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Previous Volume 340:148-149 January 14, 1999 Number 2 Next

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To the Editor: In the February 5 issue, we reported the results of a study designed to determine whether natural disasters affect suicide rates.¹ Previous research on the victims of disasters had reported an increased prevalence of post-traumatic stress disorder and depression,^2,3,4 known risk factors for suicidal thinking.^5,6 In our article, we reported increases in suicide rates among the people living in the 377 U.S. counties affected by a single, severe natural disaster between 1982 and 1989.

We regretfully report that we have discovered an error in computer programming and that our previous results are incorrect. The error was discovered when we tried to repeat the analysis to determine whether there are changes in homicide rates after natural disasters. When we retraced the process of assembling the set of data on suicide, we discovered that deaths occurring in 1990 had been counted twice. Because we included only disasters that occurred between 1982 and 1989, 1990 could only be a postdisaster year. The double counting of suicides in 1990 raised the postdisaster rates to levels that differed statistically from the predisaster rates. After the error was corrected, a new analysis showed no significant increase in suicide rates after natural disasters, either for all types of disasters combined or for individual types of disasters. The corrected rates are shown in Table 1.

View this table: [in this window] [in a new window]   Table 1. Corrected Predisaster and Postdisaster Suicide Rates per 100,000 Population According to the Type of Disaster, 1982 to 1989.

 
In our article, we reported a separate analysis of suicide rates in 70 counties affected by two disasters. When we compared rates before the disasters with rates in the first two years after the second disaster, we found an increase of 14.8 percent (95 percent confidence interval, 5.4 to 24.2 percent; P<0.001). This result was obtained with the use of a different set of computer programs and was not affected by the programming error.

The new results for counties affected by a single natural disaster do not support the hypothesis that suicide rates increase after natural disasters. However, it is important to note that suicides are an extreme sign of psychological distress. Prior research shows that victims of severe disasters may suffer less extreme forms of psychological distress, such as anxiety, depression, and post-traumatic stress disorder.^2,3,4,7 Our original conclusion that "mental health support is needed after severe disasters" remains consistent with this body of knowledge.

Etienne G. Krug, M.D., M.P.H.
Marcie-jo Kresnow, M.S.
John P. Peddicord, M.S.
Linda L. Dahlberg, Ph.D.
Kenneth E. Powell, M.D., M.P.H.
Alex E. Crosby, M.D., M.P.H.
Joseph L. Annest, Ph.D.
Centers for Disease Control and Prevention
Atlanta, GA 30341

References

1. Krug EG, Kresnow M, Peddicord JP, et al. Suicide after natural disasters. N Engl J Med 1998;338:373-378. [Free Full Text]
2. Rubonis AV, Bickman L. Psychological impairment in the wake of disaster: the disaster-psychopathology relationship. Psychol Bull 1991;109:384-399. [CrossRef][Medline]
3. Ollendick DG, Hoffman M. Assessment of psychological reactions in disaster victims. J Community Psychol 1982;10:157-167. [Medline]
4. Murphy SA. Status of natural disaster victims' health and recovery 1 and 3 years later. Res Nurs Health 1986;9:331-340. [Medline]
5. Blumenthal SJ. Suicide: a guide to risk factors, assessment, and treatment of suicidal patients. Med Clin North Am 1988;72:937-971. [Medline]
6. Haynes MA. Suicide prevention: a US perspective. In: Goldbloom RB, Lawrence RS, eds. Preventing disease: beyond the rhetoric. New York: Springer-Verlag, 1990:129-36.
7. Gerrity ET, Flynn BW. Mental health consequences of disasters. In: Noji E, ed. The public health consequences of disasters. New York: Oxford University Press, 1997:101-21.

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