title: Risk of suicide and related adverse outcomes after exposure to a suicide prevention programme in the US Air Force: cohort study.
abstract: OBJECTIVE
  To evaluate the impact of the US Air Force suicide prevention programme on risk of suicide and other outcomes that share underlying risk factors.
  
  
  METHODS
  Cohort study with quasi-experimental design and analysis of cohorts before (1990-6) and after (1997-2002) the intervention.
  
  
  METHODS
  5,260,292 US Air Force personnel (around 84% were men).
  
  
  METHODS
  A multilayered intervention targeted at reducing risk factors and enhancing factors considered protective. The intervention consisted of removing the stigma of seeking help for a mental health or psychosocial problem, enhancing understanding of mental health, and changing policies and social norms.
  
  
  METHODS
  Relative risk reductions (the prevented fraction) for suicide and other outcomes hypothesised to be sensitive to broadly based community prevention efforts, (family violence, accidental death, homicide). Additional outcomes not exclusively associated with suicide were included because of the comprehensiveness of the programme.
  
  
  RESULTS
  Implementation of the programme was associated with a sustained decline in the rate of suicide and other adverse outcomes. A 33% relative risk reduction was observed for suicide after the intervention; reductions for other outcomes ranged from 18-54%.
  
  
  CONCLUSIONS
  A systemic intervention aimed at changing social norms about seeking help and incorporating training in suicide prevention has a considerable impact on promotion of mental health. The impact on adverse outcomes in addition to suicide strengthens the conclusion that the programme was responsible for these reductions in risk.
authors.affiliation: University of Rochester Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, NY 14642, USA. Kerry_knox@urmc.rochester.edu
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Knox
authors.forename: David A
authors.initials: DA
authors.lastname: Litts
authors.forename: G Wayne
authors.initials: GW
authors.lastname: Talcott
authors.forename: Jill Catalano
authors.initials: JC
authors.lastname: Feig
authors.forename: Eric D
authors.initials: ED
authors.lastname: Caine
mesh_terms: D000328:Adult; D000337:Aerospace Medicine; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012307:Risk Factors; D040242:Risk Reduction Behavior; D014481:United States; D014754:Violence / Q000706:statistics & numerical data; D000092864:Suicide Prevention