title: An effective suicide prevention program in the Israeli Defense Forces: A cohort study.
abstract: OBJECTIVE
  To evaluate the effectiveness of the IDF Suicide Prevention Program, implemented since 2006.
  
  
  METHODS
  Quasi-experimental (before and after) cohort study.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Psychology Branch, Israel Air Force, Ramat Gan, Israel; Mental Health Department, Israel Defense Force Medical Corps, Ramat Gan, Israel. Electronic address: Lshelef4@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Shelef
authors.affiliation: Mental Health Department, Israel Defense Force Medical Corps, Ramat Gan, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Tatsa-Laur
authors.affiliation: Statistican, Medical Corps, Israel Defense Force, Ramat Gan, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Derazne
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 J
authors.initials: JJ
authors.lastname: Mann
authors.affiliation: Mental Health Department, Israel Defense Force Medical Corps, Ramat Gan, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Fruchter
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007585:Jews / Q000523:psychology / Q000706:statistics & numerical data*; D008297:Male; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012307:Risk Factors; D012959:Socioeconomic Factors; D013405:Suicide / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult; D000092864:Suicide Prevention
keywords: Israeli Defense Force; Risk factors; Suicide prevention; Suicide rate