Correspondence
Suicide rates in the aftermath of the 2011 earthquake in Japan The March, 2011 earthquake and tsunami that affected the Iwate, Miyagi, and Fukushima prefectures led to a nuclear power plant accident at the Fukushima Daiichi facility. 13 municipalities were designated as evacuation areas from radiation exposure, and 210 000 residents were evacuated. As of January, 2015, 120 000 Fukushima residents remain evacuated, with some residents deciding to relocate permanently. The Fukushima Medical University Health Management Group conducted mental health surveys with roughly 185 000 evacuees. Among those surveyed, 14·6% in 2011, 11·7% in 2012, and 10·3% in 2013 screened positive for high distress, and 21·6% in 2011, 17·4% in 2012, and 17·2% in 2013 had probable post-traumatic stress disorder (PTSD).1 In community samples throughout Japan, 3·0% of people reported high distress and 1·3% with trauma exposure had PTSD.2 Because of stigma, distress, and PTSD from the nuclear disaster, providing mental health care for Fukushima evacuees became a priority. 3 Comprehensive measures were implemented, including supportive telephone calls by clinical psychologists, public health nurses, and psychiatric social workers to more than 3000 people per year, whose questionnaires on the Fukushima Medical University survey indicated substantial symptomatology or who requested help. Six mental care centres have been established in Fukushima since 2012 and more than 500 dialogue workshops with radiation health experts have been carried out in affected communities over a 3·5 year period. The standardised suicide mortality ratio decreased during the first 2 years after the disaster in each affected prefecture compared with www.thelancet.com Vol 385 May 2, 2015
2010
2011
2012
2013
2014
Fukushima prefecture N Deaths per 100 000 people Standardised suicide mortality ratio
540
525
26·6
26·4
458
466
22·8
23·9
476* 24·5*
108
107
94
96
126
467
401
373
373
374*
Iwate prefecture N Deaths per 100 000 people Standardised suicide mortality ratio
35·1
30·1
28·6
28·8
28·9*
141
122
115
115
138
620
483
508
485
519*
Miyagi prefecture N Deaths per 100 000 people Standardised suicide mortality ratio
26·4
20·8
21·9
20·8
108
84
88
88
31 690
30 651
27 858
27 283
22·3* 110
Japan total N Deaths per 100 000 people
24·9
24·0
21·8
25 374*
21·4
19·9*
Information of suicide deaths were from the Cabinet Office, Japan and the Reconstruction Agency, Japan. We calculated standardised suicide mortality ratios to compare mortality in each prefecture based on the age-specific rates per year. *Provisional data.
Table: Suicide deaths in prefectures affected by the earthquake and tsunami of March, 2011
2010 (table), and then rose in 2014 to the pre-disaster level in Iwate and Miyagi prefectures and exceeded it in the Fukushima prefecture. In Japan as a whole, suicide prevalence is declining slightly. A similar pattern was seen after the 1995 Hanshin-Awaji earthquake, with suicide prevalence decreasing during the first 2 years and then increasing.4 It is conceivable that during 2011, when the evacuations and displacements peaked, there was both great attention from national and international authorities and a collective feeling of concern and altruism, similar to experiences during and just after World Wars I and II in the USA, France, west Germany, and Japan.5 However, once the new reality caused by the triple disaster set in, increased demoralisation and anxiety, combined with restricted employment and movement of young families to urban areas, triggered a rise in suicide in Fukushima that the mental health intervention programmes were unable to offset. Thus, long-term efforts to assist in psychological recovery are needed.
We thank the National Health Fund for Children and Adults Affected by the Nuclear Incident.
For the Cabinet Office Japan see http://www8.cao.go.jp/ jisatsutaisaku/toukei/ For the Reconstruction Agency, Japan see http://www. reconstruction.go.jp/topics/ main-cat2/subcat2-6/20140526131634.html
We declare no competing interests.
*Hitoshi Ohto, Masaharu Maeda, Hirooki Yabe, Seiji Yasumura, Evelyn E Bromet [email protected] The Fukushima Health Management Survey, Fukushima Medical University, Fukushima, 960-1295, Japan (HO, MM, HY, SY); and Department of Psychiatry and Behavioral Science, Stony Brook University, NY, USA (EEB) 1
2
3
4
5
Maeda M, Yabe H, Yagi A, et al. Psychological effects on people in Fukushima: results of a mental health and lifestyle survey. Third International Expert Symposium in Fukushima: Beyond Radiation and Health Risk Toward Resilience and Recovery; Fukushuma Sept 8–9, 2014. http://www.fmu.ac.jp/ radiationhealth/symposium201409/ media/8_S2_Maeda_FINAL%280909%29.pdf (accessed April 10, 2015). Kawakami N, Tsuchiya M, Umeda M, et al. Trauma and posttraumatic stress disorder in Japan: results from the World Mental Health Japan Survey. J Psych Res 2014; 53: 157–65. Bromet EJ. Emotional consequences of nuclear power plant disasters. Health Phys 2014; 206: 206–10. Nishio A, Akazawa K, Shibuya F, et al. Influence on the suicide rate two years after a devastating disaster: a report from the 1995 Great Hanshin-Awaji Earthquake. Psych Clin Neurosci 2009; 63: 247–50. Long-term changes of suicide rates in leading countries between 1901 and 2012. (in Japanese) http://www2.ttcn.ne.jp/ honkawa/2774.html (accessed April 10, 2015).
1727
Suicide rates in the aftermath of the 2011 earthquake in Japan The March, 2011 earthquake and tsunami that affected the Iwate, Miyagi, and Fukushima prefectures led to a nuclear power plant accident at the Fukushima Daiichi facility. 13 municipalities were designated as evacuation areas from radiation exposure, and 210 000 residents were evacuated. As of January, 2015, 120 000 Fukushima residents remain evacuated, with some residents deciding to relocate permanently. The Fukushima Medical University Health Management Group conducted mental health surveys with roughly 185 000 evacuees. Among those surveyed, 14·6% in 2011, 11·7% in 2012, and 10·3% in 2013 screened positive for high distress, and 21·6% in 2011, 17·4% in 2012, and 17·2% in 2013 had probable post-traumatic stress disorder (PTSD).1 In community samples throughout Japan, 3·0% of people reported high distress and 1·3% with trauma exposure had PTSD.2 Because of stigma, distress, and PTSD from the nuclear disaster, providing mental health care for Fukushima evacuees became a priority. 3 Comprehensive measures were implemented, including supportive telephone calls by clinical psychologists, public health nurses, and psychiatric social workers to more than 3000 people per year, whose questionnaires on the Fukushima Medical University survey indicated substantial symptomatology or who requested help. Six mental care centres have been established in Fukushima since 2012 and more than 500 dialogue workshops with radiation health experts have been carried out in affected communities over a 3·5 year period. The standardised suicide mortality ratio decreased during the first 2 years after the disaster in each affected prefecture compared with www.thelancet.com Vol 385 May 2, 2015
2010
2011
2012
2013
2014
Fukushima prefecture N Deaths per 100 000 people Standardised suicide mortality ratio
540
525
26·6
26·4
458
466
22·8
23·9
476* 24·5*
108
107
94
96
126
467
401
373
373
374*
Iwate prefecture N Deaths per 100 000 people Standardised suicide mortality ratio
35·1
30·1
28·6
28·8
28·9*
141
122
115
115
138
620
483
508
485
519*
Miyagi prefecture N Deaths per 100 000 people Standardised suicide mortality ratio
26·4
20·8
21·9
20·8
108
84
88
88
31 690
30 651
27 858
27 283
22·3* 110
Japan total N Deaths per 100 000 people
24·9
24·0
21·8
25 374*
21·4
19·9*
Information of suicide deaths were from the Cabinet Office, Japan and the Reconstruction Agency, Japan. We calculated standardised suicide mortality ratios to compare mortality in each prefecture based on the age-specific rates per year. *Provisional data.
Table: Suicide deaths in prefectures affected by the earthquake and tsunami of March, 2011
2010 (table), and then rose in 2014 to the pre-disaster level in Iwate and Miyagi prefectures and exceeded it in the Fukushima prefecture. In Japan as a whole, suicide prevalence is declining slightly. A similar pattern was seen after the 1995 Hanshin-Awaji earthquake, with suicide prevalence decreasing during the first 2 years and then increasing.4 It is conceivable that during 2011, when the evacuations and displacements peaked, there was both great attention from national and international authorities and a collective feeling of concern and altruism, similar to experiences during and just after World Wars I and II in the USA, France, west Germany, and Japan.5 However, once the new reality caused by the triple disaster set in, increased demoralisation and anxiety, combined with restricted employment and movement of young families to urban areas, triggered a rise in suicide in Fukushima that the mental health intervention programmes were unable to offset. Thus, long-term efforts to assist in psychological recovery are needed.
We thank the National Health Fund for Children and Adults Affected by the Nuclear Incident.
For the Cabinet Office Japan see http://www8.cao.go.jp/ jisatsutaisaku/toukei/ For the Reconstruction Agency, Japan see http://www. reconstruction.go.jp/topics/ main-cat2/subcat2-6/20140526131634.html
We declare no competing interests.
*Hitoshi Ohto, Masaharu Maeda, Hirooki Yabe, Seiji Yasumura, Evelyn E Bromet [email protected] The Fukushima Health Management Survey, Fukushima Medical University, Fukushima, 960-1295, Japan (HO, MM, HY, SY); and Department of Psychiatry and Behavioral Science, Stony Brook University, NY, USA (EEB) 1
2
3
4
5
Maeda M, Yabe H, Yagi A, et al. Psychological effects on people in Fukushima: results of a mental health and lifestyle survey. Third International Expert Symposium in Fukushima: Beyond Radiation and Health Risk Toward Resilience and Recovery; Fukushuma Sept 8–9, 2014. http://www.fmu.ac.jp/ radiationhealth/symposium201409/ media/8_S2_Maeda_FINAL%280909%29.pdf (accessed April 10, 2015). Kawakami N, Tsuchiya M, Umeda M, et al. Trauma and posttraumatic stress disorder in Japan: results from the World Mental Health Japan Survey. J Psych Res 2014; 53: 157–65. Bromet EJ. Emotional consequences of nuclear power plant disasters. Health Phys 2014; 206: 206–10. Nishio A, Akazawa K, Shibuya F, et al. Influence on the suicide rate two years after a devastating disaster: a report from the 1995 Great Hanshin-Awaji Earthquake. Psych Clin Neurosci 2009; 63: 247–50. Long-term changes of suicide rates in leading countries between 1901 and 2012. (in Japanese) http://www2.ttcn.ne.jp/ honkawa/2774.html (accessed April 10, 2015).
1727
