Suicide in the Israeli Military : Case-Controlled , Prospective and Retrospective Study

Background: Suicide is the third most common cause of death between ages 15-24, and a major cause for concern and research. The purpose of the current study was to deepen the understanding of the psychological state preceding suicide, attempting to identify characteristics that may contribute to suicide prevention in nontreatment seekers in the general population. Method: The current study is based on a cohort of Israeli soldiers who completed suicide between 1997 and 2008. The analysis included 227 consecutive suicide cases in Israeli Defense Force (IDF) soldiers, aged 1822. A subgroup of 70 soldiers who had been treated in mental health clinics during their military service, and who completed suicide, was compared to a control group of 214 living control subjects. Psychological autopsies, based on combination of prospective and retrospective data, were performed, using qualitative and quantitative analysis. Results: The vast majority (93.4%) of the soldiers who completed suicide were men and 89.9% used firearms. Among suicide completers, 55% did not meet Axis I DSM-IV criteria. The most common Axis II personality traits were Narcissistic (14.1%) and Avoidant (8.4%). Approximately 33% left suicide notes, and 43.6% expressed suicidal thoughts to a friend. Most of the suicide completers were not receiving mental health care in the period preceding death. Conclusion: The findings of the current study indicate that suicide is a rare, random and unpredictable event. As in other complex human behaviors, there is no significant factor or combination of factors that can predict completed suicide. Clinical implications of these findings are discussed. Address for Correspondence: Katya Rubinstein, MA, Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Ramat Gan, 52621 Israel rubins.katya@gmail.com IntroductIon Suicide epidemiology and trends are affected by numerous factors, such as age, period, country and birth cohort (1). In recent decades there has been an increase in rates of suicide among adolescents and young adults aged 15-24, with studies showing that suicide rates in this age group have tripled since 1950 (2, 3). As of today, suicide is the third most common cause of death in this age group in Western countries (4), and therefore is a major cause for concern and research. Over the years, many attempts have been made to predict suicidality in the general population, including genetic research, clinical characteristics, personality and behavioral traits (5-8). Previous studies have found various factors associated with suicide, such as psychiatric comorbidity, drug and alcohol abuse, physical illness, signs of psychological distress, such as insomnia and difficulty concentrating, social isolation, as well as suicidal threats and previous attempts. In addition, interpersonal difficulties, such as lack of social support and impaired relationships with parents were reported (2, 7, 9). Family factors, such as parental psychopathology, family history of suicide attempts, loss of parents to death or divorce, Suicide in the Israeli Military: Case-Controlled, Prospective and Retrospective Study Gadi Lubin, MD,1 Katya Rubinstein, MA,2,3 Shimon Burshtein, MD,2 Igor Barash, MD,1 Gal Afik, MA,2 Eyal Fruchter, MD,1 and Mark Weiser, MD2,3 1 Department of Mental Health, Israeli Defense Forces, Ramat Gan, Israel 2 Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel 3 Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel