title: Risk factors for suicide attempt among Israeli Defense Forces soldiers: A retrospective case-control study.
abstract: BACKGROUND
  A major risk factor for suicide is suicide attempts. The aim of the present study was to assess risk factors for nonfatal suicide attempts. Methods 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. Results 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).
  
  
  CONCLUSIONS
  Mild suicidal behavior constitutes a much larger proportion than among civilians and may have secondary gain thus distorting the suicidal behavior data.
  
  
  CONCLUSIONS
  Training primary care physicians as gatekeepers and improved monitoring, may reduce the rate of suicide attempts.
authors.affiliation: Psychology Branch, Israeli Air Force, Mental Health Unit, Medical Corps, Israel Defense Force, Israel.
authors.forename: Leah
authors.initials: L
authors.lastname: Shelef
authors.affiliation: Military Track, The Hebrew University, Hadassah Medical School, Israel. Electronic address: dan.kaminsky@mail.huji.ac.il.
authors.forename: Dan
authors.initials: D
authors.lastname: Kaminsky
authors.affiliation: Mental Health Unit, Medical Corps, Israel Defense Force, Israel.
authors.forename: Meytal
authors.initials: M
authors.lastname: Carmon
authors.affiliation: Statistican, Medical Corps, Israel Defense Force, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Kedem
authors.affiliation: Chair, Department of Psychiatry, The Hebrew University - Hadassah Medical School, Hadassah University Hospital, Israel.
authors.forename: Omer
authors.initials: O
authors.lastname: Bonne
authors.affiliation: Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York City, USA.
authors.forename: J John
authors.initials: JJ
authors.lastname: Mann
authors.affiliation: Mental Health Unit, Medical Corps, Israel Defense Force, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Fruchter
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Adolescents; Military service; Psychiatric diagnosis; Soldiers; Suicide attempt