A Herald investigation into the hidden toll of the Christchurch earthquakes - linking at least 40 suicides to the disaster - has sparked calls for research into a previously ignored issue in New Zealand.
At least 40 people who died by suicide between 2010 and 2014 suffered from some form of quake-related stress, fear and anxiety. The finding is based on an analysis of more than 220 coronial reports.
Over these four years, Christchurch's suicide rate did not increase. International trauma academics say this could be the reason behind the "total oversight" of research on this issue.
Labour's health spokeswoman, Annette King, said she was "staggered" the Government was not commencing urgent research in light of the findings.
Most of the 40 individuals were suffering from pre-existing mental health concerns that were exacerbated in the aftermath of the disaster.
It's impossible to say the quakes directly caused these deaths as the reasons why a person takes their life are often complex and varied, but academics, politicians, the Mental Health Foundation and the Chief Coroner are calling for research on the possible correlation between suicides and the quakes.
Chief Coroner Judge Deborah Marshall said more research would provide "guidance about how [disaster recovery] could be done better in the future".
"Yes, we have had a natural disaster and it would be good for an organisation to sit down and say this is what we learnt and this is how we could do it better," she said.
Judge Marshall said the ongoing role of the quakes would likely be a factor in suicides in Christchurch because the disaster had seriously affected the entire city.
"Everyone in Christchurch is under stress and some people will go on to commit suicide, but drawing a link between quake-related stressors and suicide requires expertise and is [incredibly difficult]," she said.
Very few suicides have been directly linked to the quakes by coroners, because unless an individual writes a suicide note listing the exact reasons for their decision, those left behind can only guess.
It was not the role of coroners to draw connections between these deaths, Judge Marshall said, adding the Ministry of Health was the "best place to analyse trends".
The ministry was aware the quakes had been a factor in some suicides, but Dr John Crawshaw, director of mental health, said it was "unhelpful and inaccurate to focus on a single cause".
The Government would not be commissioning research on this issue "at this stage", he said.
Mrs King said the ministry had been reluctant to acknowledge the true mental health impact of the Christchurch earthquakes "right from the beginning".
"I'm staggered the ministry would [not want to] learn from this tragedy."
Psychiatric nurse Gill Graham lost her 23-year-old daughter, Meredith Graham-Bagrie, to suicide linked to the quakes in 2012.
She suffered from stress, anxiety and fear and Ms Graham believes the ongoing nature of the disaster was her "silent killer".
Ms Graham said the coroner's report "downplayed" the role the quakes had in her daughter's death and claimed "it was something no one wanted to know about".
"There are a whole lot of us out there who haven't been able to connect in any way, until now."
Where to get help
• Lifeline: 0800 543 354 (available 24/7)
• Canterbury Support Line: 0800 777 846
• Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youthline: 0800 376 633
• Kidsline: 0800 543 754 (available 24/7)
• Whatsup: 0800 942 8787 (1pm to 11pm)
• Depression helpline: 0800 111 757 (available 24/7)
If it is an emergency and you feel like you or someone else is at risk, call 111.