Suicide Intervention Response Inventory Research Articles

The “Talk-to-Me” MOOC intervention for suicide prevention and mental health education among tertiary students: Protocol of a multi-site cross-over randomised controlled trial

IntroductionMental health problems are common among tertiary education students, with concerning levels of suicide ideation frequently observed in this population. There is a need for evidence-based mental health education and suicide prevention programs designed to meet the specific needs of these students. The “Talk-to-Me” Mass Open Online Course (MOOC) is a strengths-based mental health education program underpinned by a six-phase model for managing a suicidal crisis. MethodsTo evaluate the efficacy of the “Talk-to-Me” MOOC in improving student knowledge of appropriate responses to suicide crisis via a randomised control trial (RCT) comparing tertiary education health science and education students attending the program to a waitlist control group. Overall, 170 will be screened and randomly allocated to either the “Talk-to-Me” MOOC or a waitlist control group, with data collection occurring at three-time points (baseline, 10-weeks and 24-weeks from baseline) over one year. The primary outcome will be participants' knowledge and responses to suicidal statements as measured by the Suicide Intervention Response Inventory. Secondary outcomes will be knowledge of mental health and coping skills as well as the overall utility of the program. ConclusionsThis pragmatic RCT will demonstrate the efficacy of the “Talk-to-Me” MOOC in improving the students' ability to respond to suicidal and mental health concerns compared to the waitlist group. This design will enable rigorous evaluation of the “Talk-to-Me” MOOC, contributing to a greater understanding of the online-delivered safe-paced suicide prevention programs for tertiary students.Australian New Zealand Clinical Trials Registry (ANZCTR): #12619000630112.

Two-day assertive-case-management educational program for medical personnel to prevent suicide attempts: A multicenter pre-post observational study.

Suicide attempters have a high risk of repeated suicide attempts and completed suicide. There is evidence that assertive case management can reduce the incidence of recurrent suicidal behavior among suicide attempters. This study evaluated the effect of an assertive-case-management training program. This multicenter, before-and-after study was conducted at 10 centers in Japan. Participants were 274 medical personnel. We used Japanese versions of the Attitudes to Suicide Prevention Scale, the Gatekeeper Self-Efficacy Scale, the Suicide Intervention Response Inventory (SIRI), and the Attitudes Toward Suicide Questionnaire. We evaluated the effects with one-sample t-tests, and examined prognosis factors with multivariable analysis. There were significant improvements between pre-training and post-training in the Attitudes to Suicide Prevention Scale (mean: -3.07, 95% confidence interval [CI]: -3.57 to -2.57, P < 0.001), the Gatekeeper Self-Efficacy Scale (mean: 10.40, 95%CI: 9.48 to 11.32, P < 0.001), SIRI-1 (appropriate responses; mean: 1.15, 95%CI: 0.89 to 1.42, P < 0.001), and SIRI-2 (different to the expert responses; mean: -4.78, 95%CI: -6.18 to -3.38, P < 0.001). Significant improvements were found on all Attitudes Toward Suicide Questionnaire subscale scores, except Unjustified Behavior. The effect of training was influenced by experience of suicide-prevention training and experience of working with suicidal patients. The training program (which was developed to implement and disseminate evidence-based suicide-prevention measures) improved attitudes, self-efficacy, and skills for suicide prevention among medical personnel. Specialized suicide-prevention training and experience with suicidal patients are valuable for enhancing positive attitudes and self-efficacy; furthermore, age and clinical experience alone are insufficient for these purposes.

Assessing suicide management skills of emergency medical services providers before and after suicide intervention/prevention training with Lithuanian version of suicide intervention response inventory.

BackgroundEffective suicide management skills of emergency medical services (EMS) providers are crucially important in Lithuania, which has the highest suicide rates in Europe.MethodsRespondents were 268 EMS providers, doctors (n=78) and nurses (n=190), who agreed to participate in suicide prevention/intervention training and completed the survey twice. Study was conducted in five steps: adaptation of Lithuanian version of Suicide Intervention Response Inventory (SIRI-LT); initial assessment of suicide counseling skills of the EMS providers using SIRI-LT; suicide prevention/intervention training; second assessment of suicide counseling skills using SIRI-LT 6 months after training; data analysis evaluating the skills and effectiveness of the training among different groups of EMS providers (doctors vs nurses, age groups).ResultsSIRI-LT showed good internal consistency: Cronbach’s alpha score of 0.85 (pretest) and 0.73 (posttest). The value of Kaiser–Meyer–Olkin measure of sampling adequacy was 0.849. A four-factor solution was forced and accounted for 40.8% of the variance. The SIRI-LT mean total scores before suicide prevention/intervention training were significantly higher for doctors than for nurses (13.01±5.24 vs 11.36±5.14, respectively; P=0.031). Younger respondents with a shorter period of employment and heavier workload were significantly more effective at suicide management than older respondents with a longer period of employment and lower workload. After suicide prevention/intervention training, SIRI-LT mean total scores decreased for doctors (13.0±5.24 vs 11.02±4.76; P=0.031) and significantly increased in older (≥55 age) respondents (11.85±3.82 vs 9.28±4.44; P=0.022).ConclusionSIRI-LT has good internal consistency and can be considered a good instrument for assessing suicide management skills of EMS providers. Our results suggest that ability to find appropriate responses to suicide situations may be multidimensional, related to cultural setting and influenced by age, education, motivation, engagement, and emotional distraction. Particular attention should be paid to active listening and empathic communication skills when developing suicide prevention/intervention training for EMS providers.

SafeTALK suicide training: An evaluation of attitudes and actions among medical students

Background: SafeTALK is a half-day gatekeeper training program on recognizing persons at risk for suicide and intervening appropriately. Primary care clinicians have been increasingly targeted for suicide intervention training; however, evidence surrounding the effectiveness of safeTALK is lacking, particularly among medical learners. The aim of this study was to assess whether suicide literacy and intervention skills were enhanced by safeTALK training among medical learners.Methods: Undergraduate medical students from an Ontario university were invited to complete an online survey regardless if they had taken safeTALK training as part of their curriculum. Suicide literacy was measured with the Literacy of Suicide Scale (LOSS) and intervention skills were measured with the Suicide Intervention Response Inventory (SIRI).Results: The majority believed that suicide risk assessment training was very important to undergraduate medical education. Although limitations were noted, this study did not demonstrate that safeTALK training significantly improved medical students’ suicide literacy levels or suicide intervention skills.Conclusions: A more comprehensive program including the epidemiology of suicide and mental health disorders in addition to intervention skills is recommended to ensure medical learners are equipped to dispel the stigmas surrounding suicide and offer the appropriate care and follow up to their patients in future practice.

Suicide intervention training for college staff: Program evaluation and intervention skill measurement

ABSTRACTObjective: Suicide remains a pressing issue for college communities. Consequently, gatekeeper trainings are often provided for staff. This study examines the effect of one such program, Applied Suicide Intervention Skills Training (ASIST). Participants: 51 college employees received ASIST in August of 2014 and were compared to 30 wait-list control participants. Methods: Repeated Measures ANOVA were used to analyze pre- and post-training: (a) skills at responding to students-at-risk; (b) attitudes toward suicide; (c) knowledge about suicide; and (d) comfort/competence/confidence at helping a student-at-risk. Results: Significant positive training effects were observed for ASIST on self-report measures and also for objectively assessed skill at responding, after adjusting for a potential scoring limitation of the Suicide Intervention Response Inventory, Revised (SIRI-2). Conclusions: ASIST improved the self-perception of college staff at working with students-at-risk of suicide and also their skills at performing an intervention. Further, analysis of SIRI-2 data provides support for a potential instrument revision.

Factors influencing the suicide intervention skills of emergency medical services providers

ABSTRACTBackground: Lithuania currently has the highest suicide rate in Europe and the fifth highest worldwide.Aims: To identify the factors that influence the suicide intervention skills of emergency medical services (EMS) providers (doctors, nurses, paramedics).Method: Two hundred and sixty-eight EMS providers participated in the research. The EMS providers were surveyed both prior to their training in suicide intervention and six months later. The questionnaire used for the survey assessed their socio-demographic characteristics, suicide intervention skills, attitudes towards suicide prevention, general mental health, strategies for coping with stress, and likelihood of burnout.Results: Better suicide intervention skills were more prevalent among EMS providers with a higher level of education, heavier workload, more positive attitudes towards suicide prevention, better methods of coping with stress, and those of a younger age. Six months after the non-continuous training in suicide intervention, the providers’ ability to assess suicide risk factors had improved, although there was no change in their suicide intervention skills.Conclusions: In order to improve the suicide intervention skills of EMS providers, particular attention should be paid to attitudes towards suicide prevention, skills for coping with stress, and continuous training in suicide intervention.Abbreviations: EMS: Emergency medical services; SIRI: Suicide intervention response inventory

Suicide Intervention Skills Among Japanese Medical Residents

Patient suicide is a tragic occurrence, and it can be a demoralizing experience for medical residents. Few studies, however, have assessed suicide management skills among these front-line healthcare professionals. This study evaluated the self-assessed competence and confidence of medical residents with regard to the management of potentially suicidal patients and assessed the correlation with the residents' background characteristics. The authors conducted a multicenter, cross-sectional survey of 114 medical residents in Japan, using a modified version of the Suicide Intervention Response Inventory (SIRI-2), the Medical Outcomes Study 8-Item Short-Form Health Survey (SF-8), and a 5-point Likert scale to assess confidence in suicide management. A majority (89.5%) of the residents rated their confidence in managing suicidal patients as Not At All Confident or Rather Not Confident, although most were close to completing their psychiatric rotation. Results on the SIRI-2 suggested intermediate competence in managing suicidal behavior, as compared with that of other healthcare professionals. Competence as indicated by the SIRI-2 score was weakly and negatively correlated with the score for self-perceived Vitality on the SF-8 scale. Insufficient skills and lack of confidence in the management of suicidal patients was observed in this sample of Japanese medical residents, thus highlighting the need for improved suicide-management programs for junior medical residents in Japanese hospitals.

Effectiveness of brief suicide management training programme for medical residents in Japan: a cluster randomized controlled trial

Aims. To evaluate the effectiveness of a brief suicide management training programme for Japanese medical residents compared with the usual lecture on suicidality. Methods. In this multi-center, clustered randomized controlled trial, the intervention group attended a structured suicide management programme and the control group, the usual lecture on depression and suicidality. The primary outcome was the difference in residents' cumulative competency score to manage suicidal persons from baseline (T0) to 1 month after the intervention (T2), determined using the Suicide Intervention Response Inventory (SIRI-1) score, at individual level. Results. Analysis of 114 residents (intervention group n=65, control group n=49) assigned to two clusters in each group revealed no change in SIRI-1 score from T0 to T2 or immediately after the intervention (T1) between the two groups. As a secondary analysis, discrepancy in judgement between the participants and Japanese suicidologists was examined immediately after the intervention in the adjusted model, with a mean difference in score of 9.98 (95% confidence interval: 4.39-15.56; p=0.001). Conclusions. The structured programme was not proven to improve competency in suicide management when measured by the SIRI-1 score. Further elaboration of the programme and valid measurement of its outcome would be needed to show the program's effectiveness.

University Mental Health Professionals in Puerto Rico: Suicide Experiences, Attitudes, Practices, and Intervention Skills

This study explored suicide knowledge, experiences, attitudes, practices, and intervention skills of mental health professionals (n = 52) working in counseling centers of Puerto Rican public and private universities. Intervention skills were examined using a Spanish version of the Suicide Intervention Response Inventory (SIRI-2; Neimeyer & Bonelle, 1997). Results suggest inadequate screening practices, difficulty in exploring and assessing suicidal ideation/conduct and intent, and a lack of knowledge of risk factors. Results point to the need for further training in suicide screening and risk assessment as an early intervention strategy for prevention. Implications for future studies and practice are discussed.

GATEKEEPER TRAINING FOR SUICIDE PREVENTION IN FIRST NATIONS COMMUNITY MEMBERS: A RANDOMIZED CONTROLLED TRIAL

Gatekeeper training aims to train people to recognize and identify those who are at risk for suicide and assist them in getting care. Applied Suicide Intervention Skills Training (ASIST), a form of gatekeeper training, has been implemented around the world without a controlled evaluation. We hypothesized that participants in 2 days of ASIST gatekeeper training would have increased knowledge and preparedness to help people with suicidal ideation in comparison to participants who received a 2-day Resilience Retreat that did not focus on suicide awareness and intervention skills (control condition). First Nations on reserve people in Northwestern Manitoba, aged 16 years and older, were recruited and randomized to two arms of the study. Self-reported measures were collected at three time points-immediately pre-, immediately post-, and 6 months post intervention. The primary outcome was the Suicide Intervention Response Inventory, a validated scale that assesses the capacity for individuals to intervene with suicidal behavior. Secondary outcomes included self-reported preparedness measures and gatekeeper behaviors. In comparison with the Resilience Retreat (n = 24), ASIST training (n = 31) was not associated with a significant impact on all outcomes of the study based on intention-to-treat analysis. There was a trend toward an increase in suicidal ideation among those who participated in the ASIST in comparison to those who were in the Resilience Retreat. The lack of efficacy of ASIST in a First Nations on-reserve sample is concerning in the context of widespread policies in Canada on the use of gatekeeper training in suicide prevention.

The Impact of Experiential Exercises on Communication and Relational Skills in a Suicide Prevention Gatekeeper-Training Program for College Resident Advisors

Objective: In an effort to identify students at risk for suicide, many colleges are implementing suicide prevention training for campus gatekeepers. This study evaluated the efficacy of a 3-hour, experiential-based gatekeeper training that included an emphasis on enhancing communication skills and relational connection in addition to the didactic foci of standard gatekeeper training. Participants: Sixty-five college student resident advisors (RAs) were trained with Campus Connect. Methods: The training was dismantled to examine the specific contribution of experiential exercises on training outcomes. Results: Compared to didactic training alone, following participation in experiential exercises RAs’ training outcome scores exhibited additional improvement on the Suicide Intervention Response Inventory–2 and a 14-item self-report measure of self-efficacy for specific suicide- and crisis-related knowledge and skills. Conclusions: In gatekeeper training, experiential exercises emphasizing awareness and empathic responding and practice of these skills contribute to an improvement in crisis response skills above and beyond that of didactic training alone.

自殺の危機介入スキル尺度（SIRI）短縮版作成の試み

A Japanese version of the Suicide Intervention Response Inventory (SIRI-J) had been developed, but needed improvement especially with respect to the number of items. This study was designed to develop and evaluate a short version of the SIRI-J (SIRI-JS). Study 1 used factor analysis, which revealed that the SIRI-J included two components. On the basis of these results, we extracted five items from each component, added three items to represent practical crisis-intervention situations, and drafted the SIRI-JS with 13 items. We also confirmed a strong correlation between the original subscales and those of the short version. Study 2 reconfirmed the validity and reliability of the new measure. In summary, we demonstrated that the SIRI-JS is suitable for assessing the effects of suicide-prevention training.

Development of 2‐hour suicide intervention program among medical residents: First pilot trial

Suicide is associated not only with primary psychiatric disorders but also with physical disorders. Physicians' education on suicide prevention contributes to reducing suicide. Therefore, medical residents, who contact patients daily and who eventually become primary physicians in each specialty, might be the most appropriate candidates for intervention. In this article, we introduce our newly developed suicide intervention program among medical residents. We developed a 2-hour suicide intervention program among medical residents, based on the Mental Health First Aid (MHFA), which had originally been developed for the public. The program contains a 1-hour lecture and a 1-hour role-play session. As the first pilot trial, we conducted the program among 44 first-year medical residents at a university hospital and evaluated its effectiveness. Changes in confidence, attitudes and behavior toward suicidal people were evaluated using self-reported questionnaires before, immediately after, and 6 months after the program. Participants' confidence and attitudes significantly improved after the program. The total mean score (standard deviation) of the Suicide Intervention Response Inventory improved from 18.4 (2.0) before the intervention to 19.4 (2.0) immediately after the intervention. However, the effectiveness was limited after 6 months. In the course of 6 months, the participants learned to apply the MHFA principles in their daily clinical practice. Our newly developed brief suicide intervention program demonstrating its effectiveness among medical residents should be modified in order to be more effective in the long term. The next trial with a control group ought to be conducted to evaluate our developed program.

Suicide Risk Assessment With Asian American College Students

Scholars have based their understanding of college-student suicide in the United States largely on the study of European Americans, and therefore, its relevance to making culturally informed decisions with suicidal Asian American college students is unclear. This article explores aspects of suicide assessment potentially unique to Asian American college students and discusses possible ways to handle the process of breaking confidentiality that are more sensitive to Asian American needs. First, the authors briefly review issues of confidentiality, informed consent, and standards of care. Second, they examine several aspects of Asian American college students' experiences in the United States and of Asian cultural values. Specifically, the authors review acculturation and the experience of immigration, intergenerational relationships, collectivistic cultural values, the myth of the “model minority,” and perfectionism. Third, they offer culturally informed considerations for assessing suicidal risk and ways to manage breaking confidentiality. Finally, they suggest the Collaborative Assess-ment and Management of Suicidality model and the Suicide Intervention Response Inventory−2 as potentially useful tools for culturally sensitive work with Asian American college students.

Suicide Intervention Skills in Health Professionals: A Multidisciplinary Comparison

Training in the recognition and management of suicidal risk is of crucial importance for prevention. The aim of our study was to compare competence in assessing and managing suicidal patients in different groups of Italian professionals. Two hundred and thirty two professionals (38 psychiatrists, 50 general practitioners, 34 psychiatric nurses, 60 doctors and nurses working in accident and emergency services, and 50 medical students) completed the Suicide Intervention Response Inventory (SIRI-2) (Neimeyer & Bonelle, 1997) and a questionnaire on perceptions of risk and protective factors in suicidal patients. Exposure to suicidal patients was found to be widespread in all groups, but specific training in suicide assessment and intervention was conspicuously rare. Psychiatrists outscored all other groups and psychiatric nurses scored significantly higher than general practitioners in identifying appropriate responses to suicidal patients. Taken together, our findings suggest the necessity of further training in suicide intervention for Italian health professionals, and especially for emergency service personnel and general practitioners.

RESPONDING TO SUICIDAL CALLS: DOES TRAIT ANXIETY HINDER OR HELP?

ABSTRACT To see if trait anxiety and suicidality interfered with the ability to respond to suicidal crisis calls, 279 undergraduates completed measures of trait anxiety and suicidality in the past week, and the revised Suicide Intervention Response Inventory (SIRI-2). Unexpectedly, trait anxiety (but not suicidality) correlated with better SIRI-2 scores. In addition, students scored significantly more like the experts on the SIRI-2 if they were European-American, were relatively older, had completed a crisis intervention course, had undergone psychotherapy, or had ever been suicidal in their lives. Trait anxiety does not hinder, and may even help, in responding to a suicidal phone call.

Training health professionals in the recognition, assessement and management of suicide risk

OBJECTIVESTo set up and evaluate a multidisciplinary suicide assessment training course for “front-line” clinical staff.METHODSWe looked at the impact of two types of training courses: full day Workshops with actors role-playing patients; and a half-day Lecture. Outcome measures included the Suicide Intervention Response Inventory Form 2, a reliable and valid measure of the ability to intervene with suicidal clients, and confidence in clinical management scales.RESULTSOne hundred and seven trainees from different disciplines attended the courses. Both types of course led to improvements in the skills and confidence of the trainees which were sustained at the two month follow up.CONCLUSIONAlthough using actors to role play was more expensive, trainees commented positively on their use. The better attendance and feedback at the sessions with actors suggest the extra expense involved in using them is worthwhile. We have shown it is feasible to run a reasonably inexpensive educational course in a Mental Health facility that provides effective training in suicide prevention to a large number of trainees.

Personal and professional factors and suicide intervention skills.

This research investigated the relationship of professional and personal factors to the ability of counselors to respond appropriately to suicidal verbalizations using the Suicide Intervention Response Inventory (SIRI). Level of training, experience with suicidal clients, and death acceptance were positively related to suicide intervention competencies. A personal history of suicidality and a belief that suicide is a personal right were negatively related to such skills. Regression analysis revealed that personal history of suicidality and attitude toward suicide as a personal right accounted for a modest, but significant, percentage of the variance in SIRI scores, beyond that accounted for by professional factors. Post hoc analysis indicated that the negative relationship between personal history of suicidal behaviors and suicide counseling skills was significant in the professionally trained participants. These results highlight the importance of attitudes toward suicide and personal history of suicidality, as well as training and experience, in effectively counseling potentially suicidal clients.

THE SUICIDE INTERVENTION RESPONSE INVENTORY: A REVISION AND VALIDATION

The Suicide Intervention Response Inventory (SIRI) was developed by Neimeyer and MacInnes (1981) to assees the ability of paraprofessional counselors to recognize appropriate responses to suicidal clients. Although several studies have supported the validity of the scale, concerns have been raised about its ceiling effect when administered to more highly trained counselors. Psychometric improvements were therefore attempted, and the original dichotomous scoring system was replaced with a Likert scale format, in the SIRI-2. Because respondents were required to make more subtle judgments concerning the appropriateness of each response as defined by a criterion group of highly expert suicidologists, the ceiling effect that limited the use of the original measure was eliminated. Construct and discriminant validity were demonstrated in both verisons of the instrument. Internal consistency and test-retest reliability showed improvement with the SIRI-2. Overall, the SIRI-2 shows promise as an index of suicide counseling effectiveness, especially among more skilled counselors.

Evaluation of suicide intervention effectiveness.

Considering the prevalence of suicide and other forms of self-injurious behavior, it is ironic that relatively little attention has been paid to the training of mental health workers in suicide intervention. Still less effort has been spent in evaluating the effectiveness of such workers or the agencies in which they serve. We review the evaluation strategies that have been used to assess the process and outcome of suicide intervention, ranging from macroanalyses of the impact of crisis services on suicide rates in the community to microanalyses of the competence of individual suicide interventionists. Particular attention is paid to the Suicide Intervention Response Inventory, a self-administered test of suicide counseling skills whose validity, reliability, and practical utility suggest the benefit of its use in a broader range of research and applied settings. The advantages and disadvantages of each evaluation strategy are discussed, and guidelines are offered for the sophistication of future research and program evaluation efforts.