In 2006 we were funded through 1 R01 MH075017 to study the relationship between implementation and reductions in events of suicide in the United States Air Force (AF). In order to do that, we proposed to link individual level data from the AF personnel files for each of the covariates of interest using individual level observations on time from the beginning of service in the AF to an event or non-event of suicide. We were committed from the beginning of the project to de-identifying all data to protect the privacy and confidentiality of all AF personnel before conducting any analyses. We included a number of independent predictors, covariates and time varying dependent variables. Construction of this complex database turned out to be a much greater challenge than we could have ever anticipated. Our time dependent variables include transitions such as deployment and redeployment as well as changes in an individual's life (e.g. age, occupation, marital status, a change in rank, or a change in location). Going into this project, we knew that ultimately the quality of the database would lie in our ability to (1) Obtain access to numerous AF and Department of Defense Data Sources;(2) Develop a secure process for de-identification of all individual level data and (3) Update critical transitions and changes on individual level on a quarterly basis. It took us the better part of four years to feel confident that we had produced a longitudinal, linked database that is secure, and protects the confidentiality and privacy of all Ar Force personnel. We also have a proven, experienced, well-integrated team that has accomplished this work together, and plans to pursue the next phase of this work together if it were to be funded. We are now extremely well poised to pursue the development of new methodological approaches in suicide research, utilizing this powerful and informative longitudinal data with a cohort that starts in 2003 and can be continually updated. We have accomplished our previous aims related to examining the relationship between the level of implementation of the Air Force Suicide Prevention Program across the entire service and have identified which components of the program appear to have the strongest effect (Knox KL, Pflanz S, Talcott GW, Campise RL, Lavigne JE, Bajorska A, Tu X, Caine ED. The Air Force Suicide Prevention Program: Implications for public health policy. American Journal of Public Health;[Epub ahead of print: May 13, 2010, 10.2105]). We have added data from multiple sources and have the opportunity in the future to utilize new data sources to enhance the database. We now are ideally poised to examine the effects and interactions of individual, community and organizational factors on the risk of suicide in the AF. We propose to do this through developing predictive models, using the implementation of new initiatives in the AF to reduce suicide. Key to these new initiatives is to increase resilience in AF personnel and early identification of high risk AF personnel, still delivered through the framework of a public health model of suicide prevention.
This study will provide novel ways of thinking about suicidal behavior and avenues for its prevention through innovative research methods. It is based on our work for over 12 years in the United States Air Force studying the only population based suicide prevention program based on a public health approach that has been sustained for over 15 years, and has been shown to reduce rates of suicide.
|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|