DAF

Total Force DAF Suicide Death Reviews (CY2018-Present)

Principle Investigator: Marjan G. Holloway, Ph.D.

Co-Investigator: Melissa Mehalick, Ph.D.

Co-Investigator: Erin Cobb, Ph.D.

Sponsor: Department of the Air Force

History

  • The Department of the Air Force Standardized Suicide Fatality Analysis (DAF StandS) is a collaborative effort between DAF and USU to conduct reviews of suicide deaths in all components of the Air Force (Active Duty, Air National Guard, Air Force Reserve, and civilians) to generate actionable recommendations for military suicide prevention, intervention, and postvention.

  • For the past two decades, suicide has been identified as one of the leading causes of death for service members. To improve the ability to collect, analyze, and use surveillance data to inform suicide prevention efforts as recommended by the National and DoD Suicide Prevention Strategies, lead scientists at the Suicide CPR Initiative located USU developed the DoD Standardized Suicide Fatality Analysis (DoD StandS) methodology, in partnership with and funded by the Defense Suicide Prevention Office (DSPO). The DoD StandS framework was finalized in 2020 and pilot tested in 2021. DoD StandS builds upon the invaluable work of prior Service-level suicide death reviews (e.g., suicide analysis boards or “deep dives”) and addresses a significant gap within the military suicide prevention community. The USU-DSPO collaboration on DoD StandS resulted in the first standardized, unified, scientific and public health-driven methodology for the conduct of suicide death reviews across the DoD.

  • In 2021, USU and DAF executed an Interagency Agreement to adapt the Department of Defense Standardized Suicide Fatality Analysis (DoD StandS) for the review of all Calendar Year (CY) 2020 Total Force DAF suicides. 

Purpose

  • The goals of DAF StandS are twofold: 

    • (1) To standardize suicide death review processes to understand DAF Active-Duty, Guard, Reserve, and civilian trajectories toward suicide; and 

    • (2) To generate lessons learned and actionable recommendations for DAF suicide prevention, intervention, and postvention.

  • This project involves a public health, theory-guided suicide death review of Calendar Years 2018 through Present Total Force Department of Air Force (DAF) suicide deaths. Suicide is the culmination of complex interactions between biological, social, economic, cultural, and psychological factors operating at individual, relational, community, and societal levels. 

Current Status:

  • The project is ongoing, currently in the process of receiving CY 2025 suicide death documents for DAF Active Duty, Reserve, National Guard, and civilian personnel to extract data. We will also receive CY 2022, 2023, and 2024 source documents for data collection. CY 2018, 2019, 2020, and 2021 data extraction have been completed. A scientific report and leadership report for CY2020 was written and disseminated in 2023. A report has been written for CY 2021 data and is currently awaiting final approval for dissemination. Data cleaning for CY 2018 is in progress, with 2019 data cleaning to follow.  

Military Relevance

This project fills a critical research and programmatic gap, as the Department of War (DoW) currently does not have a standardized and unified methodology for the review of military suicides using a modified psychological autopsy or root cause analysis strategy. A comprehensive review and analysis of each DAF suicide will allow for the systematic examination of potential contributing factors and identification of lessons learned and actionable recommendations to best advance suicide prevention programmatic efforts and to inform military providers, policy makers, and leaders in their efforts to save lives.

Scholarly Dissemination:

  • Cobb, E., LaCroix, J. M., Grammer, J., Ekman, E., Hill, C., Kunerth, A., Adamson, K., Button, C., & Ghahramanlou-Holloway, M. (2025). An examination of hanging suicide deaths in the United States Air Force. Invited presentation for the Star Behavioral Health Provider Program, Center for Deployment Psychology, Uniformed Services University, May 21, 2025.

  • Drexler, N., Cobb, E., Adamson, K., Kunerth, A., Ekman, E., Hill, C., Wright, M., Button, C., LaCroix, J. M., & Ghahramanlou-Holloway, M. (2025). Adverse childhood experiences and proximal alcohol use in Air Force suicide decedents [Poster Presentation]. Suicide Research Symposium 2025, Virtual.

  • Drexler, N., Cobb, E., Adamson, K., Ekman, E., Hill, C., Button, C., LaCroix, J., Holloway, M. Mental health care utilization among U.S. Air Force suicide decedents [Poster Presentation]. American Psychological Association 2025, Virtual.

  • Wright, M., Cobb, E., Adamson, K., Drexler, N., Kunerth, A., Ekman, E., Hill, C., Button, C., LaCroix, J. M., & Ghahramanlou-Holloway, M. (2025). Lethal means choice and acute alcohol use among U.S. Air Force suicide decedents [Poster Presentation]. Suicide Research Symposium 2025, Virtual.

  • Yockey, M., Dhanraj, N., LaCroix, J., Button, C., Adamson, K., Kunerth, A., Ekman, E., Cobb, E., Lee-Tauler, S., Rowan, A., Robb, S., Moursi, N., Ton, A., Hickam, S., Kang, J., & Ghahramanlou-Holloway, M. (2025). Problematic alcohol use 30-days prior to suicide deaths among active-duty airmen: A medical records review [Poster Presentation]. Suicide Research Symposium 2025, Virtual.

  • Cobb, E., LaCroix, J. M., Grammer, J., Ekman, E., Sala, M., Button, C. J., & Ghahramanlou-Holloway, M. (2024, April). An examination of hanging suicide deaths in the U.S. Air Force during Calendar Year 2020 [Conference presentation]. Presented at the Suicide Research Symposium 2024, Virtual.

Relevant Products And Resources

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A Final Report on findings and recommendations from the CY 2021 DAF Suicide Death Review has been written and approved by DAF and is with USUHS for approval.

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LaCroix, J. M., Ekman, E., Cobb, E., Lee-Tauler, S. Y., Friedman-Wheeler, D. G., Schuler, K., & Ghahramanlou-Holloway, M. (2023). Total Force Department of the Air Force Standardized Suicide Fatality Analysis: Calendar Year 2020 Scientific Report. Bethesda, MD: Uniformed Services University of the Health Sciences, Suicide Care, Prevention, and Research Initiative.

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Ghahramanlou-Holloway, M., LaCroix, J. M., Ekman, E., Cobb, E., & Rowan, A. (2023). 2023 Total Force Department of the Air Force Standardized Suicide Fatality Analysis: Calendar Year 2020 Leadership Report. Bethesda, MD: Uniformed Services University of the Health Sciences, Suicide Care, Prevention, and Research Initiative.

Betz, M. E., Stanley, I. H., Anestis, M. D., Bryan, C. J., Buck-Atkinson, J., Carey, N., Ghahramanlou-Holloway, M., Morrissey, B. H., Holloway, K., Houtsma, C., Kennedy, R., Paine, C. M., Ramchand, R., Simonetti, J., Walsh, A., & Wright-Kelly, E. (2022). Firearm suicide prevention in the U.S. military: Recommendations from a national summit. Military Medicine, 188(9–10), 231–235. https://doi.org/10.1093/milmed/usac371. 

Cox, D. W., Ghahramanlou-Holloway, M., Greene, F. N., Bakalar, J. L., Schendel, C. L., Nademin, M. E., Jobes, D. A., Englert, D. R., & Kindt, M. (2011). Suicide in the United States Air Force: Risk Factors communicated before and at death. Journal of Affective Disorders, 133(3), 398–405. https://doi.org/10.1016/j.jad.2011.05.011. 

Kochanski-Ruscio, K., Nademin, E., Perera, K., LaCroix, J. M., Baer, M., Hassen, H. O., Englert, D., & Ghahramanlou-Holloway, M. (2016). An examination of United States Air Force suicide decedents based on documented suicide attempt histories. Archives of Suicide Research, 21(4), 556–567. https://doi.org/10.1080/13811118.2016.1240635. 

LaCroix, J. M., Walsh, A., Baggett, M. A., Madison Carter, K., & Ghahramanlou‐Holloway, M. (2021). Three department of defense‐funded public health approaches to reduce military suicide. Suicide and Life-Threatening Behavior, 51(2), 334–343. https://doi.org/10.1111/sltb.12709. 

Martin, J. S., Ghahramanlou-Holloway, M., Englert, D. R., Bakalar, J. L., Olsen, C., Nademin, E. M., Jobes, D. A., & Branlund, S. (2013). Marital status, life stressor precipitants, and communications of distress and suicide intent in a sample of United States Air Force Suicide decedents. Archives of Suicide Research, 17(2), 148–160. https://doi.org/10.1080/13811118.2013.776456. 

  • Martin, J. S., Novak, L. A., Perera, K., Olsen, C. H., Kindt, M. T., LaCroix, J. M., Bennion, L., Lee‐Tauler, S. Y., & Ghahramanlou‐Holloway, M. (2019). Suicide typologies in the United States Air Force: A hierarchical cluster analysis. Suicide and Life-Threatening Behavior, 49(6), 1707–1720. https://doi.org/10.1111/sltb.12553. 

Nademin, E., Jobes, D. A., Pflanz, S. E., Jacoby, A. M., Ghahramanlou-Holloway, M., Campise, R., Joiner, T., Wagner, B. M., & Johnson, L. (2008). An investigation of interpersonal-psychological variables in air force suicides: A controlled-comparison study. Archives of Suicide Research, 12(4), 309–326. https://doi.org/10.1080/13811110802324847.