The need for a culturally-tailored gatekeeper training intervention program in preventing suicide among Indigenous peoples: a systematic review

Bushra Farah Nasir,Srinivas Kondalsamy-Chennakesavan,Leanne Hides,Geoffrey C Nicholson,Steve Kisely,Maree Toombs,Emma Black,Geetha Ranmuthugala,Neeraj Gill

doi:10.1186/s12888-016-1059-3

Abstract

BackgroundSuicide is a leading cause of death among Indigenous youth worldwide. The aim of this literature review was to determine the cultural appropriateness and identify evidence for the effectiveness of current gatekeeper suicide prevention training programs within the international Indigenous community.MethodUsing a systematic strategy, relevant databases and targeted resources were searched using the following terms: ‘suicide’, ‘gatekeeper’, ‘training’, ‘suicide prevention training’, ‘suicide intervention training’ and ‘Indigenous’. Other internationally relevant descriptors for the keyword “Indigenous” (e.g. “Maori”, “First Nations”, “Native American”, “Inuit”, “Metis” and “Aboriginal”) were also used.ResultsSix articles, comprising five studies, met criteria for inclusion; two Australian, two from USA and one Canadian. While pre and post follow up studies reported positive outcomes, this was not confirmed in the single randomised controlled trial identified. However, the randomised controlled trial may have been underpowered and contained participants who were at higher risk of suicide pre-training.ConclusionUncontrolled evidence suggests that gatekeeper training may be a promising suicide intervention in Indigenous communities but needs to be culturally tailored to the target population. Further RCT evidence is required.

Highlights

Suicide is a leading cause of death among Indigenous youth worldwide
Uncontrolled evidence suggests that gatekeeper training may be a promising suicide intervention in Indigenous communities but needs to be culturally tailored to the target population
Search results The keyword “suicide”, “suicide prevention”, and “suicide intervention” identified 2609 articles (Fig. 1). Removing duplicates and those that did not meet the selection criteria, left 2588 articles. These 2588 articles where screened for the keywords “gatekeeper training”, and “Indigenous” and its other descriptors, leaving 21 potentially relevant articles that were reviewed for inclusion

Summary

Introduction

The aim of this literature review was to determine the cultural appropriateness and identify evidence for the effectiveness of current gatekeeper suicide prevention training programs within the international Indigenous community. Suicide in traditional Indigenous communities has emerged as a priority issue of international public concern. Until the 1960s, suicide was a rarity in Indigenous communities in Australia [1]. Latest reports indicate that Australian Indigenous men between 25 and 29 still have one of the highest suicide rates in the world [3]. Suicide risk among Indigenous populations is a multifaceted phenomenon, influenced by biological, psychological, and social factors at the individual level, as well as cultural, political, and economic issues at the family and community level [4, 5]. The main risk factors for suicide are mental disorders [6], comorbid physical illness [7], stressful life events as a result of colonisation [7], substance abuse and socioeconomic issues [8]

Methods

Results

Discussion

Conclusion