compared to richer countries.

The Suicidal Ideation of Disaster Victims: A Nationwide Cross-Sectional Study

Purpose

Various natural and human made disasters occur worldwide. This study aimed to identify the factors affecting suicidal ideation in victims of disasters such as typhoons, heavy rainfall, fires, and earthquakes.

Methods

Data were obtained from a long-term survey on life changes among disaster victims conducted in 2019 by the National Disaster Management Research Institute. The study included 2234 victims of natural and social disasters occurring in Korea between 2012 and 2018. Suicidal ideation was assessed using the Korean version of the Composite International Diagnostic Interview developed by the World Health Organization. The participants' demographic characteristics, disaster-related characteristics, physical characteristics, psychological characteristics, and social characteristics were analyzed as the influencing factors. The data were analyzed using the chi-square test, t-test, and logistic regression.

Results

Of the 2234 subjects in this study, 32 were disaster victims who had experienced suicidal ideation, accounting for 1.4%. The results showed that the factors affecting suicidal ideation included disaster-related injury/disease, depression, and social support. The odds ratio of suicidal ideation was higher when there was injury/disease (OR=1.89, 95% CI=0.07-0.48), with higher depression levels (OR=1.31, 95% CI=1.18-1.47) and with lower social support (OR=0.94, 95% CI=0.90-0.99).

Conclusion

This study identifies the significant influencing factors of suicidal ideation in disaster victims, which were as follows: disaster-related injury or disease, depression, and social support. Our study's findings would contribute to screening high-risk groups of suicidal ideation and developing effective support, interventions, and suicide prevention programs for disaster victims. Furthermore, to prevent suicide and promote the healthy recovery of disaster victims, mental health care services aimed at suicide prevention should be reinforced and the victims should be provided with psychological support and treatment without financial burden.

Beyond A to E: addressing the unfamiliar issues arising in the acute and immediate phase post-catastrophe

During a time in which there is increased focus on level 5 and 6 prehospital emergency care provision and utilisation in the deployed military space, it is important to consider the range of care that more junior medical practitioners may be exposed to. The initial response to a catastrophe at a level pertaining to General Duties Medical Officers or similar forward-deployed tri-service personnel comprises acute care and triage skills, which are widely taught through prehospital courses and Foundation training. However, beyond that, the necessary workload becomes less clear. To provide comprehensive care in-theatre, there is the need to consider more nuanced and unfamiliar issues such as components in the immediate postcatastrophe landscape. These include aspects such as care of human remains, mental health, chronic conditions in the acute phase and the scope of military medical assistance within the wider relief effort. This is a paper commissioned as a part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.

Reasons and trends in youth's suicide rates during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic posed many mental health challenges to youth through unprecedented infection control measures such as nationwide school closures. Despite this, few studies have investigated trends in suicide among youth during the pandemic, let alone their reasons.

METHODS

Population-level data on crude monthly suicide rates (2016-2021) and reasons of suicide (2018-2020) among youth aged 10-19 years were obtained from the Japanese Ministry of Health, Labour and Welfare and the National Police Agency, respectively. Using an event study design (with a Poisson regression model to calculate changes-in-changes (CiC) estimates) and interrupted time series analysis, we investigated changes in monthly suicide rates during the first 12 months of the pandemic (May 2020 to April 2021) compared to pre-pandemic levels (May 2016 to March 2020). Additionally, we investigated the changes in reasons of suicide (family-related, mental illness, social concerns, and academic concerns).

FINDINGS

In the event study analysis, suicide rates among youth increased during the pandemic relative to pre-pandemic levels, especially between August-November 2020 (e.g., ratio of the suicide rate in November 2020 relative to previous years, 1.86; 95% confidence interval (CI), 1.30 to 2.66). Though suicide levels returned closer to pre-pandemic levels by December 2020, they remained slightly elevated into 2021. In the interrupted time series analysis, suicide rates increased from May to August 2020 (0.099 cases per 100,000 youth per month; 95% CI, 0.022 to 0.176), followed by a decrease from September to December 2020 (-0.086 cases per 100,000 youth per month; 95% CI, -0.164 to -0.009). We observed elevated suicide rates for all major reasons from summer to autumn 2020, especially suicides attributed to family-related problems and social concerns. Furthermore, rates of suicides attributed to mental illness remained higher than pre-pandemic levels into December 2020.

INTERPRETATION

Suicide rates among youth remained slightly elevated compared to pre-pandemic levels into 2021. The reasons of the increase in suicide rates were multifactorial, including mental health issues and disruptions in social relationships. During a pandemic, interventions that provide mental support as well as opportunities for regular social interactions to youth may be beneficial.

FUNDING

Norwegian Agency for International Cooperation and Quality Enhancement in Higher Education.

Posttraumatic stress disorder symptoms and suicidal ideation/behavior: The moderating effects of positive mental health and social support among Iranian and German students

Suicidal ideation and behavior are common in those suffering from Posttraumatic Stress Disorder (PTSD). The present study investigated factors buffering the association between PTSD symptoms and suicidal ideation/behavior. A total of 571 Iranian students and 421 German students took part in the investigation. Social support and positive mental health (PMH) were considered as resilience factors moderating the association between PTSD symptoms and suicide ideation/behavior within both samples. PMH moderated the impact of PTSD symptoms on suicidal ideation/behavior in Iranian and German students. Social support moderated the impact of PTSD symptoms on suicidal ideation/behavior in Iranian students only. Positive mental health and perceived social support seem to confer resilience and should be taken into account, when assessing individuals for suicide risk.

Impact of Natural Disasters on Mental Health: A Cross-Sectional Study Based on the 2014 China Family Panel Survey

Mental health problems are a leading cause of disability in both developed and developing countries, and the consequences of mental health disorders for individuals, families, and society as a whole could be severe and costly. To supplement relevant research and provide insightful policy suggestions to families, government and societies, this study investigates the nexus between natural disasters and mental health for middle-aged and older adults in rural China. Based on data of 8721 observations from the 2014 China Family Panel Studies, we estimate the effects of natural disasters on mental health using ordinary least squares and propensity score matching. Our findings suggest that natural disasters have a significant negative effect on middle-aged and older adults' mental health in the case of rural China. This effect is heterogeneous depending on individuals' education level and their agricultural production status. Finally, individuals' happiness and life satisfaction are shown to be the potential mechanism through which the effect of natural disasters on mental health operates.

Suicide Death Rate after Disasters: A Meta-Analysis Study

BACKGROUND

Disasters have undesirable effects on health among individuals such as psychosocial disorders which may lead lead to suicide in some cases. Thus, the present study aimed to measure the rate of suicide death after disasters all over the world.

METHODS

In the present meta-analysis study, all of the articles published in English until the end of 2019 were probed in electronic databases such as Web of Science, PubMed, Cochrane Library, Science Direct, PsycINFO, PsycARTICLES, and Google Scholar. Then, the data were imported to STATA ver.13 software and analyzed through fixed- and random-effects models, meta-regression, and Cochrane statistical tests.

RESULTS

A total of 11 studies including a sample size of 65495867 were considered. Suicide death rates before and after the disasters were calculated as 13.61 (CI95%: 11.59-15.77) vs. 16.68 (CI95%: 14.5-19:0) among the whole population, 28.36 (CI 95%:11.29-45.43) vs. 32.17 (CI95%: 17.71-46.62) among men, and 12.71 (CI95%: 5.98-19.44) vs 12.69 (CI95%: 5.17-20.21) among women. The rate of suicide death significantly increased in the whole population and men, while no significant difference was reported among women.

CONCLUSION

Suicide death rate increases after disasters indicating the destructive impact of this phenomenon on peoples' health. Therefore, implementing supportive and interventional measures is highly suggested after disasters in order to prevent suicide death among the affected people.

The Impact of Natural Disasters on Suicide in the United States, 2003–2015

Abstract. Background: Natural disasters are increasing in frequency and severity and impacted populations develop mental health conditions at higher rates than those not impacted. Aims: In this study, we investigate the association between exposure to a major natural disaster and suicide in the US. Method: Using county-level data on disaster declarations, mortality files, and population data, suicide rates were estimated for three 12-month periods before and after the disaster. Pooled rates were estimated predisaster and compared with postdisaster suicide rates using Poisson-generated Z tests and 95% confidence intervals. Results: A total of 281 major disasters were included. The suicide rate increased for each type of disaster and across all disasters in the first 2 years of follow-up. The largest overall increases in suicide rates were seen 2 years postdisaster. Limitations: Limitations include the ecologic study design, county-level exposure, and low power. Conclusion: Increases in county-level suicide rates after disasters were not statistically significant, although there was evidence that increases were delayed until 2 years postdisaster. Additional studies are needed to improve understanding of nonfatal suicide attempts after disasters and the role elevated social support plays in suicide prevention postdisaster. Future studies should consider pre-existing mental health, secondary stressors, and proximity to hazards.

Psychological distress and alcohol use disorder during the COVID-19 era among middle- and low-income U.S. adults

PURPOSE

This study examined how exposure to events during the Coronavirus Disease-19 (COVID-19) era is linked to symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), COVID-19 era-related stress (CS), alcohol use disorder (AUD), and suicidal ideation (SI) in low and middle-income U.S adults.

METHODS

A national sample of 6,607 adults (4.4% who reported testing positive for COVID-19, 25.3% testing negative, and 70.3% untested) were recruited an online platform andcompleted the Patient Health Questionnaire-2, Generalized Anxiety Disorder-2, PTSD-Checklist for DSM-5, the Alcohol Use Disorder Identification-Consumption scale, and an item assessing SI in May-June 2020. A series of multivariable analyses were conducted.

RESULTS

In the total sample, 35.3% screened positive for current AUD, 33.6% for MDD, 33.6% for GAD, 24.6% for SI, and 20.2% for CS. Past 2-week SI (adjusted odds ratios [AORs]= 1.49-12.06), number of close friends (AORs= 1.40-2.72), history of AUD (AORs= 1.15-1.92), history of anxiety disorder (AORs= 1.07-2.63), and younger age (AORs= 0.97-0.98) were significantly associated with screening positive for MDD, GAD, CS, and AUD. COVID-19 status was not independently associated with these conditions, but the combination of testing positive for COVID-19, meeting criteria for AUD, and screening positive for MDD, GAD, or CS predicted a 96% probability for SI.

CONCLUSION

Predisposing factors are stronger predictors of psychological distress than personal COVID-19 infection or exposure. The additive effects of COVID-19 infection, alcohol use, and psychiatric problems in predicting SI suggest screening, monitoring, and treating these conditions in population-based prevention and treatment efforts may be important.

Suicidal behaviour and the coronavirus (COVID-19) pandemic: Insights from Durkheim's sociology of suicide

Whilst suicide is well established as a critical global public health burden causing around 800,000 deaths annually along with many more attempts, there is a concern that the impact of the coronavirus (COVID-19) pandemic might intensify suicidality. The purpose of this study is to draw attention to the budding correlation between the COVID-19 pandemic and suicidality from the theoretical perspective of Emile Durkheim's sociology of suicide. A review of online newspaper databases (1 January to 30 April 2020) that reported suicide cases and attempts triggered as a result of the disruptions caused by the COVID-19 pandemic were included and analysed. Out of the 28 identified cases, there were three suicide attempts, one homicide-suicide/pact-suicide, and 24 suicides spanning 10 countries. Durkheim explained the social causation of suicide and provided a four-fold suicide typology. The cases were analysed according to their appropriate typology, and classified as egoistic (9), altruistic (3), anomic (8), and fatalistic (8). Durkheim suggests that the rise and fall of suicide rates will depend on the nature of social change. As society is undergoing massive social disruption resulting from the COVID-19 pandemic, suicide rates may increase unless suicide prevention measures align with the current social reconstruction process.

Impact of the COVID-19 shutdown on orthopedic trauma numbers and patterns in an academic Level I Trauma Center in Berlin, Germany

BACKGROUND

The COVID-19 pandemic led to the implementation of drastic shutdown measures worldwide. While quarantine, self-isolation and shutdown laws helped to effectively contain and control the spread of SARS-CoV-2, the impact of COVID-19 shutdowns on trauma care in emergency departments (EDs) remains elusive.

METHODS

All ED patient records from the 35-day COVID-19 shutdown (SHUTDOWN) period were retrospectively compared to a calendar-matched control period in 2019 (CTRL) as well as to a pre (PRE)- and post (POST)-shutdown period in an academic Level I Trauma Center in Berlin, Germany. Total patient and orthopedic trauma cases and contacts as well as trauma causes and injury patterns were evaluated during respective periods regarding absolute numbers, incidence rate ratios (IRRs) and risk ratios (RRs).

FINDINGS

Daily total patient cases (SHUTDOWN vs. CTRL, 106.94 vs. 167.54) and orthopedic trauma cases (SHUTDOWN vs. CTRL, 30.91 vs. 52.06) decreased during the SHUTDOWN compared to the CTRL period with IRRs of 0.64 and 0.59. While absolute numbers decreased for most trauma causes during the SHUTDOWN period, we observed increased incidence proportions of household injuries and bicycle accidents with RRs of 1.31 and 1.68 respectively. An RR of 2.41 was observed for injuries due to domestic violence. We further recorded increased incidence proportions of acute and regular substance abuse during the SHUTDOWN period with RRs of 1.63 and 3.22, respectively.

CONCLUSIONS

While we observed a relevant decrease in total patient cases, relative proportions of specific trauma causes and injury patterns increased during the COVID-19 shutdown in Berlin, Germany. As government programs offered prompt financial aid during the pandemic to individuals and businesses, additional social support may be considered for vulnerable domestic environments.

Learned Helplessness, Psychological Wellbeing, and Proenvironment Care Behavior among Victims of Frequent Floods in Kerala

Background  In 2018 and 2019, there were floods in the coastal regions of Kerala. Many individuals and families were victims on both these occasions; these floods had devastating impact on individual psychological wellbeing, their financial stability, and on overall family wellbeing. Furthermore, many people in vulnerable geographical areas still live in uncertainty and fear. In this context, our study examined whether continuous victimization of natural calamities, like floods in Kerala, leads to the development of learned helplessness and decreased psychological wellbeing among those affected. We also studied whether proenvironment care behavior increased among flood-affected individuals. Materials and Methods  We studied 374 heads of families in Kerala, selected through the Quota sampling method. They belonged to the following three groups: (1) flood-affected only once (OFA, n = 124), (2) flood-affected twice (TFA, n = 124), and (3) never flood-affected (NFA, n = 124) households. The key variables of learned helplessness, psychological wellbeing, and proenvironment care behavior were measured using learned helplessness scale, psychological wellbeing scale, and the environmental behavior scale, respectively. Statistical Analysis  The Kruskal-Wallis test was used to analyze the data for independent groups. Results  Learned helplessness was found to be high among the TFA group. Psychological wellbeing and proenvironment care behavior were high among the OFA group as compared with the TFA group. The NFA group had higher learned helplessness in comparison to the OFA group, and psychological wellbeing and proenvironment care behavior were low when compared with the TFA group. Conclusion  We conclude that surviving a moderate amount of risk is perhaps necessary for better psychological wellbeing and that too many or too few risks in life are detrimental to good psychological health. Immediate psychological support among victims of natural calamities and periodic examination of well-being and psychological interventions among people who are vulnerable for frequent victimization of natural calamities have to part of disaster management related to natural calamities.

The Ontological Praxis Between Disaster Studies and Demography—Extension of the Scope

This chapter serves as a summary of the learnings from the present volume and an extension of the scope on disaster-demography nexus. We outline the benefits of exploring the disaster-demography nexus and develop a categorisation summarising seven different approaches to the interlink of disasters with demography from examinations of existing literature. These are: disaster impacts on population, measuring vulnerability, mass displacement, spatial-regional approach, climate change, urbanisation and an applied approach. These seven approaches are our attempt to highlight the complex and multifarious nexus between demography and disasters which may not simply be linked to vulnerability. It is recognised that others may separate or merge some of these approaches in different ways.

Quasi-experimental evaluation of text-based crisis patterns in youth following Hurricane Florence in the Carolinas, 2018

IMPORTANCE

Crisis text lines have proven to be an effective and low-cost means for delivering texting-based mental health support to youth. Yet there has been limited research examining the use of these services in capturing the psychological impact on youth affected by a weather-related disaster.

OBJECTIVE

This ecologic study examined changes in help-seeking behavior for adolescents and young adults in North and South Carolina, USA, before and after Hurricane Florence (2018).

DESIGN AND MAIN OUTCOMES

A retrospective, interrupted time-series design was used to examine pre- and post-hurricane changes in crisis text volume among youth help seekers in the Carolinas for the following outcomes: (1) text for any reason; (2) stress & anxiety; (3) depression; and (4) suicidal thoughts.

RESULTS

Results showed an immediate and sustained increase in crisis texts for stress/anxiety and suicidal thoughts in the six weeks following Florence. Overall, an immediate 15% increase in crisis texts for anxiety/stress (SE = 0.05, p = .005) and a 17% increase in suicidal thoughts (SE = 0.07, p = .02) occurred during the week of the storm. Text volume for anxiety/stress increased 17% (SE = 0.08, p = .005) and 23% for suicidal ideation (SE = 0.08, p = .01) in the 6-week post-hurricane period. Finally, forecast models revealed observed text volume for all mental health outcomes was higher than expected in the 6 weeks post-Florence.

CONCLUSIONS AND RELEVANCE

A low-cost, crisis texting platform provided 24/7 mental health support available to young people in the Carolinas impacted by Hurricane Florence. These findings highlight a new application for text-based crisis support services to address the mental health consequences in youth following a weather-related disaster, as well as the potential for these types of crisis platforms to measure situational awareness in impacted communities.

Comparison of Psychological Distress and Demand Induced by COVID-19 during the Lockdown Period in Patients Undergoing Peritoneal Dialysis and Hemodialysis: A Cross-Section Study in a Tertiary Hospital

Background

Since the outbreak of COVID-19 in December 2019, it has spread rapidly and widely, bringing great psychological pressure to the public. In order to prevent the epidemic, traffic lockdown was required in many areas of China, which led to inconvenience of treatment for dialysis patients. This study was conducted to explore the psychological distress and the psychological demand induced by CO­VID-19 in the patients undergoing dialysis and compare the difference between hemodialysis (HD) and peritoneal dialysis (PD) patients during the traffic lockdown period.

Methods

Questionnaires were given to the dialysis patients in the West China Hospital of Sichuan University. The Impact of Event Scale (IES) was used to investigate the patients' trauma-related distress in response to COVID-19.

Results

232 eligible respondents were enrolled in this cross-section study, consisting of 156 PD patients and 76 HD patients. The median IES score for all the enrolled patients was 8.00 (2.00–19.00), which belonged to the subclinical dimension of post-traumatic stress symptoms (PTSS). HD patients had a significant higher IES score than PD patients (11.50 vs. 8.00) (p < 0.05). HD patients already got more psychological support from the medical staff. According to IES scores, 22.4% HD patients and 13.4% PD patients were classified as having moderate or severe PTSS, which need psychological support (p < 0.05). But more patients of both groups considered psychological support was necessary (HD: 50%, PD: 45.5%) (p > 0.05). In the multivariate regression analysis, we found that dialysis vintage, the impact of COVID-19 on the severity of illness and daily life, and confidence in overcoming the disease contributed to IES score (p < 0.05).

Conclusions

HD patients had more severe trauma-related stress symptoms than PD patients. When major public healthy events occurred, careful psychological estimate and sufficient psychological support should be provided to the dialysis patients, especially to the HD patients.

Earthquake-related stressors associated with suicidality, depression, anxiety and post-traumatic stress in adolescents from Muisne after the earthquake 2016 in Ecuador

BACKGROUND

The Ecuadorian earthquake in April 16th was the second strongest and deadliest in 2016 worldwide, with approximately one million people affected. In this paper, we analyzed the psychological impact and the relationship between mental health events and various earthquake-related stressors related to the earthquake, 9 months after the event.

METHODS

We conducted an analytical cross-sectional study, applying an anonymous survey to 316 adolescents (13-19 years old) from Muisne, Ecuador. Suicidal tendency, depression, anxiety and post-traumatic stress (PTSD) were evaluated via the Child PTSD Symptom Scale (CPSS), Spence Children's Anxiety Scale, Okasha Suicidality Scale, and the Center for Epidemiologic Studies Depression Scale (CES-D) and the adapted seven-questions earthquake-related stressors survey.

RESULTS

We found a high prevalence of suicidal ideations and behavior, posttraumatic stress, depression and anxiety compared to international studies. Even though adolescents currently living in shelters had higher levels of anxiety, their suicidal tendency was significantly lower than those living in their own or their relatives' home. Finally, the earthquake-related stressors were not associated with suicidality and mental health events, with the exception of economic damage suffered by the family.

CONCLUSIONS

High levels of depression, post-traumatic stress and anxiety among high-school students were found, especially among those who have suffered serious economic damage. The economic impact in their families and high unemployment rates among their parents seems to be related to lack of hope and favorable perspectives for their future, situation that might lead to lead to emotional disturbances and psychological disorders. Although prolonged homelessness experience in shelters may be a stressful occurrence, might also be related with spiritual growth among adolescents, and may work as a protective factor against suicidal ideations and attempts.

Risk Factors for Suicidal Behaviours after Natural Disasters: A Systematic Review

Natural disasters have multiple psychological effects including increased risk of suicide among victims. Reviews have shown that suicidal behaviours can be an aftermath of natural disasters. The present study attempted to identify the suicide-related risk factors after natural disasters. This study was a systematic review probing English language articles related to suicide and its risk factors after natural disasters and published between 1 January 1990 and 27 September 2018 in Google Scholar, PubMed, Web of Science, Science Direct, Scopus, ProQuest and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases. After reviewing and screening the collected studies by means of specific criteria, only 30 studies were qualified to enter the survey. It was found that most of these studies had investigated suicide after earthquake. Gender, age, serious mental disorders, depression, post-traumatic stress disorder (PTSD), loss of family members, low economic status, low social support, and injury to the person and the family/relatives were identified as the most important risk factors for suicide after natural disasters. Women, adolescents, elderly, people with depression and PTSD, those suffer from low social support and parentless people were found to be among the ones being highly vulnerable to suicide after natural disasters. There is, therefore, a need for providing psychosocial support for these people after such disasters.

Prevalence of depression as measured by the CBDI in a predominantly adolescent school population in Turkey

Objectives

This cross-sectional randomised study involving a predominantly adolescent school population (ranging from the 6th to the 11th grades) was conducted to determine the prevalence and clinical characteristics of depression in adolescents in the city of Mersin, Turkey.

Subjects and methods

A stratified sample of 4256 students was selected as representative of the city’s adolescent school population. The students were divided into two groups according to diagnosis (Group I: depressive adolescents; Group II: adolescents without depression). The age range varied between 10 and 20 years, with a mean of 14.53 years (S.D. = 1.89), i.e. a mean of 14.73 years (S.D. = 1.79) for Group I, and 15.5 years (S.D. = 1.9) for Group II. Data was obtained via two structured questionnaires designed to determine the presence and clinical characteristics of depression both in adolescents and in their parents. In addition, the Child Beck Depression Inventory (CBDI) was administered to all students participating in the study. After quality control of data, the study sample was reduced to 4143 adolescents. The mean age of the students was 11.23 ± 6.44 years, and the ratio of boys/girls was 1.19:1.

Results

The prevalence of depression according to the CBDI (cut-off point: 19) was found to be 12.55% in this study group, with a significantly higher prevalence of depression in girls than in boys. Binary regression analysis demonstrated that the most important factors involved in the onset of depression in adolescents were having problems with parents, staying down a grade, and humiliation at school, and that the most common symptoms were feelings of worthlessness/guilt, sadness, emptiness, irritability and somatic disorders.

Conclusion

This cross-sectional prospective randomised school-based study has examined sociodemographic and clinical characteristics of adolescents with depression in a student population. It was found that in this study group there was a relatively high level of depressive symptoms, with a clear predominance of females over males. Other clinical characteristics of adolescents with depression have been discussed in the context of previous investigations.

Long-Term Health Consequences Among Wenchuan Earthquake Adult Survivors: Implications of a Framework for Postearthquake Reconstruction

The objective of this study was to examine the longitudinal health consequences of the Wenchuan earthquake. Based on descriptive analyses of national-level data and multivariate analyses on a six-wave repeated cross-sectional survey, the findings suggested that after 8 years health risks remained high among earthquake-affected survivors; however, a process of recovery existed. To conceptualize these findings, in this study, we proposed a three-stage recovery model in which the postdisaster health status was divided into three stages: acute, stagnant, and adaptive. At each stage, the health risk varied, and over time, associations between health outcomes and protective factors varied. The three-stage recovery model identified the trends of long-term health consequences among adult earthquake survivors and provided guidance for postdisaster reconstruction in China on the basis of protective factors analyses.

Psychiatric morbidity in December 2015 flood-affected population in Tamil Nadu, India

BACKGROUND

Floods are the most common type of natural disaster, which have a negative impact on mental health. Following floods, survivors are vulnerable to develop PTSD (post-traumatic stress disorder), depression, anxiety and other mental health problems.

AIM

The aim is to study the psychiatric morbidity in the persons affected by floods during December 2015.

MATERIALS AND METHODS

This study was carried out in Chennai and Cuddalore. In total, 223 persons who were directly exposed to floods were assessed. PTSD Checklist-Civilian Version, Beck's Depression Inventory, Beck's Anxiety Inventory and World Health Organization-Five Well-Being Scale (WHO-5) were used in the study. Chi-square test was used to compare the means.

RESULTS

Overall, psychiatric morbidity was found to be 45.29%; 60 (26.9%) persons had symptoms of PTSD. Anxiety was found in 48 (27.4%) and depression was found in 101 (45.29%) persons; and 11 (4.9%) persons have reported an increase in substance abuse.

CONCLUSION

Following disaster like floods, there is a need for better preparedness in terms of basic necessities and medical and psychological assistance, particularly emphasizing the needs of older persons in order to prevent the development of psychiatric problems.

Prevalence of depression among Bangladeshi village women subsequent to a natural disaster: A pilot study

Women living in disaster-prone areas are at risk of developing and suffering from mental health problems, such as depression. However, this issue has not been studied previously among village dwelling women in Bangladesh. Improved knowledge of post-disaster depression rates and its risk factors could facilitate design and implementation of targeted disaster management protocols. Therefore, face-to-face surveys were conducted from September to October 2017 among 111 women in Dalbangha village, Bangladesh who survived cyclone Mora. Depression was assessed using the Bangla Patient Health Questionnaire - 9 (PHQ-9) along with relevant socio-demographics and disaster-related variables. The prevalence of depression was 64.9% and 36.9% of the women failed to receive any alert prior to the disaster. Along with a wide range of post-disaster consequences, 36.0% were physically injured, 27.9% had to be absent from work with consequent income loss, and 17.1% experienced death of a family member. Lower age group (18-30 years), being an income earner, disaster-related physical injury, and post-disaster work absenteeism emerged as the risk factors associated with depressive symptoms. In light of current findings, disaster preparedness programs and management protocols should incorporate measures aimed at palliating the risk factor elements that promote depression among vulnerable women following a disaster.

Experiencing a Severe Weather Event Increases Concern About Climate Change

Climate change is primarily driven by human-caused greenhouse gas (GHG) emissions, and may therefore be mitigated by changes to human behavior (Clayton et al., 2015; IPCC, 2018). Despite efforts to raise awareness and concern about climate change, GHG emissions continue to rise (IPCC, 2018). Climate change seems to be at odds with the immediate, present threats to which humans are adapted to cope (Gifford et al., 2009; Schultz, 2014; van Vugt et al., 2014). In contrast to immediate dangers, climate change is typically abstract, large scale, slow and often unrelated to the welfare of our daily lives (e.g., Ornstein and Ehrlich, 1989; Gifford, 2011). But there are moments when the consequences of climate change are readily apparent, such as extreme weather events. In the current paper, we examine the impact of personal experience with an extreme weather event, and the impact of this experience on beliefs about climate change, and intentions to take actions that can help prepare for and mitigate the consequences of climate change.

Mediating Roles of Gratitude and Social Support in the Relation Between Survivor Guilt and Posttraumatic Stress Disorder, Posttraumatic Growth Among Adolescents After the Ya'an Earthquake

Objective: This study aims to examine the mediating roles of gratitude and social support in the relationship between survivor guilt and posttraumatic stress disorder (PTSD) as well as the relationship between survivor guilt and posttraumatic growth (PTG). Methods: The current study used self-report questionnaires to investigate 706 adolescent survivors of Lushan county three and a half years after the Ya'an earthquake. The structural equation model was used to evaluate the relations between survivor guilt, gratitude and social support in PTSD and PTG. Results: The results indicated that survivor guilt had a positive effect on both PTSD and PTG. Gratitude partly mediated the relation between survivor guilt and both PTSD and PTG; social support partly mediated the relation between survivor guilt and PTG but not PTSD as well as the relation between gratitude and PTG. Conclusion: Survivor guilt has a double-edged sword effect. Survivor guilt affects PTSD and PTG through gratitude, and it could affect PTG but not PTSD through social support. Gratitude decreases PTSD and increases PTG, whereas social support only increases PTG.

Projected Behavioral Impacts of Global Climate Change

The projected behavioral impacts of global climate change emanate from environmental changes including temperature elevation, extreme weather events, and rising air pollution. Negative affect, interpersonal and intergroup conflict, and possibly psychological distress increase with rising temperature. Droughts, floods, and severe storms diminish quality of life, elevate stress, produce psychological distress, and may elevate interpersonal and intergroup conflict. Recreational opportunities are compromised by extreme weather, and children may suffer delayed cognitive development. Elevated pollutants concern citizens and may accentuate psychological distress. Outdoor recreational activity is curtailed by ambient pollutants. Limitations and issues in need of further investigation include the following: lack of data on direct experience with climate change rather than indirect assessments related to projected changes; poor spatial resolution in environmental exposures and behavioral assessments; few rigorous quasi-experimental studies; overreliance on self-reports of behavioral outcomes; little consideration of moderator effects; and scant investigation of underlying psychosocial processes to explain projected behavioral impacts.

Medical and psychosocial needs of the Puerto Rican people after Hurricane Maria

A community clinic in Puerto Rico, the Bantiox Clinic, was developed to serve the medical needs of Toa Baja and the surrounding communities after Hurricanes Irma and Maria in response to an urgent need for medical treatment of the community residents. Within 4 months, the clinic had 4941 total visits. The Toa Baja residents used the clinic more than the offsite residents. Certain offsite towns needed medical care more than others, suggesting a lack of medical access in the mountainous areas. Elderly patients with chronic diseases were served more than younger patients. Hypertension, diabetes, and medication refills appeared to be the primary reasons for treatment. The suicide rate increased 16% from 2016. The unemployment rate and the migration rate in all occupations have continued to increase after Hurricane Maria. Puerto Rico is a human laboratory that shows the medical needs of an island after devastating climate events and provides insight on ways to better prepare for such emergencies.

Effect of the 2004 tsunami on suicide rates in Sri Lanka

Aims and Method

To investigate the effect of the 2004 tsunami on suicide rates in Sri Lanka. the number of suicides in the 2 years prior to and 1 year after the tsunami were considered for the study. Data from districts affected by the tsunami were compared with those from unaffected districts.

Results

No significant differences were found between the number of suicides before and following the disaster or between areas affected and unaffected by the tsunami.

Clinical Implications

Worldwise, the impact of disasters upon suicide rates is variable. It is possible that the tsunami failed to have any profound effect on societal forces affecting suicide rates in Sri Lanka.

Superstorm Sandy and the academic achievement of university students

Much of the literature on the consequences of natural disasters has focused on their physical and psychological ramifications. Few researchers have considered how the impacts of a natural disaster can influence academic achievement. This study analyses data collected from nearly 300 students at a mid-sized, private university in the northeast United States to determine if the effects of Cyclone Sandy in 2012 are associated with measures of academic achievement. The findings reveal that experiencing headaches after the event resulted in a higher likelihood of students suffering a loss of academic motivation. In addition, experiencing headaches and a loss of academic motivation were correlated with a lower grade point average (GPA) during the semester in which Sandy made landfall. However, the more direct effects of the superstorm, including displacement and a loss of power, did not have a significant bearing on academic achievement. Lastly, the paper examines the implications for higher education policy and future research.

Suicidality associated with PTSD, depression, and disaster recovery status among adult survivors 8 years after the 2008 Wenchuan earthquake in China

It has been eight years since the Wenchuan earthquake. We don't know how the lives of those affected by the disaster may remain blighted by its effects, or how many remain thus affected. The aim of the present study was to examine the relationship of disaster exposure, PTSD, depression and suicidal behaviors, using data from a cross-sectional survey conducted in earthquake-affected areas of China. 1369 participants were recruited from two different sites that were severely affected by the Wenchuan earthquake. The survey assessed suicidality (suicidal ideation, plans and attempts) and other mental health issues. Probable PTSD was assessed using the Impact of Event Scale-Revised (IES-R). The Center for Epidemiologic Studies Depression Scale (CES-D) Chinese edition was used to assess depressive symptoms. The results showed that 11.2% of participants felt that their lives had not yet recovered from the effects of the Wenchuan earthquake, even after eight years. Suicidal ideation, plans, and attempts were reported by 9.1%, 2.9%, and 3.3%, respectively, of the respondents. PTSD, depression, and perceived non-recovery were highly associated with suicidality. These results indicate that suicidality can be a long-term mental health sequela of disaster. Targeted, long-term suicide prevention programs for adult survivors should be further developed.

Impact of Mood Spectrum Spirituality and Mysticism Symptoms on Suicidality in Earthquake Survivors with PTSD

The aim of the present study was to explore the correlations between Spirituality/Mysticism/Psychoticism symptoms and suicidality in young adult survivors of the L'Aquila earthquake. The sample included 475 subjects recruited among high school seniors who had experienced the April 6, 2009, earthquake. Assessments included: Trauma and Loss Spectrum-Self Report and Mood Spectrum-Self Report (MOODS-SR). Mysticism/Spirituality dimension and suicidality were evaluated by means of some specific items of the MOOD-SR. The Spirituality/Mysticism/Psychoticism MOODS-SR factor score was significantly higher among subjects with PTSD diagnosis with respect to those without. Similarly, subjects with suicidal ideation, as well as those who committed a suicide attempt, reported significantly higher scores than those without.

Flooding and mental health: a systematic mapping review

Background

Floods are the most common type of global natural disaster. Floods have a negative impact on mental health. Comprehensive evaluation and review of the literature are lacking.

Objective

To systematically map and review available scientific evidence on mental health impacts of floods caused by extended periods of heavy rain in river catchments.

Methods

We performed a systematic mapping review of published scientific literature in five languages for mixed studies on floods and mental health. PUBMED and Web of Science were searched to identify all relevant articles from 1994 to May 2014 (no restrictions).

Results

The electronic search strategy identified 1331 potentially relevant papers. Finally, 83 papers met the inclusion criteria. Four broad areas are identified: i) the main mental health disorders—post-traumatic stress disorder, depression and anxiety; ii] the factors associated with mental health among those affected by floods; iii) the narratives associated with flooding, which focuses on the long-term impacts of flooding on mental health as a consequence of the secondary stressors; and iv) the management actions identified. The quantitative and qualitative studies have consistent findings. However, very few studies have used mixed methods to quantify the size of the mental health burden as well as exploration of in-depth narratives. Methodological limitations include control of potential confounders and short-term follow up.

Limitations

Floods following extreme events were excluded from our review.

Conclusions

Although the level of exposure to floods has been systematically associated with mental health problems, the paucity of longitudinal studies and lack of confounding controls precludes strong conclusions.

Implications

We recommend that future research in this area include mixed-method studies that are purposefully designed, using more rigorous methods. Studies should also focus on vulnerable groups and include analyses of policy and practical responses.

Psychiatric admissions fall following the Christchurch earthquakes: an audit of inpatient data

OBJECTIVE

Following the devastating earthquake in Christchurch, New Zealand, there was the widespread perception that the demand for inpatient mental health services would increase. However, our clinical observation was to the contrary, with substantial reductions in inpatient utilisation being noted. We therefore examined psychiatric bed occupancy and admission data to improve understanding of the impact of the disaster on mental health services.

METHOD

We audited acute psychiatric bed occupancy and admission rates prior to and following a major earthquake.

RESULTS

After the earthquake, total bed occupancy reduced from an average of 93% to 79%. Daily admissions also reduced by 20.2% for the 30 days following the earthquake. All diagnostic groups, with the exception of the 'Schizophrenia, schizotypal and delusional disorders' category, contributed to the reduction. No rebound to increased occupancy or admissions was seen over the study period.

CONCLUSION

The study confirmed our clinical observation that demand for acute inpatient psychiatric services were markedly reduced after the February 2011 earthquake.

Survivor guilt: analyzing the concept and its contexts

Survivor guilt, a concept associated with the interpersonal process of "surviving" harm while others do not, increasingly appears in nursing, medicine, and psychology literature. Paradoxically, the phenomenon is rarely defined and often poorly described. Combining Rodger's evolutionary concept analysis with a comprehensive literature review, we explain the attributes, antecedents, consequences, related concepts, and surrogate terms of survivor guilt. A new definition emerged from the evolving use of the concept in new contexts. Survivor guilt is a valid form of suffering for which effective interventions need to be developed. This analysis extends the concept, laying the foundation for comprehensive treatment strategies.

Risk of social isolation among Great East Japan Earthquake survivors living in tsunami-affected Ishinomaki, Japan

OBJECTIVE

The Great East Japan Earthquake and tsunami affected approximately 53 000 people in the city of Ishinomaki, Miyagi Prefecture. Approximately 30 000 people were relocated to temporary/rental housing. The remainder re-inhabited tsunami-affected houses, and their conditions were not known. As social isolation could affect physical and psychological health, we investigated the risk of social isolation among the survivors who returned to their homes.

METHODS

The surveyors went door-to-door to the tsunami-affected houses and interviewed each household between October 2011 and March 2012. The participants' risk of social isolation was assessed using 3 factors: whether they have (1) friends to talk with about their problems, (2) close neighbors, and (3) social/family interactions. We analyzed the groups at risk of social isolation and identified the related factors.

RESULTS

The elderly (older than age 65 years) were more likely to have close neighbors and social/family interactions, as compared with younger persons. Persons living alone were less likely to have social/family interactions. Non-elderly men who were living alone were the highest proportion of people without social/family interactions.

CONCLUSIONS

Our findings suggested that men, particularly those younger than age 65 years and living alone, were at high risk of social isolation and may need attention.

The adolescent emotional coping after an earthquake: a risk factor for suicidal ideation

The study aims to investigate the relationship of suicidal ideation with coping and resilience in a sample of adolescents who survived an earthquake. Three hundred forty-three adolescents who had experienced the L'Aquila earthquake were investigated for a screening distinguishing Suicidal Screen-Negative (SSN) from the Positive (SSP) subjects. Resilience Scale for Adolescents (READ) and Brief Cope were administered. Emotion-focused coping score was significantly higher in SSP subjects. In the SSN but not in the SSP sample the READ total score correlated with problem-focused total score. A positive correlation was seen between emotion-focused and problem-focused scores in both samples, with a higher coefficient in SSP sample. Externalising problems and maladaptive behaviours can arise in adolescents exposed to traumatic events. Attention should be paid in reducing risk factors and in the development of psychological abilities, improving the coping strategies that can protect from emotional despair and suicidal ideation.

The impact of the Great East Japan earthquake on mandatory psychiatric emergency hospitalizations in Tokyo: a retrospective observational study

On 11 March 2011, the eastern part of Japan was struck by a magnitude 9.0 quake. About 20 000 people were killed or were missing, and a nuclear crisis followed. In Tokyo, people were indirectly exposed to the earthquake and nuclear crisis by TV broadcast. The aim of our study was to evaluate the potential effect of the series of catastrophes on psychiatric emergency hospitalizations in Tokyo. Clinical records of patients who were mandatorily admitted to Tokyo Metropolitan Matsuzawa Hospital by law because of urgent risk to self or others were reviewed. Records regarding the 2 years of investigation, which include the 6 months after the earthquake, were reviewed. The six months after the earthquake were compared with the eighteen months before the earthquake in clinical and demographic data using independent t-tests or χ(2) tests. During the 6 months before and after the earthquake, 97 and 127 people were mandatorily admitted. χ(2) Tests demonstrated a significant increase in the number of patients after the earthquake (P = 0.045), attributable to the significant increase in the number of patients with schizophrenia after the earthquake (P = 0.011, 32 vs 56), whereas there were no significant differences in the number of patients with other diagnoses between those two periods. Independent t-tests revealed that patients admitted after the earthquake had marginally significantly shorter periods of education compared with those admitted before the earthquake (13.78 vs 12.82 years, P = 0.084). This work suggests that patients with schizophrenia were more sensitive to indirect exposure to the earthquake and that a shorter period of education was a potential risk factor.

Suicides in Los Angeles County in Relation to the Northridge Earthquake

Introduction:

Recently, there has been speculation that suicide rates increase after a disaster. Yet, in spite of anecdotal reports, it is difficult to demonstrate a systematic relationship between suicide and disaster. Suicides are fairly rare events, and single disasters rarely have covered geographic areas with large enough populations to be able to find statistically significant differences in such relatively rare events (annual suicide rates in the United States average 12/100,000 population).

Hypothesis:

Suicide rates increased in the three calendar years (1994–1996) following the Northridge earthquake as compared to the three calendar years (1991–1993) prior to the earthquake. Likewise the suicide rates for 1993 are compared with the rates in 1994. By looking at the suicide rates in a three-year period after the earthquake, the additional disasters that befell Southern California in 1995 and 1996 may have had an additive effect on psychological disorders and suicide rates that can be measured.

Methods:

Data on suicide mortality were compiled for the years from 1989 through 1996. Differences in rates for 1993 compared with 1994 and for three-year periods before and after the earthquake (1991–1993 vs. 1994 –1996) were analyzed using az-statistic.

Results:

There is a statistically significant difference in the rates for the years prior to the earthquake (1991–1993) when pooled and compared to the suicide rates for the years after the earthquake (1994–1996). The rates of suicide are lower in the three years following the earthquake (11.85 vs. 13.12/100,000 population) than they are in the three years prior to the earthquake (z= -3.85,p&lt;0.05). Likewise, there is a similar difference when comparing 1993 to 1994 (11.77 vs. 13.84,z= -3.57,p&lt;0.05). The patterns of suicide remain similar over time, with males and non-Hispanic Whites having the highest rates of suicide.

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.

Hospital Responses to Acute-Onset Disasters: A Review

Introduction:

Hospitals the world over have been involved in disasters, both internal and external. These two types of disasters are independent, but not mutually exclusive. Internal disasters are isolated to the hospital and occur more frequently than do external disasters. External disasters affect the community as well as the hospital. This paper first focuses on common problems encountered during acute-onset disasters, with regards to hospital operations and caring for victims. Specific injury patterns commonly seen during natural disasters are reviewed. Second, lessons learned from these common problems and their application to hospital disaster plans are reviewed.

Methods:

An extensive review of the available literature was conducted using the computerized databases Medline and Healthstar from 1977 through March 1999. Articles were selected if they contained information pertaining to a hospital response to a disaster situation or data on specific disaster injury patterns. Selected articles were read, abstracted, analyzed, and compiled.

Results:

Hospitals continually have difficulties and failures in several major areas of operation during a disaster. Common problem areas identified include communication and power failures, water shortage and contamination, physical damage, hazardous material exposure, unorganized evacuations, and resource allocation shortages.

Conclusions::

Lessons learned from past disaster-related operational failures are compiled and reviewed. The importance and types of disaster planning are reviewed.

Medical complications associated with earthquakes

Major earthquakes are some of the most devastating natural disasters. The epidemiology of earthquake-related injuries and mortality is unique for these disasters. Because earthquakes frequently affect populous urban areas with poor structural standards, they often result in high death rates and mass casualties with many traumatic injuries. These injuries are highly mechanical and often multisystem, requiring intensive curative medical and surgical care at a time when the local and regional medical response capacities have been at least partly disrupted. Many patients surviving blunt and penetrating trauma and crush injuries have subsequent complications that lead to additional morbidity and mortality. Here, we review and summarise earthquake-induced injuries and medical complications affecting major organ systems.

Suicidal intention and negative spiritual coping one year after the earthquake of L'Aquila (Italy)

BACKGROUND

This study investigated the rate of suicidal intention and its relationship with the features of religious involvement in a non-clinical sample of the adult population exposed to the L'Aquila earthquake.

METHODS

The study population was composed of 426 people who had experienced the earthquake (188 males and 238 females). For comparison, 522 people were recruited from nearby unaffected areas. The sample was investigated for suicidal intention screening, distinguishing Suicidal Screen-Negative (SSN) subjects from Positive (SSP) subjects. Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) and Impact of Event Scale (IES) assessments were administered.

RESULTS

More SSP subjects were observed in the population exposed to the earthquake (Odds Ratio 3.54). A higher proportion of females showed suicidal ideation. Multivariate analysis showed overall significance for the between-subject factor. Univariate F tests for each BMMRS variable that contributed to significant overall effect showed that negative spiritual coping was significantly different. No differences were observed for IES scores between the two groups, but correlations with negative spiritual coping were found.

LIMITATIONS

The samples are relatively small and data are based on self-reports.

CONCLUSIONS

Negative religious coping such as expression of conflict and doubt regarding matters of faith, as well as a feeling of being punished or abandoned by God, can prevail in response to prolonged stress without relief, as was experienced by the population exposed to the earthquake. These features are more associated with suicide ideation. Degree of religious affiliation and commitment examination by mental health practitioners can be useful when suicidal ideation is investigated.

Suicide risk and its correlate in adolescents who experienced typhoon-induced mudslides: a structural equation model

BACKGROUND

The aims of this study were to examine the direct and indirect effects of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), disaster-exposure experience, gender, and perceived family support on suicide risk (including suicide ideation and attempt) in adolescents 3 months after they had experienced Typhoon Morakot-associated mudslides in Taiwan using a structural equation model (SEM).

METHODS

Two hundred and seventy-one adolescents in the worst affected mountainous regions of southern Taiwan were recruited. Suicide risk and diagnoses of PTSD and MDD were assessed using the Mini-International Neuropsychiatric Interview for Children and Adolescents. The direct and indirect effects of PTSD, MDD, disaster-exposure experience, gender, and perceived family support on suicide risk were examined using SEM.

RESULTS

The results of SEM indicated that increased disaster-exposure experience and female gender had direct influences on an increased suicide risk and indirect influences on increased suicide risk that were mediated by PTSD and MDD. Perceived high family support directly decreased suicide risk. Both PTSD and MDD had direct influences on an increased suicide risk, and PTSD had an indirect influence on an increased suicide risk that was mediated by MDD.

CONCLUSIONS

Gender, disaster-exposure experience, perceived high family support, PTSD, and MDD all had effects on suicide risk in adolescents who had experienced the threat of mudslides caused by Typhoon Morakot. The results provide healthcare professionals with a comprehensive understanding to develop intervention programs to prevent and intervene in suicide risk.