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Caughlan C, Kakuska A, Manthei J, Galvin L, Martinez A, Kelley A, Craig Rushing S. Mind4Health: decolonizing gatekeeper trainings using a culturally relevant text message intervention. Front Public Health 2024; 12:1397640. [PMID: 39286750 PMCID: PMC11403716 DOI: 10.3389/fpubh.2024.1397640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 08/12/2024] [Indexed: 09/19/2024] Open
Abstract
Background When a person dies by suicide, it takes a reverberating emotional, physical, and economic toll on families and communities. The widespread use of social media among youth and adolescents, disclosures of emotional distress, suicidal ideation, intent to self-harm, and other mental health crises posted on these platforms have increased. One solution to address the need for responsive suicide prevention and mental health services is to implement a culturally-tailored gatekeeper training. The Northwest Portland Area Indian Health Board (NPAIHB) developed Mind4Health, an online gatekeeper training (90 min) and text message intervention for caring adults of American Indian/Alaska Native (AI/AN) youth. Methods The Mind4Health intervention was a multi-phase, single-arm, pre-and post-test study of users enrolled in the intervention that is available via text message (SMS) or via a 90 min online, self-paced training. We produced four datasets in this study: Mobile Commons, pre-survey data, post-survey data, and Healthy Native Youth website's Google Analytics. The analysis included data cleaning, basic frequency counts, percentages, and descriptive statistics. Qualitative data were analyzed using thematic content analysis methods and hand-coding techniques with two independent coders. Results From 2022 to 2024, 280 people enrolled in the Mind4Health SMS training, and 250 completed the 8-week intervention. Many messages in the sequence were multi-part text messages and over 21,500 messages were sent out during the timeframe. Of the 280 subscribers, 52 participated in the pre-survey. Pre-survey data show that 94% of participants were female, and nearly one-fourth lived in Washington state, 92% of participants in the pre-survey were very to moderately comfortable talking with youth about mental health (n = 48). Most participants interact with youth in grades K-12. Post-survey data demonstrate changes in knowledge, beliefs, comfort talking about mental health, and self-efficacy among participants. Mind4Health improved participant's skills to have mental health conversations with youth and refer youth to resources in their community.
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Affiliation(s)
- Colbie Caughlan
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Amanda Kakuska
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Jane Manthei
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Lisa Galvin
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Aurora Martinez
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Allyson Kelley
- Allyson Kelley & Associates PLLC, Sisters, OR, United States
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McKay S, Meza JI. Culturally contextualized suicide prevention for international students: new opportunities for research and practice. Front Psychol 2024; 15:1418185. [PMID: 39165758 PMCID: PMC11333360 DOI: 10.3389/fpsyg.2024.1418185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/26/2024] [Indexed: 08/22/2024] Open
Abstract
The rising incidence of suicide-related thoughts and behaviors among international students presents a significant public health challenge and growing concern among college campuses. Current intervention strategies often rely on Western-centric and colonized approaches developed and tested with primarily Western, Educated, Industrialized, Rich and Democratic (WEIRD) samples. Exclusion and historical underrepresentation of ethnoracially minoritized groups in suicide prevention treatment trials create gaps in advancing our science because they often miss the cultural contextualization crucial for effective prevention and intervention in diverse groups from different countries of origin. To address the limitations of these Western-centric strategies, we explored existing prevention recommendations and approaches through the lens of an expanded version of the newly developed Protective Factors Framework, tailored for non-Western cultural perspectives. We propose significant opportunities for enhancing current practices and point to promising future directions. The primary areas for development include: (1) bolstering community empowerment and ownership, (2) refining mechanisms of change to encompass multicultural viewpoints, and (3) focusing on effective implementation and thorough evaluation for ongoing refinement. This methodology not only shows promise for enhancing international student suicide prevention but also offers insights for broader application in suicide prevention among other culturally diverse populations.
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Affiliation(s)
- Samuel McKay
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jocelyn I. Meza
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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McKay S, Ng C, Kenny B, Armanto R, Lamblin M, Robinson J. Participatory Design in Suicide Prevention: A Qualitative Study of International Students' Experiences of Adapting the LivingWorks safeTALK Programme. Health Expect 2024; 27:e14164. [PMID: 39108064 PMCID: PMC11303664 DOI: 10.1111/hex.14164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Current suicide prevention approaches are not adapted to international student needs, and participatory design is a method that may facilitate the development or adaptation of appropriate programmes for this group. METHODS This qualitative study investigated the experiences of international university students studying in Australia who participated in a co-consultation process to adapt the LivingWorks safeTALK suicide prevention programme. Eight international students from the co-consultation workshop completed semi-structured interviews about their workshop experience. The data were analysed using reflexive thematic analysis. RESULTS The findings showed that participants found the co-consultation process empowering and engaging. They also reported that the experience promoted mutual learning and challenged simplistic views of suicide. No students reported experiencing distress. Suggestions for improving participatory design for international students focussed on enhancing participant interaction, supporting quiet voices to be heard and ensuring understanding of mental health and suicide through shared language. CONCLUSIONS This study underscores the value of participatory design in suicide prevention, emphasising its potential to empower international students and facilitate culturally sensitive programme adaptations. PATIENT OR PUBLIC CONTRIBUTION International students were involved in the co-consultation process to redevelop the training content and provided a series of recommendations for improving such processes for international students in the future. The two researchers who conducted the interviews and data analysis were former international students.
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Affiliation(s)
- Samuel McKay
- OrygenParkvilleVictoriaAustralia
- Centre for Youth Mental Health, The University of MelbourneParkvilleVictoriaAustralia
| | | | - Bridget Kenny
- OrygenParkvilleVictoriaAustralia
- Centre for Youth Mental Health, The University of MelbourneParkvilleVictoriaAustralia
| | | | - Michelle Lamblin
- OrygenParkvilleVictoriaAustralia
- Centre for Youth Mental Health, The University of MelbourneParkvilleVictoriaAustralia
| | - Jo Robinson
- OrygenParkvilleVictoriaAustralia
- Centre for Youth Mental Health, The University of MelbourneParkvilleVictoriaAustralia
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Kingi-Uluave D, Taufa N, Tuesday R, Cargo T, Stasiak K, Merry S, Hetrick S. A Review of Systematic Reviews: Gatekeeper Training for Suicide Prevention with a Focus on Effectiveness and Findings. Arch Suicide Res 2024:1-18. [PMID: 38884349 DOI: 10.1080/13811118.2024.2358411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Hill RM, McCray CL. Suicide-Related Stigma and Social Responsibility Moderate the Effects of an Online Suicide Prevention Gatekeeper Training Program. Arch Suicide Res 2024; 28:706-715. [PMID: 37209132 DOI: 10.1080/13811118.2023.2199802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
AIM Gatekeeper interventions are universal programs designed for use by the general public that provide brief training sessions in responding to suicidal risk. To date, the evidence base for the efficacy of gatekeeper intervention training programs has been mixed. However, little attention has been paid to potential psychological moderators of the efficacy of suicide gatekeeper interventions. We explore the potential moderating effects of suicide-related stigma and social responsibility on the efficacy of a suicide prevention gatekeeper training program. METHODS Participants were 179 college students with a mean age of 19.05 years (SD = 1.82, range 18-31). Participants were 71.5% women, 48.6% Hispanic, and 19.6% non-Hispanic White. RESULTS Results indicated that higher scores on suicide-related stigma were associated with smaller intervention effects on gatekeeper self-efficacy. In contrast, higher scores on social responsibility were associated with greater intervention effects with regard to gatekeeper preparedness and gatekeeper likelihood. CONCLUSION An improved understanding of the factors associated with efficacy of gatekeeper intervention programs may lead to the development of improved gatekeeper interventions. These findings may also contribute to the development of targeted gatekeeper interventions for specific cultural or occupational groups.
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Chiu L, Corpus GH, Lien M, Chu JP. The Culturally Infused Curricular Framework (CICF) for Suicide Prevention Trainings. Health Promot Pract 2024:15248399241234064. [PMID: 38439682 DOI: 10.1177/15248399241234064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Although suicide prevention trainings (SPT) have been a standard approach for suicide prevention for years, researchers have noted a need for more clarity in the definition of core competencies for SPTs, particularly in the areas of diversity and culture. Recent research has identified key theoretically- and empirically-based cultural considerations for suicide prevention, but translation is needed to infuse these standards for culture-related competencies into SPTs. This study performed a systematic literature review with a thematic synthesis analytic approach to establish a set of curricular guidelines for infusion of cultural considerations into SPTs. The study also examined the extent to which existing community trainings already incorporate cultural components. Based on the thematic synthesis of 39 SPT studies from 2010 to 2020 and seminal reviews of the cultural and suicide literature, results identified three overarching categories of cultural curricular competencies (suicide knowledge and awareness, suicide intervention skills, and curriculum delivery) and 14 core cultural curricular subthemes for community trainings (e.g., culturally informed risk factors and warning signs, systemic inequities, etc.). These three categories with 14 core cultural curricular competencies comprise the Culturally Infused Curricular Framework (CICF) for Suicide Prevention Trainings. The majority of trainings (62%) included five or less out of 14 total possible core cultural competencies in their training curricula, pointing to insufficient integration of cultural components in existing community trainings. This study's research-based guideline establishes a culture-inclusive framework to strengthen content and approach of community trainings and suicide prevention across cultural groups.
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Affiliation(s)
- Lorna Chiu
- Palo Alto University, Palo Alto, CA, USA
| | | | - Mego Lien
- County of Santa Clara Behavioral Health Services, San Jose, CA, USA
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Mueller-Williams AC, Hopson J, Momper SL. Evaluating the Effectiveness of Suicide Prevention Gatekeeper Trainings as Part of an American Indian/Alaska Native Youth Suicide Prevention Program. Community Ment Health J 2023; 59:1631-1638. [PMID: 37558869 PMCID: PMC10598093 DOI: 10.1007/s10597-023-01154-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/04/2023] [Indexed: 08/11/2023]
Abstract
According to the Centers for Disease Control suicide rates in 2022 for American Indian/Alaska Native youth are 2.5 times higher than the national average. An Urban Indian Health Organization's response to this crisis was to provide community and State-wide Gatekeeper trainings between 2012 and 2019 to teach trainees (N = 810) to respond appropriately to youth at-risk of suicide. We report data on pre-, post-, and six-month follow-up surveys with trainees. Data were analyzed using generalized linear models repeated measures to test within-subject, and between-subject mean score changes on suicide prevention-related measures "knowledge," "ask directly," "respond," "comfort," and "preparedness." Results indicated improved capacity to be prepared to address suicide in the short term and that having a graduate degree enhanced baseline suicide prevention knowledge. Over time those with less education benefited the most and better retained content. Future Trainings should engage young people and those with less education to realize the largest benefit.
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Affiliation(s)
| | - Jennifer Hopson
- School of Social Work, University of Michigan, Ann Arbor, USA
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Nguyen T, Ullah S, Looi JCL, Allison S, Mulder R, Bastiampillai T. Indigenous suicide rates in the United States, Australia and New Zealand between 2006 and 2019. Aust N Z J Psychiatry 2023; 57:1324-1330. [PMID: 37092737 PMCID: PMC10517587 DOI: 10.1177/00048674231167327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Indigenous suicide prevention is an important focus for national health policies. Indigenous suicide rates in formerly colonial English-speaking countries such as the United States, Australia and New Zealand are considerably higher than the general population, particularly in young males. Given the similarities in their sociocultural history, a time series analysis was conducted to assess recent sex and age trends of suicide in the Indigenous and general populations in the United States, Australia and New Zealand. METHODS Using the number of deaths by intentional self-harm and estimated resident population, suicide incidence rates were calculated for the years 2006-2019 and stratified by Indigenous status, year, time period, sex and age group (above 15 years). Incidence rates were plotted. Using the Poisson regression model, calculated suicide incidence rate ratios were used to make comparisons for sex and age. RESULTS Across all countries studied, Indigenous suicide rates have increased over time, with Indigenous males having higher suicide rates than Indigenous females. However, the increase in Indigenous female suicides was greater than that for Indigenous males in Australia and New Zealand. Indigenous males aged 15-44 years have the highest suicide rates across all countries. CONCLUSION Indigenous suicide rates have remained consistently high in the United States, Australia and New Zealand, with Indigenous males aged 15-44 years showing the highest rate. However, suicide rates for Indigenous females in Australia and New Zealand are increasing more rapidly than males. Given this, it is critical that further research is dedicated to understanding and addressing the issues driving this problem, particularly in youth.
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Affiliation(s)
- Teresa Nguyen
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jeffrey CL Looi
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University, Canberra Hospital, Canberra, ACT, Australia
| | - Stephen Allison
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Roger Mulder
- Department of Psychological Medicine (Christchurch), University of Otago, Dunedin, New Zealand
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
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Winckler B, Nguyen M, Khare M, Patel A, Crandal B, Jenkins W, Fisher E, Rhee KE. Geographic Variation in Acute Pediatric Mental Health Utilization. Acad Pediatr 2023; 23:448-456. [PMID: 35940570 DOI: 10.1016/j.acap.2022.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify locations with higher need for acute pediatric mental health (MH) interventions or services and describe these communities' socio-demographic characteristics. METHODS This single-center retrospective study included patients 5 to 18 years old with an emergency department (ED) or hospital admission between 2017 and 2019 for a primary known MH diagnosis or symptoms. We extracted visit data from the electronic medical record, mapped patients to their home census tract, calculated normalized visit rates by census tract, and performed spatial analysis to identify nonrandom geographic clusters and outliers of high utilization. Census tract utilization rates were stratified into quartiles, and socioeconomic and demographic characteristics obtained from the US Census Bureau were compared using analysis of variance, chi-square tests, and multivariable analysis. RESULTS There were 10,866 qualifying visits across 617 census tracts. ED and hospital admission rates ranged from 2.7 to 428.6 per 1000 children. High utilization clusters localized to neighborhoods with lower socioeconomic status (p < .05). Southern regions with high utilizers were more likely to have fewer children per neighborhood, higher rates of teen births, and lower socioeconomic status. Multivariate analysis showed regions with high utilizers had fewer children per neighborhood, lower median household income, and more families that lacked computer access. CONCLUSION ED and hospital utilization for pediatric MH concerns varied significantly by neighborhood and demographics. Divergent social factors map onto these locations and are related to MH utilization. Leveraging geography can be a powerful tool in the development of targeted, culturally tailored interventions to decrease acute pediatric MH utilization and advance child MH equity.
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Affiliation(s)
- Britanny Winckler
- Division of Pediatric Hospital Medicine (B Winckler, M Khare, A Patel, E Fisher, and KE Rhee), Rady Children's Hospital/University of California San Diego, San Diego, Calif.
| | - Margaret Nguyen
- Division of Pediatric Emergency Medicine (M Nguyen), Rady Children's Hospital/University of California San Diego, San Diego, Calif
| | - Manaswitha Khare
- Division of Pediatric Hospital Medicine (B Winckler, M Khare, A Patel, E Fisher, and KE Rhee), Rady Children's Hospital/University of California San Diego, San Diego, Calif
| | - Aarti Patel
- Division of Pediatric Hospital Medicine (B Winckler, M Khare, A Patel, E Fisher, and KE Rhee), Rady Children's Hospital/University of California San Diego, San Diego, Calif
| | - Brent Crandal
- Behavioral Health Quality Improvement (B Crandal), Rady Children's Hospital San Diego, San Diego, Calif
| | - Willough Jenkins
- Department of Psychiatry (W Jenkins), Rady Children's Hospital/University of California San Diego, San Diego, Calif
| | - Erin Fisher
- Division of Pediatric Hospital Medicine (B Winckler, M Khare, A Patel, E Fisher, and KE Rhee), Rady Children's Hospital/University of California San Diego, San Diego, Calif
| | - Kyung E Rhee
- Division of Pediatric Hospital Medicine (B Winckler, M Khare, A Patel, E Fisher, and KE Rhee), Rady Children's Hospital/University of California San Diego, San Diego, Calif
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Zabelski S, Kaniuka AR, A Robertson R, Cramer RJ. Crisis Lines: Current Status and Recommendations for Research and Policy. Psychiatr Serv 2022; 74:505-512. [PMID: 36475827 DOI: 10.1176/appi.ps.20220294] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The 988 telephone number was established by the National Suicide Hotline Designation Act of 2020 and implemented in July 2022 as a more accessible way to reach the National Suicide Prevention Lifeline. Current financial and training resources, however, are insufficient to ensure effective implementation. METHODS To better understand the state of the literature on crisis support lines in light of the 988 transition, the authors summarized research on suicidal and nonsuicidal outcomes of callers, research on other types of crisis support services, and the benefits of text- and chat-based crisis lines. RESULTS Overall, existing evidence for the effectiveness of crisis lines has been weak and has primarily focused on short-term improvements in user distress and on user satisfaction. In addition, research on crisis lines specifically targeted to marginalized populations (e.g., sexual minority groups) and on text- or chat-based crisis lines is lacking. CONCLUSIONS The policy-focused recommendations derived from this review include the need for additional research on crisis lines, design and evaluation of culturally tailored training for volunteers and staff, and ethical oversight of private data collected from crisis services. Scaling up state-level planning and comprehensive crisis systems is necessary to successfully implement 988 and to fill current training and research gaps.
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Affiliation(s)
- Sasha Zabelski
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte
| | - Andréa R Kaniuka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte
| | - Ryan A Robertson
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte
| | - Robert J Cramer
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte
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Cecchin HFG, Murta SG, de Macedo EOS, Moore RA. Scoping review of 30 years of suicide prevention in university students around the world: efficacy, effectiveness, and cost-effectiveness. PSICOLOGIA-REFLEXAO E CRITICA 2022; 35:22. [PMID: 35856124 PMCID: PMC9294115 DOI: 10.1186/s41155-022-00227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
A scoping review of systematic reviews was carried out to identify evidence of efficacy, effectiveness, and cost-effectiveness of universal and selective suicide prevention programs among university students worldwide. Five databases were reviewed using terms in English, Spanish, and Portuguese. The following were the inclusion criteria: systematic review or meta-analysis or meta-synthesis, suicide prevention in college students, evaluation of the efficacy, effectiveness and/or cost-effectiveness of interventions, and peer-reviewed studies. The quality of reviews was assessed. The field of study features three decades of publication in high-income countries. The strategy used, the components of the program, and the target audience to which they are delivered interfere with efficacy. In the psychoeducation strategy, the experiential and didactic components are more efficacious in the knowledge about suicide. And the motivational enhancement component promotes greater self-efficacy in suicide prevention. Programs that take a multimodal approach are effective in increasing short-term attitudes related to suicide and reducing rates of completed suicide. The gatekeeper strategy delivered to peer counselors is the most effective one in the outcomes, including short-term and long-term knowledge about suicide and its prevention and self-efficacy in suicide prevention. A greater number of evaluated studies of gatekeeper interventions were identified, indicating a trend in this research field. No review addressed the effects on subgroups that were classified based on sex, racial or sexual minorities, and special (indigenous) populations. Only one study addressed cost-effectiveness, pointing out that the psychoeducation and gatekeeper strategies have relevant net benefit rates, but the gatekeeper strategy has a higher cost-benefit ratio compared to the psychoeducation strategy. The findings indicate that psychoeducation and gatekeeper interventions tend to be more efficacious when they combine education and skills training to intervene in suicidal behavior. The components of the intervention and the target audience to which it is delivered influence efficacy. Multimodal interventions evaluate completed suicide outcomes, but require greater implementation efforts, in terms of human and financial resources and more time for the evaluation.
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Affiliation(s)
- Hareli Fernanda Garcia Cecchin
- Universidade Federal do Tocantins, Pró-reitoria de Assuntos Estudantis – PROEST, Quadra 109 Norte, Avenida NS-15, Prédio da Reitoria, Plano Diretor Norte, 77001-090 Palmas, Tocantins Brazil
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Sacca L, Shegog R, Hernandez B, Peskin M, Rushing SC, Jessen C, Lane T, Markham C. Barriers, frameworks, and mitigating strategies influencing the dissemination and implementation of health promotion interventions in indigenous communities: a scoping review. Implement Sci 2022; 17:18. [PMID: 35189904 PMCID: PMC8862215 DOI: 10.1186/s13012-022-01190-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/18/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Many Indigenous communities across the USA and Canada experience a disproportionate burden of health disparities. Effective programs and interventions are essential to build protective skills for different age groups to improve health outcomes. Understanding the relevant barriers and facilitators to the successful dissemination, implementation, and retention of evidence-based interventions and/or evidence-informed programs in Indigenous communities can help guide their dissemination. PURPOSE To identify common barriers to dissemination and implementation (D&I) and effective mitigating frameworks and strategies used to successfully disseminate and implement evidence-based interventions and/or evidence-informed programs in American Indian/Alaska Native (AI/AN), Native Hawaiian/Pacific Islander (NH/PI), and Canadian Indigenous communities. METHODS A scoping review, informed by the York methodology, comprised five steps: (1) identification of the research questions; (2) searching for relevant studies; (3) selection of studies relevant to the research questions; (4) data charting; and (5) collation, summarization, and reporting of results. The established D&I SISTER strategy taxonomy provided criteria for categorizing reported strategies. RESULTS Candidate studies that met inclusion/exclusion criteria were extracted from PubMed (n = 19), Embase (n = 18), and Scopus (n = 1). Seventeen studies were excluded following full review resulting in 21 included studies. The most frequently cited category of barriers was "Social Determinants of Health in Communities." Forty-three percent of barriers were categorized in this community/society-policy level of the SEM and most studies (n = 12, 57%) cited this category. Sixteen studies (76%) used a D&I framework or model (mainly CBPR) to disseminate and implement health promotion evidence-based programs in Indigenous communities. Most highly ranked strategies (80%) corresponded with those previously identified as "important" and "feasible" for D&I The most commonly reported SISTER strategy was "Build partnerships (i.e., coalitions) to support implementation" (86%). CONCLUSION D&I frameworks and strategies are increasingly cited as informing the adoption, implementation, and sustainability of evidence-based programs within Indigenous communities. This study contributes towards identifying barriers and effective D&I frameworks and strategies critical to improving reach and sustainability of evidence-based programs in Indigenous communities. REGISTRATION NUMBER N/A (scoping review).
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Affiliation(s)
- Lea Sacca
- grid.267308.80000 0000 9206 2401Center for Health Promotion and Disease Prevention, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin, Houston, TX 77030 USA
| | - Ross Shegog
- grid.267308.80000 0000 9206 2401Center for Health Promotion and Disease Prevention, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin, Houston, TX 77030 USA
| | - Belinda Hernandez
- grid.267309.90000 0001 0629 5880Center for Health Promotion and Disease Prevention, University of Texas Health Science Center School of Public Health in San Antonio, 7411 John Smith Drive, Suite 1100, San Antonio, TX 78229 USA
| | - Melissa Peskin
- grid.267308.80000 0000 9206 2401Center for Health Promotion and Disease Prevention, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin, Houston, TX 77030 USA
| | - Stephanie Craig Rushing
- grid.422837.80000 0000 9966 8676Northwest Portland Area Indian Health Board, 2121 SW Broadway Suite 300, Portland, OR 97201 USA
| | - Cornelia Jessen
- grid.413552.40000 0000 9894 0703Alaska Native Tribal Health Consortium, 4000 Ambassador Drive, Anchorage, AK 99508 USA
| | - Travis Lane
- grid.470274.20000 0001 0023 3814Inter Tribal Council of Arizona, Inc., 2214 North Central Avenue, Phoenix, AZ 85004 USA
| | - Christine Markham
- grid.267308.80000 0000 9206 2401Center for Health Promotion and Disease Prevention, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin, Houston, TX 77030 USA
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Revisiting evidence of primary prevention of suicide among adult populations: A systematic overview. J Affect Disord 2022; 297:641-656. [PMID: 34728288 DOI: 10.1016/j.jad.2021.10.076] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/24/2021] [Accepted: 10/23/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUNDS Primary prevention of suicidal behaviors in the general population is required to interrupt the trend of self-inflicted deaths worldwide. We reviewed the evidence of the efficacy of primary prevention of suicide among the adult population. METHODS This is an overview of systematic reviews. We searched PubMed, EMBASE, Scopus, PsycINFO, and Cochrane databases to identify articles on suicide prevention strategies in non-clinical populations. For the purpose of overview, only systematic reviews were eligible. Primary outcomes: The outcomes of the present study were changes in the number of suicide death or suicide behaviors. Two reviewers assessed the methodological quality and the risk of bias of included studies. RESULTS From the initial 2,315 records, 32 articles met inclusion criteria. Evidence of reduction of suicide-related outcomes was detected, but of small magnitude. Most multicomponent prevention programs were delivered to specific populations, comprising strategies such as restriction to lethal means, educational programs, and gatekeeper training. Means restriction was the single intervention that showed some evidence of individual efficacy in reducing suicide. There is evidence that poor quality of media reporting is related with increasing suicide and better-quality reports could help suicide prevention. Most of the included SRs were of critically-low methodological quality. LIMITATIONS Publication bias, reporting bias, study designs, outcome definition and article overlap across studies are the main concerns. CONCLUSIONS Multicomponent programs and means restriction have indicated a reduction of suicide rates, mainly in specific populations. There is insufficient evidence to recommend a widespread implementation of suicide primary prevention in the general population.
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Patel R, Mehta R, Dave K, Chaudhary P. Effectiveness of gatekeepers' training for suicide prevention program among medical professionals and medical undergraduate students of a medical college from Western India. Ind Psychiatry J 2021; 30:217-223. [PMID: 35017803 PMCID: PMC8709527 DOI: 10.4103/ipj.ipj_31_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/20/2021] [Accepted: 06/20/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION 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. The global prevalence of depression among medical students was recently estimated to be 28.0 % according to a meta-analysis of 77 studies. In the field of suicide prevention, the term gatekeeper refers to "individuals in a community who have face-to-face contact with large numbers of community members as part of their usual routine." They may be trained to "identify persons at risk of suicide and refer them to treatment or supporting services as appropriate". In our study we aimed to improved attitude and knowledge in gatekeeper to improve detection and referral of individuals who are at risk of suicide. METHODS AND MATERIAL We adapted an evidence-based gatekeeper training into a two-hour, multi-modal and interactive event for medical professional and undergraduate students. Then we evaluated the intervention compared to free-recall knowledge and attitudes questions were examined before and after participation in a student and faculty gatekeeper training program. Focus groups with students enriched interpretation of quantitative results. STATISTICAL ANALYSIS USED Knowledge, attitudes, and skills of both students and teachers were analyzed by Mann-Whitney U-test. Comparison of knowledge, attitudes, and skills between both groups was analyzed by Wilcoxon signed-rank test. RESULTS Undergraduate students developed more positive attitude for suicidal behavior where faculties developed more confident in their skill after training sessions. CONCLUSION brief gatekeeper training found effective in improving knowledge about suicide. Also, increasing participants' accuracy to identify warning signs, risk factors and protective factors about suicide.
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Affiliation(s)
| | - Ritambhara Mehta
- Department of Psychiatry, Government Medical College, Surat, Gujarat, India
| | - Kamlesh Dave
- Department of Psychiatry, Government Medical College, Surat, Gujarat, India
| | - Pradhyuman Chaudhary
- Department of Psychiatry, GMERS Medical College and Hospital, Sola, Ahmedabad, Gujarat, India
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15
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Farah Nasir B, Brennan-Olsen S, Gill NS, Beccaria G, Kisely S, Hides L, Kondalsamy-Chennakesavan S, Nicholson G, Toombs M. A community-led design for an Indigenous Model of Mental Health Care for Indigenous people with depressive disorders. Aust N Z J Public Health 2021; 45:330-337. [PMID: 34097328 DOI: 10.1111/1753-6405.13115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 02/01/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To generate outcomes for the development of a culturally appropriate mental health treatment model for Indigenous Australians with depression. METHODS Three focus group sessions and two semi-structured interviews were undertaken over six months across regional and rural locations in South West Queensland. Data were transcribed verbatim and coded using manual thematic analyses. Transcripts were thematically analysed and substantiated. Findings were presented back to participants for authenticity and verification. RESULTS Three focus group discussions (n=24), and two interviews with Elders (n=2) were conducted, from which six themes were generated. The most common themes from the focus groups included Indigenous autonomy, wellbeing and identity. The three most common themes from the Elder interviews included culture retention and connection to Country, cultural spiritual beliefs embedded in the mental health system, and autonomy over funding decisions. CONCLUSIONS A treatment model for depression must include concepts of Indigenous autonomy, identity and wellbeing. Further, treatment approaches need to incorporate Indigenous social and emotional wellbeing concepts alongside clinical treatment approaches. Implications for public health: Any systematic approach to address the social and cultural wellbeing of Indigenous peoples must have a community-led design and delivery.
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Affiliation(s)
- Bushra Farah Nasir
- Rural Clinical School, Faculty of Medicine, The University of Queensland
| | - Sharon Brennan-Olsen
- School of Health and Social Development, Deakin University, Victoria.,Institute for Health Transformation, Deakin University, Victoria
| | - Neeraj S Gill
- Rural Clinical School, Faculty of Medicine, The University of Queensland.,School of Medicine, Griffith University, Queensland
| | - Gavin Beccaria
- School of Psychology and Counselling, University of Southern Queensland
| | - Steve Kisely
- Southern Clinical School, School of Medicine, The University of Queensland.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada
| | - Leanne Hides
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland
| | | | - Geoffrey Nicholson
- Rural Clinical School, Faculty of Medicine, The University of Queensland
| | - Maree Toombs
- Rural Clinical School, Faculty of Medicine, The University of Queensland
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16
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Dabkowski E, Porter JE. An exploration into suicide prevention initiatives for mental health nurses: A systematic literature review. Int J Ment Health Nurs 2021; 30:610-623. [PMID: 33856744 DOI: 10.1111/inm.12872] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 11/30/2022]
Abstract
Mental health and suicide prevention are national health priorities in Australia, with research currently focussed towards the ZERO Suicide (ZS) initiative. The aim of this review was to evaluate the impact of suicide prevention programmes, in particular the ZS prevention initiative. A systematic review using the PRISMA guidelines was conducted using six EBSCO Host databases; Academic Search Complete, Australian/New Zealand Reference Centre, CINAHL Complete, MEDLINE, APA PsycINFO, and APA Psyc Articles. The data extracted from the eligible papers were analysed using a thematic approach. The final data set consisted of fourteen (n = 14) peer-reviewed articles meeting the eligibility criteria, which included quantitative (n = 10), mixed methods (n = 2), and qualitative studies (n = 2). Results indicated variances between suicide prevention programmes with some papers examining single workshops and others assessing multimodal, organizational interventions. Five major themes were produced from this review including measuring the success of suicide prevention programmes, improvements to the delivery of suicide prevention programmes, barriers to implementing changes, cultural considerations, and further research required for suicide prevention programmes. This review concludes that further long-term research is required to evaluate the implementation and efficacy of suicide prevention programmes in health care. Cultural awareness in suicide prevention training is another area that may benefit from further research. A growing body of evidence establishes the need for multimodal and organizational approaches for suicide prevention initiatives.
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Affiliation(s)
- Elissa Dabkowski
- Collaborative Evaluation Unit, School of Health, Federation University Australia, Churchill, Victoria, Australia
| | - Joanne E Porter
- Collaborative Evaluation Unit, School of Health, Federation University Australia, Churchill, Victoria, Australia
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17
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Westerman T, Sheridan L. Whole of community suicide prevention forums for Aboriginal Australians. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1111/ap.12470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tracy Westerman
- Indigenous Psychological Services, Perth, Western Australia, Australia,
- School of Psychology, Curtin University, Perth, Western Australia, Australia,
| | - Lorraine Sheridan
- Indigenous Psychological Services, Perth, Western Australia, Australia,
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18
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Davies K, Read DMY, Booth A, Turner N, Gottschall K, Perkins D. Connecting with social and emotional well-being in rural Australia: An evaluation of 'We-Yarn', an Aboriginal gatekeeper suicide prevention workshop. Aust J Rural Health 2020; 28:579-587. [PMID: 33245192 DOI: 10.1111/ajr.12671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE 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. DESIGN A mixed methods approach included surveys, in-depth interviews and workshop observations. SETTING Aboriginal suicide prevention training in rural New South Wales, Australia. PARTICIPANTS Attendees at We-Yarn training. INTERVENTION 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. MAIN OUTCOME MEASURES 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Kate Davies
- Centre for Rural and Remote Mental Health, University of Newcastle, NSW, Australia
| | - Donna M Y Read
- Centre for Rural and Remote Mental Health, University of Newcastle, NSW, Australia
| | - Angela Booth
- Centre for Rural and Remote Mental Health, University of Newcastle, NSW, Australia
| | - Nicole Turner
- Centre for Rural and Remote Mental Health, University of Newcastle, NSW, Australia
| | - Kristina Gottschall
- Centre for Rural and Remote Mental Health, University of Newcastle, NSW, Australia
| | - David Perkins
- Centre for Rural and Remote Mental Health, University of Newcastle, NSW, Australia
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Leske S, Paul E, Gibson M, Little B, Wenitong M, Kolves K. Global systematic review of the effects of suicide prevention interventions in Indigenous peoples. J Epidemiol Community Health 2020; 74:1050-1055. [PMID: 32788303 DOI: 10.1136/jech-2019-212368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/30/2019] [Accepted: 06/11/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Suicide rates are often higher in Indigenous than in non-Indigenous peoples. This systematic review assessed the effects of suicide prevention interventions on suicide-related outcomes in Indigenous populations worldwide. METHODS We searched CINAHL, Embase, PubMed, PsycINFO, ProQuest Dissertations & Theses and Web of Science from database inception to April 2020. Eligible were English language, empirical and peer-reviewed studies presenting original data assessing the primary outcomes of suicides and suicide attempts and secondary outcomes of suicidal ideation, intentional self-harm, suicide or intentional self-harm risk, composite measures of suicidality or reasons for life in experimental and quasi-experimental interventions with Indigenous populations worldwide. We assessed the risk of bias with the Cochrane Risk of Bias Tool and the Risk of Bias Assessment for Non-randomised Studies. FINDINGS We included 24 studies from Australia, Canada, New Zealand and the USA, comprising 14 before-after studies, 4 randomised controlled trials (RCTs), 3 non-randomised controlled trials, 2 interrupted time-series designs and 1 cohort study. Suicides decreased in four and suicide attempts in six before-after studies. No studies had a low risk of bias. There was insufficient evidence to confirm the effectiveness of any one suicide prevention intervention due to shortage of studies, risk of bias, and population and intervention heterogeneity. Review limitations include language bias, no grey literature search and data availability bias. CONCLUSION For the primary outcomes of suicides and suicide attempts, the limited available evidence supports multilevel, multicomponent interventions. However, there are limited RCTs and controlled studies.
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Affiliation(s)
- Stuart Leske
- Australian Institute for Suicide Research and Prevention, School of Psychology, Griffith University, Mt Gravatt Campus, Qld, Australia .,WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, Qld, Australia
| | - Elise Paul
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
| | - Mandy Gibson
- Australian Institute for Suicide Research and Prevention, School of Psychology, Griffith University, Mt Gravatt Campus, Qld, Australia.,WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, Qld, Australia
| | - Brock Little
- Australian Institute for Suicide Research and Prevention, School of Psychology, Griffith University, Mt Gravatt Campus, Qld, Australia.,WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, Qld, Australia
| | - Mark Wenitong
- Apunipima Cape York Health Council, Bungalow, Australia.,School of Public Health, Queensland University of Technology, Brisbane, Qld, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Qld, Australia
| | - Kairi Kolves
- Australian Institute for Suicide Research and Prevention, School of Psychology, Griffith University, Mt Gravatt Campus, Qld, Australia.,WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, Qld, Australia
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20
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Brown K, Toombs M, Nasir B, Kisely S, Ranmuthugala G, Brennan-Olsen SL, Nicholson GC, Gill NS, Hayman NS, Kondalsamy-Chennakesavan S, Hides L. How can mobile applications support suicide prevention gatekeepers in Australian Indigenous communities? Soc Sci Med 2020; 258:113015. [DOI: 10.1016/j.socscimed.2020.113015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/25/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
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21
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Hawgood J, Koo YW, Sveticic J, De Leo D, Kõlves K. Wesley LifeForce Suicide Prevention Gatekeeper Training in Australia: 6 Month Follow-Up Evaluation of Full and Half Day Community Programs. Front Psychiatry 2020; 11:614191. [PMID: 33510661 PMCID: PMC7835323 DOI: 10.3389/fpsyt.2020.614191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: Wesley Mission LifeForce training is an Australian suicide prevention gatekeeper program which has not been formally evaluated. The aims of this evaluation were to (1) determine the short- and medium- term impacts of the training on worker capabilities (perceived and declarative knowledge), attitudes, and reluctance to intervene measures; and (2) compare the impact of the half and full day workshops on these measures. Method: 1,079 Australian community workers of diverse professional backgrounds completed a pre-workshop questionnaire as part of registration for the Wesley LifeForce suicide prevention training between 2017 and 2019. Of these, 299 participants also completed the post workshop questionnaires (matched sample). They attended either half day (n = 97) or full day workshops (n = 202) and completed also a 3- and 6- month follow-up questionnaire. We used linear mixed-effect modeling for repeated measures to analyze data. Results: LifeForce training participants experienced an increase in perceived capability, declarative knowledge, more positive attitudes and reduced reluctance to intervene, at least in the short term. The program is particularly well targeted for community gatekeepers with no prior training, albeit those with prior training in this study also experienced positive and significant gains on most measured constructs. Conclusions: We found evidence of effectiveness of the Wesley LifeForce training over time, without difference between the short (half day) and longer (full day) formats of delivery. Nevertheless, the latter format offers skills-based and skills rehearsal opportunities, the impacts of which we were unable to measure in this evaluation and should be estimated in the future.
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Affiliation(s)
- Jacinta Hawgood
- Australian Institute for Suicide Research and Prevention, World Health Organisation Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Yu Wen Koo
- Australian Institute for Suicide Research and Prevention, World Health Organisation Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Jerneja Sveticic
- Australian Institute for Suicide Research and Prevention, World Health Organisation Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia.,Gold Coast Health, Mental Health and Specialist Services, Southport, QLD, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, World Health Organisation Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, World Health Organisation Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
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22
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Suggestive diagnosis of attention-deficit/hyperactivity disorder in indigenous children and adolescents from the Brazilian Amazon. Eur Child Adolesc Psychiatry 2020; 29:373-384. [PMID: 31165277 PMCID: PMC7056679 DOI: 10.1007/s00787-019-01356-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 05/23/2019] [Indexed: 11/11/2022]
Abstract
The prevalence of attention-deficit/hyperactivity disorder (ADHD) symptoms has been scarcely studied in indigenous cultures that preserve ancestral cultural characteristics. The objective of the study is to estimate the prevalence of suggestive diagnosis of ADHD among indigenous children and adolescents from villages in the Amazon. This is an analytical cross-sectional study using instruments to track ADHD symptoms (the Child Behaviour Checklist for ages 6-18: CBCL/6-18 and the teacher report form for ages 6-18: TRF/6-18) and to investigate their negative impact on the patients (using the Strengths and Difficulties Questionnaire-SDQ). The prevalence of a suggestive ADHD diagnosis according to the CBCL/TRF DSM-IV ADHD subscale without and with negative impact as assessed by the SDQ was 4.3% and 1.1%, respectively. Comorbid oppositional-defiant, conduct problems and anxious symptoms were present in all cases screening positive for ADHD. We also presented a case report as an illustration of the observed clinical presentation. ADHD is a recognizable disorder even in a culture that preserves millennial characteristics. Furthermore, the presence of ADHD symptoms was associated with significant impairment.
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23
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Walker RJ, Campbell JA, Dawson AZ, Egede LE. Prevalence of psychological distress, depression and suicidal ideation in an indigenous population in Panamá. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1199-1207. [PMID: 31055631 PMCID: PMC6790172 DOI: 10.1007/s00127-019-01719-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 04/25/2019] [Indexed: 03/01/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of serious psychological distress (SPD), depression, and suicidal ideation in an adult Indigenous population in Panamá. METHODS Data were collected from 211 Kuna adults using a paper-based survey. Depression and suicidal ideation were measured using the Patient Health Questionnaire (PHQ-9), and SPD was measured using the Kessler-6. Univariate analyses were used to describe demographic variables, followed by chi2 tests to compare differences in demographic variables for each of the mental health outcomes (depression, serious psychological distress, suicidal ideation). A regression model, adjusted for all demographic variables, was then run for each mental health outcome to understand independent correlates. RESULTS Within the sample surveyed, 6.2% (95% CI 3.4-10.4) reported serious psychological distress, 32.0% (95% CI 25.7-38.9) reported depression, and 22.9% (95% CI 17.4-29.1) reported suicidal ideation. Significant demographic differences existed with 14% of individuals between the age of 60-90 and 17% of individuals with no education reporting SPD. Women were nearly 5 times more likely to report depression than men (OR 4.90, 95% CI 1.27-19.00) and those with higher incomes were less likely to report depression (OR 0.32, 95% CI 0.13-0.78). CONCLUSION High levels of depression, SPD, and suicidal ideation were present in an Indigenous Kuna community in Panamá. Women and individuals with low income were more likely to report depression, and SPD was more common in older individuals and those with low levels of education. Suicidal ideation was high across all demographic factors, suggesting that a community-wide program to address suicide may be warranted.
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Affiliation(s)
- Rebekah J. Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Jennifer A. Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Aprill Z. Dawson
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Leonard E. Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
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Bingham B, Moniruzzaman A, Patterson M, Sareen J, Distasio J, O’Neil J, Somers JM. Gender differences among Indigenous Canadians experiencing homelessness and mental illness. BMC Psychol 2019; 7:57. [PMID: 31455404 PMCID: PMC6712855 DOI: 10.1186/s40359-019-0331-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 07/26/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Indigenous people are over represented among homeless populations worldwide and the prevalence of Indigenous homelessness appears to be increasing in Canadian cities. Violence against Indigenous women in Canada has been widely publicized but has not informed the planning of housing interventions. Despite historical policies leading to disenfranchisement of Indigenous rights in gender-specific ways, little is known about contemporary differences in need between homeless Indigenous men and women. This study investigated mental health, substance use and service use among Indigenous people who met criteria for homelessness and mental illness, and hypothesized that, compared to men, women would have significantly higher rates of trauma, suicidality, substance dependence, and experiences of violence. METHODS This study was conducted using baseline (pre-randomization) data from a multi-site trial. Inclusion in the current analyses was restricted to participants who self-reported Indigenous ethnicity, and combined eligible participants from Vancouver, BC and Winnipeg, MB. Logistic regression analyses were used to model the independent associations between gender and outcome variables. RESULTS In multivariable regression models among Indigenous participants (n = 439), female gender was predictive of meeting criteria for PTSD, multiple mental disorders, current high suicidality and current substance dependence. Female gender was also significantly associated with reported physical (AOR: 1.52, 95% CI = 1.10-2.23) and sexual (AOR: 6.31, 95% CI = 2.78-14.31) violence. CONCLUSIONS Our analyses of Indigenous men and women who are homeless illustrate the distinct legacy of colonization on the experiences of Indigenous women. Our findings are consistent with the widely documented violence against Indigenous women in Canada. Housing policies and services are urgently needed that take Indigenous historical contexts, trauma and gender into account. TRIAL REGISTRATION This trial has been registered with the International Standard Randomized Control Trial Number Register and assigned ISRCTN42520374 ; ISRCTN57595077 ; ISRCTN66721740 .
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Affiliation(s)
- Brittany Bingham
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - Akm Moniruzzaman
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - Michelle Patterson
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - Jitinder Sareen
- Psychology and Community Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Jino Distasio
- Geography, University of Winnipeg, Winnipeg, MB Canada
| | - John O’Neil
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - Julian M. Somers
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
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25
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Gatekeeper training for suicidal behaviors: A systematic review. J Affect Disord 2019; 246:506-514. [PMID: 30599375 DOI: 10.1016/j.jad.2018.12.052] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/26/2018] [Accepted: 12/16/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Gatekeeper training (GKT) is a common intervention aiming to prevent suicidal behavior. We investigated updated evidence for the effectiveness of GKT in suicide prevention using data from randomized controlled trials (RCTs) and intervention studies, and we also describe variations in existing GKT programs. METHODS We performed a systematic review. The literature search was conducted using PubMed, PsycINFO, CINAHL, the Cochrane databases, and reference lists from previous reviews. RCTs or intervention studies utilizing prospective or quasi-experimental designs were included. RESULTS The search terms identified 343 articles. Ten randomized clinical trials and six intervention studies were identified as eligible for inclusion. Among the eligible studies, a number of different types of GKT were identified, including Question, Persuade, and Refer, Applied Suicide Intervention Skills Training, OSPI, Youth Aware of Mental Health, and approaches based on e-learning. For the RCTs, the effects of GKT remained unclear in relation to knowledge, appraisals, and self-efficacy after training, though some supportive evidence was found in the uncontrolled pre-post studies. The overall quality for each RCT was rated as either low or unclear. LIMITATIONS We could not perform a meta-analysis because comparable outcomes could not be identified across studies. CONCLUSIONS The effects of GKT remain unclear. There are many variations in GKT and there is a need to replicate studies in target populations. Future research should examine the effectiveness of a standardized GKT program using high-quality RCTs which include the evaluation of pre-specified primary outcomes in comparison with appropriate control groups.
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26
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Terpstra S, Beekman A, Abbing J, Jaken S, Steendam M, Gilissen R. Suicide prevention gatekeeper training in the Netherlands improves gatekeepers' knowledge of suicide prevention and their confidence to discuss suicidality, an observational study. BMC Public Health 2018; 18:637. [PMID: 29776415 PMCID: PMC5960185 DOI: 10.1186/s12889-018-5512-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background The 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. Methods In 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. Results Pre-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. Conclusions The 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. Electronic supplementary material The online version of this article (10.1186/s12889-018-5512-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sanne Terpstra
- Department of Research & Innovation, GGz InGeest, Amsterdam, The Netherlands.
| | - Aartjan Beekman
- Department of Research & Innovation, GGz InGeest, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jens Abbing
- Department of Public and Occupational Health, VU University Medical Centre, Amsterdam, The Netherlands
| | - Sabine Jaken
- 113 Suicide Prevention, Amsterdam, The Netherlands
| | - Martin Steendam
- Department of Psychology, GGz Friesland, Leeuwarden, The Netherlands
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Nasir B, Kisely S, Hides L, Ranmuthugala G, Brennan-Olsen S, Nicholson GC, Gill NS, Hayman N, Kondalsamy-Chennakesavan S, Toombs M. An Australian Indigenous community-led suicide intervention skills training program: community consultation findings. BMC Psychiatry 2017; 17:219. [PMID: 28610603 PMCID: PMC5470249 DOI: 10.1186/s12888-017-1380-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known of the appropriateness of existing gatekeeper suicide prevention programs for Indigenous communities. Despite the high rates of Indigenous suicide in Australia, especially among Indigenous youth, it is unclear how effective existing suicide prevention programs are in providing appropriate management of Indigenous people at risk of suicide. METHODS In-depth, semi-structured interviews and focus groups were conducted with Indigenous communities in rural and regional areas of Southern Queensland. Thematic analysis was performed on the gathered information. RESULTS Existing programs were time-intensive and included content irrelevant to Indigenous people. There was inconsistency in the content and delivery of gatekeeper training. Programs were also not sustainable for rural and regional Indigenous communities. CONCLUSIONS Appropriate programs should be practical, relevant, and sustainable across all Indigenous communities, with a focus on the social, emotional, cultural and spiritual underpinnings of community wellbeing. Programs need to be developed in thorough consultation with Indigenous communities. Indigenous-led suicide intervention training programs are needed to mitigate the increasing rates of suicide experienced by Indigenous peoples living in rural and remote locations.
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Affiliation(s)
- Bushra Nasir
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, QLD Australia
| | - Steve Kisely
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, QLD Australia
- Departments of Psychiatry, Community Health & Epidemiology, Dalhouise University, Halifax, Canada
| | - Leanne Hides
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD Australia
| | - Geetha Ranmuthugala
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, QLD Australia
- School of Rural Medicine, University of New England, Armidale, NSW Australia
| | - Sharon Brennan-Olsen
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, Melbourne, Australia
| | - Geoffrey C. Nicholson
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, QLD Australia
| | - Neeraj S. Gill
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, QLD Australia
| | - Noel Hayman
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, QLD Australia
| | | | - Maree Toombs
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, QLD Australia
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Gilissen R, De Beurs D, Mokkenstorm J, Mérelle S, Donker G, Terpstra S, Derijck C, Franx G. Improving Suicide Prevention in Dutch Regions by Creating Local Suicide Prevention Action Networks (SUPRANET): A Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14040349. [PMID: 28350367 PMCID: PMC5409550 DOI: 10.3390/ijerph14040349] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/16/2017] [Accepted: 03/22/2017] [Indexed: 11/16/2022]
Abstract
The European Alliance against Depression (EAAD) program is to be introduced in The Netherlands from 2017 onwards. This program to combat suicide consists of interventions on four levels: (1) increasing the awareness of suicide by local media campaigns; (2) training local gatekeepers, such as teachers or police officers; (3) targeting high-risk persons in the community; and (4) training and support of professionals in primary care settings. The implementation starts in seven Dutch pilot regions. Each region is designated as a Suicide Prevention Action NETwork (SUPRANET). This paper describes the SUPRANET program components and the evaluation of its feasibility and impact. The findings will be used to facilitate the national implementation of EAAD in The Netherlands and to add new findings to the existing literature on EAAD.
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Affiliation(s)
- Renske Gilissen
- Department of Research, 113 Suicide Prevention, 1100 CE Amsterdam, The Netherlands; (J.M.); (S.T.)
- Correspondence:
| | - Derek De Beurs
- Netherlands Institute for Health Services Research (NIVEL), 3513 CR Utrecht, The Netherlands; (D.d.B.); (G.D.)
| | - Jan Mokkenstorm
- Department of Research, 113 Suicide Prevention, 1100 CE Amsterdam, The Netherlands; (J.M.); (S.T.)
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, 1081 BT Amsterdam, The Netherlands
- Department of Research & Innovation, GGZ inGeest, 1070 BB Amsterdam, The Netherlands
| | - Saskia Mérelle
- Public Health Service (GGD) Kennemerland, 2015 CK Haarlem, The Netherlands;
| | - Gé Donker
- Netherlands Institute for Health Services Research (NIVEL), 3513 CR Utrecht, The Netherlands; (D.d.B.); (G.D.)
| | - Sanne Terpstra
- Department of Research, 113 Suicide Prevention, 1100 CE Amsterdam, The Netherlands; (J.M.); (S.T.)
| | - Carla Derijck
- Department of Implementation, 113 Suicide Prevention, 1100 CE Amsterdam, The Netherlands; (C.D.); ; (G.F.)
| | | | - Gerdien Franx
- Department of Implementation, 113 Suicide Prevention, 1100 CE Amsterdam, The Netherlands; (C.D.); ; (G.F.)
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