title: Changes in suicide rates in disaster-stricken areas following the Great East Japan Earthquake and their effect on economic factors: an ecological study.
abstract: OBJECTIVE
  Devastating disasters may increase suicide rates due to mental distress. Previous domestic studies have reported decreased suicide rates among men following disasters. Few reports are available regarding factors associated with disasters, making it difficult to discuss how these events affect suicide rates. This study aimed to observe changes in suicide rates in disaster-stricken and neighboring areas following the Great East Japan Earthquake, and examine associations between suicide rates and economic factors.
  
  
  METHODS
  Monthly suicide rates were observed from March 2009 to February 2013, during which time the earthquake occurred on March, 2011. Data were included from disaster-stricken (Iwate, Miyagi, and Fukushima Prefectures) and neighboring (control: Aomori, Akita, and Yamagata Prefectures) areas. The association between changes in suicide rates and economic variables was evaluated based on the number of bankruptcy cases and ratio of effective job offers.
  
  
  RESULTS
  In disaster-stricken areas, post-disaster male suicide rates decreased during the 24 months following the earthquake. This trend differed relative to control areas. Female suicide rates increased during the first seven months. Multiple regression analysis showed that bankruptcy cases (β = 0.386, p = 0.038) and ratio of effective job offers (β = -0.445, p = 0.018) were only significantly associated with male post-disaster suicide rates in control areas.
  
  
  CONCLUSIONS
  Post-disaster suicide rates differed by gender following the earthquake. Our findings suggest that considering gender differences might be important for developing future post-disaster suicide prevention measures. This ecological study revealed that increasing effective job offers and decreasing bankruptcy cases can affect protectively male suicide rates in control areas.
authors.affiliation: Sendai City Mental Health and Welfare Center, 1-6 Sankyozawa, Aramaaki, Aoba-ku, Sendai, 980-0845, Japan, masatsugu_orui@city.sendai.jp.
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Orui
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Harada
authors.forename: Mizuho
authors.initials: M
authors.lastname: Hayashi
mesh_terms: D000328:Adult; D016361:Bankruptcy / Q000191:economics; D055866:Earthquakes; D004651:Employment / Q000191:economics; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D012959:Socioeconomic Factors; D013405:Suicide / Q000191:economics* / Q000706:statistics & numerical data*