Suicide rates in the aftermath of the 2011 earthquake in Japan

Abstract

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). In community samples throughout Japan, 3·0% of people reported high distress and 1·3% with trauma exposure had PTSD. Because of stigma, distress, and PTSD from the nuclear disaster, providing mental health care for Fukushima evacuees became a priority. 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 aff ected 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 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. 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. 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 Aff ected by the Nuclear Incident.