Suicidality after Natural Disasters

Abstract

Research on post-disaster suicidality has primarily focused on areas with substantial loss of lives and property damage. Cataclysmic events, such as hurricanes, earthquakes, and the recent events of COVID-19, have established associations with a rise in mental health disorders. Hurricanes weak the infrastructure and obstruct medical services. Earthquakes led to power outages and destruction of buildings, homes, and geological landmarks. More recently, the COVID-19 pandemic resulted in detrimental loss of social interactions with effects on people’s mental health. This chapter will provide valuable information to identify and mitigate the incidence of suicidal behavior after natural disasters and provide effective assistance.

1. Introduction

Natural disasters are catastrophic events that can have profound impacts on individuals, communities, and societies. These events, such as earthquakes, hurricanes, wildfires, floods, and pandemics, often result in significant economic loss, displacement, and physical harm. As a result of these phenomena, feelings of economic insecurity, stress, and anxiety arise, primarily affecting individuals who face the loss of family members, material losses, or both. According to the World Bank, disasters cause $520 billion in economic losses annually and force 26 million people into poverty [1]. In fact, between 1970 and 2019, three of the hurricanes which developed in 2017, Harvey (US$ 96.9 billion), Maria (US$ 69.4 billion), and Irma (US$ 58.2 billion) alone, accounted for 35% of the total economic damages caused by the world’s top ten disasters [2].

Accordingly, economic loss and instability that emerge from these natural disasters can impact the mental health of individuals, either by developing feelings of stress, anxiety, and depression or exacerbating preexisting ones. In 2019, the World Health Organization (WHO) reported that there were 301 million people living with anxiety and 280 million people living with depression, respectively [3]. In the aftermath of the onset of the COVID-19 pandemic, preliminary assessments revealed a significant rise in the prevalence of anxiety and depression, with an increase of 26% and 28% observed between 2019 and 2020 [3]. Furthermore, the incrementation in these mental health disorders can potentially contribute to a higher occurrence of suicidal ideation and behavior. According to the Centers for Disease Control and Prevention (CDC), between the years 2000 and 2021, there was an approximate 36% increase in suicide rates [4]. During the period from 2015 to 2019, roughly 10.6 million adults residing in the United States reported having experienced suicidal thoughts within the previous year [5]. Additionally, it was estimated that approximately 1.4 million adults had made a suicide attempt during the same time frame [5]. However, in 2021, these numbers saw a significant increase, with an estimated 12.3 suicidal thoughts reported and 1.7 million suicide attempts [4].

The relationship between natural disasters and mental health disorders is complex and multifaceted. The World Health Organization (WHO) revealed that individuals exposed to major emergencies, such as natural disasters, are at higher risk of developing mental health disorders or worsening of pre-existing mental conditions [6]. In fact, the conducted studies have reported increased rates of anxiety, depression, and post-traumatic stress syndrome (PTSD) among affected populations [6]. The adverse outcomes of natural disasters on the mental health of populations can have a profound impact on the overall well-being and functioning of individuals. These effects make it considerably challenging for individuals to cope with the aftermath of such events, consequently placing them at an increased risk of experiencing suicidal ideations and engaging in suicidal behaviors. A systematic review conducted employing data from articles published from 1990 to 2018 identified that women, adolescents, the elderly, individuals with diagnosed depression and PTSD, those suffering from low-social support, and individuals who had lost their parents exhibited heightened vulnerability to suicide in the aftermath of natural disasters [7].

Analyzing the relationship between natural disasters, mental health disorders, and suicide behaviors is imperative for the development of an effective disaster response and recovery plan. Moreover, understanding each of the risk factors for suicidal behavior and ideation that emerges from natural disasters can contribute to the implementation of appropriate prevention measures and interventions that promote the well-being of affected individuals. This review aims to offer valuable insights into the associations between natural disasters, specifically hurricanes, earthquakes, and the COVID-19 pandemic, and the risk of suicidal ideations and behaviors. Furthermore, it intends to identify underlying risk factors for such behaviors that emerge from these natural disasters and highlight the importance of comprehensive support systems and strategies in the mitigation of the adverse effects of these events on individuals’ mental well-being.

2. Methods

This chapter was a systematic review probing English/Spanish language articles related to suicide and its risk factors after natural disasters and was published between 2005 and June 2023 in Google Scholar, PubMed, Web of Science, Science Direct, Scopus, and ProQuest databases. Searched terms included “suicidality” or “suicide” and “natural disasters” or “hurricane” or “earthquake” or “forest fire” or “pandemic”. After reviewing and screening the collected studies by means of specific criteria, only 199 studies were qualified to enter the survey. It was found that most of these studies had investigated suicide after hurricanes, earthquakes, and the COVID-19 pandemic.

3. Suicidality after hurricanes

The National Oceanic and Atmospheric Administration (NOAA) describes a hurricane as a type of tropical cyclone with winds exceeding 74 miles per hour and can be categorized from 1 through 5 with the Saffir-Simpson Hurricane Wind Scale (Figure 1). Consequently, a category 1 hurricane causes less damage than a category 5 hurricane. Therefore, some of the worst hurricanes recorded in history are category 4 and 5; for example, one of the most devastating hurricanes in the past one hundred years was San Felipe-Okeechobee in September 1928. Starting with a direct hit to Puerto Rico, continuing throughout the Bahamas, and ending in Florida, USA. This category 5 hurricane had an estimated damage of $75,000,000 US dollars, and sadly, it took over 2000 lives in the process [9]. There have been more recent hurricanes, such as; Katrina in 2005, Ike in 2008, and Maria in 2017. Collectively, these weather abnormalities cost over $200 billion US dollars. Moreover, these deadly hurricanes claimed the lives of over four thousand people [10, 11, 12]. While the hurricane itself may impact the citizens, most of the damages are associated with the disastrous aftermath they leave, like lake surges. When the San Felipe hurricane was passing Florida, there was a six to nine feet rise in Lake Okeechobee, flooding the surrounding terrain, taking the majority of lives lost in this disaster, and dangerously rapid winds often damaging the infrastructure of the affected area [9].

Figure 1.

The Saffir-Simpson Hurricane Wind Scale categorizes hurricanes in 1–5 according to the speed of their wind [8].

Another example is when Hurricane Maria greatly damaged Puerto Rico’s power grid. In 2017, Puerto Rico got hit by Hurricane Irma a couple of weeks before Hurricane Maria. Previously, the island’s physical structure was weakened by Irma. Thus, Hurricane Maria solidified the damages. Puerto Rico’s electricity structure consists of above-ground lines, making it extremely vulnerable to abnormal weather. Puerto Rico had the longest blackout in the United States’ history since electricity was fully restored almost eleven months after Maria [13]. With the loss of electricity comes many strains. Because of this power outage, first necessity items, such as food, perished. Additionally, most streets were blocked by debris, and essential workers could not get to neighborhoods. Equally important, citizens with refrigerated medications, such as insulin-dependent diabetics, were greatly affected because their medication did not have proper storage. However, because the water plants are powered by electricity, the loss of power is directly correlated to the lack of water, which presents two risks. Since people could not bathe, clean, or cook properly, people were drawn to use contaminated water from lakes, beaches, wells, and pits.

According to the CDC, mental health is a combination of “social, emotional, and psychological well-being” factors that affect and determine how an individual acts, perceives the world and relates to other beings [14]. As of 2019, 1 in 8 people in the world reported living with some type of mental health disorder, with the leading diseases being depression and anxiety [15]. The World Health Organization characterizes anxiety disorder as a collection of symptoms that leave the patient with irrational fear and worry [15]. As stated by NIH statistics based on the USA population, women from ages 18–29 and 30–44 years old are more likely to suffer from any form of anxiety [16]. On the contrary, depression is characterized by feelings of extreme sadness, emptiness, irritability, and anhedonia [15]. The NIH surveyed USA citizens and concluded that females from ages 18–25 years old were more likely to suffer from depression [17]. Furthermore, worldwide 280 million people currently suffer from some type of depression, reported twice as much by women than men [18]. Sadly, depression often leads to suicidal thoughts, suicide being the leading cause of death in groups ages 15–29 years old [18]. The hallmark of anxiety is increased levels of the neurotransmitter Norepinephrine but decreased levels of the neurotransmitters GABA and Serotonin. However, patients suffering from depression are notorious for having decreased levels of the neurotransmitters Dopamine, Norepinephrine, and Serotonin.

Although some may consider suicide attempts quickly after an incident, it is important to take into account how mental health and resiliency vary in the population. Therefore, in most cases, Major Depression, General Anxiety Disorder, and Post Traumatic Stress Disorder are the first toll on mental health after a hurricane that people experience [19]. While a percentage of the population may receive the help needed to battle these conditions, some may never overcome them, and the less fortunate may not have access to healthcare, to begin with. For this reason, the University of Delaware made a study based on data from the Federal Emergency Management Agency, which compared suicide rates three years before and after natural disasters [20]. They included phenomena such as hurricanes, floods (which are common aftermath of hurricanes), and ice storms. However, this study also took into account countries that only had one natural disaster in a year. Hence their data may be an underestimation of the real number of suicide rates [20]. Their data suggests that there is a 23% increase in suicide rates after these events [20]. Nevertheless, there was a difference between suicidality trends after hurricanes and floods. For instance, the spike in suicide rates increased by 26% after hurricanes occurred during the first year after the disaster, while suicidality increased by 61% for floods two years after [20]. Nonetheless, for all of the disasters, suicide rates began to fall following the third-year post-catastrophe [20].

Because Hurricane Maria was the main example of a country’s aftermath, we will start by discussing Puerto Rico’s statistics on suicidality after this catastrophe. From the years 2015 to 2019, 90% of the suicides were committed by men, 10% by women, for both genders, and the majority of cases were adults ages 40–69 years old [21]. The most common method to commit suicide was hanging, followed by firearms and ingestion of venom [21]. Following the same logic that the University of Delaware used, Puerto Rico’s statistics portrayed the same trends their study concluded. For instance, a year before Hurricane Maria, in 2016, Puerto Rico reported the lowest suicide rates the island had seen in 10 years, with a total of 211 people committing suicide [21]. On the other hand, the following two years after Maria, suicide rates increased, with 260 suicides in 2017 and 243 suicides in 2018 [21]. The Health Department and the Statistics Institute of Puerto Rico based their crude rate on 100,000 habitants. For example, the crude rates for suicidality were 5.8 in 2016 and 7.8 in 2017 (Figure 2). Therefore, we can conclude that in the year Hurricane Maria hit Puerto Rico, suicidality increased by roughly 35% [21].

Figure 2.

Percentage of Reported Suicidal Ideations Before and After Hurricanes in Puerto Rico, United States, and Taiwan [21, 22, 23, 24, 25].

Hurricane Katrina, which struck the Gulf Coast of the United States in August 2005, was one of the deadliest and costliest hurricanes in U.S. history. The storm caused widespread destruction and loss of life, leaving a lasting impact on the affected communities. In the aftermath of Hurricane Katrina, various studies and reports highlighted the mental health impact on the affected communities. The National Center for Biotechnology Information (NCBI) published research indicating an increase in mental health disorders and distress among survivors in the months following the hurricane. Interestingly, suicide ideations decreased following Hurricane Katrina. A study demonstrated that the prevalence of suicidal ideation was significantly lower in the post-Katrina survey, from 8.4% before to 0.7% (Figure 2) [22]. In addition, plans for suicide decreased from 3.6% to 0.4% after Katrina [22]. For instance, although Hurricane Katrina was catastrophic to most states in the US, citizens felt a shared sense of purpose which helped them look at the circumstances in a positive light. Nevertheless, in a follow-up study one year later was found that suicidal ideation increased to 6.4% and suicidal plans to 5%, which is higher than before Katrina [23].

Hurricane Harvey, a category 4 hurricane, struck the Gulf Coast of Texas in August 2017, causing catastrophic flooding and widespread damage in the region. Two months after the hurricane, 10% of the survivors reported suicide ideation (Figure 2), 2.5 times higher than typically reported in the general population [24]. In this study, women are more at risk of suicide ideation compared to men. Additionally, the most significant risk factor is prior mental health problems [24].

Typhoon Morakot, also known as Typhoon Ketsana, struck the Philippines, Taiwan, and China in August 2009. The only difference between a hurricane and a typhoon is the location where the storm occurs. The storm resulted in significant loss of life and widespread damage, particularly in Taiwan, where it caused severe flooding and landslides. The trauma of experiencing such a catastrophic event, losing homes and loved ones, and facing challenges in recovery and rebuilding can contribute to emotional distress and mental health issues. In a study made one year after the typhoon, 4.1% of adolescents reported trying to kill themselves (Figure 2) [25]. The results of this study found that among adolescents who had experienced Typhoon Morakot, the disaster exposure experiences increased suicide risk [25].

Hurricane’s impact extended beyond physical damage and had significant effects on the mental health of affected individuals. After a disaster like a hurricane, people may experience emotional distress, trauma, grief, and a range of mental health issues, including depression, anxiety, and post-traumatic stress disorder (PTSD). These factors can contribute to an increased risk of suicidal thoughts for some individuals.

4. Suicidality after earthquakes

Earthquakes vary according to their magnitude and intensity. Magnitude measures the energy released by an earthquake at its epicenter [26]. The Richter Scale measures magnitude, and the Mercalli Scale measures the intensity (Figure 3). How it measures, the earthquake’s effects on the environment is based on the damage and shocks perceived by people, buildings, and objects in the affected area and the damage they cause. As the intensity and magnitude increase, the damages increase as well.

Figure 3.

Earthquakes Richter’s scale and Mercalli scale [26].

We know that earthquakes are sudden natural phenomena that cause land shifts which later causes fires, tsunami, avalanches, and the collapse of buildings, homes, bridges, and roads. This leads people to face mental health problems, post-traumatic stress disorder, and possible death. Generally, suicidal ideation and suicide cases after earthquakes are promoted by some of these factors: damage made to the property, material losses, or simply how they handle situations [27]. Besides material losses being such a huge trigger for suicide after this catastrophe, the biggest trigger is their mental status and how it was affected. This is why it is important to be aware of mental health after a natural disaster to prevent suicide.

A study made in 2021 on the number of deaths by suicide in the Great East Japan Earthquake in 2011 observed that the suicide rate was 18% lower than the average mortality rate for the previous three years [28]. Another study which focused on the designated evacuation areas of the disaster in Japan, showed an increasing rate of male suicide immediately after the disaster occurred (Figure 4), and that suicide rate later decreased two years later [29]. In contrast, the female suicide rate in the evacuation areas of Japan decreased slightly after the disaster; one year later, this suicide rate increased [29]. Although there was a decrease in suicides, it was reflected in the designated evacuation areas, which greatly impacted their mental health.

Figure 4.

Country comparison of registered suicide cases before and after the earthquakes [29, 30, 31, 32].

In Chile, in 2010 occurred, an earthquake of a magnitude of 8.8; a study was made on suicidal ideation and post-traumatic stress after the earthquake and tsunami of 27-F. This study demonstrated and recorded 22 cases of suicidal ideation in post-earthquake respondents, 8.9% of the sample [33]. They also found in this study that there is a greater risk of suicidal ideation in women who are housewives, which shows that work would also be a trigger after the earthquakes.

Ecuador suffered a strong earthquake of magnitude 7.8 that devastated the country; as a consequence of this event, the suicides registered between January 2011 and December 2020 were investigated. 10,380 cases of suicides were reported, where 8.15 were found per 100,000 inhabitants in 2011, increasing the suicide rate after the earthquake (Figure 4) [30].

Another example of a country whose residents suffered greatly from natural disasters was Puerto Rico. After a series of earthquakes that began at the end of 2019 and ended in January 2020, many citizens were greatly affected by this series of continuous earthquakes. The consequences of this series of earthquakes in Puerto Ricans were many, among them losing homes, running out of electricity service, losing water, and living in places that were shelters since their houses were destroyed. Besides material losses that people had, it left many people having mental health problems. The Department of Health Government of Puerto Rico, makes a monthly report of suicides that occurred on the island. We can note a comparison of suicide cases from the year 2000 to the current year. Analyzing the data for the years 2019 and 2020, we see that for the year 2020, there was a difference of 113 cases due to suicide compared with the suicide rate of 2019 [31]. Therefore, fewer suicides are reflected for the year 2020 than in 2019. It reflects the number of suicide cases per month; during the month of December 2019, 20 cases were reported suicide cases. Then, in January 2020, some 22 cases of suicide were reported, being the month with the highest number of deaths from suicide in Puerto Rico (Figure 4) [31]. They show that 63 suicides occurred in this time frame, 41 of which were by hanging, 16 were with firearms, 1 by poisoning, and 5- marked others. There was certainly a decline at the end of the year 2020 in deaths from suicide comparing it to the beginning of the year since most suicides occurred in January.

On the other hand, an article reports that in Nepal, after an earthquake of magnitude 7.8 that occurred in April 2015, suicides increased by 41.24% three months after the earthquake [32]. The cases of suicides that had been registered from half of January to half of April were 965. However, three months later, the cases of suicide increased to 1363 (Figure 4).

Undoubtedly, people, after facing natural disasters and not leaving earthquakes behind, are mentally affected, having to deal with mental disorders for the rest of their lives because of these catastrophes. These studies reflect that young people have thought about taking their own life at some point, but few commit suicide. However, it does not remove the importance of attending to post-traumatic mental disorders because of these catastrophes that affect the citizens of said countries. It is crucial that the governments of countries that have gone through catastrophes provide a mental help service to citizens and that this help is accessible to everyone. Since it is proven that after natural disasters, the mental health of the people who witnessed this catastrophe is compromised, it’s important to raise awareness to countries to be able to provide the help needed. Governments of said countries can contribute to preventing suicidal thoughts from becoming suicides and reduce the rate of suicide and suicidal ideation by providing adequate help to its people after a natural disaster like an earthquake.

5. Suicidality after pandemic

Another aspect that must be considered when studying the incidence of suicidal ideation and behavior following natural disasters is the COVID-19 pandemic, which was declared a public health emergency on January 30, 2020, by the World Health Organization. As a result of these events, multiple risk factors for self-harm, exhibited in Figure 5, emerged, which contributed to the substantial decline of mental health worldwide. During the quarantine period, the COVID-19 pandemic compelled numerous companies to shutter or halt their operations, leading to high unemployment rates. This, in turn, coupled with global inflation, engendered economic insecurity within households across the globe. A study conducted to evaluate the association between food insecurity and mental health among low-income Americans during the COVID-19 pandemic established that food insecurity is linked to a significantly elevated risk of anxiety, with a 257% higher likelihood, and a similarly heightened risk of depression, with a 253% increase [34]. Moreover, the results indicated that the loss of employment during the pandemic is associated with a 32% higher risk of anxiety and a 27% higher risk of depression [34]. A more recent study performed among Shanghai residents after the lockdown of April 2022 concluded that the likelihood of experiencing depression and anxiety was linked to factors such as job loss and income loss [35]. Furthermore, moderate food insecurity was associated with over a threefold increase in the odds of screening positive for depression and anxiety and reporting suicidal thoughts, while severe food insecurity was associated with over a fivefold increase [35].

Figure 5.

Risk elements for suicidal behavior and ideations during the COVID-19 pandemic.

Prevention and control measures for COVID-19 incorporated a constant practice of social distancing and lockdown. Accordingly, it was anticipated that social isolation would exacerbate feelings of loneliness, thereby leading to an adverse effect on mental health. A survey conducted among 5211 participants representing all 34 provinces in Indonesia reported that within this group, 39.3% experienced self-harm and thoughts of suicide during the pandemic [36]. Following the analysis, the results of the correlational test indicated a statistically significant (p < 0.001) and positive (r = 0.51) relationship between the intensity of loneliness and incidents of suicidal ideation [36]. Correspondingly, a longitudinal cohort study recruited adults aged ≥55 years from all 50 states, the District of Columbia, and Puerto Rico to investigate the impact of pandemic-related stressors, such as isolation, on the mental health and well-being of middle-aged and older adults in the United States. As shown in Figure 6, approximately one-third of middle-aged adults screened positive for symptoms of depression, anxiety, and loneliness [37].

Figure 6.

Population-weighted prevalence of depression (8-item Center for Epidemiological Studies Depression Scale score ≥ 3), anxiety (5-item Beck Anxiety Inventory Scale score ≥ 10) and loneliness (3-item UCLA Loneliness Scale score ≥ 6), among U.S. adults >55 years, in which the mean age of the weighted sample was 67.8 years [37].

An additional contributing factor to self-harm behaviors, particularly during the pandemic and the associated lockdown measures, was the increasing incidence of domestic violence. A systematic review, enclosing a comprehensive analysis of 32 studies from various regions, including North America, Europe, Asia-Pacific Area, Africa, and multinational research, has conclusively demonstrated that the COVID-19 pandemic resulted in a surge of domestic violence cases [38]. This increase was particularly notable during the initial week of the COVID-19 lockdown in each respective country [38]. Moreover, the implementation of social distancing guidance led to the cease of operations of support services for these victims, resulting in constant contact with their abusers and, hence, adverse effects on their psychological well-being. The acute impact of COVID-19 on domestic violence, along with its effect on Tunisian women’s (18–79 years) mental health, was assessed on an online survey using the Depression Anxiety and Stress Scales (DASS-21). More than half the participants (57.3%) experienced extremely severe distress symptoms, as indicated by the DASS-21 assessment [39]. Individuals with a prior history of mental illness and those who reported incidents of abuse during the lockdown exhibited heightened levels of depression, anxiety, and stress symptoms [39].

Furthermore, the exponential rise in positive cases and the number of patients being admitted to hospitals resulted in a shortage of healthcare workers which exacerbated feelings of emotional distress and burnout. Working in healthcare professions inherently entails significant emotional strain and constant exposure to stressful situations. As this public health emergency continued to escalate quickly, concerns about the severity of the disease, lack of knowledge during the first months of its onset, and scarcity of protective equipment and ventilators became the primary catalysts for exhaustion and stress among healthcare personnel. A meta-review of systematic reviews aimed to provide an overview of the general mental well-being of healthcare workers amidst the COVID-19 pandemic revealed that anxiety (16–41%), depression (14–37%), and stress/post-traumatic stress disorder (18.6–56.5%) were the most prevalent effects on mental health [40]. The most significant risk factors identified were female gender, younger age, being a nurse, and working on the frontline [40]. Between August and October 2020, approximately 3.4% of healthcare workers across Australia reported ‘frequent’ thoughts of suicide in the preceding two weeks, while 7.1% stated ‘occasional’ [41]. Similarly, a study performed among physicians in New York City reported prevalence rates for depression, suicidal ideation, and burnout of 6.2, 6.6, and 19.6%, respectively [42]. Further analysis utilizing a general linear model demonstrated that older age had a protective effect; conversely, individuals with a history of prior diagnosis or treatment for depression or anxiety, as well as those with an increased frequency of on-call duties, displayed higher scores on the Patient Health Questionnaire for Depression (PHQ-9) [42].

Overall, an increase in suicide ideation and attempts was hypothesized during the COVID-19 pandemic due to exacerbated feelings of depression, stress, and anxiety. A systematic review enclosing data mainly from the United States., India, United Kingdom, China, and Bangladesh revealed that the pooled prevalence of suicidal ideation was 12.1% [43]. Additionally, a different investigation in the UK reported that 18% of participants experienced thoughts of suicide during the first month of lockdown and that at least 5% had committed self-harm since the start of the country’s lockdown [44]. Common risk factors contributing to these behaviors were socioeconomic disadvantage, mental disorders, and poor physical health [43, 44]. There was an increase of 3.7% in the number of calls related to suicide, including both ideations and attempts, received by ‘Línea PAS’ in Puerto Rico from 2019 to 2020, while an increase of 40.1% was observed from 2020 to 2021. This means that from 2020 to 2021, more than a three-fold increase in calls related to self-harm was observed compared to the 2019 to 2020 period.

Interestingly, the number of deaths attributed to suicides in countries such as the USA, England and Wales, Japan, and Puerto Rico exhibited fluctuations between 2019 and 2021 without following an identical pattern (Figure 7). In the USA and England, and Wales, there was a decline in the number of suicides from 2019 to 2020, followed by an increase in incidents from 2020 to 2021. In contrast, Japan witnessed an increase in suicides between 2019 and 2020, which was subsequently followed by a decrease in the number of incidents from 2020 to 2021. On the other hand, Puerto Rico reported a decrease in suicides from 2019 to 2020, followed by a consistent number of incidents from 2020 to 2021 [45, 46, 47].

Figure 7.

Suicide incidence in Puerto Rico, Japan, England and Wales, and the USA between 2019 and 2021 [45, 46, 47].

It is of paramount importance to persevere in the study of the ramifications of natural disasters, such as the COVID-19 pandemic, on suicide patterns, as well as the ensuing risk factors. This research is vital to enable each nation or regional government to formulate a comprehensive plan that safeguards the mental well-being and welfare of its population while effectively addressing their needs. Furthermore, the identification of protective factors assumes the utmost significance for policymakers in the development of such a blueprint. Equally essential is the promotion of uninterrupted availability of helplines to support individuals dealing with suicidal ideation, anxiety, depression, stress, or any other distressing circumstances. The general effectiveness of these helplines was proven by a study conducted by the Autonomous University of Santo Domingo and the School of Psychology in the Dominican Republic, which outcome revealed that the UASD COVID-19 Psychological Helpline, jointly operated by both institutions, acquired high levels of satisfaction among its users and yielded noticeable improvements in their emotional well-being [48]. Finally, supervisors of healthcare facilities must focus on creating an environment that promotes resilience and social support, which have been identified as protective factors against negative mental health outcomes for healthcare workers [49]. Hence, contributes to the improvement of anxiety, depression, stress, and burnout constantly experienced by healthcare providers.

6. Conclusion

In conclusion, the effects of natural disasters such as hurricanes, earthquakes, and pandemics on suicidality can be complex. Natural disasters can significantly impact mental health and increase the risk of suicidal ideation and behavior in affected populations. It’s crucial to recognize the potential mental health impacts of natural disasters and provide appropriate support and resources to affected communities. Unfortunately, there are no studies about suicidality after forest fires. The climate change has increased the frequency and intensity of forest fires which have significant consequences on individuals’ mental health. People directly affected by forest fires, such as those who lose their homes or loved ones, may experience symptoms of trauma, anxiety, depression, and post-traumatic stress disorder (PTSD) [50]. Future studies must investigate forest fire effects on suicidality.

In addition, most studies investigating the effects of natural disasters on mental health focus on first-world countries. It would be interesting to compare these effects between first-world and third-world countries and how mental health services are implemented.

Disaster response and recovery efforts should include mental health services, counseling, and community support to address the emotional toll on survivors. Additionally, friends, family, and community members can play a vital role in identifying signs of distress and providing support to those at risk.

Acknowledgments

We want to thank the San Juan Bautista School of Medicine and Dr. Estela Estape for their support.

Conflict of interest

The authors declare no conflict of interest.