046 Did suicide rates increase in areas impacted by Hurricane Florence in North Carolina? A time series analysis

Abstract

<h3>Statement of Purpose</h3> Natural disasters like hurricanes and flooding can lead to severe financial and mental health burdens, however, their impact on suicidal behaviors is unclear. We examined the impact of Hurricane Florence (September, 2018), which resulted in massive property damage, flooding, and 59 deaths across the Carolinas and Virginia, on suicides in North Carolina (NC). <h3>Methods/Approach</h3> We used Federal Emergency Management Agency’s (FEMA) designations for disaster assistance for Florence to categorize counties as unexposed (not designated to receive assistance) or exposed (designated to receive individual and public assistance). NC death records data were used to identify suicide deaths using ICD 10 codes. Quarterly suicide rates were calculated from 2014 to the third quarter of 2020. We conducted a controlled interrupted time series study using autoregressive integrated moving average models to compare suicide trends in exposed and unexposed counties before and after Florence. Analysis was restricted to NC residents older than 10 years. <h3>Results</h3> Suicides rates were similar in both hurricane exposed and unexposed counties prior to the hurricane. Following the hurricane there was a small decrease in the suicide rates across the exposed and unexposed counties, but there was no Florence-related change in suicide rates. We did not find any effect measure modification by race (white, black, other) or ethnicity (Hispanic and non-Hispanic). <h3>Conclusions</h3> In this study, we did not observe a change in suicide deaths among FEMA designated disaster assistance counties compared with counties that were not designated for disaster assistance. <h3>Significance</h3> This finding suggests that any potential change in suicide rates that may have occurred due to Florence cannot be observed at the county level and may require better exposure classification; or was ameliorated by local, state, and federal aid. Future research should also examine suicidal ideation and self-harm.