{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T03:23:32Z","timestamp":1783999412976,"version":"3.55.0"},"reference-count":44,"publisher":"BMJ","issue":"2","funder":[{"name":"National Institutes of Health, National Institute of Mental Health","award":["R01MH124752"],"award-info":[{"award-number":["R01MH124752"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Inj Prev"],"accepted":{"date-parts":[[2022,11,6]]},"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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 \u22122.69 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 \u22120.33 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/ip-2022-044709","type":"journal-article","created":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T13:25:51Z","timestamp":1670937951000},"page":"180-185","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Hurricane Florence and suicide mortality in North Carolina: a controlled interrupted time-series analysis"],"prefix":"10.1136","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3537-649X","authenticated-orcid":false,"given":"Vanessa Eve","family":"Miller","sequence":"first","affiliation":[{"name":"Injury Prevention Research Center, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian W","family":"Pence","sequence":"additional","affiliation":[{"name":"Injury Prevention Research Center, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"},{"name":"Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4410-4608","authenticated-orcid":false,"given":"Kate Vinita","family":"Fitch","sequence":"additional","affiliation":[{"name":"Injury Prevention Research Center, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"},{"name":"Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Swilley-Martinez","sequence":"additional","affiliation":[{"name":"Injury Prevention Research Center, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"},{"name":"Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew L","family":"Kavee","sequence":"additional","affiliation":[{"name":"Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Dorris","sequence":"additional","affiliation":[{"name":"Injury Prevention Research Center, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toska","family":"Cooper","sequence":"additional","affiliation":[{"name":"Injury Prevention Research Center, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander P","family":"Keil","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley N","family":"Gaynes","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"},{"name":"Department of Psychiatry, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy S","family":"Carey","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Goldston","sequence":"additional","affiliation":[{"name":"Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3944-3912","authenticated-orcid":false,"given":"Shabbar","family":"Ranapurwala","sequence":"additional","affiliation":[{"name":"Injury Prevention Research Center, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"},{"name":"Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,12,13]]},"reference":[{"key":"2025092603020046000_29.2.180.1","unstructured":"United Nations . 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