SAMHSA Disaster Technical Assistance Center 

Supplemental Research 

Bulletin 

Issue 5: Traumatic Stress and Suicide 

After Disasters

August 2015
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 1

Supplemental Research Bulletin: Issue 5 

Traumatic Stress and Suicide After Disasters 

Table of Contents

In This Issue .................................................................................................................................... 3

Traumatic Stress and Suicide After Disasters ................................................................................. 5

The Context ..................................................................................................................................6

Key Research Questions ..............................................................................................................6

Do suicide rates increase after disasters? .................................................................................7

Does suicidal ideation and do suicide plans or attempts increase after disasters? ...................7

Do suicidal ideations, or suicide plans or attempts, increase after disasters among 

specific groups of people?......................................................................................................10

Are there other factors that make people more likely to engage in suicidal ideation, 

planning, or attempts following a disaster? ...........................................................................10

Which types of traumatic stress issues and related diagnoses may arise after a disaster? .....10

Which groups are most at risk for traumatic stress and related diagnoses after a disaster? ..12

Which groups are least at risk for traumatic stress, suicidality, and related behavioral 

health problems after a disaster? ............................................................................................12

In Conclusion .............................................................................................................................14

Abstracts ....................................................................................................................................... 15

Citations ........................................................................................................................................ 18
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 2

The Substance Abuse and Mental Health Services Administration (SAMHSA) Disaster 

Technical Assistance Center (DTAC) is pleased to provide you with this supplement to our 

ongoing monthly e-communication, the SAMHSA DTAC Bulletin. This supplement will be sent 

twice annually in an effort to inform the field of new and salient research. Please email your 

feedback or suggestions for topics to: DTAC@samhsa.hhs.gov. To subscribe, please enter your 

email address into the “SAMHSA DTAC Bulletin” section of the SAMHSA DTAC Resources

page of our website. 

SAMHSA DTAC is administered by the Emergency Mental Health and Traumatic Stress 

Services Branch of the SAMHSA Center for Mental Health Services Division of Prevention, 

Traumatic Stress, and Special Programs, located at 1 Choke Cherry Road, Rockville, MD 20857. 

SAMHSA DTAC provides disaster technical assistance, training, consultation, resources, 

information exchange, and knowledge brokering to help disaster behavioral health professionals 

plan for and respond effectively to mental health and substance use needs following a disaster. 

To learn more, please call 1-800-308-3515, email DTAC@samhsa.hhs.gov, or visit the 

SAMHSA DTAC website at http://www.samhsa.gov/dtac. 

SAMHSA is not responsible for the information provided by any of the web pages, materials, or organizations 

referenced in this communication. Although the Supplemental Research Bulletin includes valuable information and 

links, SAMHSA does not necessarily endorse any specific products or services provided by public or private 

organizations unless expressly stated. In addition SAMHSA does not necessarily endorse the views expressed by 

such sites or organizations nor does SAMHSA warrant the validity of any information or its fitness for any 

particular purpose.
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 3

In This Issue

“The frequency of major disasters in the United States alone is 

staggeringly high: once a week on average, a new disaster strikes 

somewhere in the United States. Considering the frequency and 

devastation caused by such events in the United States and worldwide, 

understanding the psychiatric sequelae of major disasters is a public 

health issue of paramount importance” (North et al., 2012, p. e40).

This issue of the Supplemental Research Bulletin focuses on research highlights related to 

traumatic stress and suicide, including suicide rates, suicidal ideation, and suicide plans and 

attempts, in relation to disasters. These topics are particularly timely in that climate change may 

lead to more extreme weather over time, or to shifts in seasonal weather patterns, highlighting 

the need for all-hazards preparedness throughout the year, as well as a coordinated disaster 

response that incorporates physical safety, health, and behavioral health. 

Research on the behavioral health consequences of disasters encompasses case studies, crosssectional and longitudinal research, and reviews of literature from across the United States and 

around the world. In this issue, we focus on research published in the last 5 years and with adult 

participants in the United States—though we include some research that is older, and some that 

includes participants from other countries. We also identify populations that research has shown 

may be especially vulnerable in disasters, and we note some risk and protective factors in 

relation to traumatic stress and suicidality as they pertain to disasters.

Because disasters happen in real time and involve many variables that are difficult or impossible 

to control for, it might seem that it would be hard to find consistencies in the chaos—lessons 

learned that can be applied to any disaster. However, certain strong themes do recur throughout 

the literature—for example, resilience is more common than not among disaster survivors. As 

North et al. note in a report on 10 disaster-related investigations, “We found that one-third of 

survivors experienced a post-disaster disorder. Although these results provide considerable 

evidence of the adverse mental health effects of disasters, they also attest to human 

psychological resilience because most survivors did not suffer psychiatric illness despite 

substantial disaster exposures” (2012, p. e44). We hope that this issue of the Supplemental 

Research Bulletin supports you in your work to contribute to disaster behavioral health research, 

and to bring lessons learned to the field. 
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 4

Warmest regards,

CAPT Erik Hierholzer, B.S.N. 

Program Management Officer, Emergency Mental Health and Traumatic Stress Services Branch 

Erik.hierholzer@samhsa.hhs.gov 

Nikki Bellamy, Ph.D. 

Public Health Advisor, Emergency Mental Health and Traumatic Stress Services Branch 

Nikki.bellamy@samhsa.hhs.gov 

Brenda Mannix 

SAMHSA DTAC Project Director 

DTAC@samhsa.hhs.gov
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 5

Traumatic Stress and Suicide After Disasters

Following are the articles that we reviewed in depth in developing this issue. At the end of 

the issue is a comprehensive list of all articles cited in this issue.

Gordon, K. H., Bresin, K., Dombeck, J., Routledge, C., & Wonderlich, J. A. (2011). The 

impact of the 2009 Red River Flood on interpersonal risk factors for suicide. Crisis, 

32(1), 52–55. doi: 10.1027/0227-5910/a000051 

Hackbarth, M., Pavkov, T., Wetchler, J., & Flannery, M. (2012). Natural disasters: An 

assessment of family resiliency following Hurricane Katrina. Journal of Marriage 

and Family Therapy, 38(2), 340–351. 

Kōlves, K., Kōlves, K. E., & De Leo, D. (2013). Natural disasters and suicidal behaviors: 

A systematic literature review. Journal of Affective Disorders, 146, 1–14. 

http://dx.doi.org/10.1016/j.jad.2012.07.037 

North, C. S., Oliver, J. & Pandya, A. (2012). Examining a comprehensive model of 

disaster-related posttraumatic stress disorder in systematically studied survivors of 

10 disasters. American Journal of Public Health, 102(10), e40–e48. 

doi:10.2105/AJPH.2012.300689 

Pietrzak, R. H., Tracy, M. Galea, S., Kilpatrick, D. G., Ruggiero, K. J., Hamblen, J. L., 

Southwick, S. M., & Norris, F. H. (2012). Resilience in the face of disaster: 

Prevalence and longitudinal course of mental disorders following Hurricane Ike. 

PLOS One, 7(6), e38964, 1–14. doi: 10.1371/journal.pone.0038964 
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 6

The Context

Suicide is a pressing public health issue. In 2013, the most recent year for which final national 

data are available from the Centers for Disease Control and Prevention, 41,149 people in the 

United States died by suicide, making suicide that year’s 10th leading cause of death. Among 

young people in the United States, suicide was the second leading cause of death in 2013. 

According to an estimate cited by the American Association of Suicidology, for each death by 

suicide in the United States that year, there were 25 attempts (Drapeau & McIntosh for the 

American Association of Suicidology, 2015). 

In this issue, we have chosen to focus on disasters, traumatic stress, and suicide and suicidality 

for several reasons. Because suicide and suicidality relate closely to a range of issues in 

behavioral health, we saw this focus as a way to understand more about behavioral health 

responses to disaster in general. Also, we wanted to look at an apparent paradox in the research: 

although traumatic stress is a risk factor for suicide, and traumatic stress increases in the 

aftermath of disaster, in many cases suicide rates have not increased after disasters. Finally, by 

reviewing highlights of research on suicide, suicidality, and traumatic stress linked to disasters, 

we hoped to find ways to provide more effective support to disaster survivors. 

Key Research Questions

This issue of the SAMHSA DTAC Supplemental Research Bulletin covers research highlights 

that help to address several important questions about traumatic stress, associated mental 

disorders, and suicidality in association with disasters. The following depicts the order of the 

research topics that we present in this issue:

1. Changes in suicide rates associated with disasters

2. How disasters affect suicidal ideation, plans, and attempts 

3. Whether disasters affect different groups of people in different ways in terms of suicidal 

ideation, plans, and attempts 

4. Other factors that may affect post-disaster suicidality

5. Post-disaster traumatic stress and related behavioral health problems

6. Factors that make people vulnerable to these issues 

7. Factors that may be protective

Note: This issue offers major conclusions of recent research investigations in this area. The 

highlights presented here do not reflect an exhaustive review of the literature.
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 7

Do suicide rates increase after disasters?

In a paper on interpersonal risk factors for suicide among survivors of the 2009 Red River flood 

in North Dakota, Gordon et al. (2011) cite several studies that found no increases in suicide rates 

for 4 years following natural disasters (Krug et al., 1999), as well as studies that found decreases 

in suicide rates over 3 years after natural disasters (Nishio et al., 2009; Shoaf et al., 2004). 

Pridemore et al. (2009) found no statistically significant increases or decreases in suicide rates at 

local, state, and national levels after the September 11, 2011, terrorist attacks and the 1995 

Oklahoma City bombing. 

In comparison, in a review of empirical research on suicidal behavior after natural disasters 

around the world, Kōlves et al. (2013) found that suicide rates sometimes dropped, held steady, 

or increased after natural disasters. However, increases in suicide rates were generally limited to 

population subgroups (men after the 1999 Nantou earthquake in Taiwan, and youth in the United 

States, though not to a statistically significant extent, after Hurricane Andrew in 1992) (p. 12). 

Does suicidal ideation and do suicide plans or attempts increase after disasters?

Gordon et al. (2011) cite cases from the research literature in which rates of suicidal ideation 

decreased following natural disasters (a heat wave in France in August 2003; Morali et al., 2008; 

and Hurricane Katrina in 2005 in the United States; Kessler et al., 2006), although “overall rates 

of psychiatric disorders doubled in both cases” (p. 51). Morali et al. looked at depressive 

disorders, anxiety, stress disorder, and suicidal behavior from June through October 2003 among 

people seeking emergency psychiatric care at a general hospital in Paris. They compared these 

rates to rates for the same hospital for the same months in 2002. 

In their study, Kessler et al. (2006) screened for anxiety and mood disorders, including some 

serious mental illnesses and some mild-moderate mental illnesses. Although their research cited 

lower prevalence of suicidal ideation 5 to 8 months after Hurricane Katrina, later research 

conducted as part of the same effort showed a significant increase in suicidal ideation, among 

roughly the same population. In the 2006 report on their research, Kessler et al. showed that, 

among people estimated to have mental illness, suicidal ideation and suicide plans were 

significantly less prevalent after Hurricane Katrina (2005) than before it. In their report, they 

compared data from the National Comorbidity Survey-Replication (NCS-R) conducted before 

Hurricane Katrina in areas later affected by the hurricane to data from a survey done 5 to 8 

months after the hurricane with the Hurricane Katrina Community Advisory Group (CAG), a 
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 8

sample of 1,043 Katrina survivors who had agreed to take part in several surveys in the years 

after the hurricane to help researchers understand how effective the disaster response was. 

Members of the CAG were surveyed again a year after the 5- to 8-month post-disaster survey. In 

a 2008 paper that included results of the later survey, another team led by Kessler notes 

significant increases in prevalence rates for suicide ideation and plans (as well as posttraumatic 

stress disorder [PTSD]) from the 5- to 8-month post-hurricane survey to the survey a year later. 

They attribute these and other outcomes they observed at follow-up to the fact that stressors 

associated with the hurricane remained common at the time of the follow-up, which was nearly 2 

years after the hurricane. The persistence of these stressors may have led to the increases they 

saw. 

Pietrzak et al. (2012) assessed prevalence of suicidality (ideation, plans, and attempts), as well as 

of several mental disorders, in three waves of interviews after Hurricane Ike (2008), of people 

who had lived in the geographic areas affected by the disaster for at least 1 month before the 

hurricane. Study team members conducted interviews 2 to 5 months after Hurricane Ike in the 

first wave; 5 to 9 months post-hurricane in the second wave; and 14 to 18 months after the 

hurricane in the third wave. Although the team did not interview people in their sample prior to 

the hurricane, they asked them about their experiences before the hurricane in the first wave of 

interviews. Investigators reported that prevalence of PTSD linked to a trauma other than 

Hurricane Ike, as well as depression, panic disorder, and suicidality, held fairly steady across 

assessments, while PTSD linked to Hurricane Ike and generalized anxiety disorder declined in 

the second-wave assessment and stabilized at the third. However, from the second wave of 

assessment to the third, the prevalence of suicidality increased (Pietrzak et al., 2012). 

To understand trends in suicidality in these studies, it may help to consider typical phases of 

psychological reactions to disasters. Zunin and Myers initially described these phases, which 

were also covered in a SAMHSA training manual in 2000 (DeWolfe, 2000). In this model 

(please see Figure A), survivors’ emotions generally become more difficult to manage around the 

time of disaster warning, and their negative feelings increase through disaster threat and impact. 

Their emotions improve in a heroic phase, in which they are inclined to try to contribute to the 

disaster response, followed by a honeymoon phase, when community cohesion peaks. Following 

the honeymoon, however, is disillusionment, sometimes spurred by disappointment in the 

slower-than-expected pace of disaster recovery. Disillusionment typically occurs in the second 

half of the year after the disaster, and after the disaster’s first anniversary, it is generally followed 

by reconstruction, as survivors come to terms with their “new normal” after the disaster.
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 9

Figure A. Phases of Psychological Reactions to Disasters

Adapted from Zunin & Myers as cited in DeWolfe, 2000.

In the 2006 paper by Kessler et al., the reduction in prevalence of suicidal ideation and suicide 

plans among people estimated to have mental illness may have related to the fact that they 

conducted their second survey 5 to 8 months after the hurricane, at which point survivors may 

have been in the heroic or the honeymoon phase. In their 2008 paper, Kessler et al. reported 

significant increases in prevalence of suicidal ideation and plans and PTSD from the 5- to 8-

month post-disaster survey to another survey 1 year later. Their latter survey was administered at 

a point at which survivors would generally be in the reconstruction phase. In the reconstruction 

phase, emotions have not returned to the highs they rose to in the heroic phase, and particularly 

in the honeymoon phase. Also as mentioned above, their findings may have reflected survivors’ 

emotional responses to the protracted pace of recovery that distinguished Hurricane Katrina. 

Pietrzak et al.’s (2012) finding of increased prevalence of suicidality from the second wave of 

assessment (5 to 9 months after Hurricane Ike) to the third (14 to 18 months after the disaster) 

may also have reflected the transition from heroic and honeymoon phases to the reconstruction 

phase, which, though it involves more positive emotion, does not involve the intensity of positive 

emotion of heroic and honeymoon phases. 
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 10

In an article reviewing research literature on natural disasters and suicidal behavior from around 

the world, Kōlves et al. (2013) also note the relationship of their findings to typical phases of 

disaster response. According to Kōlves et al., “There seems to be a drop in non-fatal suicidal 

behavior in the initial post-disaster period (Kessler et al., 2008; Yu et al., 2010), which appears 

to occur during the ‘honeymoon’ phase (Madianos and Evi, 2010), although some studies also 

indicate this tendency during the ‘pulling together’ phenomenon (Gordon et al., 2011). A delayed 

increase in suicidal ideation was observed after Hurricane Katrina (Kessler et al., 2008) and the 

Nantou earthquake in Taiwan (Chou et al., 2007), likely having occurred during the 

disillusionment phase” (2013, p. 12). 

Do suicidal ideations, or suicide plans or attempts, increase after disasters among 

specific groups of people?

In their 2006 report, Kessler et al. note that suicidal ideation correlated significantly with only 

two of the sociodemographic variables they examined: age (being between 18 and 39 years) and 

race/ethnicity (non-Hispanic white) (p. 935). 

Kōlves et al. report conflicting findings about whether males or females are at higher risk for 

suicidal ideation or behaviors following disasters, or whether risk does not differ based on 

gender. As mentioned, this research team looked specifically at research on natural disasters 

(2013, p. 12). 

Are there other factors that make people more likely to engage in suicidal ideation, 

planning, or attempts following a disaster?

Kōlves et al. cite several studies suggesting an association of current major depression and PTSD 

and previous mental health problems with increases in suicidal behaviors following natural 

disasters. They also identify some experiential factors that may be associated with suicidal 

behaviors, including severe destruction of property, injuries sustained by relatives, and danger to 

one’s own life, as well as adverse economic conditions, including high rates of unemployment 

(2013, p. 12). 

Which types of traumatic stress issues and related diagnoses may arise after a disaster?

Norris et al. (2002) reviewed approximately 250 articles, chapters, and books describing research 

on 160 samples of survivors of a range of types of disasters around the world. The total sample 

size exceeded 60,000 people. Investigators grouped outcomes of disasters into six sets: specific 

psychological problems, nonspecific distress, health problems, chronic problems in living, 
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 11

resource loss, and problems specific to youth. They reported that “[o]utcomes in the first set, 

specific psychological problems, were identified in 121 (77 percent) of the samples. . . . 

Undoubtedly, the condition most often assessed and observed in these samples was PTSD (109 

samples, 68 percent)” (Norris et al., 2002, p. 211). In a companion article, the research team adds 

a qualification to their findings: “In interpreting [our] results, it should be kept in mind that the 

relative frequencies of these outcomes are a function of how frequently they were assessed as 

well as how frequently they were observed if assessed” (Norris et al., 2002, p. 241). 

North et al. (2012) examined data on 811 survivors of 10 disasters, including natural, 

technological, and intentionally caused disasters, from October 1987 through April 1995. 

Specifically, they looked at data from interviews completed by the survivors from 1 to 6 months 

after the disaster they had experienced. The interviews assessed PTSD, major depression, alcohol 

and drug use or dependence, panic disorder, and generalized anxiety disorder, as well as disaster 

experiences that survivors might have found traumatic. They found that one-third of the disaster 

survivors they interviewed had a post-disaster disorder, the most prevalent of which was PTSD 

(one-fifth)—echoing the Norris et al. (2002) findings. 

In Kessler et al.’s 2008 report on research with the Hurricane Katrina CAG, they also note 

statistically significant increases from interviews of survivors 5 to 8 months after Hurricane 

Katrina (2005) to interviews conducted 1 year later in estimated prevalence of PTSD and serious 

mental illness (p. 378). 

In the first wave of Pietrzak et al.’s interviews 2 to 5 months after Hurricane Ike (2008), they 

found a past-month prevalence of 20.6 percent of any of several mental or substance use 

conditions, including PTSD related to Hurricane Ike or to another trauma, generalized anxiety 

disorder, panic disorder, depression, alcohol dependence and use, and suicidality. By the third 

wave of interviews, past-month prevalence dropped to 10.9 percent, but these conditions were 

evident in all three waves of interviews, except for alcohol use and dependence, which were not 

assessed in the second and third interview waves (2012, p. 6). Pietrzak et al. note, “PTSD, both 

due to the hurricane and other traumatic events, was the most prevalent disorder at Wave 1 

assessment. This finding is consistent with a large body of prior research, which has similarly 

documented high prevalence of PTSD following disaster exposure [3,4,5,43,44,45]” (2012, p. 

10). 
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 12

Which groups are most at risk for traumatic stress and related diagnoses after a 

disaster? 

In describing their research on more than 800 survivors of 10 disasters, North et al. write that 

“predictors of PTSD were female gender, younger age, Hispanic ethnicity, less education, evermarried status, pre-disaster psychopathology, disaster injury, and witnessing injury or death; 

exposure through death or injury to friends or family members and witnessing the disaster 

aftermath did not confer additional PTSD risk” (2012, p. e40). The researchers note, “This study 

did not detect differences in PTSD by type of disaster” (2012, p. e47). 

In their paper, North et al. (2012) explain that the Diagnostic and Statistical Manual of Mental 

Disorders, Fourth Edition, Text Revision (DSM-IV-TR) PTSD criteria include three groups. 

Group B includes re-experiencing symptoms, group C includes avoidance or numbing 

symptoms, and group D includes hyperarousal symptoms. They observe that, while more than 

two-thirds of survivors who were interviewed as part of their research met DSM-IV-TR criteria 

in group B and group D, less than one-third of them met the full diagnostic criteria (including the 

avoidance or numbing symptoms in group C). However, 84 percent of people meeting the group 

C criteria met the full set of criteria for a diagnosis of PTSD. The researchers note that group C 

criteria may therefore serve as a marker for PTSD—i.e., people who show the avoidance and 

numbing symptoms that are in this group may be more likely than others to go on to develop full 

PTSD (2012, p. e44). In their earlier review, Norris et al. (2002) made a similar observation: 

“Among those studies that examined the separate criteria for PTSD, a common finding was for 

intrusion [group B] and arousal [group D] to be highly prevalent and avoidance [group C] less 

so, and thus the latter tended to drive the diagnosis of PTSD (Catapano et al., 2001; McMillen et 

al., 2000; Maes et al., 1998; Norris, 1992; North et al., 1999)” (pp. 211, 216). 

According to research by Kessler et al. (2008) with the Hurricane Katrina CAG, increases in 

rates of PTSD were significantly higher among group members ages 40 through 59 than among 

respondents in other age ranges. Low family income also was a statistically significant predictor 

of increased prevalence over time of PTSD, as well as of serious mental illness and suicidal 

ideation (2008, p. 378). 

Which groups are least at risk for traumatic stress, suicidality, and related behavioral 

health problems after a disaster? 

Norris et al. classified samples from studies in their review by degree of impairment linked to 

physical and behavioral health problems and other effects of disasters. They assigned values 
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 13

ranging from 1, which indicated “minimal impairment, highly specific or selected effects, or very 

transient effects,” to 4, the value for samples in which more than half had psychopathology 

(2002, p. 218). They underscore the resilience of rescue and recovery workers, pointing to their 

finding that of the samples consisting of rescue and recovery workers, only 13 percent were 

classified as 4, or severely impaired.

Gordon et al.’s 2011 research suggests that time spent volunteering in disaster-related efforts 

may reduce suicidality among disaster survivors. Specifically, among their sample of 

undergraduate students, they found that more time spent volunteering in disaster-related efforts 

around the time of the Red River flood in Fargo, North Dakota (2009), correlated positively with 

lower levels of “thwarted belongingness” and “perceived burdensomeness,” two components 

identified by Joiner (2005) in his interpersonal-psychological theory as part of the desire for 

suicide. This suggests that volunteering to assist with disasters could improve well-being and 

reduce the likelihood of suicide, although Gordon et al. also hypothesized that the physical 

hardships involved in volunteering could make the volunteers more likely to develop a third 

component necessary for death by suicide in Joiner’s theory: the acquired capability for suicide, 

or the ability to commit suicide, which he proposes is strengthened by experiences of physical 

pain and difficulty. Gordon et al. found that more hours of volunteer work did indeed correlate 

with higher levels of acquired capability for suicide, though not to a statistically significant 

degree. 

Pietrzak et al. observed lower levels of prevalence of most of the disorders they examined—

including PTSD, depression, and panic disorder—among members of their Hurricane Ike (2008)-

affected sample than have been observed in survivors of other disasters. Among possible 

explanations they posit for this phenomenon is that the participants in their study, as residents of 

a geographic area frequently affected by hurricanes, may have been “‘stress inoculated,’” or 

protected by their prior experience of disasters, as well as better prepared to deal with the 

consequences of hurricanes (2012, p. 12). They add that there is some support for this idea in the 

fact that 47.8 percent of their sample in the Wave 1 interviews reported prior experience of a 

natural disaster (2012, p. 12). 

Research by Hackbarth et al. (2012) suggests that families as units may have attributes that help 

them cope more effectively with disasters. Specifically, they found that families cope more 

effectively with challenging situations such as disasters if they also possess hope; 

spirituality/religiosity; and hardiness, which they describe as internal strengths and resilience of 

the family unit, as well as the family’s ability to collaboratively address issues initially 
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 14

confronting one of their members. Similarly, as Kōlves et al. relate from the research they 

reviewed, “Family support may act as a buffer against the worst effects of natural disasters (Tang 

et al., 2010) (2013, p. 12). 

In Conclusion

Of the studies cited in this issue, several found no increases in suicide rates after disasters, 

particularly in the United States. According to studies in this issue, suicidal ideation, plans, and 

attempts are more likely to start to occur several months after a disaster, rather than immediately 

after it. Some studies found decreases in suicidal ideation, plans, and attempts in spite of 

increases in some mental disorders. The studies cited did not consistently find that specific 

populations are at heightened risk for suicidal ideation, plans, or attempts after disasters. 

One study did find greater risk for suicidal ideation among people between the ages of 18 and 39 

years and among non-Hispanic white people (Kessler et al., 2006). PTSD seems to be the most 

common type of traumatic stress diagnosis after a disaster; however, as Norris et al. (2002) point 

out, this may be in part because researchers are more likely to assess populations under 

investigation for this disorder than for others. Groups who may be at higher risk for PTSD after 

disasters include females, young people, and people who have been injured or who witnessed 

injury or death. People with avoidance and numbing symptoms may be more likely than those 

with other PTSD symptoms to develop the disorder. Individuals who volunteer in disaster-related 

efforts may experience less suicidality. Rescue and response workers may be less at risk for 

behavioral health problems after disasters, as may people who have survived prior disasters. 

Families may have attributes that make their members better able to cope with disasters.
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 15

Abstracts

Gordon, K. H., Bresin, K., Dombeck, J., Routledge, C., & Wonderlich, J. A. (2011). The impact 

of the 2009 Red River Flood on interpersonal risk factors for suicide. Crisis, 32(1), 52–

55. doi: 10.1027/0227-5910/a000051

Background: Natural disasters are frequently associated with increases in risk factors for 

suicide, yet research indicates that suicide rates tend to stay the same or decrease in the wake of 

disasters (e.g., Krug et al., 1999). Aims: The present research sought to shed light on this 

counterintuitive phenomenon by testing hypotheses derived from Joiner’s (2005) interpersonalpsychological theory of suicidal behavior, which proposes that the desire to die by suicide is the 

result of feeling like one does not belong and feeling like one is a burden on others. During 

natural disasters, community members often pull together in volunteering efforts, and it was 

predicted that such behaviors would boost feelings of belonging and reduce feelings that one is a 

burden. Methods: The present study tested these predictions in a sample of 210 undergraduate 

students in Fargo, North Dakota, following the 2009 Red River Flood. Results: Consistent with 

prediction, greater amounts of time spent volunteering in flood efforts were associated with 

increased feelings of belongingness and decreased feelings of burdensomeness. Conclusions:

The findings in the current study are consistent with the notion that communities pulling together 

during a natural disaster can reduce interpersonal risk factors associated with the desire for 

suicide.

Hackbarth, M., Pavkov, T., Wetchler, J., & Flannery, M. (2012). Natural disasters: An 

assessment of family resiliency following Hurricane Katrina. Journal of Marriage and 

Family Therapy, 38(2), 340–351. 

This study explored the role of family characteristics in the coping process of a family after 

having experienced Hurricane Katrina to gain an understanding of the relationship between 

family resiliency, hope, family hardiness, and spirituality for survivors of this natural disaster. It 

was hypothesized that families who demonstrate higher levels of hope, family hardiness, and 

spirituality would be more likely to effectively cope after the storm. Further, great resource loss 

was hypothesized to diminish a family's ability to cope. Four hundred fifty-two participants 

completed the survey. Results indicate a relationship between hope, family hardiness and 
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 16

spirituality, and the criterion variable, family coping. The importance of these findings in terms 

of exploring family resiliency following a natural disaster is discussed.

Kōlves, K., Kōlves, K. E., & De Leo, D. (2013). Natural disasters and suicidal behaviors: A 

systematic literature review. Journal of Affective Disorders, 146, 1–14. 

http://dx.doi.org/10.1016/j.jad.2012.07.037

Background: Various consequences including suicidal behaviors can arise in the aftermath of 

natural disasters. The aim of the present review was to systematically analyze the existing 

literature on the potential impact of natural disasters on suicidal behaviors. Methods: A 

systematic search of English-language articles indexed in electronic databases was conducted. 

The current review covers 42 papers containing empirical analyses of the relationship between 

natural disasters and suicidal behaviors. Results: In total, 19 papers analyzed suicide mortality 

and 23 non-fatal suicidal behaviors. The effects of earthquakes on suicidal behaviors are the 

most frequently studied among natural disasters (n = 20), followed by hurricanes (n = 11). 

Further, there were four papers about tsunamis, three about floods, three about heat waves and 

drought, and one investigating the effects of multiple natural disasters. The studies show 

different directions in suicide mortality following natural disasters. Nevertheless, there seems to 

be a drop in non-fatal suicidal behaviors in the initial post-disaster period, which has been 

referred to as the ‘honeymoon’ phase. A delayed increase in suicidal behaviors has been reported 

in some studies. However, other factors increasing the risk of suicidal behaviors after natural 

disasters have been reported, such as previous and current mental health problems. Furthermore, 

contributing factors, such as economic conditions, should also be considered. Limitations: The 

exclusion of non-English articles. Conclusions: In light of the various methodological 

limitations observed, there is a need for further studies using proper designs. Mental health and 

suicidal behaviors should continue to be monitored for several years after the disaster.

North, C. S., Oliver, J. & Pandya, A. (2012). Examining a comprehensive model of disasterrelated posttraumatic stress disorder in systematically studied survivors of 10 disasters. 

American Journal of Public Health, 102(10), e40–e48. doi:10.2105/AJPH.2012.300689

Objectives: Using a comprehensive disaster model, we examined predictors of posttraumatic 

stress disorder (PTSD) in combined data from 10 different disasters. Methods: The combined 

sample included data from 811 directly exposed survivors of 10 disasters between 1987 and 
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 17

1995. We used consistent methods across all 10 disaster samples, including full diagnostic 

assessment. Results: In multivariate analyses, predictors of PTSD were female gender, younger 

age, Hispanic ethnicity, less education, ever-married status, pre-disaster psychopathology, 

disaster injury, and witnessing injury or death; exposure through death or injury to friends or 

family members and witnessing the disaster aftermath did not confer additional PTSD risk. 

Intentionally caused disasters associated with PTSD in bivariate analysis did not independently 

predict PTSD in multivariate analysis. Avoidance and numbing symptoms represented a PTSD 

marker. Conclusions: Despite confirming some previous research findings, we found no 

associations between PTSD and disaster typology. Prospective research is needed to determine 

whether early avoidance and numbing symptoms identify individuals likely to develop PTSD 

later. Our findings may help identify at-risk populations for treatment research.

Pietrzak, R. H., Tracy, M. Galea, S., Kilpatrick, D. G., Ruggiero, K. J., Hamblen, J. L., 

Southwick, S. M., & Norris, F. H. (2012). Resilience in the face of disaster: Prevalence 

and longitudinal course of mental disorders following Hurricane Ike. PLOS One, 7(6), 

e38964, 1–14. doi: 10.1371/journal.pone.0038964

Objectives: Natural disasters may increase risk for a broad range of psychiatric disorders, both in 

the short- and in the medium-term. We sought to determine the prevalence and longitudinal 

course of posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic 

disorder (PD), depression, and suicidality in the first 18 months after Hurricane Ike. Methods:

Six hundred fifty-eight adults representative of Galveston and Chambers Counties, Texas 

participated in a random, population-based survey. The initial assessment was conducted 2 to 5 

months after Hurricane Ike struck Galveston Bay on September 13, 2008. Follow-up assessments 

were conducted at 5 to 9 and 14 to 18 months after Hurricane Ike. Results: Past-month 

prevalence of any mental disorder (20.6 percent to 10.9 percent) and hurricane-related PTSD (6.9 

percent to 2.5 percent) decreased over time. Past-month prevalence of PTSD related to a nondisaster traumatic event (5.8 percent to 7.1 percent), GAD (3.1 percent to 1.8 percent), PD (0.8 

percent to 0.7 percent), depression (5.0 percent to 5.6 percent), and suicidality (2.6 percent to 4.2 

percent) remained relatively stable over time. Conclusions: PTSD, both due to the hurricane and 

due to other traumatic events, was the most prevalent psychiatric disorder 2 to 5 months after 

Hurricane Ike. Prevalence of psychiatric disorders declined rapidly over time, suggesting that the 

vast majority of individuals exposed to this natural disaster ‘bounced back’ and were resilient to 

long-term mental health consequences of this large-scale traumatic event.
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 18

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Pietrzak, R. H., Tracy, M. Galea, S., Kilpatrick, D. G., Ruggiero, K. J., Hamblen, J. L., 

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e38964, 1–14. doi: 10.1371/journal.pone.0038964
SUPPLEMENTAL RESEARCH BULLETIN  Issue 5 20

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