Landmark study gives high marks to AF suicide prevention program

By G.W. Pomeroy
Air Force Surgeon General Public Affairs

WASHINGTON -- A landmark University of Rochester study of suicide in the United States Air Force concluded that the service’s suicide prevention program reduced the risk of suicide by 33 percent during the past six years.

The research was reported in the Dec. 12 British Medical Journal.

"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 model program with every expectation that it can be exported to other settings both large and small," said David Jobes, professor of psychology at The Catholic University of America in Washington, D.C.

“There is nothing that compares with this program,” said Jobes, a past president of the American Association of Suicidology.  "There have never been results quite as striking as these."

The University of Rochester Medical Center analyzed data collected by the Air Force on its active duty personnel from 1990 to 2002.

“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,” said lead author Kerry L. Knox, assistant professor of Community and Preventive Medicine, Division of Epidemiology at the University of Rochester. 

“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,” Knox said.

Knox said that key lessons from the Air Force’s suicide prevention program could be adapted to police and fire departments, large corporations, schools and universities and small countries.

Concerned about the escalating rate at which Air Force active-duty members  were taking their own lives, in 1996 Air Force leaders made suicide prevention a priority.  They established 11 initiatives to decrease the stigma associated with mental health problems, and established a community-based approach in which everyone was invested in taking care of one another.

The Rochester study was the first of its kind in many respects, Knox said.

Although risk factors for suicide are fairly well known, little research exists on what might prevent the tragedy.  Knox and her 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 Air Force rates of suicide, homicide, accidental death and family violence before and after the suicide prevention program was in place in 1996. 

Severe family violence declined the most, 54 percent, while homicides dropped 51 percent, suicides decreased 33 percent and accidental deaths slid 18 percent, according to the study.  Measuring change in social norms is more difficult, but the researchers noted that in a random survey in 1999, 73 percent of Air Force unit commanders were aware of and concerned about suicide prevention.

“Dr. Knox's study illustrates that when an entire community becomes involved, suicide can be reduced," said Lt. Col. Rick Campise, Air Force Suicide Prevention Program manager.

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.

In August, the Air Force’s Suicide Prevention Program was hailed as a “model program” in a report released by the president's New Freedom Commission on Mental Health.

The Air Force uses an integrated system of chaplains and professionals from mental health, family support, child and youth services, health and wellness centers and family advocacy. All of them work together and take responsibility for prevention. This community approach to suicide prevention launched to national prominence in 2001 when then-U.S. Surgeon General Dr. David Satcher made the program a model for the nation and incorporated it into the National Suicide Prevention Strategy.

Suicide rates in the Air Force have declined throughout the last six years. From 1991 to 1996, the active-duty suicide rate was 14.1 per 100,000. From 1997 -- the year in which the suicide prevention program was fully implemented -- through 2002, the annual average was 9.1 per 100,000. The service’s suicide rate in 2002 was 8.3 per 100,000 people -- its second lowest in 20 years.

As of Dec. 11, there had been 34 suicides among active-duty airmen in 2003 -- a rate of 9.9 per 100,000. No suicides were among active-duty airmen deployed in Operation Iraqi Freedom.