Rochester Medicine

No One Left Behind: U.S. Air Force Rolls Out Suicide-Prevention Technique to Every Base in the World

Aug. 14, 2023
URMC Program Takes a Radical New Approach

For decades, the problem has grown worse—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.

A University of Rochester Medical Center program is taking a different approach to address the problem. The Wingman-Connect research trial ran for nearly a decade at an Air Force base in Wichita Falls, Texas. The results were so impressive, the Air Force is now putting $5 million behind expanding the program to all of its 68 bases around the world.

What makes Wingman-Connect so unique is its focus on the source. It harnesses the power of groups and social networks to prevent thoughts of suicide before they ever occur.

The intervention is projected to reach more than half a million airmen (the Air Force term for its members) by 2035.

Peter Wyman-2
Peter Wyman, PhD

The even bigger promise of the program is that it can apply to other settings.

“For a suicidal individual, being embedded within a cohesive, healthy social network can be the difference between life-saving hope and despair,” said Peter A. Wyman, PhD, co-director of the Center for the Study and Prevention of Suicide (CSPS) at URMC, and founder and director of the Wingman-Connect program.

In recently funded work, Wyman’s team is adapting the program to first-responder groups and predominantly Black churches. So far, these efforts have gone well. Versatility could prove to be the program’s biggest breakthrough.

A Vital Discovery

The success of Wingman-Connect is especially significant because the problem has proven so resistant to change.

“If you think of suicide as the tip of the iceberg, something isn’t working well,” said 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. The problem is, most suicides occur in people not identified as high risk.

So it was absolutely necessary to go back to the drawing board. In doing so, Wyman’s group made an important discovery. Suicide-preventive coping skills are most often learned from close-knit peers.

In a radical departure from most suicide prevention efforts, Wingman-Connect builds suicide protection directly into military social networks.

By strengthening the members and connections within a small peer network, vulnerable members can “borrow strength” from the others during times of need.

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

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” said Wyman. “And so we don’t say, ‘Hey, come to anti-suicide training.’ That’s not a strong motivator. We say, ‘Come to career-enhancement training.’”

Wyman conducted a randomized trial with 1,485 airmen in 215 training classes. The study, published in JAMA Network Open in 2020, found that Wingman-Connect 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.

Wingman-Connect wasn’t designed specifically for airmen at greater risk of suicide, but people in 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,” said Ian Cero, PhD, 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.”

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

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

Finding Wingmen Through Sharing


A remarkable aspect of Wingman-Connect’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,” said core research member Anthony R. Pisani, PhD, professor of Psychiatry.

One goal of the training is to ensure that everyone leaves with at least two valued colleagues. Trainees discover that they have a wingman. And, typically, more than one.

In videotaped comments, Airman Tyler Wilkey said: “I learned that you have to have a balance in life. If you don’t get that balance, then everything just falls apart. And it did fall apart once or twice since I’ve been in, but I had my friend to back me up whenever I needed him.”

Airman Tarzis Lobos said the interactivity made the training more effective, prompting him to open up and share with the other trainees.

“At certain times you feel very alone,” he said. “You need those bonds, people who can pull you out of your room so you’re not just sitting and stewing in your sadness but can get you out there so you can see brightness again.”

Using Contagious Attitudes for Good

The success of Wingman-Connect has led the team to further adapt the program to reach other groups in need.

“Schools, workplaces, faith and other community organizations provide most people with some opportunity to become part of a social network,” Wyman said.

It is well established that peers hold tremendous power over each other, so Wyman decided to make use of that as a force for change.

“Rather than bemoaning this fact, it actually offers immense opportunity to capture and leverage peer group influence for prevention and health,” Wyman said. “Just as suicide can be contagious, so too can be the attitudes and behaviors that counter suicide and help people thrive.”

Wyman’s team collaborated with Sherry Molock, PhD, of George Washington University and Sidney Hankerson, MD, of Mount Sinai in New York City to adapt the Connect strategies to address the increasing suicide rate of Black adolescents.

The Haven-Connect program is now being tested in a dozen predominantly Black churches in Rochester and Harlem.

Pastor Johnson
Pastor Fredrick Johnson

Pastor Fredrick Johnson of the First Genesis Baptist Church in the city of Rochester said he hopes the training will help heal the damage that lingers since the darkest days of the pandemic.

So far, Johnson has heard only positive comments from the teens and adult church members who have gone through the training.

They appreciate the engaging, group-bonding activities that replace the standard method of dispensing advice via slide shows. Some teens who were introverted or disruptive began to alter their behavior after the training.

“I think there’s a hunger of many young folks looking for healthy, engaging relationships,” Johnson said. “This program creates an environment of healthy, supportive interaction. And it’s not just for those in crisis mode but for those who are ready to shift paths. It gives them tools.”

Another new expansion is the Connect program for New York State police officers, which so far has been implemented in Albany, Mamaroneck, and Port Chester, with support from the New York State Office of Mental Health. Wyman said it has been well received by the officers.

Positivity is one component that sets Wingman-Connect and its offshoots apart from other prevention programs.

“Other trainings focus on the negative effects that come from stressors,” said Airman Destiny Garner, “whereas Wingman-Connect, I believe, is focused on—it’s in the name—building that connection.”