Intended for healthcare professionals


Risk of suicide and related adverse outcomes after exposure to a suicide prevention programme in the US Air Force: cohort study

BMJ 2003; 327 doi: (Published 11 December 2003) Cite this as: BMJ 2003;327:1376

Delgardonian psychocivilising of the armed forces?

It is difficult to know what if anything to make of this study (1).
There are no controls. Many important metabolic variables, including
alcohol and drug abuse, smoking, diabetes, immunisations, medications and
exposure to environmental mitochondrial toxins, have not been considered.
Not even the risk factors cited by the authors appear to have been
considered by appropriate statistical means. An interesting observation in
this very large cohort of US Air Force employees is that the risk of
suicide appears to be linked to the risks of homicide, accidents and
family violence. This adds weight to the evidence suggesting that all
psychiatric disorders including violent behavioural disorders might be
the products of an intracerebral energy deficit (2,3).

I became interested in depression and other mental disorders in the
evolution of a thirty-year interest in the pathogensesis of stress
ulceration which I have come to realise is the product of a intramucosal
"energy deficit", a term coined by Menguy and Masters in 1976 (4). It was
the relevance of a tissue energy deficit to head injuries that ultimately
lead to my interest in the mental consequences of an intracerebral energy

In short the likelihood of developing an intracerebral energy deficit
would seem to increase as the delivery and uptake of oxygen decreases. By
releasing cytokines, which have been observed in enterocytes to decrease
oxygen uptake by decreasing NAD(+)/NADH pool size, and in other tissues to
uncouple oxidative phosphorylation and promote the generation of free
radicals by converting xanthine dehydrogenase to xanthine oxidase,
immunisations can be expected to increase the likelihood of developing an
intracerebral energy deficit. By impairing oxidative phosphorylation any
mitochondrial toxins in air, water and/or food, some of which might have
come from weapons used in training or combat, might also cause or
contribute to the development of an intracerebral energy deficit.

"Fundamental to the approach taken by the Air Force [in this study]
was the understanding that only through reducing stigma ["in many cultures
surrounding psychosocial or mental health problems, which deters
individuals from seeking help"] could its community save lives"(1). This
statement alarms me because it raises the possibility that this study was
commissioned by the authors's superiors and the manuscript screened by
them before submission for publication. [If so this would present a
serious conflict of interest].

The intent of the US Air Force might conceivably have been obtaining
data to justify their creation of Delgardonian psychocivilised armed
forces and even extending it to include civilian society especially in
disadvantaged communities where homicide and family violence are every day
events. The statement is particularly alarming if these behavioural
problems are the products of an intracerebral energy deficit as has been
proposed and if psychotropic drugs, which in themselves may cause an
energy deficit, are be added to support the Air Force's Delgardonian

In disadvantaged communities an intracerebral energy deficit might be
caused covertly by malnutrition and/or cytokine release induced by gut
mucosal injury from infestations with parasites. In advantaged communities
it might be caused covertly by drugs are administered to prevent acute
cardiaovascular and cerebrovascular events. Indeed the administration of
some of these drugs have been found in prospective studies to be
associated with an increased risk of violent behaviour and accidents.

Let us hope that the Air Force will consider these possiblities
before using these data to justify having implemented their Delgardonian
programme and extending it to other armed forces and even civilian
populations. Let us further hope that the data have not been doctored by
covert means with political intent without the authors's knowledge and/or
consent. I have good reason to believe that this is a very real

1. Kerry L Knox, David A Litts, G Wayne Talcott, Jill Catalano
Feig, Eric D Caine. Risk of suicide and related adverse outcomes after
exposure to a suicide prevention programme in the US Air Force: cohort
study. BMJ 2003;327:1376 (13 December), doi:10.1136/bmj.327.7428.1376
2.Debbie A Lawlor, George Davey Smith, and Shah Ebrahim.
Association of insulin resistance with depression: cross sectional
findings from the British women's heart and health study
BMJ 2003; 327: 1383-1384 (Electronic response).
3. Patrick Bracken and Philip Thomas Time to move beyond the mind-body
BMJ 2002; 325: 1433-1434 (Electronic responses).
4. Menguy R, Masters YF. Mechanism of stress ulcer: influence of sodium
taurocholate on gastric mucosal energy metabolism during hemorrhagic shock
and on mitochondrial respiration and ATPase in gastric mucosa.
Am J Dig Dis. 1976 Dec;21(12):1001-7.

Competing interests:
I was fired by the Department of Veteran Affairs after a brief tenure as Chief of Surgery in a VA hospital

Competing interests: No competing interests

17 December 2003
Richard G Fiddian-Green