Gatekeeper Training Research Articles

Talking about suicide: An uncontrolled trial of the effects of an Aboriginal and Torres Strait Islander mental health first aid program on knowledge, attitudes and intended and actual assisting actions.

Suicide is a leading cause of death among Aboriginal and Torres Strait Islander people. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is at risk of suicide. We developed culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islander people experiencing suicidal thoughts or behaviour and used this as the basis for a 5-hour suicide gatekeeper training course called Talking About Suicide. This paper describes the outcomes for participants in an uncontrolled trial of this training course. We undertook an uncontrolled trial of the Talking About Suicide course, delivered by Aboriginal and Torres Strait Islander Mental Health First Aid instructors to 192 adult (i.e. 18 years of age or older) Aboriginal and Torres Strait Islander (n = 110) and non-Indigenous (n = 82) participants. Questionnaires capturing self-report outcomes were self-administered immediately before (n = 192) and after attending the training course (n = 188), and at four-months follow-up (n = 98). Outcome measures were beliefs about suicide, stigmatising attitudes, confidence in ability to assist, and intended and actual actions to assist a suicidal person. Despite a high level of suicide literacy among participants at pre-course measurement, improvements at post-course were observed in beliefs about suicide, stigmatising attitudes, confidence in ability to assist and intended assisting actions. While attrition at follow-up decreased statistical power, some improvements in beliefs about suicide, stigmatising attitudes and intended assisting actions remained statistically significant at follow-up. Importantly, actual assisting actions taken showed dramatic improvements between pre-course and follow-up. Participants reported feeling more confident to assist a suicidal person after the course and this was maintained at follow-up. The course was judged to be culturally appropriate by those participants who identified as Aboriginal and/or Torres Strait Islanders. The results of this uncontrolled trial were encouraging, suggesting that the Talking About Suicide course was able to improve participants' knowledge, attitudes, and intended assisting actions as well as actual actions taken.

Connecting with social and emotional well-being in rural Australia: An evaluation of 'We-Yarn', an Aboriginal gatekeeper suicide prevention workshop.

This evaluation considered the potential of We-Yarn, a suicide prevention gatekeeper training workshop, to contribute to Aboriginal suicide prevention in rural New South Wales. A mixed methods approach included surveys, in-depth interviews and workshop observations. Aboriginal suicide prevention training in rural New South Wales, Australia. Attendees at We-Yarn training. We-Yarn provided culturally safe suicide prevention skills training for Aboriginal people and for those who work with Aboriginal communities and persons in rural New South Wales. Training workshops were delivered across multiple locations for 6 hours in one day. Workshops were facilitated by two facilitators with lived and professional experience; one Aboriginal and one non-Aboriginal facilitator. We-Yarn content was developed by staff from the Centre for Rural and Remote Mental Health, and in consultation with Aboriginal Elders and representatives of Aboriginal Medical Services to ensure relevance and cultural appropriateness. Pre and post-workshop surveys captured capacity and participants' confidence in identifying and responding to a person at risk of suicide. Interviews explored participants' experiences of workshops, implementation of learning, and attitudes regarding social and emotional wellbeing and suicide. Observations detailed the workshop environment, participants' engagement, and participants' responses to facilitators and content. We-Yarn was considered culturally appropriate. Participants responded to facilitators' lived experiences. Participants reported significant improvements in understanding the links between cultural strengths, social and emotional wellbeing and suicide prevention. However, health professionals with existing knowledge wanted a stronger focus on clinical training. We-Yarn promoted discussion of suicide prevention within a holistic health framework, building on participants' pre-existing knowledge about social and emotional wellbeing. Importantly, skilful facilitators with lived experience were vital to the success of the workshops. Consideration should be given to attracting people with low suicide prevention knowledge to the workshops, developing tailored workshops for health professionals and ensuring prolonged engagement with communities. Multifaceted and long term responses in addition to this type of training are important.

The Effectiveness of Active Learning Strategies in Gatekeeper Training on Behavioral Outcomes.

Background: Studies of suicide prevention gatekeeper trainings (GKT) show temporary enhancements in short-term behavioral outcomes and limited enhancements in intermediate behavioral outcomes. Aims: We aimed to examine the impact of two training enhancements (role-play and booster) on intermediate GKT outcomes. Method: The study used a factorial randomized controlled design to assign participants to one of four groups. Three indicators of gatekeeper behavior at 6-month follow-up were the primary outcomes of interest. We used propensity score-based techniques to address observed imbalances. Results: At 6 months, among participants assigned to role-play, a significantly larger proportion of those assigned to booster performed identifications and referrals followed by a notification to the referral source, and followed by escorting the youth to the resource. Limitations: While observed imbalances were addressed, unobserved differences may persist. The validity of self-reported indicators to measure actual behavior remains unknown. Conclusion: Results suggest that active learning strategies can, in combination, enhance the effectiveness of trainings. The strategies seem to increase the comprehensiveness of gatekeeper behaviors.

Contents of the Standardized Suicide Prevention Program for Gatekeeper Intervention in Korea, Version 2.0.

ObjectiveSuicide is a huge nationwide problem that incurs a lot of socio-economic costs. Suicide also inflicts severe distress on the people left behind. The government of the Republic of Korea has been making many policy efforts to reduce suicide rate. The gatekeeper program, ‘Suicide CARE’, is one of the meaningful modalities for preventing suicide. MethodsMultidisciplinary research team collaborated to update the ‘Suicide CARE’ to version 2.0. ResultsIn the ‘Introductory part’, the authors have the time to think about the necessity and significance of the program before conducting full-scale gatekeeper training. In the ‘Careful observation’ part, trainees learn how to understand and recognize the various linguistic, behavioral, and situational signals that a person shows before committing suicide. In the ‘Active listening’ part, trainees learn how to ask suicide with a value-neutral attitude as well listening empathetically. In the ‘Risk evaluation and Expert referral’ part, trainees learn intervening strategies to identify a person’s suicidal intention, plan, and past suicide attempts, and connect the person to appropriate institutes or services. ConclusionSubsequent studies should be conducted to verify the efficacy of the gatekeeper program.

Gatekeeper Training and the Medical Community’s Fight Against Depression and Suicide—A Shared Burden

Gatekeeper Training and the Medical Community’s Fight Against Depression and Suicide—A Shared Burden

"Suicide CARE" (Standardized Suicide Prevention Program for Gatekeeper Intervention in Korea): An Update.

Objective In 2011, “Suicide CARE” (Standardized Suicide Prevention Program for Gatekeeper Intervention in Korea) was originally developed for the early detection of warning signs of suicide completion, since there is a tendency to regard emotional suppression as a virtue of Korean traditional culture. A total of 1.2 million individuals completed the training program of “Suicide CARE” in Korea. Methods More sophisticated suicide prevention approaches according to age, sex, and occupation have been proposed, demanding for a more detailed revision of “Suicide CARE.” Thus, during the period from August 2019 to February 2020, “Suicide CARE” has been updated to version 2.0. The assessments on domestic gatekeeper training programs for suicide prevention, international gatekeeper training programs for suicide prevention, psychological autopsy interview reports between 2015 and 2018, and the evaluation of feedback from people who completed “Suicide CARE” version 1.6 training were performed. Results We describe the revision process of “Suicide CARE,” revealing that “Suicide CARE” version 2.0 has been developed using an evidence-based methodology. Conclusion It is expected that “Suicide CARE” version 2.0 be positioned as the basic framework for many developing gatekeeper training programs for suicide prevention in Korea in the near future.

Don't Invite Everyone! Training Variables Impacting the Effectiveness of QPR Trainings.

Gatekeeper trainings have been increasingly utilized in response to rising suicide rates in youths. However, the extent to which common factors inherent to gatekeeper trainings impact training outcomes is largely understudied. As such, the present study explored how factors such as training size and trainer engagement abilities influenced trainee participation and outcomes (i.e. changes in attitudes, perceived behavioral control (PBC), and knowledge regarding suicide prevention). All trainees participated in a gatekeeper training; trainers were not randomly assigned. Mediation and moderation analyses were completed using the PROCESS macro for SPSS (Hayes in Introduction to mediation, moderation, and conditional process analysis: a regression-based approach, Guilford Press, New York, 2013). Trainee participation in a training was examined as a mediator of the relationship between the training size and training outcomes, while trainer engagement was examined as a moderator of the relationship between size of training and trainee participation. Size of training was significantly related to lower changes in participant knowledge, along with lower trainee participation in gatekeeper trainings. Trainee participation significantly mediated the relationship between size of training, attitudes, and PBC. Additionally, trainer engagement significantly moderated the association between size of training and trainee participation. The results of this study suggest that general gatekeeper training-related variables may influence participant outcomes, specifically through trainee participation.

Using ex-ante economic evaluation to inform research priorities in pesticide self-poisoning prevention: the case of a shop-based gatekeeper training programme in rural Sri Lanka.

ObjectivesSuicide by pesticide self‐poisoning is a major public health challenge in low‐ and middle‐income countries. While effectiveness studies are required to test alternative prevention approaches, economic evidence is lacking to inform decision‐making in research priority setting. Therefore, this study aimed to estimate the costs of a shop‐based gatekeeper training programme for pesticide vendors seeking to prevent pesticide self‐poisoning in rural Sri Lanka and assess its potential for cost‐effectiveness.MethodsEx‐ante cost and cost‐effectiveness threshold (CET) analyses were performed from a governmental perspective based on a three‐year analytic horizon, using ‘no programme’ as a comparator. A programme model targeting all 535 pesticide shops in the North Central Province and border areas was applied. Total programme costs (TPC) were estimated in 2019 USD using an ingredients approach and 3% annual discounting. The Sri Lankan gross domestic product per capita and life years saved were used as CET and effectiveness measure, respectively. Sensitivity analyses were performed.ResultsTPC were estimated at 31 603.03 USD. TPC were sensitive to cost changes of training material and equipment and the programme lifetime. The programme needs to prevent an estimated 0.23 fatal pesticide self‐poisoning cases over three years to be considered cost‐effective. In the sensitivity analyses, the highest number of fatal cases needed to be prevented to obtain cost‐effectiveness was 4.55 over three years.ConclusionsFrom an economic perspective, the programme has a very high potential to be cost‐effective. Research assessing its effectiveness should therefore be completed, and research analysing its transferability to other settings prioritised.

Suicide Prevention Gatekeeper Self-Efficacy Scale (GKSES).

Background: To date there is no standardized scale for the evaluation of self-efficacy of gatekeeper skills. Aim: The aim of this study was to develop the Gatekeeper Self-Efficacy Scale (GKSES), which consists of nine items assessing laypersons' confidence in their own gatekeeper skills, and to confirm its reliability and validity. Method: Altogether 875 participants joined in gatekeeper training between 2010 and 2017 and completed the GKSES both before and after training. After exploratory factor analysis, we analyzed Pearson's correlation between total GKSES scores and Attitude Toward Suicide Scale subscale scores and performed one-way analysis of variance for the score differences by demographics. Results: The GKSES is a univariate scale with good fit. Total GKSES score correlated with the appropriate attitudes for suicide prevention. Self-efficacy ratings after training improved irrespective of attribute. Participants who had had contact with suicidal individuals and those who had received previous suicide prevention training had high self-efficacy ratings, while a greater improvement was seen in the ratings of participants who had not had any previous contact or training. Limitations: It is necessary to assess the GKSES using more participants across other populations. Conclusion: The GKSES is a simple and useful measure with good internal consistency and validity for self-efficacy assessment of gatekeeper skills.

Characterization of adopted suicidal behavior and its main influencing factors: A qualitative study with adolescents

IntroductionA better understanding of the meanings that adolescents associate with suicide, contributes to the development of psychotherapeutic intervention programs to be implemented by nurse specialists in mental health and psychiatric nursing. Therefore, adolescents need to characterize their adopted suicidal behaviors and identify the personal characteristics that contribute to this same behavior. MethodologyA descriptive, exploratory, and qualitative study was conducted with 33 adolescents with suicidal behavior, hospitalized in a child psychiatry unit. Data were collected through a structured interview, and data treatment used the content analysis technique. ResultsSuicidal behaviors are characterized according to causality, meaning, and intent. Causality is mostly related to psychological factors (sadness, desperation, mental suffering, internal pain, emptiness, and rejection). As to the meaning, suicidal behavior is understood as an escape but also as a personal choice, sometimes regarded as rational. In what concerns intent, the intent to die is the most frequently reported. The most-reported personal characteristics which contributed to the suicidal behavior are feelings of exclusion, rejection, and humiliation, and also introversion. ConclusionsThe results point to the need to reflect on the perceptions of adolescents with suicidal behavior. The current intervention strategies should be adjusted especially through the identification of the signs associated with mental distress in adolescents and the training of gatekeepers, contributing to productive and congruent suicide prevention in this vulnerable group.

Development and Evaluation of a Gatekeeper Training Program Regarding Anxiety about Radiation Health Effects Following a Nuclear Power Plant Accident: A Single-Arm Intervention Pilot Trial.

After the Fukushima Daiichi Nuclear Power Plant accident in March 2011, residents perceived a radiation exposure risk. To address the concerns about radiation exposure and the subsequent effects on their health, we developed the gatekeeper training program for radiation health anxiety and mental health issues. The program consisted of a presentation and roleplay, with educational objectives to the increase knowledge and understanding around radiation health anxiety, alcoholism, depression, and suicide. Twenty-six counselors participated in the program as a single-arm intervention. To measure the outcomes, the subjects reported self-confidence when they counselled with residents with radiation health anxiety and other mental health issues. Comparing the answers to pre- and 2-month follow-up surveys, the confidence levels were higher after 2 months than at baseline, especially for the question “How confident are you at supporting a resident with mental health issues?”, which showed the largest increase (p < 0.001). Regarding radiation health anxiety the questions “Can you communicate coping skills to a resident with radiation health anxiety?” (p = 0.007) and “Can you refer a resident with radiation health anxiety to professionals who can cope appropriately?” (p = 0.016) showed significant increases in their confidence levels. This program could be useful for on-going health activities and future nuclear disasters.

A Pilot Randomized Controlled Trial of the Alliance Project Gatekeeper Training for Suicide Prevention

Gatekeeper trainings are an approach intended to increase help seeking for suicide prevention. However, little is known of gatekeeper training’s function in increasing gatekeeper intent to intervene with those in distress. The current study utilized the theory of planned behavior as a guide to predict gatekeeper’s intention to intervene over a six-month period in a pilot randomized controlled trial of the Alliance Project gatekeeper training. Results suggested that the Alliance Project, predicted the growth curve of trainees’ intention to intervene better than a control training from pretest through six months. Attitudes toward completing gatekeeper behaviors and perceived behavioral control over gatekeeper behaviors approached significance in a less parsimonious model. These findings suggest the Alliance Project produces changes in gatekeeper’s intent to intervene through three months’ time.

CALM gatekeeper training is associated with increased confidence in utilizing means reduction approaches to suicide prevention among college resident assistants

Background Most suicide prevention programs focus on increasing knowledge regarding the problem of suicide, yet many fail to include information on the science and application of means reduction approaches. In an attempt to address this gap in practice, the Counseling on Access to Lethal Means (CALM) program was developed to educate clinicians on the importance of means reduction interventions. Methods In the current study, a gatekeeper CALM training was delivered to 167 resident assistants. Confidence levels regarding suicide prevention and means reduction skills were assessed at baseline, post-training, and after a 6-week follow-up. Results Results were suggestive of medium to large training effects. Though there was a small decay of training effects at follow-up, the effects were durable when compared to baseline levels. Conclusion Given these findings, future gatekeeper trainings should be provided more consistently to help sustain the effects and data on the implementation of CALM principles should be measured during follow-up assessments.

The Suicide Prevention for College Student Gatekeepers Program.

Background: American college students are presenting with increasingly lower levels of mental health and higher levels of anxiety and depression. Close to 30% of college students report having seriously considered suicide in their lifetime. It is critical to train peer gatekeepers to recognize and react to mental health emergency scenarios on college campuses. Aims: The Suicide Prevention for College Student Gatekeepers training program was designed to provide college students with information about the warning signs of suicide, as well as how to intervene when indicated. The program incorporates research specific to college students and suicide risk, utilizes a college student co-leader alongside a licensed psychologist, and maximizes discussion and role-play to support student learning and engagement. Method: The program was piloted with 65 undergraduate students and the results of the program are discussed. Results: Students who participated in the program reported increased feelings of suicide prevention competence both immediately after the training and at a 12-week follow-up. Additionally, students demonstrated increased knowledge about suicide and decreased stigma. Finally, students indicated high levels of acceptability of the program. Limitations: The lack of diversity and small sample size within this pilot should be addressed in future studies. Conclusion: This pilot study offers promising results for an efficient, college-student focused suicide prevention gatekeeper training program.

Characteristics of Disaster-Related Suicide in Fukushima Prefecture After the Nuclear Accident.

. Background: Suicide is a major concern after the 2011 earthquake and nuclear accident in Fukushima. Aims: This study delineates characteristics of the disaster-related suicides in Fukushima. Method: Data provided by the Fukushima Prefectural Police and data published by the Fukushima or Japanese Government were analyzed. Numbers of disaster-related suicides and evacuees were compared among the three prefectures affected. Age, sex, occupation, and means for disaster-related suicides in Fukushima were compared with overall suicides in Fukushima or Japan. History of medical treatment, changes in job and family structure after the disaster, and signs of contemplation were examined within the disaster-related suicides of Fukushima. Results: While other prefectures have experienced a drop in disaster-related suicides, Fukushima has not. Age-standardized disaster-related suicide rates were remarkably higher in men than in women. Moreover, disaster-related suicide rates in Fukushima were higher in women in their 50s and 80s as compared with overall suicide rates in Fukushima or Japan. Limitations: No detailed comparisons were made between disaster-related and non-disaster-related suicides. Conclusion: Disaster-related suicide rates were higher in men than in women. Also, it was found that the disaster-related suicide rates of elderly women were higher compared with overall suicide rates in Japan and Fukushima. In addition, many who died by suicide showed signs of contemplation before the attempt and had started psychiatric treatment. Improvement of suicide risk assessment skills for mental health professionals and gatekeeper training among residents will be essential to prevent disaster-related suicides.

Together With Veterans: VA National Strategy Alignment and Lessons Learned from Community-Based Suicide Prevention for Rural Veterans.

Rural veterans are at increased risk for dying by suicide compared with urban veterans, yet interventions for preventing suicide among rural veterans have been limited. (1) Describe how Together With Veterans (TWV), a community-based intervention to prevent suicide among veterans in rural communities, aligns with the VA National Strategy for Preventing Veteran Suicide; (2) share lessons learned while beginning to implement TWV in rural communities. Together With Veterans is being implemented in four rural communities and comprises six suicide prevention best practices: (1) reducing stigma and promoting help-seeking; (2) lethal means safety, with an emphasis on firearms; (3) gatekeeper training; (4) training primary care providers; (5) improving access to crisis services; and (6) enhancing support for high-risk veterans. Together With Veterans best practices align with most, but not all, of the strategies in the VA National Strategy for Preventing Veteran Suicide. Community veteran partners have shown a willingness to collaborate and provide local leadership, enthusiasm, and a sense of duty. By supporting and facilitating local veteran leaders and their community partners in increasing suicide prevention knowledge, public awareness, and resources, we propose that TWV offers an acceptable and feasible approach that builds on the strengths of rural communities. Systematic evaluation is warranted.

Barriers for the Research, Prevention, and Treatment of Suicidal Behavior.

Efforts in research, prevention, and treatment of suicidal behavior have produced mixed results. One of the main barriers to combating suicidal behavior lies in the very conceptualization of suicide, a phenomenon that is at once sociological, psychiatric, and even philosophical, and one that has not always been included in the field of health care. There are also many barriers at the social level, ranging from stigma against people with suicidal behavior to stigma towards psychiatric care, as well as the controversial role of the media. The media plays an important role in society and depending on its attitude it can be either beneficial or harmful in our fight against suicidal behavior. Differences between countries - in the provision of resources, in the way of understanding the phenomenon or in the manner of providing official figures - pose an additional challenge to suicide prevention on a global level. In the field of research, predicting suicidal behavior by identifying effective risk markers is severely hampered by the low occurrence of suicide in the population, which limits the statistical power of studies. The authors recommend combining various risk factors to build predictive models. This, in addition to employing increasingly precise machine learning techniques, is a step in the right direction, although there is still a long way to go before the expected results can be obtained. Finally, adequate training of health professionals, both specialized and non-specialized, as well as gatekeeper training, is crucial for implementing suicide prevention strategies in the population.

Evaluation of a Peer-Led Implementation of a Suicide Prevention Gatekeeper Training Program for College Students.

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.

Suicide Prevention Interventions for Older People in Nursing Homes and Long-Term Care Facilities: A Systematic Review.

The death rate due to suicide among older people is high, especially among men. Because many older people live in nursing homes or long-term care facilities in high-income countries, reviewing the impact of prevention strategies on the suicidal behavior of residents in these settings is of interest. Following PRISMA guidelines, we performed a systematic review of the existing literature found in Pubmed, Scopus, Web of Science, PsycINFO, and Sociological Abstracts, focusing on interventions to prevent suicidal behavior or ideation in nursing home residents. The studies' quality was evaluated according to TIDieR and MMAT. Only 6 studies met the inclusion criteria. Four of them described various "gatekeeper" trainings for nursing home staff and 2 described interventions focused on residents. Only 1 study was randomized. Gatekeeper training studies were mostly before/after comparisons. No intervention demonstrated a direct effect on suicidal ideation or behaviors. One study showed that "life review" had a long-lasting effect on depression scores and another that gatekeeper training led to changes in the care of suicidal residents. Interventions to prevent suicidal ideation or behaviors in nursing homes are not rigorously evaluated, and no conclusion can be drawn on their effectiveness in preventing suicidal behaviors. We propose to better evaluate gatekeeper training for staff as well as peer support. Individual interventions targeting residents could be modified for broader implementation.

Sexual and Gender Minorities' Readiness and Interest in Supporting Peers Experiencing Suicide-Related Behaviors.

Background: Gatekeeper training is a widely recommended suicide prevention intervention that encourages the development of knowledge and the identification and support of those at risk of suicide. Yet, this strategy has not been implemented among sexual and gender minorities (SGM), a group at high risk of suicide. Aim: The aim of this study was to describe the readiness and interest of SGM in supporting peers experiencing suicide-related behaviors. Method: We analyzed data from an online cross-sectional survey of Canadian SGM (n = 2778). Results: In total, 90% of participants had ≥1 SGM peer with depression, and 73% had ≥1 SGM peer who had previously attempted suicide; 74% said they knew what to do to support a peer experiencing suicide risk, and 77% indicated they knew where to refer them. Furthermore, 94% were interested in learning how to recognize signs of suicidality, while 95% were interested in learning skills to support a peer struggling with suicidality and 81% of those indicated a preference to learn these skills online. Limitations: The study used a nonprobability sample and cross-sectional design. Conclusion: SGM are largely interested in learning suicide prevention skills and, as such, more resources are needed to implement and scale up evidence-based approaches for gatekeeper training among SGM.