New Article: Shelef et al, Risk Factors for Suicide Attempts among IDF Soldiers

Shelef, Leah, Dan Kaminsky, Meytal Carmon, Ron Kedem, Omer Bonne, J. John Mann, and Eyal Fruchter. “Risk Factors for Suicide Attempt among Israeli Defense Forces Soldiers: A Retrospective Case-Control Study.” Journal of Affective Disorders 186 (2015): 232-40.

 

URL: http://dx.doi.org/10.1016/j.jad.2015.07.016

 

Abstract

Background

A major risk factor for suicide is suicide attempts. The aim of the present study was to assess risk factors for nonfatal suicide attempts.

Methods

The study’s cohort consisted of 246,814 soldiers who were divided into two groups: soldiers who made a suicide attempt (n=2310; 0.9%) and a control group of soldiers who did not (n=244,504; 99.1%). Socio-demographic and personal characteristics as well as psychiatric diagnoses were compared.

Results

The strongest risk factors for suicide attempt were serving less than 12 months (RR=7.09) and a history of unauthorized absence from service (RR=5.68). Moderate risk factors were low socioeconomic status (RR=2.17), psychiatric diagnoses at induction (RR=1.94), non-Jewish religion (RR=1.92), low intellectual rating score (RR=1.84), serving in non-combat unit (RR=1.72) and being born in the former Soviet Union (RR=1.61). A weak association was found between male gender and suicide attempt (RR=1.36). Soldiers who met more frequently with a primary care physician (PCP) had a higher risk for suicide attempt, as opposed to a mental health professional (MHCP), where frequent meetings were found to be a protective factor (P<0.0001). The psychiatric diagnoses associated with a suicide attempt were a cluster B personality disorder (RR=3.00), eating disorders (RR=2.78), mood disorders (RR=2.71) and adjustment disorders (RR=2.26).

Limitations

Mild suicidal behavior constitutes a much larger proportion than among civilians and may have secondary gain thus distorting the suicidal behavior data.

Conclusions

Training primary care physicians as gatekeepers and improved monitoring, may reduce the rate of suicide attempts.

New Article: Shelef et al, Characteristics of Soldiers with Self-Harm in the IDF

Shelef, Leah Eyal Fruchter, Dror Ortasse Spiegel, Gal Shoval, J. John Mann, and Gil Zalsma. “Characteristics of Soldiers with Self-Harm in the Israeli Defense Forces.” Archives of Suicide Research 18.4 (2014): 410-418.

 

URL: http://www.tandfonline.com/doi/abs/10.1080/13811118.2013.845121

 

Abstract

Suicide is the leading cause of soldier death in the Israeli Defense Forces (IDF) in peace time. Suicide attempt (SA) and non-suicidal self-injury (NSSI) are risk factors for death by suicide in civilian studies and therefore their predictive value needs to be determined in the military. All army screening, psychometric and demographic data on consecutive cases of IDF soldier self-harm during the years 2010–2011 were analyzed. The Columbia Suicide Severity Rating Scale was used retrospectively to classify self-harm as suicidal or NSSI. The Suicide Ideation Scale and the Suicide Intent Scale were scored retrospectively by trained clinical psychologists. A total of 107 soldiers reported self-harm during the study period, comprising 70 SA and 37 with NSSI. The most prevalent diagnosis was personality disorder (n = 48). Soldiers with any mood/anxiety disorders comprised the smallest group (n = 21) and included major depression, dysthymia, anxiety, and posttraumatic stress disorder. Soldiers with NSSI (n = 37) did not differ in any of the characteristics from those who attempted suicide (n = 70). Unlike the well-known female dominance in both SA and NSSI patients in other settings, males dominated this army sample in both groups. Soldiers with self-harm (both SA and NSSI) cannot be easily distinguished by any demographics or specific psychological attributes detectable at induction, and the scales used in suicide research cannot predict an attempt or NSSI. Unlike civilian samples, males dominated attempter and NSSI groups and the reason for this may be multifactorial. These retrospective findings, if replicated, indicate the need for different screening strategies at induction into the military.