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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 ,
L. Tatsa-Laur ,
E. Derazne ,
J.J. Mann  and
E. Fruchter
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:Lshelef4@gmail.com (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.

Keywords

Suicide preventionSuicide rateIsraeli Defense ForceRisk factors
Type
Original article
Information
European Psychiatry , Volume 31 , January 2016 , pp. 37 - 43
Copyright
Copyright © European Psychiatric Association 2015

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