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Holocaust exposure and subsequent suicide risk: a population-based study
Cendrine Bursztein Lipsicas1, Itzhak Levav2, Stephen Z Levine2
1Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 3498838, Haifa, Israel. cendrinebursztein@gmail.com.
Social Psychiatry and Psychiatric Epidemiology
|December 30, 2016
Summary
Holocaust survivors with partial direct exposure to genocide, particularly from high-persecution countries, faced increased suicide risk. Those with full direct exposure showed resilience, suggesting complex trauma responses to genocide.
Area of Science:
- Psychiatry
- Genocide Studies
- Public Health
Background:
- The Holocaust represents a period of extreme persecution with long-term psychological impacts.
- Understanding the nuanced effects of varying levels of genocide exposure on survivor mental health is crucial.
Purpose of the Study:
- To investigate the association between the extent of Holocaust exposure and subsequent suicide risk among survivors.
- To identify specific exposure levels correlating with elevated suicide risk.
Main Methods:
- A cohort of 209,429 Holocaust survivors who immigrated to Israel was followed from 1950 to 2014.
- Survivors were categorized into indirect, partial direct, and full direct exposure groups based on immigration timing relative to WWII and country of origin genocide levels.
- Cox proportional hazards models and sensitivity analyses were used to assess suicide risk.
Main Results:
- Survivors with partial direct exposure from high-genocide countries exhibited a statistically significant increased suicide risk (HR 1.78).
- This increased risk was consistent across sensitivity analyses examining age and years since immigration.
- Survivors with full direct exposure did not show a significant increase in suicide risk compared to the indirect exposure group.
Conclusions:
- Holocaust survivors with full direct exposure may represent a resilient group.
- Protracted guilt and witnessing atrocities may contribute to the heightened suicide vulnerability observed in the partial direct exposure group from high-persecution areas.
- The extent and nature of genocide exposure significantly modulate long-term suicide risk.
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