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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: https://doi.org/10.1136/bmj.327.7428.1376 (Published 11 December 2003) Cite this as: BMJ 2003;327:1376

Evaluation of suicide prevention programme in US air force did not take account of changing rates of suicide in the general population

 

Evaluation of suicide prevention programme in US air force
did not take account of changing rates of suicide in the general population

 

 

Knox et al report substantial (33%) reductions in suicide in
the six years after a suicide prevention programme for US air force
personnel.(1)  Their analysis does not,
however, take account of temporal changes – or factors influencing such changes
- in the US general population suicide rate in the 7 years before (1990-6) and 6
years after (1997-2002) the intervention.

 

US general population suicide rates in 15-24 and 25- 34 year
olds - the age groups likely to contribute in greatest part to Air force
personnel – fell between 1994 and 2001 (see table). In 15-24 year olds, suicide
rates fell by 19% from a mean of 13.1 per 100,000 in 1990-1996 to 10.6 per
100,000 in 1997-2001. Amongst 25-34 year olds rates fell by 11% from 15.0 to
13.4 per 100,000. This suggests that the observed post-intervention reductions
in suicide may, in part at least, reflect a more general fall in suicide
amongst people of this age

 

Table USA suicide rates per 100,000 for 15-24 and 25-34
year old men and women 1990-2001 (2) 

 

year

15-24 years

25-34 years

1990

13.2

15.2

1991

13.1

15.2

1992

13

14.5

1993

13.5

15.1

1994

13.8

15.4

1995

13.3

15.4

1996

12

14.5

1997

11.4

14.3

1998

11.1

13.8

1999

10.3

13.5

2000

10.4

12.8

2001

9.9

12.8

 

Whilst the theoretical basis for the intervention evaluated
by Knox and colleagues seems sound, any effect on suicide is likely to have
been more modest than they suggest. Explanations for the recent downturn in US
suicide rates amongst young people require investigation as these may
contribute to the currently weak evidence base informing international suicide
prevention strategies.(3,4)

 

1.Knox KL, Litts DA, Talcott GW, Catalano Feig J, CaineED. Risk of suicide and
related adverse outcomes after exposure to a suicide prevention programme in
the US Air Force: cohort study.
BMJ  2003;327:13768

2. http://www.suicidology.org/associations/1045/files/2001datapg.pdf,
(accessed 16 / 12 / 2003)

3. US
Department of Health and Human Services. National Strategy for Suicide
Prevention:  goal and objectives for
action
. Rockville, MD: 2001.

4.
Department of Health National suicide prevention strategy for England.
London: Department of Health, 2002.

 

Competing interests:
None declared

Competing interests:  

19 December 2003
David Gunnell
professor of epidemiology
Dept. Social Medicine, University of Bristol, Canynge Hall, Whiteladies Rd. Bristol BS8 2PR