February 1993

Death Without Warning?A Clinical Postmortem Study of Suicide in 43 Israeli Adolescent Males

Author Affiliations

From the Israel Defense Force Medical Corps (Drs Apter, Bleich, Kron, Fluch, and Kotler); the Yale Child Study Center, Yale University School of Medicine, New Haven, Conn (Drs King and Cohen); the Department of Psychiatry, Sackler School of Medicine, Tel Aviv, Israel (Drs Apter and Bleich); and Geha Psychiatric Hospital, Department of Child and Adolescent Psychiatry, Sackler School of Medicine, Tel Aviv, Israel (Dr Apter).

Arch Gen Psychiatry. 1993;50(2):138-142. doi:10.1001/archpsyc.1993.01820140064007

• Forty-three consecutive Israeli male suicides, 18 to 21 years of age, that occurred during compulsory military service were studied using preinduction assessment data, service records, and extensive postmortem interviews with family and peers. At preinduction, subjects, as a group, appeared above average in intelligence, physical fitness, and measures predictive of successful adaptation to military service. Active duty performance was generally satisfactory. Ascertained post mortem, 53.5% met formal criteria for major depressive disorder; most cases, however, appeared recent and reactive. Narcissistic and/or schizoid traits were common. Substance abuse was absent and antisocial personality disorder was rare (4.7%). Furthermore, in eight patients (18.6%) no Axis I diagnosis could be made; half of these also lacked any significant Axis II pathology. These findings, at partial variance with US studies, suggest a complex relationship between suicide and mental disorder. The striking failure of intensive screening and preventive measures to prevent these suicides highlights unresolved questions of etiology and intervention.