Developing a Research Strategy for Suicide Prevention in the Department of Defense

Status of Current Research, Prioritizing Areas of Need, and Recommendations for Moving Forward

by Rajeev Ramchand, Nicole K. Eberhart, Christopher Guo, Eric R. Pedersen, Terrance Dean Savitsky, Terri Tanielian, Phoenix Voorhies

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Research Questions

  1. What research is currently being conducted on suicide prevention that is directly relevant to military personnel?
  2. How well do these research efforts map to the strategic research needs of the U.S. Department of Defense (DoD) as they relate to suicide prevention?
  3. Do proposed DoD research strategies align with the national research strategy, and are they well integrated with DoD's data collection and program evaluation strategies?

In response to the elevated rate of suicide among U.S. service members, a congressionally mandated task force recommended that the U.S. Department of Defense (DoD) create a unified, comprehensive strategic plan for suicide prevention research to ensure that DoD-funded studies align with DoD's goals. To help meet this objective, a RAND study cataloged the research funded by DoD and other entities that is directly relevant to military personnel, examined the extent to which current research maps to DoD's strategic research needs, and provided recommendations to ensure that proposed research strategies align with the national research strategy and integrate with DoD's data collection and program evaluation strategies. The study found that although DoD is one of the largest U.S. funders of research related to suicide prevention, its current funding priorities do not consistently reflect its research needs. The study indexed each of 12 research goals according to rankings of importance, effectiveness, cultural acceptability, cost, and learning potential provided by experts who participated in a multistep elicitation exercise. The results revealed that research funding is overwhelmingly allocated to prevention goals already considered by experts to be effective. Other goals considered by experts to be important and appropriate for the military context receive relatively little funding and have been the subject of relatively few studies, meaning that there is still much to learn about these strategies. Furthermore, DoD, like other organizations, suffers from a research-to-practice gap. The most promising results from studies funded by DoD and other entities do not always find their way to those responsible for implementing suicide prevention programs that serve military personnel. The RAND study recommended approaches to thoughtfully integrate the latest research findings into DoD's operating procedures to ensure that evidence-based approaches can benefit suicide prevention programs and prevent the further loss of lives to suicide.

Key Findings

DoD Is the Largest Single Funder of Suicide Prevention Research, but Work Being Conducted Outside DoD May Be Relevant to Military Personnel.

  • Suicide prevention research tends to focus on identifying who dies by suicide (i.e., risk and protective factor interactions), psychotherapeutic interventions to treat individuals at risk for suicide (i.e., psychosocial interventions), and ensuring that those at risk can access affordable, accessible, and effective care.
  • DoD could leverage studies conducted elsewhere to support programs that serve military personnel.

DoD and RAND Experts Identified Varying Levels of Effectiveness and Learning Potential Across the Various Suicide Prevention Strategies in DoD.

  • DoD stakeholders and non-DoD experts considered the department's goals for suicide prevention on five grounds: (1) overall importance, (2) effectiveness, (3) cultural acceptability, (4) cost, and (5) learning potential (i.e., the amount that could be learned by pursuing strategies tied to the goals). A multistep assessment provided a more nuanced view of DoD's priorities and gaps in the research.
  • DoD stakeholders ranked gatekeeper training (peer support for suicidal personnel) as important, culturally acceptable, and the least costly but currently not very effective. The RAND experts ranked it as having a high level of learning potential. These factors indicate that DoD should invest in more research on these approaches.

There Is a Gap Between DoD's Needs and Ongoing Research, and There Are Challenges to Translating Research into Practice.

  • DoD, like other organizations, suffers from a research-to-practice gap. The most promising results from studies by DoD and other entities do not always find their way to those responsible for implementing suicide prevention programs that serve military personnel.
  • Leadership buy-in, incentives, increased funding, and evidence of effectiveness can all boost the uptake of new strategies by DoD suicide prevention programs that serve military personnel.

Recommendations

  • DoD leadership should provide guidance for implementing a unified research strategy on suicide prevention and request input from relevant stakeholders. It should also continually evaluate DoD's research priorities in light of new findings, new policies, and new suicide prevention strategies.
  • DoD should prioritize research on promising strategies that have not been the subject of much research. Similarly, it can extend the effectiveness of existing cost-effective strategies by implementing policy changes to make them more culturally acceptable to service members.
  • DoD's funding agencies should make a proactive effort to evaluate the effectiveness of interventions (funded by DoD or another entity) in the military context.
  • To ensure that research funds are allocated efficiently, DoD should establish a central repository to track DoD-wide research on suicide prevention. Funding agencies and the staff who implement suicide prevention programs would also benefit from a centralized way to stay abreast of new research being conducted both within and outside DoD.
  • DoD should encourage formal and informal collaboration across agencies responsible for funding suicide prevention programs to promote the dissemination of new strategies, particularly evidence-based strategies. It should also provide dissemination materials and technical assistance to help organizations implement new approaches or adapt existing ones.
  • To help ensure that suicide prevention research is disseminated into practice, DoD must ensure that it has leadership buy-in when it comes to new approaches and technologies. Those responsible for program implementation should be involved in training their peers to implement new approaches and use new technologies.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Current Suicide Prevention Research in the United States That Is Directly Relevant to Military Personnel

  • Chapter Three

    Prioritizing Research Needs in the U.S. Department of Defense

  • Chapter Four

    Preliminary Gap Analysis

  • Chapter Five

    Modeling DoD's Suicide Prevention Research Priorities

  • Chapter Six

    Translating Research into Practice

  • Chapter Seven

    Recommendations for a Research Strategy

  • Appendix A

    Ongoing Studies of Relevance to Suicide Prevention Among Military Personnel

  • Appendix B

    Alternative Allocation Analysis

  • Appendix C

    Statistical Procedure for Extracting Rankings from the RAND ExpertLens Panel

  • Appendix D

    Feedback from DoD Stakeholders About the RAND ExpertLens Process

  • Appendix E

    Sensitivity Analysis of the Benefit-Cost Index Rankings

  • Appendix F

    Research Domains and Approaches for Assessing Research Quality

This report was sponsored by the National Action Alliance for Suicide Prevention and produced by the RAND National Defense Research Institute.

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