The devastating Great East Japan Earthquake (GEJE) and tsunami disasters led to the mandatory evacuation of thousands of residents of the affected region. Consequently, evacuees were forced to live under very stressful conditions while at the same time facing the loss of their relatives, houses and jobs, and having to adjust to new circumstances. In our previous study, we found that there was a delayed increase in the male suicide rate in the affected area 1.5 years after the GEJE. In the recovery phase following the earthquake, a number of policy changes (such as the termination of the provision of free temporary housing to the evacuees) may have worsened the already fragile mental health of the evacuees and increased the incidence of suicide. However, despite such changes in environmental factors in the recovery phase following natural disasters, long-term monitoring of suicide rates has been limited. This study sought to monitor the suicide rate in the affected area of Japan during the recovery phase after the GEJE. The study had a descriptive design, and monitoring subjects were selected from the 14 municipalities in the coastal area of Miyagi Prefecture. Monthly suicide data were collected each municipality in Miyagi Prefecture, for the period March 2009 to February 2019. The suicide rate in the affected area was compared to the non-affected area using a time-series analysis (12-month moving average). Although the increasing suicide rate was relatively small compared with the first increase the rates at 1.5 years after the GEJE (from 16.6 to 22.0/100,000 populations), there was a tendency to re-increase the rates gradually from 15.6 in June 2016 to 17.9 in January 2019, when the provision of free temporary housing was terminated. According to gender analysis, the male suicide rates increased around June 2016, and female rates showed a delayed increase about 1.5 years later than males. Although the specific reasons for the increase in suicide rates in the recovery phase were not determined, the termination of the provision of free temporary housing may have had an impact, according to our findings. The provision of temporary housing was terminated in stages, starting from June 2016, and this increased the financial hardship faced by needy evacuees. Moreover, re-separation and the cutting of social ties made between the evacuees living in temporary housing may have also been a factor. Therefore, our findings suggest that careful monitoring of suicide rates, even in the recovery phase following a natural disaster, is important. We hope that our findings will be used to guide future policies regarding mental healthcare, both in the affected area following the Great East Japan Earthquake and in relation to future disasters.
 <Authors' abstract>