No One Left Behind

By Sandra Parker

In recent decades, military suicide rates have increased substantially. Suicides now account for 25 percent of all active-duty military deaths, and rates in the Air Force have risen even faster than other military branches. Since 2015, the Air Force has lost more members to suicide than to combat.

That same year, a University of Rochester Medical Center program of the Center for the Study and Prevention of Suicide (CSPS) launched at an Air Force base in Wichita Falls, Texas. That in itself was noteworthy—research trials between universities and the military are rare. But this intervention also took a decidedly different approach.

Peter A. Wyman (Flw ’88, PhD ’87, MA ’84), co-director of the CSPS, founded and directed the Wingman-Connect program as proactive, “upstream” prevention aimed at the source. It would work to harness the power of groups and social networks to prevent thoughts of suicide before they ever occurred.

After nearly a decade of deployment, the program’s results have been impressive—impressive enough for the Air Force to expand the program to all 68 bases around the world. The Air Force’s $5 million contract will allow Wyman and core members Anthony R. Pisani, PhD (Flw ’03) and Bryan Yates (BA ’13) to update the curriculum and develop resources for a large-scale rollout that is projected to reach more than half a million airmen (the Air Force term for all of its members) by 2035.

Their success is especially significant because the problem has proven stubbornly resistant to change, despite unprecedented increases in funding to support military suicide prevention.

“If you think of suicide as the tip of the iceberg, something isn’t working well,” says Eric D. Caine, MD, a long-time member of the research team measuring results. “Suicide is the uppermost weathervane for how a service is doing.”

Most other programs present information about suicide warning signs and adopt a reactive approach by identifying and treating people at risk. But one chilling statistic explained the need for something more: Most suicides occur in people not identified as high risk. So it was absolutely necessary to go back to the drawing board and “build a better aircraft.”

In doing so, Wyman’s group made an important discovery. Suicide-preventive coping skills are most often learned from close-knit peers who are readily accessible and share values.

In a radical departure from the standard suicide prevention paradigm, Wingman-Connect builds suicide protection directly into military social networks. By strengthening all members and connections within a small peer network, vulnerable members can “borrow strength” from the others during times of need.

Members of one Air Force cohort in the program learned the importance of keeping fellow airmen from isolating too much.

“For a suicidal individual, being embedded within a cohesive, healthy social network can be the difference between life-saving hope and despair,” Wyman says.

The promise of this approach is that it can apply to other settings. In recently funded work, Wyman’s team is adapting the program to other groups that are high priorities in suicide prevention. As testament to the versatility of the “Connect” model, new projects have begun in predominantly Black churches and also first-responder groups.

So far, these efforts have gone well. Versatility could prove to be the model’s biggest breakthrough.

Career Goals = Health Goals

Wyman’s gold-standard, randomizedcontrolled trial at Sheppard Air Force Base in Wichita Falls assessed the program for first-term airmen.

“Typically, military suicide prevention programs have been rolled out with minimal testing,” says Wyman, “and that’s part of why this problem has been so hard to resolve. And so conducting a rigorous randomized trial of this program is both important and rarely done.”

Wyman obtained a $4 million grant in 2014 from the Department of Defense to create Wingman-Connect for the Air Force and roll it out over a five-year period. He selected four core principles—kinship, purpose, guidance, and balance—based on research showing that they’re key to health, mental health, and career success. And he made the strategic decision to promote the training primarily as a means to improve overall health and career success.

“Our initial work showed that airmen are highly motivated to achieve their career goals, and this was the key incentive to getting them engaged” says Wyman. “And so we don’t say, ‘Hey, come to anti-suicide training.’ That’s not a strong motivator. We say, ‘Come to careerenhancement training.’ ”

To test the program, Wyman conducted a special cluster randomized trial, which randomly assigns whole groups rather than individuals. Participants were 1,485 airmen in 215 training classes. Half were enrolled in Wingman-Connect (three blocks of two hours each), using interactive, group-facilitated sessions and sharing of personal examples to build cohesion.

The other half, the control group, received training designed to mimic standard military mental health resilience training. This included a two-hour stress management program using passive learning through slide shows, videos, and discussions. Afterward, both groups received a one-hour refresher session and follow-up text messages.

The study, published in JAMA Network Open in 2020, found that WingmanConnect, in comparison to the stress management program, significantly reduced the severity of suicide-risk scores, depression symptoms, and work-related issues. And the effects were still apparent in follow-up contact six months later.

It’s not just about stemming individual negative behaviors, but also about building positive group connections and practices that serve as a strong foundation of healthy norms. The study reported gains on multiple suicideprotective factors: “cohesion, morale, bonds to classmates, and perceptions that members support healthy behaviors.”

In follow-ups, airmen in the WingmanConnect program were 20 percent less likely to report elevated depression symptoms than those who participated in the stress management program.

And they were 50 percent less likely to report significant incidents of occupational problems such as corrective job training.

Borrowed Strength

Wingman-Connect was not designed specifically for airmen at elevated suicide risk, but analysis showed that those who entered the program already at risk for suicide experienced the greatest benefit.

“For airmen who were at elevated risk for suicide, their isolation tends to worsen over time, and this is a known risk factor for suicide,” according to Ian Cero (Flw ’21), a member of the research team. “Wingman-Connect, in contrast, counteracted this expected drift, increasing the number of new connections that vulnerable airmen made to members of their unit.”

Ian Cero

Cero and Wyman published these findings in 2022 in Social Science and Medicine. Cero says the most surprising thing about these findings is that Wingman-Connect increased the number of healthy airmen who said they were connected to vulnerable members, even though the training provides no specific direction to connect with at-risk peers.

In the control group, however, 10 percent of vulnerable airmen remained isolated, reporting no connections to classmates at the end of the training.

Wyman says suicides are commonly preceded by “disrupted relationships,” a common issue in the military as members often move far from home. Yet the standard paradigm for preventing suicides doesn’t address disconnection from others, which is a known risk.

“In more connected, healthier units, vulnerable members can borrow strength from adaptive members,” Wyman found.

Participants in Wingman-Connect were significantly more likely to name two classmates as “valued connections,” which was the benchmark for successful unit integration set by the military.

The study validated Wyman’s “network health model”—the idea of strengthening the network so it can strengthen the individual.

How that’s done might come as a surprise to people who have preconceived notions about what the military is like.

A Six-Hour Tour— Yarn Provided

A startling aspect of WingmanConnect’s success is that the program consists of only six hours of actual training: Three two-hour blocks take place over three days, followed by weekly text messages for six months.

It’s also active, as opposed to the traditional—and passive—approach of sitting through slide presentations. Airmen take part in experiential group activities, with a facilitator playing a nuanced role in encouraging the trainees to discover positive strategies from each other.

“The learning happens through personally meaningful sharing,” says Pisani.

Sometimes it involves an empty chair and a ball of blue yarn.

In a departure from the boring icebreaker of going around the room and stating your name, WingmanConnect opens with a version of the musical chairs game. The group of about 40 airmen sit on chairs arranged in a circle. Seven of them volunteer to turn their chairs around and gather in the middle to share their names, hometowns, and reasons for enlisting.

“Airmen sharing their reasons for enlisting increases the personal meaningfulness of the training, and others learn of their values, critical for building strong bonds,” Wyman says.

Then the facilitator asks questions, such as who has ever caught a fish. As the airmen-fishermen rise and come to the middle, others race to fill their empty seats. The game ends when everyone who is willing to share has done so. By the end of the game, almost everyone has shared (no one is forced to share), and the bonds of kinship begin to grow.

In the yarn knot game, pairs are tied together with yarn and need to figure out how to untether themselves without simply pulling off the yarn. There’s a trick to it, which involves working with your partner.

Another game shows that small cracks, not just major ones, can lead to hardship. One person stands on a wooden platform while 12 others grab attached ropes and hoist the platform. They march around the room, supporting the person on the wobbly platform. Then the number of people holding the ropes is gradually reduced, representing the loss of relationships supporting those four principles that are at the core of the program. Things get wobblier as core support diminishes.

After a discussion about stressors, airmen make posters to illustrate what has gotten them through the tough times at Basic Military Training and what helps them manage the stress and challenges in technical school. Some simply write a list, others draw their answers (stick figures abound, and labeling is critical to tell a cat from a rat, but that’s fine—it’s a lesson in bonding, not artistry). The posters explore the program’s core principles: kinship, purpose, guidance, and balance. Airmen begin to see the person behind the uniform, says core member Yates, who serves as one of the facilitators.

The culmination arrives when airmen do a self-assessment of the four core principles. In one session, Yates asks them to share their strategies for managing anger, sadness, and anxiety, focusing on the positive coping mechanisms rather than the challenging emotion itself. Then Yates introduces the idea of sustaining oneself through personal initiative and group support. Rather than offer a list of solutions, Yates asks trainees to share their own strategies and ways they’ve found success in their military careers.

On day two, the seed previously planted has typically germinated. The chair game is repeated, but this time airmen share their favorite healthy activities. The discussion session that follows is about purpose, so they’re asked to share how to turn their initial reasons for enlisting into commitment. After acknowledging difficult issues that arise, such as thoughts of quitting, Yates shifts the focus to the positive by encouraging airmen to share strategies for staying connected to and building their core of purpose.

At this point, a group identity has emerged and, after the day’s training, breakout groups are tasked with devising a plan to build on one of the core strengths. Some build kinship by dining together or working out in the gym. Yates recalls that one participant, Airman Juel Eason, persuaded his group to buy 1980s-style basketball shorts and ride through the base on bicycles. It was a spectacle and great fun.

On the last day, groups fill out a poster listing everyone’s name and strength under at least one of the four principles. Many airmen are surprised at how others in the group view them.

“We often see a real transformation that unifies them in ways we haven’t seen before,” Wyman says.

One airman who had continually voiced her opposition to being at the training announced that she wasn’t strong in any category because she was falling short of her goals. The group strongly disagreed, pointing out that she was motivated and accomplished.

“People in her group weren’t going to let her talk down about herself,” Yates says. “That’s the secret sauce. This training is not just about mindset but behavior. The connections that carry forward from the room are the new protection.”

In an audio recording of one group, a collegial and relaxed dynamic is obvious as airmen enthusiastically call out each other’s names.

“Beamer goes in ‘Guidance’,” one airman says. “He mentors us.” Another chimes in: “He tells us not to stress out.”

Then Mace Beamer himself weighs in cheerfully. “I bring a lot of life experience,” he says.

Other airmen are praised for strengths such as being the voice of reason, or staying focused on values and goals. There is typically a class comedian, the one who “lightens the mood.” Someone else gets a nod in the kinship column for being “the fist-bump god.”