Bulletin: Psychology and Psychiatry in Israel



New Article: Shelef et al, An Effective Suicide Prevention Program in the IDF

Shelef, L., L. Tatsa-Laur, E. Derazne, J.J. Mann, and E. Fruchter. “An Effective Suicide Prevention Program in the Israeli Defense Forces: A Cohort Study.” European Psychiatry 31 (2016): 37-43.

URL: http://dx.doi.org/10.1016/j.eurpsy.2015.10.004



To evaluate the effectiveness of the IDF Suicide Prevention Program, implemented since 2006.


Quasi-experimental (before and after) cohort study.


Two cohorts of IDF mandatory service soldiers: the first inducted prior to (1992–2005, n = 766,107) and the second subsequent to (2006–2012, n = 405,252) the launching of the intervention program.


The IDF Suicide Prevention Program is a population-based program, incorporating: reducing weapon availability, de-stigmatizing help-seeking behavior, integrating mental health officers into service units, and training commanders and soldiers to recognize suicide risk factors and warning signs.

Main outcome measure

Suicide rate and time to suicide in cohorts before and after exposure to the Suicide Prevention Program.


Trend analysis showed lower suicide rates in the cohort after intervention. The hazard ratio for the intervention effect on time to suicide was 0.44 (95% CI = 0.34–0.56, P < .001) among males. Lower risk was associated with: male gender; born in Israel; higher socio-economic status; higher intelligence score; and serving in a combat unit (HR = 0.43: 95% CI = 0.33–0.55).


There was a 57% decrease in the suicide rate following the administration of the IDF Suicide Prevention Program. The effect of the intervention appears to be related to use of a weapon, and being able to benefit from improved help-seeking and de-stigmatization. Future efforts should seek to extend the program’s prevention reach to other demographic groups of soldiers. The success of the IDF program may inform suicide prevention in other military organizations and in the civilian sector.




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




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


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.


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).


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


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



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.

Cite: Brym and Araj, Suicidality and Suicide Bombing Revisited

Brym, Robert J. and  Bader Araj. “Suicidality and Suicide Bombing Revisited: A Rejoinder to Merari.” Studies in Conflict & Terrorism 35.10 (2012): 733-739.


URL: http://www.tandfonline.com/doi/abs/10.1080/1057610X.2012.712033



Ariel Merari purports to demonstrate a tendency on the part of suicide bombers to be motivated by depression and suicidal tendencies. However, he misconstrues the present authors’ critique of his work and misinterprets their research. By clarifying both issues, this article seeks to substantiate three claims: (1) Merari’s sampling procedure precludes generalization; (2) interviewer and contextual effects probably bias his findings; (3) evidence challenges his inferences.