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 non-treatment 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 18-22. 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.