The Kobe Earthquake and Reduced Suicide Rate in Japanese Males S uicide ranks among the top 10 causes of death for individuals of all ages in most countries. 1 It is also among the 2 or 3 leading causes of death for those aged 15 to 34 years. 1 In the United States, suicide ac- counts for over 30 000 deaths annually. 2 In Japan, there are more than 20 000 suicides a year, twice as many as the number of traffic fatalities. 3 Although suicide is not a logical response to extreme stress, typical stressors as- sociated with suicide acts include adverse events in one’s life. 4 Suicide victims have often encountered more changes in terms of living conditions, work problems, and hu- miliating experiences than most of the population. 5 For example, bereavement involving a close interpersonal re- lationship in the few years preceding suicide has been more common among suicide victims than among the general population. 6 On January 17, 1995, at 5:46 AM, a devastating earth- quake measuring 7.2 on the Richter scale shook the city of Kobe, Japan, leaving 3897 people dead, more than 13 000 severely injured, 54 000 houses completely or par- tially destroyed, and 230 000 people displaced from their homes. Most of the people in Kobe sustained heavy losses and many people went through bereavements of one or more close interpersonal relationships. For the citizens of Kobe, this earthquake was certainly a very notable stress or adverse life event. This prompted us to review the sui- cide rate in Kobe before and after the earthquake. We observed a significant reduction in the suicide rate in Kobe in the remainder of 1995. Compared with the suicide rates in Kobe in the 13 years from 1985 to 1997, the decrease in the suicide rate in 1995 looks quite apparent. The Figure provides the suicide rate (per 100 000) and population in Kobe during the 10 years (1985-1994) before the earthquake and also from 1995 to 1997. The data were compiled by the Medical Exam- iner’s Office of Hyogo Prefecture and published in their annual reports (the population in Kobe was 1 518 082 in 1994 and 1 423 792 in 1995, a decrease of 6.2%). The rate suicide rate (per 100 000) of 1995 (12.57 persons per 100 000 people) in total population was the lowest in the last 52 years (1946-1997), ie, since the conclusion of World War II. The year 1995 had a significantly lower suicide rate than the average (16.33 per 100 000) sui- cide rate of the 10 years before the earthquake (1985- 1994) (x 2 = 7.06, P,.01) and a tendency to decrease com- pared with the year 1994 (15.08) before the earthquake (x 2 = 3.25, P,.08). The figure shows that the suicide rate (1996-1997) gradually returned to average in the 2 years after the earthquake. Interestingly, as compared with the average of the 10-year period before the earthquake (21.35 per 100 000 people), only the male suicide rate was sig- nificantly reduced in 1995 (16.39 per 100 000) (x 2 = 4.52, P,.05), whereas the female rate was not significantly dif- ferent. To examine a trend in changes in rates over the 11-year period (1985-1995), using the Bartholomew test, the rates in the total and female populations showed a trend toward reduction (x 2 = 29.54, P,.01; x 2 = 19.55, P,.05, respectively), while the rate for males did not. Of the male suicides, those in their 30s and 50s particu- larly showed a reduction in 1995. Also, in 1995 there was a decrease in the percentage (16.8%) of suicides associ- ated with falling, specifically jumping from high places, compared with the average (22.8%) of 10 years prior (1985-1994), and also the rates observed in 1996 (25.6%) and 1997 (21.4%). The effect of major societal upheaval on the sui- cide rate has been documented. In 1995, Soma- sundaram and Rajadurai 7 studied the effect of war on the suicide rate in the biggest town in north Sri Lanka for 10 years from 1980 to 1989. They found a marked drop in the suicide rate, particularly the male rate, during the war. The sex difference suggests that adverse life events may have a differential effect on male and female sub- jects. In 1993, Lester 8 also reported that suicide rates in France were lower during years of war than during years of peace (1826-1913), although female suicides contrib- uted to the reduced rate. On the contrary, Krug et al 9 re- cently examined the changes in the suicide rate in the total population after 4 earthquakes and reported an in- 30 25 20 15 10 0 1.6 1.0 1.2 1.4 0.8 0.6 0.4 0.2 1985 1985 1990 1991 1992 1993 1994 1989 1988 1987 1986 1995 1996 1997 1990 1991 1992 1993 1994 1989 1988 1987 1986 1995 1996 1997 Year Year Suicide Rate per 100 000 16.33 The Average of the Total Suicide Rate (1985-1994) Total Male Female Kobe Earthquake Jan 17, 1995 Population × 10 6 People Upper and lower parts of the figure represent the changes in suicide rate per 100 000 people and population in Kobe, Japan, covering 13 years, respectively. Shaded area shows the years before the earthquake. The dotted line indicates the average of 10 years (1985-1994) of total suicide rate (16.33 per 100 000). Compared with 1994, the tendencies were toward lower total and male suicide rates in 1995 (x 2 =3.35, P,.08; x 2 =3.07, P,.09, respectively). There were also significant differences between the average of 10 years and 1995 in the total and male suicide rates (x 2 = 7.06, P,.01; x 2 = 4.52, P,.05, respectively). LETTERS TO THE EDITOR ARCH GEN PSYCHIATRY/ VOL 56, MAR 1999 282 ©1999 American Medical Association. All rights reserved.