The Impact of Exposure to Terror Attacks on Hospital Admissions due to Suicide-Related Behavior

Among the environmental factors affecting suicide-related-behavior, warfare has been associated with decrease suicide attempts (SA). However, it is not clear whether short-term stress during terror attacks, as missile attacks and bombing, have the same effect. We examined the association between fluctuations in the national stress levels, reflected by television news rating points (TVNRP), and trends in hospital admissions due to suicide attempts (HASTSA).

This study is a population-based retrospective study including all cases of SA admitted to Soroka University Medical Center (SUMC) between the years 2002-2012. We used a case-crossover analysis to examine the association between daily TVNRP and HASTSA, adjusted for daily average temperature and holidays. We defined the exposure as the TVNRP at the same day, 1 day and 2 days before the SA. We repeated our models stratified by peacetime and war period to assess potential modification effect. Results are presented as Odd Ratios (OR) and 95% confidence-intervals (CI) for per 1 point increase in the news rating.

We obtained data from 3,354 patients with 4,300 admissions SUMC. The median age at the time of admission was 28 years, 38.6% of the cases were males. Overall, the risk for SA was not associated with increase in the TVNRP of the same day (OR 1.01, 95% CI 0.98–1.03).

When stratifying by peacetime and war periods, we found significant increases in HASTSA, associated with TVNRP two days before the event, in war times (OR 1.23, 95% CI 1.04-1.46) but not in peacetime (OR 1.01 95% CI 0.98-1.03).

We observed a higher risk for SA associated with TVNRP two days before the event, suggesting that during war times this measure can be used as a proxy for national stress. In view of these findings, further research is warranted to study the effect of short-term terror attacks on suicide-related behavior.