Suicide Among Holocaust Survivors: A National Registry Study

Abstract

Previous findings regarding European Holocaust survivors’ suicide risk are conflicting. North African survivors’ suicide risk was not previously studied. In this study, we aimed to determine suicide risk among European and North African Holocaust survivors. The study was based on the Israeli population census from 1972, followed until 2015 for suicide. European survivors were grouped into survivors of severe Nazi persecution (HS) and early HS. North African survivors were grouped into those from Algeria, Libya and Tunisia who were likely to have suffered more severe persecution (group 1) and those from Morocco who apparently suffered less persecution (group 2). Comparison groups were chosen according to similar ethnic origins who were not under Nazi control. Age standardized suicide rates, Standard Mortality Ratios (SMR) were calculated. Cox regression analysis was used to assess suicide risk. The age adjusted suicide rates (per 100,000) among Europeans were: HS 17.8 (95%CI 16.9–18.6), early HS 28.6 (95%CI 24.9–32.2), comparison group 20.3 (95%CI 18.5–22.1). Among North Africans: group 1, 6.9 (95%CI 5.6–8.2), group 2, 4.8 (95%CI 4.0–5.5), comparison group, 8.5 (95% CI 6.4–11.0). The SMRs with European comparisons were 0.88 (95%CI 0.84–0.92) for HS and 1.41 (95%CI 1.20–1.65) for early HS. SMRs with North African comparisons were 0.81 (95%CI 0.67–0.97) for group 1 and 0.57 (95%CI 0.48–0.66) for group 2. Cox regression models showed significantly higher suicide risk for European early HS vs comparisons (Hazard Ratio (HR) = 1.31, 95% CI 1.12–1.52), and lower risk for HS (0.89, 95%CI 0.80–0.98). North African group 2 had significantly lower HR (0.58, 95%CI 0.43–0.79). To conclude, higher resilience was found among European survivors of severe adversity, compared to those who suffered lesser persecution. No elevated risk was found among North African survivors.

Keywords:

• Holocaust survivors
• resilience
• suicide

ACKNOWLEDGEMENTS

We would like to acknowledge the essential contribution of the Israel Central Bureau of Statistics to this study: preparation of the data file and use of their research room for performing the analyses and in particular Dr. Ahmed Halihal. We would also like to thank Prof. Itzhak Levav for his contribution to this study.

Additional information

Funding

This study was supported by the Lizzy and Arthur Levenstein fund, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.