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Suicide in the Air Force: Enlisting Help

Friday, December 12, 2003

Kerry Knox, Ph.D.

A landmark University of Rochester study of suicide in the United States Air Force concludes that a prevention program reduced the risk of suicide by 33 percent during the past six years, while also decreasing the rates of domestic abuse, murder and other forms of violence among active duty men and women. The research is reported in today’s British Medical Journal.

The UR Medical Center analyzed data collected by the Air Force on more than five million active duty personnel from 1990 to 2002. Suicide prevention efforts began after a rise in suicides among 24-to-35-year-old airmen in the early 1990s. Concerned about the level of personal suffering in the ranks, USAF leaders made suicide prevention a priority and established several initiatives to decrease the stigma, improve coping skills, and train USAF personnel on reducing violence associated with mental health problems. The ultimate goal was to change social norms so that seeking help would be a statement of strength, not a sign of weakness.

The UR then evaluated whether the USAF suicide prevention program actually worked. It’s the first study of its kind in many respects, according to lead author Kerry L. Knox, Ph.D., assistant professor of Community and Preventive Medicine, Division of Epidemiology, at the UR in Rochester, N.Y. Although risk factors for suicide are fairly well known, little research exists on what might prevent the tragedy. Knox and colleagues took the novel approach of studying all Air Force personnel, not just those at high risk for suicide, which is the more typical approach.

Researchers compared USAF rates of suicide, homicide, accidental death and family violence before and after the suicide prevention program was in place. (1990-’96 and 1996-2002.) Severe family violence declined the most, 54 percent, while homicides dropped 51 percent, suicides decreased 33 percent and accidental deaths slid 18 percent. Measuring change in social norms is more difficult, but the researchers noted that in a random survey in 1999, 73 percent of AF unit commanders were aware of and concerned about suicide prevention.

“What we gained from this investigation is a remarkable global view of violence prevention in a tightly organized group of people under considerable job stress,” Knox says. “The Air Force was successful in that they reached out to all folks, instead of just those identified at high risk. I believe this approach can be replicated in other workplaces.”

Indeed, Knox says that key lessons from the USAF’s suicide prevention programs could be adapted to police and fire departments, large corporations, schools and universities, and small countries.

The study was funded in part by grants from the National Institute of Mental Health and the Department of Defense, Army Medical Research Acquisition Activity.

Co-investigators include: David A. Litts, O.D., now Associate Director of the Suicide Prevention Resource Center, Newton, Mass.; G. Wayne Talcott, Ph.D., chief, Community Prevention Division, Air Force Medical Operations Agency; Jill Catalano Feig, M.D., MPH, physician epidemiologist, Air Force Medical Operations Agency; Eric D. Caine, M.D., John Romano Professor and Chair of Psychiatry, University of Rochester Medical Center, Rochester, N.Y.

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