Suicidal ideation, substance use, and sense of coherence in Greek male conscripts

Military Medicine, Jun 2003 by Giotakos, Orestis

This study aimed to estimate the comorbidity of suicidal behavior and substance use in young male conscripts and to analyze the association between personal coping resources and the severity of these behaviors. A total of 1,098 Greek male conscripts participated in this study, completing the Antonovsky's sense of coherence questionnaire and a standard questionnaire concerning their lifetime and current suicidal and substance-use behavior. A proportion of 11.7% and 24%, respectively, had lifetime and current feelings that life is not worth living. The differences between past and current death wishes (8.9% vs. 9.2%), suicidal thoughts (8.3% vs. 7.6%), and suicide attempts (2.4% vs. 2.9%) were not significant. All of the subgroups with suicidal ideation or behavior showed a significantly lower sense of coherence questionnaire score as compared with the whole sample. The comorbidity of past and current suicide thoughts and substance use ranged from 16.4% to 33.3% and 31.4% to 44.2%, respectively, depending on the kind of the substance. Finally, the subjects with past or current substance use had a significantly higher incidence of past or current, respectively, suicidal ideation or behavior, as compared with those without a history of substance use. We suggest the necessity of the early detection of these high-risk behaviors applying closer monitoring and integrated prevention programs.

Introduction

Most questionnaire studies of nonclinical populations report a high lifetime prevalence of suicidal ideation and suicidal behavior in late adolescence or young adulthood.1-3 In addition, it is well documented that suicidal behavior is reported frequently by substance abusers,4-7 and prevalence rates of attempted suicide range between 15% and 45%.8 Several explanations for the increased risk of suicidal behavior in substance abusers have been given, whereas there is evidence that substance abuse and suicidal behavior may share some common characteristics or individual predisposition.9

Aaron Antonovsky's sense of coherence (SOC)10,11 ought to explain why some people can manage stress whereas others break down. The model of Antonovsky proposes that the individual's SOC, which is a personal orientation toward life, determines one's health experience and can be seen as a relatively stable (trait) measure.12,13 Lower SOC scores were found to be correlated significantly with difficulty in performing activities of daily living, in patients with rheumatoid arthritis,14 with psychopathology in a sample of psychotic patients,15 with burnout and depression in a nursing staff sample,16 and with inability to complete the detoxification therapy in a drug-addicted sample.17

Several studies have shown that those receiving basic military training actually constitute a high-risk group for suicidal ideation or suicide attempt.18,19 Mehlum,3 using the SOC questionnaire in a sample of male conscripts, found that respondents with suicidal ideation or behavior had on average significantly lower SOC scores compared with respondents with no suicidal ideation or behavior. The present study was designed to study the prevalence of suicidal ideation and behavior and the comorbidity of suicide and substance use in young male conscripts as well as to investigate the continuity of these behaviors during the basic training and to analyze the association between personal coping resources and the severity of these behaviors.

Methods

From 18 to 22 months, depending on the military branch, military service is compulsory in all men in Greece, and it usually begins between age 18 and 24 years. Individuals suffering from serious physical and mental disorders and/or those who apply to join the civil service are exempted. Conscripts from five major Army training bases in southern Greece were selected randomly and were asked to participate on a voluntary basis. These conscripts had come from all over the country and they represented all sociodemographic categories of Greece. The study was conducted between the 30th and the 35th day of their basic training.

A total of 1,098 trainees with a mean age of 21.5 (SD = 3.1) years actually agreed to participate in the study and completed anonymously the following questionnaires: (1) a questionnaire concerning the basic sociodemographic data; (2) the Antonovsky's sense of coherence questionnaire (SOC-13),10,11 which is a self-reported measure of the SOC (the Cronbach [alpha] of different studies using the SOC-13 range from 0.74 to .91);11 (3) a questionnaire concerning the suicidal ideation and behavior at any time before the conscription as well as during the first month in the Army (the items were: "Have you ever thought that life is not worth living?" "Have you ever wished you were dead?" "Have you ever thought about killing yourself?" "Have you ever tried to kill yourself?"); and (4) a questionnaire concerning the drug use or abuse at any time before as well as during the first month in the Army (with questions: "Is any member of your family a substance user or abuser?" "Have you ever used a drug yourself?" "Have you ever consumed a large quantity of alcohol?" "Have you ever used hashish or pills?" "Have you ever used heroine or cocaine?").