Abstract

Previous findings regarding European Holocaust survivors’ suicide risk are conflicting. North African survivors’ suicide risk was not previously studied. In this study, we aimed to determine suicide risk among European and North African Holocaust survivors. The study was based on the Israeli population census from 1972, followed until 2015 for suicide. European survivors were grouped into survivors of severe Nazi persecution (HS) and early HS. North African survivors were grouped into those from Algeria, Libya and Tunisia who were likely to have suffered more severe persecution (group 1) and those from Morocco who apparently suffered less persecution (group 2). Comparison groups were chosen according to similar ethnic origins who were not under Nazi control. Age standardized suicide rates, Standard Mortality Ratios (SMR) were calculated. Cox regression analysis was used to assess suicide risk. The age adjusted suicide rates (per 100,000) among Europeans were: HS 17.8 (95%CI 16.9–18.6), early HS 28.6 (95%CI 24.9–32.2), comparison group 20.3 (95%CI 18.5–22.1). Among North Africans: group 1, 6.9 (95%CI 5.6–8.2), group 2, 4.8 (95%CI 4.0–5.5), comparison group, 8.5 (95% CI 6.4–11.0). The SMRs with European comparisons were 0.88 (95%CI 0.84–0.92) for HS and 1.41 (95%CI 1.20–1.65) for early HS. SMRs with North African comparisons were 0.81 (95%CI 0.67–0.97) for group 1 and 0.57 (95%CI 0.48–0.66) for group 2. Cox regression models showed significantly higher suicide risk for European early HS vs comparisons (Hazard Ratio (HR) = 1.31, 95% CI 1.12–1.52), and lower risk for HS (0.89, 95%CI 0.80–0.98). North African group 2 had significantly lower HR (0.58, 95%CI 0.43–0.79). To conclude, higher resilience was found among European survivors of severe adversity, compared to those who suffered lesser persecution. No elevated risk was found among North African survivors.

摘要

先前关于欧洲大屠杀幸存者自杀风险的调查结果相互矛盾。以前没有研究过北非幸存者的自杀风险。在这项研究中，我们旨在确定欧洲和北非大屠杀幸存者的自杀风险。该研究基于 1972 年的以色列人口普查，一直到 2015 年自杀。欧洲幸存者分为严重纳粹迫害 (HS) 和早期 HS 的幸存者。北非幸存者分为可能遭受更严重迫害的阿尔及利亚、利比亚和突尼斯人（第 1 组）和来自摩洛哥的受迫害明显较少的人（第 2 组）。比较组是根据不受纳粹控制的类似种族血统选择的。计算了年龄标准化的自杀率、标准死亡率（SMR）。Cox回归分析用于评估自杀风险。欧洲人的年龄调整自杀率（每 100,000 人）为：HS 17.8（95%CI 16.9-18.6），早期 HS 28.6（95%CI 24.9-32.2），对照组 20.3（95%CI 18.5-22.1）。在北非人中：第 1 组 6.9 (95%CI 5.6–8.2)，第 2 组 4.8 (95%CI 4.0–5.5)，对照组 8.5 (95% CI 6.4–11.0)。HS 与欧洲比较的 SMR 为 0.88 (95%CI 0.84–0.92)，早期 HS 为 1.41 (95%CI 1.20–1.65)。第 1 组与北非比较的 SMR 为 0.81 (95%CI 0.67–0.97)，第 2 组为 0.57 (95%CI 0.48–0.66)。Cox 回归模型显示欧洲早期 HS 与比较的自杀风险显着更高（危险比（ HR) = 1.31, 95% CI 1.12–1.52)，HS 风险较低 (0.89, 95% CI 0.80–0.98)。北非组 2 的 HR 显着降低 (0.58, 95% CI 0.43–0.79)。总而言之，与遭受较少迫害的人相比，在严重逆境中的欧洲幸存者中发现了更高的复原力。在北非幸存者中未发现风险升高。