Suicide Risk Among Holocaust Survivors Following Psychiatric Hospitalizations: A Historic Cohort Study

Abstract

The association between Holocaust experience, suicide, and psychiatric hospitalization has not been unequivocally established. The aim of this study was to determine the risk of suicide among 3 Jewish groups with past or current psychiatric hospitalizations: Holocaust survivors (HS), survivors of pre-Holocaust persecution (early HS), and a comparison group of similar European background who did not experience Holocaust persecution. In a retrospective cohort study based on the Israel National Psychiatric Case Register (NPCR) and the database of causes of death, all suicides in the years 1981–2009 were found for HS (n = 16,406), early HS (n = 1,212) and a comparison group (n = 4,286). Age adjusted suicide rates were calculated for the 3 groups and a logistic regression model was built to assess the suicide risk, controlling for demographic and clinical variables. The number of completed suicides in the study period was: HS—233 (1.4%), early HS—34 (2.8%), and the comparison group—64 (1.5%). Age adjusted rates were 106.7 (95% CI 93.0–120.5) per 100,000 person-years for HS, 231.0 (95% CI 157.0–327.9) for early HS and 150.7 (95% CI 113.2–196.6) for comparisons. The regression models showed significantly higher risk for the early HS versus comparisons (multivariate model adjusted OR = 1.68, 95% CI 1.09–2.60), but not for the HS versus comparisons. These results may indicate higher resilience among the survivors of maximal adversity compared to others who experienced lesser persecution.

Keywords:

• Holocaust survivors
• psychiatric hospitalization
• suicide

Additional information

Notes on contributors

Ido Lurie

Ido Lurie, Kfar Saba Adult Clinic, Shalvata Mental Health Center, Hod Hasharon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Adi Gur

Adi Gur, The department of residency in Family Medicine, Maccabi Healthcare Services, Israel. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Ziona Haklai

Ziona Haklai, Ministry of Health, Jerusalem, Israel.

Nehama Goldberger

Nehama Goldberger, Ministry of Health, Jerusalem, Israel.