October 26, 2020
2 min read
Wyman reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Fihn reports being deputy editor and Perlis associate editor of JAMA Network Open, but neither was involved in decisions related to the review or acceptance of the editorial.
A universal prevention program effectively reduced suicidal ideation and depression symptoms among a general Air Force population, according to results of a cluster randomized clinical trial published in JAMA Network Open.
“Universal prevention programs have not been identified that reduce suicidal thoughts and behaviors in military populations,” Peter A. Wyman, PhD, of the department of psychiatry at University of Rochester School of Medicine and Dentistry in New York, and colleagues wrote. “Cognitive skill training impacts physical performance, social cognition (e.g., perspective taking), coping and problem solving among U.S. military personnel. Recent testing of coping and interpersonal skill training found no benefits on mental health for Canadian military or Royal Air Force enlistees; investigators of the Royal Air Force study noted that cognitive training may lack ecological validity without addressing unit functioning.”
Wyman and colleagues sought to determine whether Wingman-Connect, a network health suicide and depression prevention program for the United States Air Force, reduced suicidal ideation, depression and occupational problems among Airmen-in-training vs. a stress management program. They also wanted to test whether cohesive, healthy units protected against suicidal ideation. Across 2 years, they compared outcomes of classes of personnel who were followed up for 6 months. The study took place at a U.S. Air Force technical school among 1,485 participants in 215 classes. Wingman-Connect interventions included group skill building for cohesion, shared purpose and managing career and personal stressors in three blocks of 2 hours each, whereas stress management training included cognitive and behavioral strategies in 2-hour sessions. Both conditions incorporated a 1-hour booster session, as well as text messages.
Primary outcomes included scores on the depression and suicidal ideation scales of the Computerized Adaptive Test for Mental Health, as well as military occupational impairment according to self-report. The investigators assessed class network protective factors thought to mediate the effect of Wingman-Connect using four measures: cohesion, morale, healthy class norms and bonds to classmates.
A total of 748 individuals and 737 individuals were enrolled in the Wingman-Connect program and the stress management program, respectively. Results showed lower suicidal ideation severity and depression symptoms, as well as fewer occupational problems, among the Wingman-Connect group at 1 month. Moreover, the Wingman-Connect group reported lower depression symptoms at 6 months, although the difference in suicidal ideation severity was not significant. Wyman and colleagues reported a number needed to treat of 21 to produce one fewer participant with elevated depression at either follow-up point. Training benefits on occupational problems did not extend beyond 1 month. The Wingman-Connect program appeared associated with bolstered cohesive, healthy class units, which played a role in reducing suicidal ideation severity and depression symptom scores at 1 month.
“Further research is recommended to test upward extension into operational Air Force and longer-term impact on preventing suicidal behaviors,” Wyman and colleagues wrote.
In a related editorial, Roy H. Perlis, MD, MSc, of the department of psychiatry at Massachusetts General Hospital and Harvard Medical School, and Stephan D. Fihn, MD, MPH, of the department of medicine at University of Washington, underscored the implications of these findings.
“This study adds to a literature that group-based interventions are effective in reducing
depressive symptoms and may have advantages in resource-constrained environments,” they wrote. “Notably, the study does not actually demonstrate prevention of suicide per se. Whether targeted strategies to reduce suicide are worthwhile, rather than simply developing better treatments for depression, remains to be studied.”