The number of people who committed suicide associated with the 2011 massive earthquake and tsunami in northeastern Japan totaled 246 in the 11 years to January 2022, government data showed.

Mutsuko Iitsuka, the wife of 60-year-old Masahiro, took her own life about three years ago at the age of 57 in Sendai in Miyagi Prefecture.

Photo taken on March 4, 2022, in Sendai shows Masahiro Iitsuka speaking about his wife Mutsuko, who died in April 2019.(Kyodo)

On the night of April 11, 2019, the couple had boiled fish for dinner and went to bed after watching television. They laughed as they fought over the futon as usual.

The next morning, Masahiro woke up alone. He was later notified by police that his wife had died. She did not leave a suicide note, he said.

The Iitsukas had survived the magnitude-9.0 quake and ensuing tsunami that hit eastern and northeastern Japan on March 11, 2011, and left 15,900 people dead and more than 2,500 missing.

But their house in Iwanuma in Miyagi Prefecture was destroyed by the quake and aftershocks. In August 2011, they moved to temporary housing in Sendai, where 233 prefabricated houses were built.

As head of a neighborhood association, Iitsuka worked hard to prevent people from dying alone. But his wife, who had developed depression before the quake, grew weaker and at times she could barely get out of bed.

In spring of 2015, they moved to a nearby condominium that had been set up as public housing for disaster victims.

As Mutsuko had started to go out with her friends, Masahiro felt their lives had started to stabilize. "We cannot be disaster victims forever" he thought and he looked at ways of returning to some form of normalcy.

But after his wife's death, Iitsuka asked himself, why she had died without saying anything to him, and if he had overlooked anything unusual.

Though he never came up with an answer, he was unable to stop thinking, "If the disaster had never happened."

Attracted by her calm personality, the Iitsukas started dating when they were high school students and later got married.

Supplied photo taken in Sendai in August 2020 shows a gathering of residents of public housing for 2011 earthquake disaster victims. The event was hosted by a nonprofit group working to prevent suicides associated with the disaster. (Photo courtesy of the nonprofit group)(Kyodo)

Several months after her death, he almost followed her. But after being hospitalized, he started to live with his daughter.

Iitsuka now lives quietly with support from his family, but continues to go to hospital after being diagnosed as suffering from depression. "It will be a very long time before I can draw the line that the disaster is over," he said.

Suicides are officially associated with the disaster if they meet one of five requirements such as the place where the body is found and statements from bereaved family members.

The number of such suicides was highest in 2011 with 55. Though the figure is on a decreasing trend, it increased in 2017 and 2019.

Eiko Moriyama, the head of a nonprofit group in Miyagi working to prevent suicides associated with the disaster, said some survivors had to wait until recent years to unveil their feelings for the first time.

"It is impossible to measure what they are thinking in their heart with years. Long-term support is needed," Moriyama said.