This application is first and foremost a study of the relationship between implementation and reductions in events of suicide. In 1997, the United States Air Force had fully implemented a complex, multifaceted suicide prevention program. As such, the United States Air Force provides an excellent environment in which to study which components of a multifaceted program are most effective in producing the desired outcomes. While there has been a surge of interest in the role that implementation plays in determining the effectiveness of a program, there are relatively few empirical studies that specifically investigate the relationship between implementation and prevention and/or intervention outcomes. For this study, we have defined five core, functional components of the Air Force Suicide Prevention Program (AFSPP) based on the Eleven Initiatives that have constituted the program since its inception. However, our current understanding of the effectiveness of the AFSPP has been limited to the apparent success of the program based on a nonspecific understanding of the temporal association between implementation of these Eleven Initiatives and declines in events of suicide and other related outcomes. Conducting this study at this time is important for several related reasons. First, on-going programmatic efforts in the Air Force will greatly benefit from attaining a more concrete understanding of the functional components of what has been a very complex, multifaceted program. Second, replication of the AFSPP to new settings is potentially of great scientific value. The Air Force has a good track record with its program, is one of the few community based programs for suicide prevention in a very large population, and may prove to be an exemplary model of service to science. As a sample of the U.S. population the Air Force is comprised of a healthy open cohort, which serves to reduce the selection bias inherent in studies of suicide that utilize clinical or psychiatric samples. As such, our findings may be significant for other relatively healthy populations, including college students and men and women in the middle years of life. However, there is an unresolved but on-going debate about how best to combine the perceived need for fidelity across different sites with sufficient flexibility that permits successful engagement with communities with diverse demographic characteristics and cultural norms. The data from this study will have great significance for the field of mental health prevention in general if we can reach a greater appreciation for which of the core components of the AFSPP can be flexibly translated across sites, while at the same time maintaining the full functionality associated with those components.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Community-Level Health Promotion Study Section (CLHP)
Program Officer
Chambers, David A
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University of Rochester
Public Health & Prev Medicine
Schools of Dentistry
United States
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Conner, Kenneth R; McCarthy, Michael D; Bajorska, Alina et al. (2012) Mood, anxiety, and substance-use disorders and suicide risk in a military population cohort. Suicide Life Threat Behav 42:699-708
Knox, Kerry L; Pflanz, Steven; Talcott, Gerald W et al. (2010) The US Air Force suicide prevention program: implications for public health policy. Am J Public Health 100:2457-63