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Hurricane Florence and suicide mortality in North Carolina: a controlled interrupted time-series analysis
  1. Vanessa Eve Miller1,
  2. Brian W Pence1,2,
  3. Kate Vinita Fitch1,2,
  4. Monica Swilley-Martinez1,2,
  5. Andrew L Kavee3,
  6. Samantha Dorris1,
  7. Toska Cooper1,
  8. Alexander P Keil2,
  9. Bradley N Gaynes2,4,
  10. Timothy S Carey5,
  11. David Goldston6,
  12. Shabbar Ranapurwala1,2
  1. 1Injury Prevention Research Center, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
  2. 2Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
  3. 3Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  4. 4Department of Psychiatry, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
  5. 5Department of Internal Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
  6. 6Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
  1. Correspondence to Dr Vanessa Eve Miller, Injury Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; vmiller{at}unc.edu

Abstract

Background Natural disasters are associated with increased mental health disorders and suicidal ideation; however, associations with suicide deaths are not well understood. We explored how Hurricane Florence, which made landfall in September 2018, may have impacted suicide deaths in North Carolina (NC).

Methods We used publicly available NC death records data to estimate associations between Hurricane Florence and monthly suicide death rates using a controlled, interrupted time series analysis. Hurricane exposure was determined by using county-level support designations from the Federal Emergency Management Agency. We examined effect modification by sex, age group, and race/ethnicity.

Results 8363 suicide deaths occurred between January 2014 and December 2019. The overall suicide death rate in NC between 2014 and 2019 was 15.53 per 100 000 person-years (95% CI 15.20 to 15.87). Post-Hurricane, there was a small, immediate increase in the suicide death rate among exposed counties (0.89/100 000 PY; 95% CI −2.69 to 4.48). Comparing exposed and unexposed counties, there was no sustained post-Hurricane Florence change in suicide death rate trends (0.02/100 000 PY per month; 95% CI −0.33 to 0.38). Relative to 2018, NC experienced a statewide decline in suicides in 2019. An immediate increase in suicide deaths in Hurricane-affected counties versus Hurricane-unaffected counties was observed among women, people under age 65 and non-Hispanic black individuals, but there was no sustained change in the months after Hurricane Florence.

Conclusions Although results did not indicate a strong post-Hurricane Florence impact on suicide rates, subgroup analysis suggests differential impacts of Hurricane Florence on several groups, warranting future follow-up.

  • suicide/self?harm
  • natural disaster
  • time series
  • mortality
  • surveillance

Data availability statement

Data are available upon reasonable request. The programming code used to perform analyses for this article is available from the corresponding author on request. The suicide data were obtained through a restricted data use agreement with the NC Center for Health Statistics and are not available for public dissemination.

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Data availability statement

Data are available upon reasonable request. The programming code used to perform analyses for this article is available from the corresponding author on request. The suicide data were obtained through a restricted data use agreement with the NC Center for Health Statistics and are not available for public dissemination.

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Footnotes

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  • Contributors VEM: conceptualisation, methodology, software, writing—original draft; BWP: conceptualisation, methodology, investigation, writing—original draft, supervision, funding acquisition, data curation, writing—reviewing and editing; KVF: writing—reviewing and editing; MS-M: writing—reviewing and editing; ALK: data curation, writing—reviewing and editing; SD: project administration, writing—reviewing and editing; TC: project administration, writing—reviewing and editing; APK: writing—reviewing and editing; BNG: writing—reviewing and editing; TSC: writing—reviewing and editing; DG: writing—reviewing and editing; SR: conceptualisation, methodology, investigation, writing—original draft, visualisation, supervision, funding acquisition.

  • Funding Financially supported by the National Institutes of Health, National Institute of Mental Health, 5-R01MH124752.

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  • Competing interests None declared.

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