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עמוד בית
Fri, 19.04.24

December 2018 (Issue 39-40)


Introduction
Articles
Leah Shelef, Noam Paz, Ariel Ben-Yehuda
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Introduction: Suicide during military service is not unique to the Israeli army. While the US military has seen an upward trend in the rate of suicide among soldiers over the past decade, in the IDF the rate has dropped more than 50%.

Methods: In the present literary review, seven studies on suicides and four studies on suicide attempts among Israeli soldiers were included. The goal was to compare the characteristics of the soldiers who died by suicide compared with the characteristics of the soldiers who attempted suicide.

Results: Many risk factors were found to be related to suicide among soldiers. The characteristics found to be in correlation include male, aged 19-20, first year of military service, high intelligence, usually stationed in a combat unit, Country of origin - Ethiopia, low socio-demographic status, psychiatric diagnosis and slight adjustment difficulties effecting function. Regarding service motivation, some of the findings indicate a high level of motivation for service, while others indicate low and moderate motivation for combat service. Additionally, alcohol use was found to be a significant risk factor for suicide. It was found that about a third of the suicides are directly related to military service. In spite of this, it was found that there is certain protective measure within the military system including support from commanders, special attention to psychological struggles and monitoring by mental health professionals.

Conclusions: In the army, despite the unique environment combining stress and availability of weapons, the rate of suicide is declining. This can be attributed to the suicide prevention program in the IDF, which includes psychoeducation for commanders on stress reactions among soldiers, as well as monitoring by mental health professionals.

Keywords: suicide; suicide attempts; soldiers.
Leah Shelef, Chen Goren, Idit Oz, Ron Kedem, Ariel Ben-Yehuda
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Introduction: Suicide rate among Ethiopian immigrants in Israel is higher than among former Soviet-Union immigrants and native-born Israelis, relative to their proportion in the population. In addition, they have lower suicide attempt rate.

Objectives: Examination of risk factors for suicide among Ethiopian soldiers who committed suicide during their service in the IDF.

Method: A case-control study design comparing sociodemographic variables, personal characteristics and psychiatric diagnoses of all Ethiopian soldiers who were drafted to military service during 1992-2012 (n=22,896). The study group consisted of all Ethiopian soldiers who died by suicide during their military service (n=32). Two control groups were used for comparison. The first group consisted of Ethiopian soldiers who did not die by suicide during their military service (n=22,434). The second group consisted of non-Ethiopian soldiers who died by suicide during their military service (n=430).

Results: Among 13,909 male Ethiopian soldiers, 32 died by suicide over the years 1992-2012. Among 8,525 females Ethiopian soldiers, not one committed suicide in the reported years (p=0.042). Soldiers serving in combat units were 3.57 times more likely (p<0.001) to commit suicide than those serving in non-combat units. A comparison between the suicidal groups, Ethiopian and non-Ethiopian who died by suicide, found that the proportion of Ethiopians who served in combat units was lower (48.1% vs. 30.3%, p=0.046), and the intelligence scores of the Ethiopians were four times lower (58.1% versus 14.4%, p<0.001).

Conclusions: Amongst Ethiopian soldiers who committed suicide, the lower intelligence scores combined with service in combat units, may contribute to elevated stress due to the cultural gap and difficult integration process. In light of these findings, culture-sensitive intervention programs are needed in order to reduce suicidal behavior amongst Ethiopian soldiers.

Keywords: Suicide; soldiers; Ethiopian origin.
Gal Chaikin, Ravit Rubinstein, Maya Feinholtz Klein
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Introduction: The IDF Combat Reactions Unit provides psychotherapy services to former combatants in cases of mental distress due to combat action. The areas of treatment of Post-Traumatic Stress Disorder (PTSD) are characterized by many different approaches, although only in a minority of approaches does research support their effectiveness. The diagnostic process is of utmost importance in the success of the treatment, since at this stage, the professional team jointly outlines the appropriate course of treatment for each patient.

Objective: This article describes the diagnostic approach and the principles applied in the Combat Reactions Unit of the Medical Corps, to treat those suffering from PTSD. The diagnostic process used was reviewed for two categories of former combatants: (1) Those who experienced a traumatic event a few months prior to seeking treatment; (2) Combatants who waited a longer period of time before seeking treatment.

Discussion & Conclusions: The effectiveness of the evaluation process is derived from the staff’s extensive professionalism and their ability to create a treatment program based on knowledge, experience and research for each patient. In addition, consideration of the nature of the patient’s injury and maximal adaptation to their personality and coping abilities are crucial. The last two variables affect the degree of cooperation on the patient’s part and their ability to benefit from the treatment. An effective diagnostic process significantly improves the adapting of the treatment to the patient in terms of maximizing the patient’s benefit from the proposed treatment and reducing treatment drop-out rate.

Keywords:Combat Reactions Unit, Post-Traumatic Stress Disorder, Combat Reaction among Worriers, Diagnostic Process of Post-Traumatic,Stress Disorder, Efficient Diagnostic Process following Recent Event, Trauma Focused Treatments
Ofir Ohayon, Keren Shaul, Vlad Svetlitzky, Ariel Ben-Yehuda, Avishai Antonovsky
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Introduction: Mental challenges faced by combat soldiers in the battlefield have been thoroughly studied. Less attention has been given to soldiers in combat support roles who are not exposed directly to the battlefield, such as Observation Systems Operators (OSOs). OSOs, who are exposed to combat from behind screens, confront mental challenges as well. The current study attempted to uncover mental challenges that OSOs face, effecting their functioning and mental wellbeing.

Methods: Participants were 114 female OSOs, in training and on the job. Data were collected qualitatively in focus groups and quantitatively using questionnaires. Medical records of 29 OSOs who had dropped out earlier were also analyzed.

Results: Participants in the focus groups reported that job functioning is affected mainly by professional knowledge, attention bias, fear of failure, fear of punishment, group cohesiveness and physical proximity of the commander during battle. Mental well-being was found to be affected by self-efficacy, perceived professional competence, concern over mistakes and doubts about actions.

Discussion and Conclusions: The findings were discussed in terms of the three components of sense of coherence, the core concept in Antonovsky’s salutogenic model of health: OSOs perceived functioning and their mental well-being are positively affected by understanding the mission (comprehensibility), by having resources to carry out the mission (manageability) and by finding meaning in the mission (meaningfulness). Following the establishment of the Field and Mental Fitness Branch in the IDF Medical Corps, this study calls for developing programs which can aid OSOs in coping with mental challenges during their military service.

Keywords: Mental Fitness, Military Observation Systems Operators, Combat Support, Stress and Coping, Sense of Coherence
Dorit Tzur, Ron Kedem, Gilad Twig, Ariel Ben Yehuda, Abergil Maya, Elon Glassberg
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Introduction: Data from the Ministry of Health regarding the five leading causes of death among 15-24-year-old shows– accidents, suicide, murder, cancer and heart disease. This data demonstrates that a considerable proportion death in this age group are from preventable causes as opposed to physiological disease.

Objective: To examine data about overall military circumstances of death during the last three decades (1990- 2016) and present selected parameters in the area of serious injuries and hospitalizations in intensive care unit in order to identify trends that characterize injuries compared with mortality.

Methods: The study population included all soldiers in compulsory service, permanent service and active reserve duty who were hospitalized in Israeli hospitals or died from any cause during the years 1990-2016 (Total of 233,904 soldiers, including 3,297 mortalities). Details regarding injury circumstances and hospitalization are based on reports of medical units in hospitals to IDF manpower. Data regarding mortality events is based on IDF registration system.

Results: Operational death circumstances constituted 29% of total mortalities, compared to 24% suicide circumstances and road accident circumstances (21%). It was found that there is a downward trend in cases of death due to disease (2.5% per year) and trauma (2.7% per year). The trend is maintained even in calculation of rate in relation to the average soldier population size. The percentage of casualties of operational circumstances among fatalities and hospitalized soldiers in the intensive care unit under indicates that there is a downward trend of 1.9% per year. The rate of decline of 1.5% - was observed in a similar measure for the other trauma circumstances. In addition, it was found that there is a downward trend in the percentage of total cases hospitalized or died: operational circumstances – 2.2% per year, road accident circumstances – 1.7% per year.

Conclusions: Decrease in mortality trends were found among soldiers in all death circumstances, focusing on trauma circumstances. These reductions can be perhaps assigned to effectiveness of programs for improvements military medical response over the years, this issue requires continued deepening and exploration. A rather dichotomous division between death and hospitalization reach operational circumstances implies that is required to continue investing through triage, treatment and evacuation area.

Keywords:Death circumstances, Trauma, Hospitalization, Intensive care, Traffic accidents
Reviews
Leah Shelef, Eyal Fruchter
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Introduction: During 2009, a woman suffering from bipolar disorder committed suicide by hanging during her psychiatric hospitalization. Her relatives appealed to court blaming the hospital management for causing death by negligence. The legal proceeding revived the debate regarding the caregiver’s responsibility for suicide prevention.

Objective: This paper’s aim is to display and expand the limitations in suicide risk assessment and list the tools at the disposal of the therapist and his responsibility. Israeli Psychiatric Association’s litigation on the therapist and patient’s liability shifts the unreasonable expectations for future suicide prediction to a responsible clinical evaluation, rational judgment and a tailor-made solution for patient’s needs. Retrospective assessment of suicidal intention is never easy - after a prior suicide attempt, let alone after suicidal thoughts, as these tend to change significantly. Therefore, evaluating suicidal thoughts can apply only to the examination time, as well as suicidal intention assessment. It is crucial to evaluate past and present suicidality levels, to understand that suicidality is a changing situation.

Methods: Review of articles that reflect dilemmas and issues during assessment of suicidal behavior. Results: The urge to commit suicide is volatile, and in many cases the desire to die is ambivalent, elusive, fickle and ambiguous. The implementation of the impulse depends on a variety of factors, such as the intensity of the experience and the availability of a lethal means.

Conclusions: Caregivers, professionals in mental health, and general physician, must recognize their obligation to assess the risk of suicide, when necessary. At the same time, one must recognize the limits of this evaluation without resorting to defensive medicine that could interfere with the discretion and quality of the professional decisions. Knowledge on risk and protective factors against suicide can help reduce the risk of suicide.

Keywords: Suicide risk assessment, Suicide, Suicide attempts
Leah Shelef, Noam Paz, Miriam Schiff, Shira Barzilay
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Introduction: Therapists who experienced a patient’s suicide report that this is one of the most painful professional experiences. It is important to understand whether the experience of suicide has an impact on the emotional and professional functioning of the therapist, especially with regard to the treatment or assessment of other patients at risk for suicide.

Methods: The purpose of this article is to review relevant literature since the 2000s on the responses of mental health professionals (social workers, psychologists, psychiatrists) to a patient’s suicide.

Results: About one third of mental health professionals may experience a patient’s suicide during their careers. It was found that soldiers, similar to civilians, contact mental health and medical doctors prior to, and in proximity to, committing suicide. The suicide of a patient has a great effect on both the therapist’s feelings (e.g. pain, guilt, sense of competence, professional doubt) and behavior (e.g. increased use of consultation, more conservative recording, attention bias, and hospitalization).

Discussion and Conclusions: It is very important to recognize the phenomenon in order to be prepared for this possibility and to support therapists’ recoveries following a patient’s suicide. In addition, it is important to understand its effect, if present, on risk assessment and treatment of other patients at risk for suicide.

Keywords: suicide, suicide attempt, Impact of client suicide
Leah Shelef, Darya Shalev, Gil Raviv, Dror Garbi, Shirley Gordon
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Introduction: Introduction: Although suicide is an extreme phenomenon, about a million people commit suicide every year worldwide. Hence, it is very important to investigate various aspects of the suicide phenomenon and to examine ways of reducing it. One of the approaches examines the relationship between environmental variables and the timing of suicide.

Objective: To review the relationship between environmental variables and the timing of suicide.

Method: This study will review the literature on suicides and seasonal suicide behavior to understand the pattern of suicide, if any exists.

Results: Studies (from the Northern Hemisphere) indicate that the highest frequency of suicides occurred in May. Other studies point to the spring season as a time when suicides are high in comparison with other seasons. In Israel between 1998 and 2013, the highest frequency of suicide occurred in May. In the IDF, during the years 1992-2016, there were two definite periods of increased suicide among soldiers , mid-year (April to May and August) and the beginning and the end of the year (January and December), with the highest frequency of suicide in January.

Discussion & Summary: One of the most common explanations for suicide at the beginning of the summer (in May, in countries where this month marks the beginning of the summer) is the renewed energy that accompanies the spring period and gives the strength necessary to achieve the ability to commit suicide. In the IDF, most of the training takes place between August and December, and it is possible that a peak point in suicide is added as a result of the massive entry of soldiers into the system regardless of the seasons of the year. The first year of military service increases the risk of suicide.

Keywords: seasonal suicide, suicide, suicide attempted
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