Components of Effective Suicide Prevention in the USAF

说明(申请人提供)：本申请首先是关于自杀事件的实施和减少之间的关系的研究。1997年，美国空军全面实施了一项复杂、多方面的自杀预防计划。因此，美国空军提供了一个很好的环境，可以在其中研究一个多方面计划的哪些组成部分在产生预期结果方面最有效。虽然人们对实施在决定计划有效性方面的作用感兴趣，但专门调查实施与预防和/或干预结果之间关系的实证研究相对较少。在这项研究中，我们定义了空军自杀预防计划(AFSPP)的五个核心功能组成部分，这些组成部分基于自该计划成立以来构成该计划的11项倡议。然而，我们目前对AFSPP有效性的理解仅限于该计划的明显成功，其基础是对这11项倡议的实施与自杀事件和其他相关结果的下降之间的时间关联的非特定理解。在这个时候进行这项研究很重要，有几个相关的原因。首先，空军正在进行的计划努力将极大地受益于对这一非常复杂、多方面的计划的功能组成部分有了更具体的了解。其次，将AFSPP复制到新的环境中具有潜在的重大科学价值。空军的项目有着良好的记录，是为数不多的以社区为基础的、在非常大的人口中预防自杀的项目之一，可能会被证明是服务于科学的典范。作为美国人口的样本，空军由一个健康的开放队列组成，这有助于减少利用临床或精神样本进行自杀研究时固有的选择偏见。因此，我们的发现可能对其他相对健康的人群具有重要意义，包括大学生和中年男性和女性。然而，关于如何最好地将跨不同地点对保真度的感知需求与足够的灵活性结合起来，以便成功地与具有不同人口特征和文化规范的社区接触，存在着一个悬而未决但仍在进行的辩论。如果我们能够更好地理解AFSPP的哪些核心组成部分可以跨网站灵活地翻译，同时保持与这些组成部分相关的全部功能，那么这项研究的数据将对一般的精神健康预防领域具有重大意义。

DESCRIPTION (provided by applicant): 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.