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An effective suicide prevention program in the Israeli Defense Forces: A cohort study

Published online by Cambridge University Press:  23 March 2020

L. Shelef*
Affiliation:
Psychology Branch, Israel Air Force, Ramat Gan, Israel Mental Health Department, Israel Defense Force Medical Corps, Ramat Gan, Israel
L. Tatsa-Laur
Affiliation:
Mental Health Department, Israel Defense Force Medical Corps, Ramat Gan, Israel
E. Derazne
Affiliation:
Statistican, Medical Corps, Israel Defense Force, Ramat Gan, Israel
J.J. Mann
Affiliation:
Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York City, USA
E. Fruchter
Affiliation:
Mental Health Department, Israel Defense Force Medical Corps, Ramat Gan, Israel
*
*Corresponding author. Psychology Branch, Israel Air Force, Ramat Gan, Israel. E-mail address:[email protected] (L. Shelef).
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Abstract

Objective

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

Design

Quasi-experimental (before and after) cohort study.

Participants

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.

Exposure

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.

Results

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).

Conclusions

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.

Type
Original article
Copyright
Copyright © European Psychiatric Association 2015

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References

Almasi, OSuicide in the IDF and Review of the Suicide Prevention Programs of the US DOD Jerusalem, Israel: The Israeli parliament (The Knesset); 2013Google Scholar
Althaus, D, Hegerl, UThe evaluation of suicide prevention activities: state of the art. World J Biol Psychiatry 2003;4(4):156165.CrossRefGoogle ScholarPubMed
Apter, A, Bleich, A, King, RA, et al.Death without warning? A clinical post-mortem study of suicide in 43 Israeli adolescent males. Arch Gen Psychiatry; 1993;50(2):138142.CrossRefGoogle Scholar
Apter, A, King, RA, Bleich, A, et al.Fatal and non-fatal suicidal behavior in Israeli adolescent males. Arch Suicide Res 2008;12(1):2029http://dx.doi.org/10.1080/13811110701798679.CrossRefGoogle ScholarPubMed
Archuleta, D, Jobes, DA, Pujol, L, et al.Raising the clinical standard of care for suicidal soldiers: an army process improvement initiative. US Army Med Depart J; 2014;4(14):5566.Google Scholar
Bagley, , Munjas, B, Shekelle, PA systematic review of suicide prevention programs for military or veterans. Suicide Life Threat Behav 2010;40(3):257265http://dx.doi.org/10.1521/suli.2010.40.3.257.CrossRefGoogle ScholarPubMed
Bodner, E, Ben-Artzi, E, Kaplan, ZSoldiers who kill themselves: the contribution of dispositional and situational factors. Arch Suicide Res 2006;10(1):2943http://dx.doi.org/10.1080/13811110500318299.CrossRefGoogle ScholarPubMed
Bodner, E, Iancu, I, Sarel, A, et al.Efforts to support special-needs soldiers serving in the Israeli Defence Forces. Psychiatr Serv 2007;58(11):13961398http://dx.doi.org/10.1176/appi.ps.58.11.1396.CrossRefGoogle Scholar
Britt, TW, Dickinson, JM, Moore, D, et al.Correlates and consequences of morale versus depression under stressful conditions. J Occup Health Psychol 2007;12(1):3447http://dx.doi.org/10.1037/1076-8998.12.1.34.CrossRefGoogle ScholarPubMed
Eaton, KM, Messer, SC, Garvey Wilson, AL, et al.Strengthening the validity of population-based suicide rate comparisons: an illustration using US military and civilian data. Suicide Life Threat Behav 2006;36(2):182191http://dx.doi.org/10.1521/suli.2006.36.2.182.CrossRefGoogle Scholar
Fishman, G, Morris-Dycian, A, Kotler, MSuicide in the Israeli army. Suicide Life Threat Behav 1990;20(3):225239.Google ScholarPubMed
Frei, A, Han, A, Weiss, MG, et al.Use of army weapons and private firearms for suicide and homicide in the region of Basel, Switzerland. Crisis; 2006;27(3):140146.CrossRefGoogle ScholarPubMed
Friedman, MJSuicide risk among soldiers: early findings from army study to assess risk and resilience in service members (Army STARRS). JAMA Psychiatry 2014;71(5):487489http://dx.doi.org/10.1001/jamapsychiatry.2014.24.CrossRefGoogle Scholar
Gal, RA Portrait of the Israeli Soldier Westport, Conn: Greenwood Press; 1986Google Scholar
Goldsmith, SKPellmar, TCKleinman, AM, et al.Reducing Suicide: A National Imperative; Washington (DC): The National Academies Press; 2002.Google Scholar
Hochman, E, Shelef, L, Mann, JJ, et al.Primary health care utilization prior to suicide: a retrospective case-control study among active duty military personnel. J Clin Psychiatry 2014;75(8):e817e823.CrossRefGoogle ScholarPubMed
Hoge, CW, Castro, CAPreventing suicides in US service members and veterans: concerns after a decade of war. JAMA 2012;308(7):671672http://dx.doi.org/10.1001/jama.2012.9955.CrossRefGoogle Scholar
Israel Central Bureau of Statistics Characterization and Classification of Local Authorities by the Socio-Economic Level of the Population Jerusalem: Israel Central Bureau of Statistics; 2006Google Scholar
Kaplan, Z, WeiserM, , Reichenberg, A, et al.Motivation to serve in the military influences vulnerability to future posttraumatic stress disorder. Psychiatry Res; 2002;109(1):4549.CrossRefGoogle ScholarPubMed
Kessler, RC, Heeringa, SG, Stein, MB, et al.Thirty-day prevalence of DSM-IV mental disorders among non-deployed soldiers in the US army: results from the army study to assess risk and resilience in service members (Army STARRS). JAMA Psychiatry 2014;71(5):504513http://dx.doi.org/10.1001/jamapsychiatry.2014.28.CrossRefGoogle Scholar
Kleinbaum, DG, Klein, MSurvival Analysis – A Self-Learning Text 3rd ed.New York: Springer; 2012.Google Scholar
Knox, KL, Litts, DA, Talcott, GW, et al.Risk of suicide and related adverse outcomes after exposure to a suicide prevention programme in the US Air Force: cohort study. BMJ 2003;327(7428):1376http://dx.doi.org/10.1136/bmj.327.7428.1376.CrossRefGoogle ScholarPubMed
Knox, KL, Pflanz, S, Talcott, GW, et al.The US Air Force suicide prevention program: implications for public health policy. Am J Public Health. 2010;100(12):2457CrossRefGoogle ScholarPubMed
Kuehn, BMSoldier suicide rates continue to rise: military, scientists work to stem the tide. JAMA 2014;301(11):11111113http://dx.doi.org/10.1001/jama.2009.342.CrossRefGoogle Scholar
LeardMann, CA, Powell, TM, Smith, TC, et al.Risk factors associated with suicide in current and former US military personnel. JAMA 2013;310(5):496506http://dx.doi.org/10.1001/jama.2013.65164.CrossRefGoogle ScholarPubMed
Lubin, G, Werbeloff, M, Halperin, D, et al.Decrease in suicide rates after a change of policy reducing access to firearms in adolescents: a naturalistic epidemiological study. Suicide Life Threat Behav 2010;40(5):421424http://dx.doi.org/10.1521/suli.2010.40.5.421.CrossRefGoogle ScholarPubMed
Mann, JJ, Apter, A, Bertolote, J, et al.Suicide prevention strategies: a systematic review. JAMA 2005;294(16):20642074http://dx.doi.org/10.1001/jama.294.16.2064.CrossRefGoogle ScholarPubMed
Mirsky, JPsychological distress among immigrant adolescents: culture specific factors in the case of immigrant students from the former Soviet Union. Int J Psychol 1997;32:221230.Google Scholar
Mirsky, J, Kohn, R, Levav, I, et al.Psychological distress and common mental disorders among immigrants: results from the Israeli-based component of the World Mental Health Survey. J Clin Psychiatry 2008;69:17151720.CrossRefGoogle ScholarPubMed
Nock, MK, Borges, G, Bromet, EJ, et al.Suicide and suicidal behavior. Epidemiol Rev 2008;30:133154http://dx.doi.org/10.1093/epirev/mxn002.CrossRefGoogle ScholarPubMed
Nock, MK, Deming, CA, Fullerton, CS, et al.Suicide among soldiers: a review of psychosocial risk and protective factors. Psychiatry 2013;76(2):97125.CrossRefGoogle ScholarPubMed
Nock, MK, Green, JG, Hwang, I, et al.Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry 2013;70(3):300310.CrossRefGoogle ScholarPubMed
Nock, MK, Stein, MB, Heeringa, SG, et al.Prevalence and correlates of suicidal behavior among soldiers: results from the army study to assess risk and resilience in service members (Army STARRS). JAMA Psychiatry 2014;71(5):514522http://dx.doi.org/10.1001/jamapsychiatry.2014.30.CrossRefGoogle Scholar
Reisch, T, Steffen, T, Habenstein, A, et al.Change in suicide rates in Switzerland before and after firearm restriction resulting from the 2003 “Army XXI” reform. Am J Psychiatry 2013;170(9):977984http://dx.doi.org/10.1176/appi.ajp.2013.12091256.CrossRefGoogle ScholarPubMed
Reisch, T, Steffen, T, Habenstein, A, Tschacher, WChange in suicide rates in Switzerland before and after firearm restriction resulting from the 2003 “Army XXI” reform. Am J Psychiatry 2013CrossRefGoogle Scholar
Rihmer, Z, Kantor, Z, Rihmer, A, et al.Suicide prevention strategies – a brief review. Neuropsychopharmacol Hung 2004;6(4):195199.Google Scholar
Rosenbaum-Tamari, Y, Demian, NImmigrants from the Former Soviet Union 2001 – the First Year in Israel, A Follow-Up Study. Report no. 14, Jerusalem. Israel: Ministry of Immigrants’ Absorption; 2003.Google Scholar
Schoenbaum, M, Kessler, RC, Gilman, SE, et al.Predictors of suicide and accident death in the Army Study to Assess Risk and Resilience in Service members (Army STARRS): results from the Army Study to Assess Risk and Resilience in Service members (Army STARRS). JAMA Psychiatry 2014;71(5):493503http://dx.doi.org/10.1001/jamapsychiatry.2013.4417.CrossRefGoogle Scholar
Shelef, L, Fruchter, E, Spiegel, DO, et al.Characteristics of soldiers with self-harm in the Israeli Defence Forces. Arch Suicide Res 2014;18(4):410418.CrossRefGoogle Scholar
Shelef, L, Laur, L, Raviv, G, et al.A Military Suicide Prevention Program in the Israeli Military Defence Force 2015. http://dx.doi.org/10.1186/s40696-015-0007-y.CrossRefGoogle Scholar
Spirito, A, Esposito-Smythers, CAttempted and completed suicide in adolescence. Annu Rev Clin Psychol 2006;2:237266http://dx.doi.org/10.1146/annurev.clinpsy.2.022305.095323.CrossRefGoogle ScholarPubMed
Tubiana, JH, Ben-Shakhar, GAn objective group questionnaire as a substitute for a personal interview in the prediction of success in military training in Israel. Pers Psychol 1982;35(2):349357http://dx.doi.org/10.1111/J.1744-6570.1982.Tb02200.X.CrossRefGoogle Scholar
van der Feltz-Cornelis, CM, Sarchiapone, M, Postuvan, V, et al.Best practice elements of multilevel suicide prevention strategies: a review of systematic reviews. Crisis 2011;32(6):319333http://dx.doi.org/10.1027/0227-5910/a000109.CrossRefGoogle ScholarPubMed
Zamorski, MASuicide prevention in military organizations. Int Rev Psychiatry 2011;23:173180.CrossRefGoogle ScholarPubMed
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