Individual and Community and Organizational Factors for Suicide Risk in the USAF

描述（由申请人提供）：2006年，我们通过1 R01 MH075017获得资助，研究美国空军（AF）实施与减少自杀事件之间的关系。为了做到这一点，我们建议将AF人员档案中的个人水平数据与每个感兴趣的协变量联系起来，使用从AF服务开始到自杀事件或非自杀事件的个人水平观察时间。我们从项目一开始就承诺在进行任何分析之前去识别所有数据，以保护所有AF人员的隐私和机密性。我们纳入了许多独立预测因子、协变量和时变因变量。构建这个复杂的数据库是一个比我们预期的要大得多的挑战。我们的时间相关变量包括调动和再调动等转变，以及个人生活的变化（如年龄、职业、婚姻状况、军衔的变化或地点的变化）。进入这个项目，我们知道，最终数据库的质量将取决于我们的能力：(1)获得访问众多AF和国防部的数据源；(2)为所有个人层面的数据制定一个安全的去识别流程；(3)每季度更新个人层面的关键转变和变化。我们花了四年的大部分时间才确信我们已经建立了一个纵向的、连接的数据库，它是安全的，并保护了所有空军人员的机密性和隐私。我们也有一个经过验证的、经验丰富的、整合良好的团队，他们一起完成了这项工作，并计划在得到资助的情况下共同开展这项工作的下一阶段。我们现在已经做好了充分的准备，在自杀研究中开发新的方法方法，利用从2003年开始并可以不断更新的强大且信息丰富的纵向数据。我们已经完成了之前的目标，即研究空军自杀预防计划在整个服务中的实施水平之间的关系，并确定了该计划的哪些组成部分似乎具有最强的效果（Knox KL, Pflanz S, Talcott GW, Campise RL, Lavigne JE, Bajorska A, Tu X, Caine ED）。空军自杀预防计划：对公共卫生政策的影响。美国公共卫生杂志；[Epub出版前：2010年5月13日，10.2105])。我们已经添加了来自多个来源的数据，并且将来有机会利用新的数据源来增强数据库。我们现在已经准备好检查个人、社区和组织因素对房颤自杀风险的影响和相互作用。我们建议通过开发预测模型来做到这一点，并在房颤中实施新的举措来减少自杀。这些新举措的关键是提高房颤人员的复原力和早期识别高风险房颤人员，这仍然是通过预防自杀的公共卫生模式框架提供的。

DESCRIPTION (provided by applicant): 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.