Professionals who receive answer calls of distress from the Israeli population on a daily basis warn that in light of the continuation of the wars in Gaza, Lebanon, and beyond, they expect an increase in suicide risk rates, as was seen in studies conducted after the terrorist attacks of September 11, 2001 in New York and the Pentagon that affected Americans personally much less that the current war against Iran, Hezbollah, and Hamas.
A new study conducted and analyzed by the University of Haifa, the ERAN (Emotional First Aid), Tel Aviv University (TAU), the College of Management Academic Studies in Rishon Lezion, and New York’s Columbia University, found that in the first days after October 7, there was a decrease in the number of suicidal calls received at the ERAN help centers. However, there was a sharp increase in conversations in contexts of general psychological distress such as anxiety, depression, and trauma.
Data including over 600,000 calls to the ERAN helpline were examined, comparing the 20 months before October 7 and the three months after. Changes in suicide rates after a nationwide trauma may be different from alterations in psychiatric symptoms or general distress after such events. However, very few studies have examined short-term suicide-related reactions after such an event, they wrote.
The number of calls for general psychological distress increased from 67,555 in the three months preceding the attack to 89,445 calls in the three months after.
“In contrast, there was a decrease in the number of suicidal calls from 1,887 calls in the three months preceding the war to a total of 1,663 calls in the three months following. Although mental distress increased, no increase in suicidal risk was observed in the immediate term in the days after October 7, which indicates that suicide is not necessarily an immediate response to traumatic events on a large scale,” said Dr. Joy Benatov of the special education department at the University of Haifa who led the research. It has just been published in the prestigious scientific journal JAMA Psychiatry under the title “Suicidality Calls to a National Helpline After a Terror Attack and War.”
What does the study say?
The new study shows that the total number of suicidal calls decreased in the three months after October 7 compared to the three-month period before the outbreak of the war. In contrast, there was a sharp increase in the number of distress calls received after October 7, which highlights the increase in general mental distress in the months following the murderous attack. Furthermore, the pattern over time has reversed, as the general mental distress rose immediately on October 7. There was a downward trend in the following months; then, the suicidal risk index decreased and gradually began to rise.
Now, over a year since the beginning of the Iron Swords War and the horrendous attack on southern Israel, followed by a devastating war front opened in the north and a serious risk of war with Iran, the professionals worry about severe psychological consequences since the end of the crisis cannot be seen.
Previous studies have reported an increase in emotional distress after national traumas, with suicides decreasing in the short-term period after these events. Although the latter is usually attributed to the belongingness and social support experiences characterizing national traumas, it may also reflect a self-preservation reaction to an acute threat (fight-or-flight reaction).
In later stages, when the threat is reduced or becomes chronic, the initial reaction might be replaced by experiences that give rise to suicidality (despair and mental-resources deprivation), thus leading to an increase in suicide risk. Such a trajectory was found in a study on the number of calls to a New York City helpline (LifeNet) in the months after the 9/11 attacks, showing an increase in calls for anxiety and post traumatic stress disorder symptoms; however, calls that related to depression increased only later, after a few months.
In the current study, the team of researchers, which also included, Dr. Liat Itzhaky, TAU psychiatrist Dr. Shiri Daniels, and Prof. Gil Zalsman, sought to examine the effect of the events of October 7 on the suicide risk rates in the general population in Israel. For this purpose, data including over -600,000 calls to ERAN’s helpline, comparing the 20 months before October 7 and the three months after.
Daniels, the national professional director of ERAN association and head of the educational counseling program at the College of Management said in an interview with The Jerusalem Post that “suicide is a complex result of a combination of mental, social and environmental factors that integrate together. Each case is unique and can’t be reduced to a single factor. It is important to avoid establishing a one-dimensional relationship between a certain event and suicide, as it may mistakenly present it as a ‘logical’ or legitimate response to a difficult situation.
“Suicide arises from deep mental suffering and its understanding requires a broad observation of the person’s mental state. Since an increase in suicides can be a delayed response to the powerful national trauma that it brings war, we must prepare for this ahead of time and strengthen the various mental health services in order to create accessible and effective treatment sequences.”
The attacks on New York and Washington were horrible and traumatic, but they did not affect all Americans personally and quickly ended – unlike the situation in Israel for more than a year – the hostages taken, hundred of soldiers killed and thousands wounded, hundreds of civilians slaughtered or killed by terror attacks and rockets, and more. We live in continuous war and terror.
“Israelis are confronting external enemies, and they keep us busy,” said Daniels. “But we have to be prepared for a rise in suicides here. There are already 500 a year, like a Jumbo jet falling out of the sky. There’s a ‘National Plan to Prevent Suicide,” but it is not backed up by enough professional personnel and funding. It’s a higher death toll than from road accidents, and it includes young people, even teens, the lonely, and the elderly.
Men are more likely to end their lives because they have more access to violence means, while women are more likely to make attempts but not go through with it because they tend more to seek help. Many authorities, including the Health, Social Welfare, and Education Ministries, as well as voluntary organizations, have to be involved. The need for emotional help now is very great.”
“One of the possible reasons for the decrease in the number of suicidal conversations in the immediate period after October 7 is the increased social cohesion that sometimes exists in the initial phase of a national crisis, this effect is called in the professional literature the ‘pull together effect,’ and it contributes to a decrease in suicidal risk,” the authors wrote.
“However, other explanations are possible, including the fact that the effect of increasing social cohesion fades with the continuation of crises. And in light of the continuation of the war and the national crisis, we expect an increase in suicide risk rates, as we saw in the studies conducted after the terrorist attack of the Twin Towers and the Pentagon in the US 23 years ago,” said Benatov.
The researchers noted that the current study referred to the general population in Israel, but there are also specific groups at increased risk during national crises or wars, including veterans, survivors of trauma, and members of the primary aid forces, such as ZAKA personnel who removed corpses or pathologists who assisted in their identification.
ERAN provides an immediate, anonymous, life-saving emotional first-aid service. It can be reached at 1201 and on the ERAN website at https://www.eran.org.il or via WhatsApp, email and text messages.