Prioritizing Prevention: Difference between revisions

Latest revision as of 13:53, 22 July 2026

Dr Peter Wyman describes the import of prioritizing universal approaches to prevention for community mental health.

Prevention works best when it changes the environment people already belong to, rather than waiting to find and treat people once they are already struggling. This is the central argument behind network health approaches to suicide prevention: instead of screening individuals for risk, they strengthen the relationships and group bonds that already exist in a school, workplace, or team.

Dr Peter Wyman explains that a "preventatative intervention" that engages a community as a whole and creates natural networks through shared experience can build protective factors into the community.

Wyman (2014) frames this as a shift toward "upstream" prevention, "modifying... risk and protective processes—before the emergence of suicidal behaviour," a design that "stands in contrast to current youth suicide prevention programming focused on identifying and treating individuals who are already suicidal or at high risk by training adult gatekeepers and screening" (p. S252). The case for this shift is not only conceptual. Wyman (2014) points to specific limits on identify-and-treat strategies, including "limited ability to identify specific individuals who will die by suicide" and "limited evidence that use of usual mental health treatment services will reduce suicide risk" (p. S252). Because these limits are structural, no improvement to an individual-level service resolves them; the population that needs protecting is always larger than the population any screening process will flag.

This is why network health approaches treat the group itself, not the individual, as the target of intervention. In Wyman's (2014) words, "system-level interventions modify social-ecologic contexts, which have risk-protective effects above and beyond individual factors" (p. S252), in plain terms, making a class, team, or unit more cohesive protects everyone in it, including people no one has flagged as at risk.

This logic was tested directly. A cluster randomized trial of the Wingman-Connect programme worked with intact U.S. Air Force training classes rather than individually selected trainees, aiming to "target natural organizational groups to strengthen bonds, cohesion, and adaptive coping norms" (Wyman et al., 2020, Introduction). Benefits were "distributed across personnel with different levels of those problems at baseline," evidence that "diverse personnel benefited from the program illustrates a strength of a universal prevention strategy for military populations with members at low risk and others at higher risk who may not seek mental health services" (Wyman et al., 2020, Discussion). Because the training was built into ordinary occupational skills rather than run alongside them, the authors conclude that "universal prevention programs that support operational and suicide prevention objectives are more likely to be sustained" (Wyman et al., 2020, Discussion). Mediation analysis confirmed that cohesion itself carried the effect: "participants' perceptions of being embedded in a more cohesive, healthy class accounted for significant portions of Wingman-Connect's impact on reducing suicidal ideation and depression symptoms" (Wyman et al., 2020, Results).

Context: Prevention in Schools

Schools matter to prevention because childhood and adolescence are the years when most future risk takes shape. Wyman (2014) notes that "approximately one half of emotional and behavioral disorders that are well-defined risk factors for suicide have onset of symptoms by age 14 years" (p. S252). His model works in two stages: building self-regulation early through "family and school-based programs," then, in adolescence, working through "peer norms" already present in the school (Wyman, 2014, p. S253). In practice, this has meant training student peer leaders to "modify norms through their natural social networks," which "has increased schoolwide help-seeking acceptability, coping norms, and engagement of adults to help suicidal peers" (Wyman, 2014, p. S254). As a whole-school foundation for this kind of work, Positive Behavioral Interventions and Supports improves school climate and behaviour broadly (Santiago-Rosario et al., 2023), though it has not been tested as a suicide-prevention measure specifically.

Context: Prevention among Remote Workers in IT and Technology

No trial has tested a network-cohesion prevention programme with software teams, so this extends the same logic to a population studied only for its risk, not its remedy. Distributed software development shows what erodes when a team splits across sites: work spanning more than one location "take about two and one-half times as long to complete" as collocated work (Herbsleb & Mockus, 2003, Abstract), and separated developers report markedly less "teamness," a gap the authors link to distance disrupting "the usual stages by which individuals become coherent groups or teams" (Herbsleb & Mockus, 2003, Discussion). A large study of Microsoft staff found remote work "caused larger increases for engineers than non-engineers" in messaging and calls, "reflective of the fact that software development teams are particularly reliant on informal communication" once carried face to face (Yang et al., 2022, Results), the cohesion Wingman-Connect targets, untested here.

References

Herbsleb, J. D., & Mockus, A. (2003). An empirical study of speed and communication in globally distributed software development. IEEE Transactions on Software Engineering, 29(6), 481–494. https://doi.org/10.1109/TSE.2003.1205177

Santiago-Rosario, M. R., McIntosh, K., Izzard, S., Cohen Lissman, D., & Calhoun, E. (2023). Is positive behavioral interventions and supports (PBIS) an evidence-based practice? Center on PBIS, University of Oregon. https://www.researchgate.net/publication/375487373_Is_Positive_Behavioral_Interventions_and_Supports_PBIS_an_Evidence-Based_Practice

Wyman, P. A. (2014). Developmental approach to prevent adolescent suicides: Research pathways to effective upstream preventive interventions. American Journal of Preventive Medicine, 47(3, Suppl. 2), S251–S256. https://doi.org/10.1016/j.amepre.2014.05.039

Wyman, P. A., Pisani, A. R., Brown, C. H., Yates, B., Morgan-DeVelder, L., Schmeelk-Cone, K., Gibbons, R. D., Caine, E. D., Petrova, M., Neal-Walden, T., Linkh, D. J., Matteson, A., Simonson, J., & Pflanz, S. E. (2020). Effect of the Wingman-Connect upstream suicide prevention program for Air Force personnel in training: A cluster randomized clinical trial. JAMA Network Open, 3(11), e2022532. https://doi.org/10.1001/jamanetworkopen.2020.22532

Yang, L., Holtz, D., Jaffe, S., Suri, S., Sinha, S., Weston, J., Joyce, C., Shah, N., Sherman, K., Hecht, B., & Teevan, J. (2022). The effects of remote work on collaboration among information workers. Nature Human Behaviour, 6, 43–54. https://doi.org/10.1038/s41562-021-01196-4

@@ Line 1: / Line 1: @@
-=== '''Upstream prevention is necessary'''. ===
+[[File:Universal Prevention.mp4|thumb|Dr Peter Wyman describes the import of prioritizing universal approaches to prevention for community mental health.]]
-[[File:Universal Prevention.mp4|thumb|Dr Peter Wyman describes the import of prioritizing universal approaches to prevention for community mental health.]]An appeal to logic will suggest that prevention is, in fact, the most effective way to prevent many mental health issues. [citation needed]. Social Network Health approaches, which emphasize community relationships, are suited for prevention by nature and design. Network health interventions target natural organizational groups to strengthen bonds, cohesion, and adaptive coping norms, all of which are proven targets for upstream suicide prevention. The side effects of focusing on prevention are, in sum, positive for entire community mental health. In the absence of effective screeners, or risk indicators available through diagnosis, broad based prevention reaches an entire community to reduce risk factors and increase protective factors.[citation needed]  Preventive Interventions delivered in social systems are therefore the only likely way to reach most community members who are in need.
+Prevention works best when it changes the environment people already belong to, rather than waiting to find and treat people once they are already struggling. This is the central argument behind network health approaches to suicide prevention: instead of screening individuals for risk, they strengthen the relationships and group bonds that already exist in a school, workplace, or team.
 [[File:Prevention or Intervention.mp4|thumb|Dr Peter Wyman explains that a "preventatative intervention" that engages a community as a whole and creates natural networks through shared experience can build protective factors into the community.|left]]
-Most existing intervention programming focuses on detecting and remediating risk after suicidal individuals are identified.<sup> </sup> Although a critical part of an integrated system of care, that approach is insufficient on its own. According to Wyman (2020), using a network health framework, that  strengthens  positive social bonds and building healthy norms that incentivize adaptive coping, is a prevention model that has shows promising benefits. Expanding the focus on modifying “upstream” risk and protective processes—before the emergence of suicidal behavior—stands in contrast to current prevention programming focused on adult gatekeepers and screening after risks are identified. (Wyman 2014)
+Wyman (2014) frames this as a shift toward "upstream" prevention, "modifying... risk and protective processes—before the emergence of suicidal behaviour," a design that "stands in contrast to current youth suicide prevention programming focused on identifying and treating individuals who are already suicidal or at high risk by training adult gatekeepers and screening" (p. S252). The case for this shift is not only conceptual. Wyman (2014) points to specific limits on identify-and-treat strategies, including "limited ability to identify specific individuals who will die by suicide" and "limited evidence that use of usual mental health treatment services will reduce suicide risk" (p. S252). Because these limits are structural, no improvement to an individual-level service resolves them; the population that needs protecting is always larger than the population any screening process will flag.
-Upstream interventions, delivered through social systems in childhood and early adolescence, have the potential for reducing population-level suicide rates. By decreasing the number of adolescents with mental emotional and behavioral problems, as well as creating social environments that expose adolescents to positive coping norms, increase youth-adult connections, and reducing the impact adverse experiences. (Wyman 2014) Childhood and adolescence are key suicide “prevention window” periods. Approximately one half of emotional and behavioral disorders that are well-defined risk factors for suicide have onset of symptoms by age 14 years.
+This is why network health approaches treat the group itself, not the individual, as the target of intervention. In Wyman's (2014) words, "system-level interventions modify social-ecologic contexts, which have risk-protective effects above and beyond individual factors" (p. S252), in plain terms, making a class, team, or unit more cohesive protects everyone in it, including people no one has flagged as at risk.
-=== Research References to integrate: ===
+This logic was tested directly. A cluster randomized trial of the Wingman-Connect programme worked with intact U.S. Air Force training classes rather than individually selected trainees, aiming to "target natural organizational groups to strengthen bonds, cohesion, and adaptive coping norms" (Wyman et al., 2020, Introduction). Benefits were "distributed across personnel with different levels of those problems at baseline," evidence that "diverse personnel benefited from the program illustrates a strength of a universal prevention strategy for military populations with members at low risk and others at higher risk who may not seek mental health services" (Wyman et al., 2020, Discussion). Because the training was built into ordinary occupational skills rather than run alongside them, the authors conclude that "universal prevention programs that support operational and suicide prevention objectives are more likely to be sustained" (Wyman et al., 2020, Discussion). Mediation analysis confirmed that cohesion itself carried the effect: "participants' perceptions of being embedded in a more cohesive, healthy class accounted for significant portions of Wingman-Connect's impact on reducing suicidal ideation and depression symptoms" (Wyman et al., 2020, Results).
-[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578767/#:~:text=That%20diverse%20personnel%20benefited%20from%20the%20program%20illustrates%20a%20strength%20of%20a%20universal%20prevention%20strategy%20for%20military%20populations%20with%20members%20at%20low%20risk%20and%20others%20at%20higher%20risk%20who%20may%20not%20seek%20mental%20health%20services. 1] - That diverse personnel benefited from the program illustrates a strength of a universal prevention strategy for military populations with members at low risk and others at higher risk who may not seek mental health services.
-[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578767/#:~:text=The%20dual%20benefits,to%20be%20sustained. 2] - The dual benefits for occupational functioning and mental health underline a strength of upstream prevention implemented before the detection of serious suicidal behavior: skills that strengthened the trainee’s capability to meet job-related challenges also reduced depression and suicidal ideation. Universal prevention programs that support operational and suicide prevention objectives are more likely to be sustained.
+=== '''Context: Prevention in Schools''' ===
+Schools matter to prevention because childhood and adolescence are the years when most future risk takes shape. Wyman (2014) notes that "approximately one half of emotional and behavioral disorders that are well-defined risk factors for suicide have onset of symptoms by age 14 years" (p. S252). His model works in two stages: building self-regulation early through "family and school-based programs," then, in adolescence, working through "peer norms" already present in the school (Wyman, 2014, p. S253). In practice, this has meant training student peer leaders to "modify norms through their natural social networks," which "has increased schoolwide help-seeking acceptability, coping norms, and engagement of adults to help suicidal peers" (Wyman, 2014, p. S254). As a whole-school foundation for this kind of work, Positive Behavioral Interventions and Supports improves school climate and behaviour broadly (Santiago-Rosario et al., 2023), though it has not been tested as a suicide-prevention measure specifically.
-'''Prevention in schools:'''
+=== '''Context: Prevention among Remote Workers in IT and Technology''' ===
+No trial has tested a network-cohesion prevention programme with software teams, so this extends the same logic to a population studied only for its risk, not its remedy. Distributed software development shows what erodes when a team splits across sites: work spanning more than one location "take about two and one-half times as long to complete" as collocated work (Herbsleb & Mockus, 2003, Abstract), and separated developers report markedly less "teamness," a gap the authors link to distance disrupting "the usual stages by which individuals become coherent groups or teams" (Herbsleb & Mockus, 2003, Discussion). A large study of Microsoft staff found remote work "caused larger increases for engineers than non-engineers" in messaging and calls, "reflective of the fact that software development teams are particularly reliant on informal communication" once carried face to face (Yang et al., 2022, Results), the cohesion Wingman-Connect targets, untested here.
-Modern conceptions of mental health have transitioned from a predominantly problem reduction focus to a wellness promotion focus (Suldo & Shaffer, 2008). Thus, rather than exclusively targeting symptom reduction in individuals with mental illness, mental health services have gravitated towards prevention services that promote general wellness of the population (Prinz & Sanders, 2007). To attend to these issues, school-wide interventions based on the public health prevention model emerged in schools, most notably in the form of positive behavior interventions and support (PBIS; Smith, Molina, Massetti, Waschbush, & Pelham, 2007). Tier 1 systems, data, and practices support everyone across all settings. They establish the foundation for delivering regular, proactive support and preventing unwanted behaviors.
+=== '''References''' ===
+Herbsleb, J. D., & Mockus, A. (2003). An empirical study of speed and communication in globally distributed software development. ''IEEE Transactions on Software Engineering, 29''(6), 481–494. <nowiki>https://doi.org/10.1109/TSE.2003.1205177</nowiki>
+Santiago-Rosario, M. R., McIntosh, K., Izzard, S., Cohen Lissman, D., & Calhoun, E. (2023). ''Is positive behavioral interventions and supports (PBIS) an evidence-based practice?'' Center on PBIS, University of Oregon. <nowiki>https://www.researchgate.net/publication/375487373_Is_Positive_Behavioral_Interventions_and_Supports_PBIS_an_Evidence-Based_Practice</nowiki>
-'''Peer-adult network structure and suicide attempts in 38 high schools: implications for network-informed suicide prevention (10,291 students)  '''
+Wyman, P. A. (2014). Developmental approach to prevent adolescent suicides: Research pathways to effective upstream preventive interventions. ''American Journal of Preventive Medicine, 47''(3, Suppl. 2), S251–S256. <nowiki>https://doi.org/10.1016/j.amepre.2014.05.039</nowiki>
+Wyman, P. A., Pisani, A. R., Brown, C. H., Yates, B., Morgan-DeVelder, L., Schmeelk-Cone, K., Gibbons, R. D., Caine, E. D., Petrova, M., Neal-Walden, T., Linkh, D. J., Matteson, A., Simonson, J., & Pflanz, S. E. (2020). Effect of the Wingman-Connect upstream suicide prevention program for Air Force personnel in training: A cluster randomized clinical trial. ''JAMA Network Open, 3''(11), e2022532. <nowiki>https://doi.org/10.1001/jamanetworkopen.2020.22532</nowiki>
+Yang, L., Holtz, D., Jaffe, S., Suri, S., Sinha, S., Weston, J., Joyce, C., Shah, N., Sherman, K., Hecht, B., & Teevan, J. (2022). The effects of remote work on collaboration among information workers. ''Nature Human Behaviour, 6'', 43–54. <nowiki>https://doi.org/10.1038/s41562-021-01196-4</nowiki>
-'''Journal of Child Psychology and Psychiatry *: * (2019), Peter A. Wyman, Trevor A. Pickering, Anthony R. Pisani, et al.'''
-'''Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training.  A Cluster Randomized Clinical Trial'''
-'''JAMA Open Network, October, 2020'''