Correction to “What is known about suicide prevention gatekeeper training and directions for future research”

Adolescent suicide is a pressing concern in Guyana, a low-to middle-income country in South America with the highest adolescent suicide rate globally. Gatekeeper trainings for suicide prevention conducted in high-income countries have been found to increase knowledge of suicide prevention, increase referrals of at-risk youth, and reduce stigma toward help-seeking for suicidality. The current study sought to engage in a pilot examination of the effectiveness, acceptability, and feasibility of a culturally informed gatekeeper training suicide prevention program for Guyanese youth. Secondary school teachers and staff ( N = 16) were trained in a culturally informed, evidence-based gatekeeper suicide prevention program. Mixed methods analyses revealed significant increases in knowledge of suicide prevention, as well as decreases in rigid or judgmental attitudes toward suicide post-training among secondary school teachers and staff. Further, results indicated that participants deemed the program culturally acceptable and feasible for use in the school setting. Findings have implications for the delivery and implementation of culturally informed gatekeeper training programs for suicide prevention in low-to middle-income countries.

Suicide prevention training that teaches skills to support a person experiencing thoughts of suicide and create community support networks, often termed, "gatekeeper" training (GKT), has been a longstanding pillar of international, national, and local suicide prevention efforts. GKT aims to improve knowledge, attitudes, and self-efficacy in identifying individuals at risk for suicide, hopefully enhancing one's willingness and ability to intervene with a person experiencing a crisis. However, little is known about GKT's effectiveness in creating the essential behavior change (e.g., increase in intervening behaviors) it sets out to accomplish. This paper explores the history and theoretical background of GKT, reviews the current state of research on GKT, and provides framing and recommendations for next steps to advance research and practice around GKT. Through positioning GKT appropriately within the field of suicide prevention, we argue that the field of suicide prevention needs more rigorous research around GKT that includes long-term follow-up data on usage of skills learned during training, data on outcomes of those who have received an intervention from a trained gatekeeper, and the integration of implementation science to further our understanding of which trainings are appropriate for which helpers.

The majority of individuals experiencing depression or in crisis do not seek assistance through formal support pathways. Thus, the presence of informal "gatekeepers" in the community is vital to identifying and supporting these individuals through crisis. The objective of this study was to evaluate the longitudinal effectiveness of "SafeTALK" suicide prevention gatekeeper training in a general community sample. Two hundred and sixty-two community members participated in half-day (4-h) gatekeeper training sessions. Surveys were taken pre- and post-training and at 6-month follow-up to evaluate participants' knowledge, preparedness, and efficacy, as well as reluctance to intervene as a suicide prevention gatekeeper. Longitudinal effects were revealed for three of four evaluated appraisals. Scores for knowledge, preparedness, and efficacy were significantly higher (improved) 6months after training, compared to pre-test. While participants showed even greater immediate effects (i.e., pre-test to post-test), follow-up scores indicate that the positive effects of training were sustained over 6months. This study is the first to evaluate SafeTALK in a community population. SafeTALK was shown to be effective at improving knowledge, preparedness, and efficacy with effects declining over time but remaining significant from pre-test. Community suicide prevention programs can benefit from the inclusion of gatekeeper training programs.

Clinical providers and “front line” nonclinical staff who work with veterans, families, and communities are natural gatekeepers to identify and to refer veterans at risk for suicide. A national cohort (n = 602) of community based counseling center staff from the U.S. Department of Veterans Affairs (VA) participated in an evaluation of a brief standardized gatekeeper training program and a scripted behavioral rehearsal practice session. A significant difference in knowledge and self efficacy was observed from pre to post (p < .0001) with the nonclinicians showing larger effect sizes for knowledge (0.96 vs. 0.42) and self efficacy (0.89 vs. 0.41). Gatekeeper training for suicide prevention shows promise for increasing the capacity of VA staff to work with at risk veterans.

Suicide prevention remains a challenge across communities in North America and abroad. We examine a suicide prevention effort that is widely used, termed gatekeeper training. There are 2 aims: review the state of the evidence on gatekeeper training for suicide prevention, and propose directions for further research. Studies were identified by searching MEDLINE (PubMed) and PsycINFO from inception to the present for the key words suicide, suicide prevention, and gatekeeper. In addition, a manual scan of relevant articles' bibliographies was undertaken. Gatekeeper training has been implemented and studied in many populations, including military personnel, public school staff, peer helpers, clinicians, and Aboriginal people. This type of training has been shown to positively affect the knowledge, skills, and attitudes of trainees regarding suicide prevention. Large-scale cohort studies in military personnel and physicians have reported promising results with a significant reduction in suicidal ideation, suicide attempts, and deaths by suicide. Gatekeeper training is successful at imparting knowledge, building skills, and molding the attitudes of trainees; however, more work needs to be done on longevity of these traits and referral patterns of gatekeepers. There is a need for randomized controlled trials. In addition, the unique effect of gatekeeper training on suicide rates needs to be fully elucidated.

For college students, suicide is the second leading cause of death. In this study, we evaluated a gatekeeper training suicide prevention program that em-phasizes emotional connectivity with students in crisis and incorporates the collaborative efforts between Housing/Residential Programs and the Counsel-ing Center. Participants consisted of graduate and resident assistants. Very significant gains were found from pre-training to post-training and from pre-training to three-month follow-up in knowledge, skills, and emotional connectivi-ty. Two years of data will be presented.

Suicide prevention gatekeeper training (GKT) is considered an important component of an overall suicide-prevention strategy. The primary aim of this study was to conduct the first robust review of systematic reviews of GKT to examine the overall effectiveness of GKT on knowledge, self-efficacy, attitudes, behavioral intentions, and behavioral change. The study also examined the extent to which outcomes were retained long term, the frequency of refresher sessions, and the effectiveness of GKT with Indigenous populations and e-learning delivery. For this review of reviews, MEDLINE, PsycINFO, Embase; and the Cochrane Database of Systematic Reviews were searched. ROBIS was applied to assess risk of bias and findings were synthesized using narrative synthesis. Six systematic reviews were included comprising 61 studies, of which only 10 were randomized controlled trials (RCTs). Immediate positive effects of GKT on knowledge, skills, and self-efficacy were confirmed, including for interventions tailored for Indigenous communities. Evidence was mixed for change in attitude; few studies measured e-learning GKT, retention of outcomes, booster sessions, behavioral intentions, and behavioral change, with some positive results. Evidence supports the immediate effects of GKT but highlights a need for more high-quality RCTs, particularly for Indigenous and e-learning GKT. This review identified a concerning lack of long-term follow-up assessments at multiple time points, which could capture behavioral change and a significant gap in studies focused on post-training interventions that maintain GKT effects over time.

As part of an evaluation component of a youth suicide prevention, a quasi-experimental repeated measures design tested hypotheses about two brief suicide prevention gatekeeper trainings (Question, Persuade, Refer [QPR] and RESPONSE) and one longer suicide intervention skills training (Applied Suicide Intervention Skills Training [ASIST]). All three trainings showed large changes in prevention attitudes and self-efficacy, largely maintained at follow-up. ASIST trainees had large increases in asking at-risk youth about suicide at follow-up. Convergent with other research, modeling and role-play in training are crucial to increased prevention behaviors. Practice and research implications are discussed, including social work roles in suicide prevention and research.

This study examines the efficacy of a gatekeeper training for suicide prevention among diverse at-risk populations in Israel. One hundred and ninety-three participants, engaging with adolescents, LGBTQ individuals, and the elderly, underwent a four-hour gatekeeper training session, conducted online or in-person. Pre- and post-training self-report questionnaires assessed attitudes toward suicide, perceived knowledge and ability to assist individuals in suicidal distress. Significant improvements were observed in all measures across genders and at-risk populations, with no group differences. An interaction revealed greater knowledge improvement for men. Both training formats demonstrated equivalent effectiveness. Attitudes toward suicide, perceived knowledge, and ability to assist a person in distress were improved. Therefore, incorporating suicide prevention community gatekeeper training for diverse at-risk populations, irrespective of gender, is vital for reducing suicide-related deaths. Online training offers cost-effective options. Future studies should include follow-up assessments for sustained effects.

BackgroundSuicide is a critical public health problem around the globe. Asian populations are characterized by elevated suicide rates and a tendency to seek social support from family and friends over mental health professionals. Gatekeeper training programs have been developed to train frontline individuals in behaviors that assist at-risk individuals in obtaining mental health treatment. The purpose of this study is to assess the efficacy of a brief, multi-component gatekeeper intervention in promoting suicide prevention in a high-risk Asian community in the United States.MethodsWe adapted an evidence-based gatekeeper training into a two-hour, multi-modal and interactive event for Japanese-Americans and related stakeholders. Then we evaluated the intervention compared to an attention control using mixed methods.ResultsA sample of 106 community members participated in the study. Intervention participants (n = 85) showed significant increases in all three types of intended gatekeeper behavior, all four measures of self-efficacy, and both measures of social norms relevant to suicide prevention, while the control group (n = 48) showed no significant improvements. Additional results showed significantly higher satisfaction and no adverse experiences associated with the gatekeeper training. The separate collection of qualitative data, and integration with the quantitative survey constructs confirmed and expanded understanding about the benefits of the intervention.ConclusionsA brief, multi-modal gatekeeper training is efficacious in promoting positive gatekeeper behaviors and self-efficacy for suicide prevention in an at-risk ethnic minority population of Japanese Americans.

Background: Gatekeeper training remains fundamental to broad suicide prevention strategies. In this descriptive study, Question, Persuade, Refer, an evidence-based suicide prevention gatekeeper training program, was implemented community-wide in a state among the highest for suicide in the United States. Objective: To describe and compare cohort pre-post responses to suicide prevention gatekeeper training. Methods: Quantitative and qualitative data were collected from 2013 to 2016 utilizing pre-post training surveys (n=894). Results: Quantitative results were statistically significant (p<0.0001) with little between-cohort variance. Significant differences in pre-post ratings concerned ‘how to ask about suicide’, ‘how to persuade someone to receive help’ and ‘information about resources’. Post-survey qualitative results revealed a main theme of ‘appreciating learning about suicide prevention’. Conclusion: Findings from the ethnically homogenous sample are consistent with other research outcomes, adding to understandings from the few other published community-wide gatekeeper studies. Of note is that gatekeeper training is feasible, beneficial and cost-effective aligning with international and national initiatives. Future research is needed on the sustainability of gatekeeper training outcomes over time and its’ impact on suicide rates.

BackgroundThe gatekeeper training is designed to help identify suicidal individuals, respond to suicidal ideation and refer to help. The internationally widely used training shows promising results. This is the first study presenting its effectiveness in the Netherlands and the first study investigating the effect in different employment sectors.MethodsIn an observational study, 113 Suicide Prevention – the Dutch suicide prevention expertise centre and lifeline - trained 526 professionals as gatekeepers. Changes in gatekeepers’ identifying and referral behaviour, knowledge of suicide prevention and skills-confidence were studied, using a pre-post (6 weeks after training) self-report questionnaire. Outcomes were analyzed with General Linear Model (GLM) repeated measures with four employment sectors (healthcare-, educational-, socioeconomic and other sectors) as a between-subjects factor.ResultsPre-post self-reports of 174 respondents showed no change in the identification of suicidal people, referrals to the general practitioner (GP) or lifeline 113, but significant improvement in professionals’ knowledge and confidence (p < .001). Results did not differ between employment sectors.ConclusionsThe gatekeeper training significantly increases suicide prevention knowledge and skills confidence in abilities to address suicidality. Healthcare, education, socioeconomic and other professionals (e.g. security, justice, transport, church workers) benefit similarly from the training. Increasing the number of gatekeeper training programs in all sectors is recommended.

Web-based training programs have advantages such as increased scheduling flexibility and decreased training costs. Yet the feasibility of applying them to injury prevention programs such as suicide prevention gatekeeper training has not been empirically verified. Two studies were conducted to assess the feasibility and effectiveness of a web-based version of the Question, Persuade, and Refer (QPR) gatekeeper training program. Results of Study 1 revealed that participants in a web-based training demonstrated significant gains in knowledge of suicide prevention, self-efficacy for suicide prevention, and behavioral intentions to engage in suicide prevention, as compared to those in a control group. Results of Study 2 further showed that the web-based training may be as effective as the face-to-face QPR training across pre- (T1) and post training (T2); however, knowledge, self-efficacy, and behavioral intentions in both groups generally declined from T2 to 6-months after the training. Overall, these results provide initial evidence to support the feasibility of adopting web-based media to deliver gatekeeper training. Moreover, the present findings suggest the need to understand how to maintain gatekeepers' knowledge, confidence, motivation, and skills after training.

Objective This study is a feasibility evaluation of The HOLLY Program, a suicide prevention gatekeeper training (GKT) program that uses the core processes of Acceptance and Commitment Therapy (ACT) and is tailored to Christian faith-based organisations (FBOs). Method: Thirteen participants received the program, and nine participants provided post-intervention data. Results Paired samples t-tests corrected for familywise error did not find any significant outcomes. However, there were marginally significant trends for improvements in self-efficacy, prevention behaviors, stigma, and engagement with values, which were supported by the qualitative and descriptive data. Across the sample, high levels of satisfaction with the program’s helpfulness, relevance, and practical content were reported. Qualitative data investigating perceptions of suicide motivation and suicide prevention found that participants recognised the psychological nature of suicide and provided sound, scientific suggestions for prevention. Conclusions While large-scale validation is required, proximate outcomes as presented in this study suggest that The HOLLY Program is viable and promising, and that members of Christian FBOs are willing and suitable recipients of GKT for suicide prevention.

Background: Research on models of implementation that enable widespread dissemination of suicide prevention to young adults is needed to address the critical public health issue of suicide among young adults. A peer-to-peer implementation approach may increase widespread dissemination of suicide prevention on college campuses.Aims: The current study involved the evaluation of a peer-led implementation of the evidence-based program Question, Persuade, and Refer Gatekeeper Training for Suicide Prevention (QPR). Method: A total of 161 college students attended one of eight QPR implementations conducted by student peer educators certified as QPR trainers. Questionnaires were administered at pretest and posttest to assess knowledge of suicide, likelihood of intervening with someone suicidal, and self-efficacy to intervene with someone suicidal. Results: Results from a series of paired-samples t tests showed significant increases from pretest to posttest on the three outcomes of interest - knowledge of suicide, self-efficacy to intervene with someone suicidal, and likelihood to intervene with someone suicidal. Limitations: The short time frame of the current study is a limitation. Conclusion: Support for a peer-led model of implementation for college students has critical implications in terms of increasing the capacity for widespread dissemination of suicide prevention efforts on college campuses.