Suicides after the 1999 Taiwan earthquake.

BACKGROUND The impact of a disaster on extreme post-traumatic responses of the victims, such as suicide, remains unclear. We conducted this study to investigate the risk of committing suicide between victims and non-victims after the 1999 Taiwan earthquake. METHODS This population cohort study linked the National Health Insurance files, family registration, and death certificates. It consists of the 3 432 705 residents aged >/=15 years of central Taiwan, 1998-2000. They were stratified into victims (n = 301 327) and non-victims (n = 3 131 378). Victims refer to those who lost co-resident family members, were injured, or experienced property loss during the earthquake. Non-victims refers to all others. The suicide rate was calculated for the period 2-15 months after the earthquake. Adjusted odds ratios were estimated with logistic regression. RESULTS After adjusting for residential location, age, gender, major disease status, and level of urbanization, we found that victims were 1.46 times more likely than non-victims to commit suicide following an earthquake (95% CI: 1.11, 1.92). CONCLUSIONS Given the large study population and individual information available to identify victim status, this study was able to detect a statistically significant earthquake effect on suicide rate. This effect on suicide might be diluted if only geographically based stratification were possible, as opposed to victim status stratifications. Mental health programmes or other preventive strategies might be more effective by specifically targeting victims rather than by simply targeting individuals living in earthquake-affected areas.