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November 26, 1999 / Vol. 48 / No. 46 - page 3 / 20

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Vol. 48 / No. 46 Suicide — Continued

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bers facing substantial stress receive the care and support of their military unit (i.e., local community), even when the stress stemmed from violating community norms (i.e., Uniform Code of Military Justice [UCMJ]). The team also established policies that required any USAF agency investigating a member to coordinate with unit leaders to ensure that the leaders carried out their gatekeeping role.

Restructuring of Prevention Services

Prevention services on all USAF installations were restructured by establishing a limited psychotherapist-patient privilege to protect members charged under the UCMJ. Mental health providers were mandated to initiate community-based primary prevention, and the USAF integrated the services of the six agencies involved in pre- vention services (mental health, family support centers, child and youth development, health and wellness centers, chaplains, and family advocacy). The six agencies in each geographic community were required to conduct an assessment of the risk for suicide and to develop a coordinated prevention plan with measurable goals.

Surveillance

Gathering suicide data from the USAF population is facilitated by standardized data systems that track each member. Each active duty member’s death is investigated by the USAF Office of Special Investigations, a forensic agency autonomous from the local command authority. Since 1997, USAF suicide data (completions, attempts, and gestures) have been collected in a database that includes demographics, details of the events, use of prevention services before the event, and associated psychological, so- cial, behavior, and economic factors.

From 1994 to 1998, the suicide rate among USAF members decreased significantly, from 16.4 suicides per 100,000 members to 9.4 (p<0.002) (Figure 1). On the basis of the first eight months of 1999, the 1999 estimated rate is 2.2 suicides per 100,000 members—approximately 80% lower than the lowest annual rate since 1980 (Fig- ure 1).*

Reported by: DA Litts, K Moe, CH Roadman, R Janke, J Mille , Suicide Integrated Product Team, United States Air Force, Dept of Defense. Div of Violence Prevention, National Center for Injury Prevention and Control, CDC.

Editorial Note: During 1994–1995, suicide prevention became a USAF priority. Initially, the focus of prevention activities occurred within several major commands; however, this approach was succeeded in 1996 by a servicewide program, whose goals corre- spond to recommendations made by the UN and WHO to governments and local com- munities in developing suicide prevention strategies (2 ). These efforts were temporally associated with a substantial decrease in the suicide rates among active USAF personnel. Suicide rates in the other military services do not demonstrate the sustained decline over the same period (U.S. Army, U.S. Navy, and U.S. Marines, un- published data, 1999) (Figure 2).

The USAF’s approach to suicide prevention emphasized the role of the entire com- munity, not only health care, in reducing and preventing factors thought to contribute to suicide. It also included components that promoted protective factors such as social networks. Readiness to address the suicide problem was established quickly because

*The 1999 rate was estimated by dividing the number of deaths by the number of months of data to get a monthly average and then multiplied by 12 to get an approximate numerator for the annual rate.

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