@article{ref1,
title="Suicide behavior results from the U.S. Army's Suicide Prevention Leadership Tool Study: the behavioral health readiness and suicide risk reduction review (R4)",
journal="Military medicine",
year="2022",
author="Curley, Ltc Justin M. and Duffy, Farifteh F. and Kim, Paul Y. and Clarke-Walper, Kristina M. and Riviere, Lyndon A. and Wilk, Joshua E.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="INTRODUCTION: The U.S. Army developed a new tool called the Behavioral Health Readiness and Suicide Risk Reduction Review (R4) for suicide prevention. A 12-month evaluation study with the primary objective of testing the hypothesis (H1) that Army units receiving R4 would demonstrate improved outcomes in suicidal-behavior measures following the intervention, relative to control, was then conducted. The results of analyses to answer H1 are herein presented. <br><br>MATERIALS AND METHODS: The R4 intervention (R4-tools/instructions/orientation) evaluation study, Institutional Review Board approved and conducted in May 2019-June 2020, drew samples from two U.S. Army divisions and employed a repeated measurement in pre-/post-quasi-experimental design, including a nonequivalent, but comparable, business-as-usual control. Intervention effectiveness was evaluated using self-report responses to suicide-related measures (Suicide Behaviors Questionnaire-Revised/total-suicide behaviors/ideations/plans/attempts/non-suicidal self-injuries) at 6-/12-month intervals. Analyses examined baseline to follow-up linked and cross-sectional cohorts, incidence/prevalence, and intervention higher-/lower-use R4 subanalyses. <br><br>RESULTS: Both divisions demonstrated favorable in-study reductions in total-suicide burden, with relatively equivalent trends for total-suicide behaviors, total-suicide risk (Suicide Behaviors Questionnaire-Revised), suicidal ideations, and non-suicidal self-injuries. Although both demonstrated reductions in suicide plans, the control showed a more robust trend. Neither division demonstrated a significant reduction in suicide attempts, but subgroup analyses showed a significant reduction in pre-coronavirus disease 2019-attempt incidence among those with higher-use R4 relative to control. <br><br>CONCLUSIONS: There is no evidence of harm associated with the R4 intervention. R4 effectiveness as a function of R4 itself requires confirmatory study. R4 is judged an improvement (no evidence of harm + weak evidence of effectiveness) over the status quo (no safety data or effectiveness studies) with regard to tool-based decision-making support for suicide prevention in the U.S. Army.<p /> <p>Language: en</p>",
language="en",
issn="0026-4075",
doi="10.1093/milmed/usac169",
url="http://dx.doi.org/10.1093/milmed/usac169"
}