A Chronological Perspective on Suicide—The Last Days of Life

Abstract

A combined psychological autopsy and narrative approach was used to study the completed suicides of 67 Israeli soldiers. Three issues were addressed. First, the authors examined the typology of the life narratives of suicide completed during active army duty. Second, focusing on the last 3 weeks of the soldiers' lives, they sought to examine their triggers for suicide, emotional state of mind, army duty functioning, and communication of suicidal intent. Finally, they examined military responses to communication of intent, help provision, and help acceptance. Four types of narratives were identified: regressive, stable, tragic (progression and sudden collapse), and romantic (ups and downs). During the last days of life, suicide completers exhibited a split between an emotional state of mind (evidencing an emotional deterioration) and a behavioral military functioning, which was mostly stable. The analysis also revealed a resistance to receive help and a resistance to provide help, both of which impeded intervention. The gap between functioning and emotional distress in suicidal individuals and the incongruence between crisis and help are highlighted. The need to educate military personnel to look beyond duty functioning and the need to develop clear guideline about referrals to professional helps are discussed.

The Relation of Cognitive Reappraisal and Expressive Suppression to Suicidal Ideation and Suicidal Desire

“…This is in line with results reported by Orbach et al. () who postmortem investigated narratives covering the last 3 weeks of life of 67 Israeli soldiers who completed suicide. The authors found a split between an inner state of progressing emotional deterioration and simultaneously a mostly unimpaired outer appearance including behavioral military functioning, which was mostly stable.…”

“…Thus, one may assume that an increased effort in trying to suppress and thus not overtly showing negative feelings was accompanied by an increase in suicidal ideation and the development of suicidal plans and behavior. The authors also point out that suppression of negative emotional states may be a distinct risk factor for suicidal behavior because it is accompanied by a resistance to receive help and thus impairs help allocation by professional services (Orbach et al., ).…”

“…The effect of emotion and especially emotion regulation on suicidal ideation, desire, intent, and subsequent suicidal attempts has only rarely been addressed empirically so far. A couple of studies report that emotion dysregulation is a predictor of suicidal ideation (e.g., Lynch, Cheavens, Morse, & Rosenthal, ; Orbach et al., ). Recently, Anestis, Bagge, Tull, and Joiner () found that individuals with low distress tolerance and high negative urgency reported higher levels of suicidal desire.…”

Overcoming the fear of lethal injury: Evaluating suicidal behavior in the military through the lens of the Interpersonal–Psychological Theory of Suicide

“…One study of soldiers who died by suicide found that although many of these soldiers effectively maintained their military duties and expectations right up until death by suicide, they also demonstrated signs of emotional deterioration during the last days of their lives (Orbach et al, 2007). Thus, although a member of the military may appear to be functioning adequately, he or she may be masking suicidal ideation and preparation.…”

Psychological autopsy study comparing suicide decedents, suicide ideators, and propensity score matched controls: results from the study to assess risk and resilience in service members (Army STARRS)

“…Only a handful of psychological autopsy studies have been conducted with military samples, most of which are characterized by the inclusion of small samples (e.g., <40 cases), low response rates, and non-standardized assessment instruments, limiting the inferences that can be drawn from the results of these studies (Dedic and Panic, 2010, Farberow et al, 1990, Orbach et al, 2007). Moreover, many prior psychological autopsy studies have used either no control condition, or have included as controls people who have died from other causes (e.g., accidents, natural death), or people with a psychiatric disorder (Cavanagh et al, 2003).…”