Risk Factors Associated With Various Severities of Suicidal and Non-Suicidal Self-Harm Among Israel Defense Forces Soldiers—A Nested Case–Control Study

Abstract

Objective: Severe suicide attempt is a major risk factor for completed suicide. The aim of the present study was to focus on suicide behavior and timing to gain better understanding of these populations. Method: The nested case–control retrospective study based on medical records of 246,866 soldiers, who demonstrated suicide attempts of varying severity, including death by suicide were compared with soldiers who did not demonstrate such behavior. Results: Risk for death by suicide was associated with males, military seniority of less than 12 months. High frequency of visits with mental health care professionals was associated with being severe suicide attempters (SAs). Moderate suicide attempts were associated with being a male, visiting a primary care physician frequently, and belonging to one of the two latest immigrant groups in Israel (Ethiopians and former Soviet Union). Mild suicide attempts were associated with having a psychiatric diagnosis on the enlistment day, visiting a mental health care professional at high or average frequency, visiting a primary care physician at high or average frequency, being a male, and being born in the former Soviet Union. While the proportion of males demonstrating suicidal behavior was higher than the females’, severe SAs were higher among females. There was a clear tendency of female suicide attempters at all levels to act toward the end of their military service. Conclusions: Although half of the SAs were females, their characteristics may be similar to those of the male SAs, contrary to the sex differences in suicide behavior among civilians.