Scaling Up Implementation Support for Violence Prevention and Resilience Promotion in the Air Force.

Closing the gap between research and practice requires that organizations can consistently incorporate new ideas and best practices. The Department of the Air Force (DAF) Integrated Resilience Directorate is leading a coordinated effort to increase the adoption of evidence-based violence prevention and resilience promotion programs across the entire Department. To support this effort, DAF is using Getting To Outcomes (GTO), an evidence-based implementation support that helps organizations plan, implement, and self-evaluate programs. Thus, the DAF is not only scaling up prevention programs but is also embarking on the largest scale-up of GTO to date. The study team trained personnel from every Air Force installation across the world to use GTO for their programs. Quantitative findings from training questionnaires and ratings of implementation plans as well as qualitative results from resilience personnel interviews suggest some lessons learned for scaling up implementation support. This study builds on established implementation science frameworks for scaling up interventions by identifying critical tasks and unique supports needed to scale up evidence-based prevention. Results suggest GTO helped DAF scale-up prevention across the Department, and that establishing leadership buy-in, simplifying evidence-based program selection and adaptation, monitoring implementation and outcomes, and creating dedicated prevention practitioner roles are critical tasks to support scale-up of evidence-based prevention. Unique supports needed to scale-up evidence-based prevention include multitiered learning systems; integrated tools that improve access to data and evolving evidence; prevention personnel with skills in program management, adaptation, and evaluation; timely crosscutting data; continuous learning to support sustainability; and leadership buy-in.

Pathways to depressive symptoms in young adults: examining affective, self-regulatory, and cognitive vulnerability factors.

Recent models of depression (e.g., from Hyde and colleagues) have integrated affective and cognitive vulnerability factors, positing that a temperamental factor (i.e., negative emotionality) contributes to the development of cognitive vulnerability factors, which in turn conveys risk for depressive symptoms. Recent literature suggests that effortful control may reduce the strength of the relationship between affective and cognitive factors. However, few studies have examined the different cognitive vulnerability factors (cognitive style, brooding, and stress-reactive rumination) through which negative emotionality contributes to depressive symptoms, or how effortful control may influence these paths. 315 young adults (72% women, M age= 20.7 yr., SD = 1.4) answered psychometric measures of temperament factors (negative emotionality and effortful control), and three cognitive vulnerability factors (cognitive style, brooding, stress-reactive rumination), and depressive symptoms. Two hypotheses were tested concerning mediation and moderation of the relationship between negative emotionality and depressive symptoms. Cognitive style and brooding were significant mediators of this relationship, while effortful control did not moderate relations between negative emotionality and cognitive vulnerability factors. Results support models that integrate affective and cognitive vulnerability factors predicting depressive symptoms.

Wingman-Connect Program increases social integration for Air Force personnel at elevated suicide risk: Social network analysis of a cluster RCT.

U.S. military suicides are increasing and disrupted relationships frequently precede them. Group-level interventions are needed that reduce future suicide vulnerability among healthy members and also ameliorate risk among those already suicidal. We examined whether our Wingman-Connect Program (W-CP) strengthened Air Force relationship networks and socially integrated at-risk members. Air Force personnel classes in training were randomized to W-CP or active control (cluster RCT), followed up at 1 and 6 months (94% and 84% retention). Data were collected in 2017-2019 and analyzed in 2020-2021. Participants were 1485 male and female Airmen in 215 technical training classes. W-CP training involved strengthening group bonds, skills for managing career and personal stressors, and diffusion of healthy norms. Active control was stress management training. Primary outcomes were social network metrics based on Airmen nominations of valued classmates after 1 month. Baseline CAT-SS >34 defined elevated suicide risk. W-CP increased social network integration, with largest impact for Airmen already at elevated suicide risk (n = 114, 7.7%). For elevated risk Airmen, W-CP improved all network integration metrics, including 53% average gain in valued connection nominations received from other Airmen (RR = 1.53, 95% CI = 1.12, 2.08) and eliminated isolation. No elevated risk Airmen in W-CP were isolates with no valued connections after 1-month vs. 10% among controls (P < .035). In contrast to at-risk controls, at-risk W-CP Airmen increased connections after intervention. W-CP's effect on a key indicator, ≥2 connections, was still greater 2-4 months after classes disbanded (6-months). Wingman-Connect Program built enhanced suicide protection into unit relationship networks and counteracted standard drift towards disconnection for at-risk Airmen, despite no explicit content targeting connections specifically to at-risk Airmen. Findings support a growing case for the unique contribution of group-level interventions to improve social health of broader military populations while also ameliorating risk among individuals already at elevated suicide risk.

The association between temperament and depressive symptoms in adolescence: brooding and reflection as potential mediators.

This study examined whether rumination subtypes (brooding and reflection) mediated prospective associations between temperament (negative emotionality and positive emotionality) and depressive symptoms in a community sample of 423 adolescents. Effortful control and sex were examined as potential moderators of the mediated pathway. Youth self-reported negative emotionality (NE), positive emotionality (PE), and effortful control (EC) at age 12; brooding and reflection subtypes of rumination at age 14; and depressive symptoms at ages 12, 14, and 15. Hierarchical linear regression analyses indicated that, controlling for initial levels of depressive symptoms, high NE, but not low PE, predicted increases in depressive symptoms from age 12 to age 15. Brooding, but not reflection, mediated the association between NE and depressive symptoms. Neither sex nor EC moderated either indirect pathway in the mediated model. The results confirm and extend previous findings on the association between affective and cognitive vulnerability factors in predicting depressive symptoms in adolescence.

Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training: A Cluster Randomized Clinical Trial.

Importance: Suicide has been a leading manner of death for US Air Force personnel in recent years. Universal prevention programs that reduce suicidal thoughts and behaviors in military populations have not been identified. Objectives: To determine whether the Wingman-Connect program for Airmen-in-training reduces suicidal ideation, depression, and occupational problems compared with a stress management program and to test the underlying network health model positing that cohesive, healthy units are protective against suicidal ideation. Design, Setting, and Participants: This cluster randomized clinical trial was conducted from October 2017 to October 2019 and compared classes of personnel followed up for 6 months. The setting was a US Air Force technical training school, with participants studied to their first base assignment, whether US or international. Participants in 216 classes were randomized, with an 84% retention rate. Data analysis was performed from November 2019 to May 2020. Interventions: The Wingman-Connect program used group skill building for cohesion, shared purpose, and managing career and personal stressors (3 blocks of 2 hours each). Stress management training covered cognitive and behavioral strategies (2 hours). Both conditions had a 1-hour booster session, plus text messages. Main Outcomes and Measures: The primary outcomes were scores on the suicidal ideation and depression scales of the Computerized Adaptive Test for Mental Health and self-reports of military occupational impairment. Class network protective factors hypothesized to mediate the effect of Wingman-Connect were assessed with 4 measures: cohesion assessed perceptions that classmates cooperate, work well together, and support each other; morale was measured with a single item used in other studies with military samples; healthy class norms assessed perceptions of behaviors supported by classmates; and bonds to classmates were assessed by asking each participant to name classmates whom they respect and would choose to spend time with. Results: A total of 215 classes including 1485 individuals (1222 men [82.3%]; mean [SD] age, 20.9 [3.1] years) participated; 748 individuals were enrolled in the Wingman-Connect program and 737 individuals were enrolled in the stress management program. At 1 month, the Wingman-Connect group reported lower suicidal ideation severity (effect size [ES], -0.23; 95% CI, -0.39 to -0.09; P = .001) and depression symptoms (ES, -0.24; 95% CI, -0.41 to -0.08; P = .002) and fewer occupational problems (ES, -0.14; 95% CI, -0.31 to -0.02; P = .02). At 6 months, the Wingman-Connect group reported lower depression symptoms (ES, -0.16; 95% CI, -0.34 to -0.02; P = .03), whereas the difference in suicidal ideation severity was not significant (ES, -0.13; 95% CI, -0.29 to 0.01; P = .06). The number needed to treat to produce 1 fewer participant with elevated depression at either follow-up point was 21. The benefits of the training on occupational problems did not extend past 1 month. The Wingman-Connect program strengthened cohesive, healthy class units, which helped reduce suicidal ideation severity (estimate, -0.035; 95% CI, -0.07 to -0.01; P = .02) and depression symptom scores (estimate, -0.039; 95% CI, -0.07 to -0.01; P = .02) at 1 month. Conclusions and Relevance: Wingman-Connect is the first universal prevention program to reduce suicidal ideation and depression symptoms in a general Air Force population. Group training that builds cohesive, healthy military units is promising for upstream suicide prevention and may be essential for ecological validity. Extension of the program to the operational Air Force is recommended for maintaining continuity and testing the prevention impact on suicidal behavior. Trial Registration: ClinicalTrials.gov Identifier: NCT04067401.

Affective, biological, and cognitive predictors of depressive symptom trajectories in adolescence.

Heterogeneity in the longitudinal course of depressive symptoms was examined using latent growth mixture modeling among a community sample of 382 U.S. youth from ages 11 to 18 (52.1 % female). Three latent trajectory classes were identified: Stable Low (51 %; displayed low depressive symptoms at all assessments), Increasing (37 %; reported low depressive symptoms at age 11, but then significantly higher depressive symptoms than the Stable Low class at ages 13, 15, and 18), and Early High (12 %; reported high early depressive symptoms at age 11, followed by symptoms that declined over time yet remained significantly higher than those of the Stable Low class at ages 13, 15, and 18). By age 15, rates of Major Depressive Disorder diagnoses among the Early High (25.0 %) and Increasing (20.4 %) classes were more than twice that observed among the Stable Low class (8.8 %). Affective (negative affectivity), biological (pubertal timing, sex) and cognitive (cognitive style, rumination) factors were examined as predictors of class membership. Results indicated general risk factors for both high-risk trajectories as well as specific risk factors unique to each trajectory. Being female and high infant negative affectivity predicted membership in the Increasing class. Early puberty, high infant negative affectivity for boys, and high rumination for girls predicted membership in the Early High class. Results highlight the importance of examining heterogeneity in depression trajectories in adolescence as well as simultaneously considering risk factors across multiple domains.