Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training

Key Points Question Does group training to build cohesion, shared purpose, and healthy coping for classes of new US Air Force Airmen reduce suicidal thoughts, depression symptoms, and occupational problems? Findings In this cluster randomized clinical trial of 1485 personnel in 215 training classes, the Wingman-Connect program reduced suicidal ideation, depression symptoms, and occupational problems at 1 month by fostering cohesive, healthy classes. Reduced depression symptoms were maintained through 6 months, and the odds of having elevated depression symptoms were lower (odds ratio, 0.80) at either follow-up point. Meaning Wingman-Connect is the first universal prevention program to reduce suicidal ideation and depression in a general Air Force population.

training (one month later).

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A core concept of Wingman-Connect is that individuals sharing real-world examples of strength helps create a 221 healthy culture. Participants in the training will therefore be invited to contribute to two optional video-recorded public 222 service campaigns. These strength-based campaigns provide opportunities for participants to share a brief "testimonial" about 223 how they maintain and strengthen supportive relationships and other "Four-Cores" of strength. Participants will be informed 224 at the time they are given the option to participate that these strength-based videos: are voluntary; will be sent out to 225 participants in their training cohort (email, text); and will be available to share with other Airmen and family outside the 226 training group via a weblink on Wistia.com. These digital recordings will not contain any sensitive information (all video 227 recordings are reviewed by the PI). These public service campaign videos do not identify anyone as a study participant, could 228 not be used to link any individual to study data, and will be not be retained as data.

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After 1 month, Wingman-connect has a 1 hr. "Booster" session. The Booster has seven modules aimed at reviewing well as self-reported problems with technical training course, we will use multilevel growth models in Mplus (Brown, Costigan, to examine the change in these variables over time. In particular, at the individual level, we will model subject i's response on 548 pertinent measures at time t (baseline, 1 month, 6 months) in the g th workforce group, Y igt , as having a linear growth model that is 549 specified by a random intercept a ig and random slope b ig , Y igt ,= a ig + b ig t + ε igt where the last term is an independent error 550 representing variation of each observation about one's linear trajectory. In this model, the slopes b ig carry the information about 551 intervention effect, and because randomization is at the level of the group, the overall change in symptoms and behaviors due to 552 Wingman-Connect (H g = 1) compared to control (H g = 0), is modeled as b ig = μ + β H g + γ g + ε ig . Here β is the mean difference in 553 slopes for Wingman-Connect versus control, and the two error terms, γ g and ε ig, represent variation across and within groups 554 respectively. The test of change will be based on a Wald-type test of the magnitude of the estimate of β relative to its standard

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These analyses will also examine the interactive effect of intervention by proposed mediator .

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We also plan to conduct additional mediation analyses that clarify how the putative intervention effect is being achieved.

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Specifically, we hypothesize that Wingman-Connect would work when more healthy relationship ties are created and 567 strengthened among those in the same workforce group. These analytic models will allow us to assess how the level of 568 implementation of Wingman-Connect, including its reach to those airmen who are originally on the periphery of the social 569 networks, receive messages and find them useful.

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In all of these analyses, we will handle missing data using full information likelihood methods (FIML), which is known to not members of the DSMC, will be available for each to meeting to provide a progress report of the study, answer 591 questions and receive additional guidance from the DSMC, including requests for additional information.

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The DSMC will meet every six months during the course of the RCT to review interim data, and may 593 schedule additional meetings as needed. In advance of those meetings the members will receive data summarizing

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Along with interim data summary, the chief statistician (Dr. C. Hendricks Brown) will oversee analyses computing 601 whether suicide ideation risk varies by training condition (at each DSM report).

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The DSMC will be informed of any unanticipated problems that may occur during recruitment or 603 participation in training or assessments. The DSMC will also be informed of any adverse advents that may occur 604 (e.g., deaths) and come to the attention of the project team, including those unrelated to study participation. The 605 study team is likely to be aware of adverse events during the 2-4 months that participants are at Sheppard Air Force 606 Base for Technical training, but is unlikely to be aware of deaths or other serious adverse events that occur after 607 participants have transferred to operational air force bases.