Effectiveness Trial of Wingman-Connect Implemented Across Career Phases

摘要 军事自杀率从2008年到2019年增加了61%，美国空军的自杀率增长更快 美国空军（USAF）与其他军种相比。目前，主要的军事自杀预防方法是 在发现有自杀倾向的人后，尝试补救自杀风险。无RCT验证的通用程序 被证明可以降低自杀倾向。为了填补这一空白，Wingman-Connect计划是一个 基于团体的干预，加强保护性关系网络和职业管理技能， 个人挑战，以减少在广大美国空军人口自杀的脆弱性。这一拟议 混合动力系统-实施试验测试了Wingman-Connect计划的有效性， 个人自杀风险和基层自杀企图。我们将研究理论驱动的调解人， 主持人和美国空军（非研究）人员根据 真实的世界条件跨越2个连续的早期职业生涯阶段。有效性研究是下一个关键阶段 在大规模推广以防止自杀死亡的转化管道中。严格测试 为了提高疗效，我们与美国空军合作伙伴共同开发了一种2阶段随机设计。(1)的第一阶段 随机化将在初始技术培训，其中396类美国空军人员将被 随机分配到Wingman-Connect或主动对照组（N= 2，970名飞行员），并随访一年。这些 这些培训班将很大比例的毕业生送往8个业务基地。(2)第二阶段随机化将 发生在这8个作战基地中，这8个作战基地将被随机成对地在4- 月间隔（阶梯楔形设计）。一旦WC在每个基地启动，所有进入第一学期的 飞行员将接受WC，所有基地共有约17,400名飞行员接受培训。这两个阶段的设计将产生 强有力的多层次有效性调查结果。 目的1：测试WC在降低（a）自我报告的自杀风险和（B）基础水平方面的有效性 自杀企图率。我们将评估（a）自杀风险，抑郁症， 长达1年的职业问题;以及（B）自杀企图的基层行政记录。 目的2：评估理论提出的网络健康调解员和主持人。WC预计将 增加飞行员积极的社会联系、群体凝聚力、士气和健康的社会应对规范 这些变化将有助于减少自杀风险、抑郁症和职业问题。 目标3：审查执行决定因素和机制，并完善执行 包.关键的实施结果将是美国空军实施者的保真度提供WC（n=24-30）， 参与培训/技术支持。实施者的忠诚度和参与度预计将由以下因素预测： 基地实施氛围和WC嵌入到基地通信和支持活动中。

ABSTRACT Military suicide rates increased 61% from 2008 – 2019 and rates have increased faster in the U.S. Air Force (USAF) compared to other branches. Currently, the predominant military suicide prevention approach is to try to remediate suicide risk after suicidal individuals are identified. No RCT-validated universal programs shown to reduce vulnerability to suicide are in wide use. To fill this gap, the Wingman-Connect Program is a group-based intervention that strengthens protective relationship networks and skills for managing career and personal challenges, to reduce vulnerability to suicide across the broad USAF population. This proposed Hybrid Effectiveness-Implementation trial tests the effectiveness of the Wingman-Connect Program on individual suicide risk and on base-level suicide attempts. We will examine theory-driven mediators and moderators and implementation of the program as delivered by US Air Force (not research) personnel under real world conditions across 2 sequential early career phases. This effectiveness study is the critical next stage in the translational pipeline toward large-scale roll-out to prevent suicide deaths. To rigorously test effectiveness, we co-developed with USAF partners a 2-stage randomized design. (1) The first stage of randomization will be at Initial Technical Training, in which 396 classes of USAF personnel will be randomized to Wingman-Connect or to an active control (N=2,970 Airmen) and followed for one year. These classes send a high proportion of graduates to 8 operational bases. (2) The second stage of randomization will occur among these 8 operational bases, which will be randomized in pairs to start implementing WC at 4- month intervals (stepped wedge design). Once WC has been initiated at each base, all entering first-term Airmen will receive WC, with ~17,400 total Airmen trained across all bases. This 2-stage design will yield robust, multi-level effectiveness findings. Aim 1: Test effectiveness of WC on reducing (a) self-reported suicide risk and (b) base-level rates of suicide attempts. We will evaluate (a) individual level outcomes of suicide risk, depression, and occupational problems up to 1 yr; and (b) base-level administrative records of suicide attempts. Aim 2: Evaluate theory-proposed network health mediators and moderators. WC is expected to increase Airmen's positive social bonds, group cohesion, morale, and healthy coping norms in their social networks; those changes will contribute to reduced suicide risk, depression and occupational problems. Aim 3: Examine implementation determinants and mechanisms, and refine Implementation Package. Key implementation outcomes will be USAF implementers' fidelity delivering WC (n=24-30) and engagement in training/technical support. Implementer fidelity and engagement is expected to be predicted by base implementation climate and WC embeddedness into base communications and support activities.