Suicidal Ideation
Conditions
Brief summary
A study evaluating a training program to decrease risk for suicidal thoughts and behaviors among early career trainees in the United States Air Force.
Detailed description
Relationship disruptions and social isolation are major precipitants for military suicides and a range of problems that impair functioning and reduce mission readiness. However, nearly all current military suicide prevention programming focuses on a narrow range of approaches for individuals already at high-risk (e.g., training to detect warning signs and refer for treatment services). This project addresses the need for universal prevention approaches to proactively strengthen protective factors across military populations, including strengthening social connectedness and skills to grow and sustain relationships across service. The aims of this project are to (a) develop an intervention for early-career, enlisted United States Air Force personnel using an active training approach to strengthening social bonds, and (b) test the intervention (i.e., Wingman-Connect) using a randomized controlled trial design. Wingman-Connect focuses on Airman-in-Training to build protective factors in: Kinship (healthy bonds); Guidance (support from mentors and mental health); Purpose (goals, sense of being valued and valuable); and Balance (self-care and support). Half of the training is focused on the class as a group to build belonging and shared purpose.
Interventions
BEHAVIORALWingman Connect
Wingman-Connect combines group and individual skill training. Group exercises build cohesion, belonging and shared purpose, and promote value of healthy unit, giving and receiving support. Individual skills promote the ability to thrive during transitions, manage stressors and meet career goals, and decrease barriers to utilizing organizational resources (family, health). The training has a total of 22 modules comprised of specific learning objectives and activities. Six months of text messages (1-2 per week) to reinforce and extend program concepts and skills.
BEHAVIORALStress Management
Stress management training reviews the basics of the hypothalamic-pituitary-adrenal axis stress-response system; common experiences of stress (physiological, cognitive, emotional); the impact of chronic stress on the brain and other domains of health; how exercise reduces harmful effects of stress; and relaxation techniques that have been shown to reduce stress and adverse effects of stress on health. Additional modules review the physiological stress response and effects of stress on health; introduces how cognition influences stress responses; common cognitive distortions/attributions are reviewed that affect stress including strategies to strengthen protective cognitive responses. Six months of text messages (1-2 per week) to reinforce and extend program concepts and skills.
Sponsors
United States Department of Defense
University of Rochester
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
The study design will involve randomizing approximately 1440 Airman-in-Training (AiT) within 160 Technical Training classes to one of two conditions: Wingman-Connect or a brief Stress Management training. Randomization will occur at the class level, since Wingman-Connect is designed to train AiTs within a class together as a group (those who voluntarily enroll).
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Airmen-in-Training (AiT) in Technical Training classes in the 365 or 363 Training Squadrons of the 82 Training Wing (82 TRW) * Eligible classes must be between 37-91 class days in length
Exclusion criteria
* Airmen from other countries receiving training in US * Airmen who are not in their first year of enlistment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean Computerized Adaptive Testing for Suicide Severity | 6 months | Participants will complete a computerized adaptive test for suicide severity. Participants will answer questions about their mental health. Participant scores will range from 0-100 with 100 indicating higher likelihood of current suicidal ideation and higher risk for suicide attempt. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean Computerized Adaptive Testing for Depression | 6 months | Participants will complete a computerized adaptive test for depression. Participants will answer questions about their mental health. Participant scores will range from 0-100 with 100 indicating higher risk for clinical depression. |
| Computerized Adaptive Testing for Depression | 1 month | Participants will complete a computerized adaptive test for depression. Participants will answer questions about their mental health. Participant scores will range from 0-100 with 100 indicating higher risk for clinical depression. |
| Mean Behavioral Occupational Performance Outcomes | 6 months | Participants will complete 5 yes/no questions about job performance, including if superior has expressed concerns about work performance, if Airman has received corrective training for substandard performance, received a negative counseling statement, received a Letter of Reprimand. The sum of affirmative responses will be calculated. Scores will range from 0-5 with 5 indicating greater work impairment. |
| Mean Class Cohesion | 1 month | Participants will complete a 3-item scale on how well members of their class cooperate, can depend on each other and stand up for each other. Scores range from 0 to 4 with higher scores indicating higher class cohesion. |
| Mean Number of Positive Connections to Classmates | 1 month | Participants will be asked to name up to 5 other students in their class who they respect and would choose to spend time with. Participants can name 0-5 classmates. |
Countries
United States
Participant flow
Recruitment details
Recruitment of classes was staggered over 16 months-Oct 2017 - Jan 2019-with classes matched. Clusters of class units within training squadron were formed over time as they became available, selected to maximize balance (e.g., AFSC), and randomized to one of two training conditions.
Participants by arm
| Arm | Count |
|---|---|
| Wingman Connect Wingman-Connect total training time is 5 hours, typically spread over three consecutive training 'blocks'(or days), plus 1-hour of booster training (one month later).
Wingman Connect: Wingman-Connect combines group and individual skill training. Group exercises build cohesion, belonging and shared purpose, and promote value of healthy unit, giving and receiving support. Individual skills promote the ability to thrive during transitions, manage stressors and meet career goals, and decrease barriers to utilizing organizational resources (family, health). The training has a total of 22 modules comprised of specific learning objectives and activities. Six months of text messages (1-2 per week) to reinforce and extend program concepts and skills. | 746 |
| Stress Management The control training condition will consist of a 2 hr. informational training that provides an overview of the human stress response system and strategies to manage stress.
Stress Management: Stress management training reviews the basics of the hypothalamic-pituitary-adrenal axis stress-response system; common experiences of stress (physiological, cognitive, emotional); the impact of chronic stress on the brain and other domains of health; how exercise reduces harmful effects of stress; and relaxation techniques that have been shown to reduce stress and adverse effects of stress on health. Additional modules review the physiological stress response and effects of stress on health; introduces how cognition influences stress responses; common cognitive distortions/attributions are reviewed that affect stress including strategies to strengthen protective cognitive responses. Six months of text messages (1-2 per week) to reinforce and extend program concepts and skills. | 735 |
| Total | 1,481 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | no data provided | 1 | 0 |
| Overall Study | Withdrawal by Subject | 7 | 0 |
Baseline characteristics
| Characteristic | Wingman Connect | Stress Management | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 746 Participants | 735 Participants | 1481 Participants |
| Age, Continuous | 20.96 years STANDARD_DEVIATION 3.255 | 20.87 years STANDARD_DEVIATION 3.019 | 20.92 years STANDARD_DEVIATION 3.14 |
| Educational Background Associates Degree | 72 Participants | 87 Participants | 159 Participants |
| Educational Background Bachelor's Degree or higher | 47 Participants | 54 Participants | 101 Participants |
| Educational Background GED | 30 Participants | 23 Participants | 53 Participants |
| Educational Background High School Diploma | 597 Participants | 571 Participants | 1168 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 137 Participants | 154 Participants | 291 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 608 Participants | 581 Participants | 1189 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants | 0 Participants | 1 Participants |
| Military Component Active Duty | 617 Participants | 596 Participants | 1213 Participants |
| Military Component National Guard | 92 Participants | 90 Participants | 182 Participants |
| Military Component Reserves | 37 Participants | 49 Participants | 86 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 6 Participants | 5 Participants | 11 Participants |
| Race (NIH/OMB) Asian | 31 Participants | 31 Participants | 62 Participants |
| Race (NIH/OMB) Black or African American | 91 Participants | 83 Participants | 174 Participants |
| Race (NIH/OMB) More than one race | 59 Participants | 72 Participants | 131 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 9 Participants | 10 Participants | 19 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 52 Participants | 51 Participants | 103 Participants |
| Race (NIH/OMB) White | 498 Participants | 483 Participants | 981 Participants |
| Sex: Female, Male Female | 128 Participants | 125 Participants | 253 Participants |
| Sex: Female, Male Male | 616 Participants | 606 Participants | 1222 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 748 | 0 / 737 |
| other Total, other adverse events | 0 / 748 | 0 / 737 |
| serious Total, serious adverse events | 0 / 748 | 0 / 737 |
Outcome results
Primary
Mean Computerized Adaptive Testing for Suicide Severity
Participants will complete a computerized adaptive test for suicide severity. Participants will answer questions about their mental health. Participant scores will range from 0-100 with 100 indicating higher likelihood of current suicidal ideation and higher risk for suicide attempt.
Time frame: 1 month
Population: Some participants completed the main survey, but not the computerized adaptive test section.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Wingman Connect | Mean Computerized Adaptive Testing for Suicide Severity | 11.05 units on a scale | Standard Deviation 13.25 |
| Stress Management | Mean Computerized Adaptive Testing for Suicide Severity | 13.43 units on a scale | Standard Deviation 13.94 |
p-value: 0.00195% CI: [-0.39, -0.09]Mixed Models Analysis
Primary
Mean Computerized Adaptive Testing for Suicide Severity
Participants will complete a computerized adaptive test for suicide severity. Participants will answer questions about their mental health. Participant scores will range from 0-100 with 100 indicating higher likelihood of current suicidal ideation and higher risk for suicide attempt.
Time frame: 6 months
Population: Some participants completed the main survey, but not the computerized adaptive test section.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Wingman Connect | Mean Computerized Adaptive Testing for Suicide Severity | 10.76 units on a scale | Standard Deviation 13.87 |
| Stress Management | Mean Computerized Adaptive Testing for Suicide Severity | 12.12 units on a scale | Standard Deviation 13.5 |
p-value: 0.06295% CI: [-0.29, 0.01]Mixed Models Analysis
Secondary
Computerized Adaptive Testing for Depression
Participants will complete a computerized adaptive test for depression. Participants will answer questions about their mental health. Participant scores will range from 0-100 with 100 indicating higher risk for clinical depression.
Time frame: 1 month
Population: Some participants completed the main survey, but not the computerized adaptive test section.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Wingman Connect | Computerized Adaptive Testing for Depression | 15.42 units on a scale | Standard Deviation 16.93 |
| Stress Management | Computerized Adaptive Testing for Depression | 18.38 units on a scale | Standard Deviation 16.87 |
p-value: 0.00295% CI: [-0.41, -0.08]Mixed Models Analysis
Secondary
Mean Behavioral Occupational Performance Outcomes
Participants will complete 5 yes/no questions about job performance, including if superior has expressed concerns about work performance, if Airman has received corrective training for substandard performance, received a negative counseling statement, received a Letter of Reprimand. The sum of affirmative responses will be calculated. Scores will range from 0-5 with 5 indicating greater work impairment.
Time frame: 6 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Wingman Connect | Mean Behavioral Occupational Performance Outcomes | 0.29 units on a scale | Standard Deviation 0.93 |
| Stress Management | Mean Behavioral Occupational Performance Outcomes | 0.28 units on a scale | Standard Deviation 0.94 |
p-value: 0.82195% CI: [-0.12, 0.11]Mixed Models Analysis
Secondary
Mean Behavioral Occupational Performance Outcomes
Participants will complete 5 yes/no questions about job performance, including if superior has expressed concerns about work performance, if Airman has received corrective training for substandard performance, received a negative counseling statement, received a Letter of Reprimand. The sum of affirmative responses will be calculated. Scores will range from 0-5 with 5 indicating greater work impairment.
Time frame: 1 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Wingman Connect | Mean Behavioral Occupational Performance Outcomes | 0.17 units on a scale | Standard Deviation 0.62 |
| Stress Management | Mean Behavioral Occupational Performance Outcomes | 0.25 units on a scale | Standard Deviation 0.73 |
p-value: 0.02495% CI: [-0.31, -0.02]Mixed Models Analysis
Secondary
Mean Class Cohesion
Participants will complete a 3-item scale on how well members of their class cooperate, can depend on each other and stand up for each other. Scores range from 0 to 4 with higher scores indicating higher class cohesion.
Time frame: 1 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Wingman Connect | Mean Class Cohesion | 3.16 units on a scale | Standard Deviation 0.72 |
| Stress Management | Mean Class Cohesion | 3.05 units on a scale | Standard Deviation 0.75 |
p-value: 0.01295% CI: [0.04, 0.29]Mixed Models Analysis
Secondary
Mean Computerized Adaptive Testing for Depression
Participants will complete a computerized adaptive test for depression. Participants will answer questions about their mental health. Participant scores will range from 0-100 with 100 indicating higher risk for clinical depression.
Time frame: 6 months
Population: Some participants completed the main survey, but not the computerized adaptive test section.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Wingman Connect | Mean Computerized Adaptive Testing for Depression | 13.36 units on a scale | Standard Deviation 17.18 |
| Stress Management | Mean Computerized Adaptive Testing for Depression | 15.64 units on a scale | Standard Deviation 15.21 |
p-value: 0.02795% CI: [-0.34, -0.02]Mixed Models Analysis
Secondary
Mean Number of Positive Connections to Classmates
Participants will be asked to name up to 5 other students in their class who they respect and would choose to spend time with. Participants can name 0-5 classmates.
Time frame: 1 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Wingman Connect | Mean Number of Positive Connections to Classmates | 2.08 classmates | Standard Deviation 1.61 |
| Stress Management | Mean Number of Positive Connections to Classmates | 1.83 classmates | Standard Deviation 1.56 |
p-value: 0.0195% CI: [0.05, 0.35]Mixed Models Analysis