Feature Article
Analyzing program results through research
The December 2003 publication of a University of Rochester study of the USAF suicide prevention program is pivotal. This study notes a reduction in risk for suicide in the U.S. Air Force by 33 percent over a six-year period.
The study is even more groundbreaking given the lack of evidence in the literature for the effectiveness of broadly based community level suicide prevention programs, and the lack of understanding about the role that protective factors - such as decreased stigma to tapping mental health services, and increased social support and coping skills - might have in preventing suicide.
The study's publication in the “British Medical Journal” further adds to its import.
“This is a prestigious international medical journal, and the fact that they have published this means that the Air Force suicide prevention program is being seen as a model program with every expectation that it can be exported to other settings both large and small,” says David Jobes, Ph.D., professor of psychology at The Catholic University of America and past president of the American Association of Suicidology.
Lead author of the study Kerry L. Knox, Ph.D., an assistant professor of community and preventive medicine at the University of Rochester, agrees.
“This is a top-tier journal,” she says of the “British Medical Journal.” “We were determined to get our research published in an international medical research journal with broad reach and prominence. The fact that we succeeded makes a very compelling argument as to the importance of the USAF program and its potential applicability beyond military to civilian populations as well.”
It was one thing for the USAF to spearhead and implement a program to reduce suicide within its ranks. When that program was associated with suicide rates plummeting, its success was celebrated.
But it took an objective third-party evaluation of this unique community-based program and its seeming success to corroborate it and consider its reach beyond the Air Force. That outside evaluation came through researchers at the University of Rochester Center for the Study and Prevention of Suicide, who in 1999 launched an in-depth research study of the USAF Suicide Prevention Program.
“The NIMH (National Institute of Mental Health) suggested grantees with evaluation interest and experience,” notes David Litts, O.D., retired USAF colonel and now with the Suicide Prevention Resource Center (SPRC) in Newton, Mass. “The team from the University of Rochester found this project particularly interesting.”
The U of R research team analyzed data collected from 1990 to 2002 by the Air Force on its active-duty airmen, reviewing suicide rates among about 350,000 active duty men and women before and after the Air Force implemented the program. Researchers studied all airmen and not just those at high risk for suicide, which is the more typical approach.
Research published in the BMJ reports on the first six years of this ongoing USAF program and shows the following:
- Suicides decreased 33 percent
- Severe family violence declined 54 percent
- Homicides dropped 51 percent
- Accidental deaths declined 18 percent
“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,” says Knox. “The Air Force was successful in that they reached out to all folks instead of just those identified at high risk. We believe key lessons from this program could be adapted to other workplaces including police and fire departments, large corporations, schools, universities and even small countries.”
The University of Rochester study of the USAF program
"Risk of suicide and related adverse outcomes after exposure to a suicide prevention programme in the US Air Force: cohort study." Knox KL, Litts DA, Talcott GW, Feig JC, Caine ED. British Medical Journal. 13 Dec 2003; 327 (7428).
Correspondence to K L Knox Kerry_knox@urmc.rochester.edu
