title: Death without warning? A clinical postmortem study of suicide in 43 Israeli adolescent males.
abstract: Forty-three consecutive Israeli male suicides, 18 to 21 years of age, that occurred during compulsory military service were studied using preinduction assessment data, service records, and extensive postmortem interviews with family and peers. At preinduction, subjects, as a group, appeared above average in intelligence, physical fitness, and measures predictive of successful adaptation to military service. Active duty performance was generally satisfactory. Ascertained post mortem, 53.5% met formal criteria for major depressive disorder; most cases, however, appeared recent and reactive. Narcissistic and/or schizoid traits were common. Substance abuse was absent and antisocial personality disorder was rare (4.7%). Furthermore, in eight patients (18.6%) no Axis I diagnosis could be made; half of these also lacked any significant Axis II pathology. These findings, at partial variance with US studies, suggest a complex relationship between suicide and mental disorder. The striking failure of intensive screening and preventive measures to prevent these suicides highlights unresolved questions of etiology and intervention.
authors.affiliation: Israel Defense Force Medical Corps.
authors.forename: A
authors.initials: A
authors.lastname: Apter
authors.forename: A
authors.initials: A
authors.lastname: Bleich
authors.forename: R A
authors.initials: RA
authors.lastname: King
authors.forename: S
authors.initials: S
authors.lastname: Kron
authors.forename: A
authors.initials: A
authors.lastname: Fluch
authors.forename: M
authors.initials: M
authors.lastname: Kotler
authors.forename: D J
authors.initials: DJ
authors.lastname: Cohen
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D005190:Family; D006801:Humans; D007360:Intelligence; D007557:Israel / Q000453:epidemiology; D007585:Jews / Q000145:classification; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics; D008889:Military Personnel; D010809:Physical Fitness; D012067:Religion; D013405:Suicide / Q000706:statistics & numerical data*; D000092864:Suicide Prevention