Wesley LifeForce Suicide Prevention Gatekeeper Training in Australia: 6 Month Follow-Up Evaluation of Full and Half Day Community Programs

Evaluating suicide prevention gatekeeper training designed to identify and support people from asylum-seeking and refugee backgrounds

BACKGROUND

Suicide-related behaviours and individual risk factors for suicide differ between ethnicities and demonstrate additional variation based on voluntary and forced migration. People forcibly displaced by violence and conflict, such as those seeking asylum and refugees, are likely to face stressors that can increase suicide risk. Research into evidenced-based suicide prevention strategies among people from asylum-seeking and refugee backgrounds is scarce. However, early, contextually-appropriate, identification and intervention may be a promising way to facilitate support for people in these groups. This research proposes that a contextually-responsive gatekeeper training is an appropriate strategy to increase the identification and support for people from asylum-seeking and refugee backgrounds.

METHODS

The present article relates to the statistical findings of a larger mixed-method study used to validate and refine a contextually-responsive gatekeeper training program. The qualitative results of this research will be published separately. The outcome measures - knowledge about suicide in multicultural contexts, attitudes towards suicide and prevention, and self-efficacy to intervene were measured quantitatively, adopting a similar pre- and post-training procedure used in previous training evaluations. Using Generalised Estimating Equations, statistical comparisons were made between three identical self-report surveys completed by participants across three consecutive time points - pre-training, immediately post-training, and three months following training completion - known in this investigation as time-point zero (T0), time-point one (T1), and time-point two (T2). Lastly, during the T2 follow-up, additional open-ended questions were included to understand which areas of training they feel prepared them effectively and how the program could have better prepared them to intervene.

RESULTS

A total of 28 participants took part in the study. Quantitative analysis indicated the program's capacity to exert a significant favourable and lasting influence on knowledge about suicide and self-efficacy to intervene. In addition, follow-up measurements suggest that the content delivered to participants transferred effectively into real-world suicide prevention behaviours.

CONCLUSIONS

Findings suggest that tailored suicide prevention training can have a significant influence on knowledge about suicide in multicultural contexts, self-efficacy to intervene in a crisis, and that course content translates effectively into real-world suicide prevention behaviour. Modifying training practices, based on feedback from contextually-experienced attendees, appears to be a pivotal factor in promoting the support of people from asylum-seeking and refugee backgrounds.

Efficacy of an online gatekeeper program for relatives of men at risk of suicide - a randomized controlled trial

BACKGROUND

Men at risk for suicide are a challenging population group to reach with suicide prevention strategies. Gatekeepers hold a pivotal role in the prevention of male suicide, yet effective intervention requires them to have a level of knowledge and strategies to provide support.

AIM

This study aimed to examine the efficacy of an online gatekeeper program for gatekeepers in male suicide prevention, assessing knowledge, perceived preparedness, self-efficacy, and psychopathological symptoms of gatekeepers.

METHODS

Eighty-four participants were randomized to either the intervention (n = 43) or the waitlist control group (n = 41). The intervention comprised four modules providing knowledge and strategies for addressing men in suicidal crises. Outcomes included depression (PHQ-9), distress (PSS-10), burden (BAS), involvement (IEQ), as well as gatekeeper outcomes and knowledge.

RESULTS

Completer analyses revealed significant improvement of depressive symptoms (d = 0.39) and an increase in gatekeeper outcomes (d = 0.58 to d = 0.84) and knowledge (d = 0.62) from baseline to post-assessment. The effects were maintained for 3 months. No significant effects could be found for burden, distress, and involvement.

CONCLUSIONS

The findings indicate that a brief gatekeeper program can serve as a valuable resource. Future research should focus on examining the mental health of gatekeepers themselves and its long-term effects on intervention behavior.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00030758, registered on 05.12.2022.

Online versus in-person gatekeeper suicide prevention training: comparison in a community sample

BACKGROUND

Suicide prevention gatekeeper Training (GKT) is a frequently used suicide prevention intervention, however, there is still limited information about its long-term impact and effectiveness of online delivery.

AIMS

The current study aimed to test the effectiveness of online GKT compared to in-person GKT in improving participant training outcomes.

METHODS

A non-randomised comparison of pre-, post- and six-month follow-up data was conducted. In total 545 people participated in GKT, 317 in SafeTALK in-person sessions and 228 in online "Start" GKT by LivingWorks. Main outcome measures included: perceived knowledge; perceived preparedness; gatekeeper efficacy; and gatekeeper reluctance to intervene.

RESULTS

Linear mixed model analysis demonstrated a significant effect for time for both modes of delivery for all four outcome measures. Post-hoc testing revealed that significant improvement in all outcomes were maintained above baseline at six-months following online and in-person training.

CONCLUSIONS

Online training performed as good, or better than in-person GKT, on measured outcomes demonstrating utility and effectiveness of the modality for use in suicide prevention training practices. Findings additionally indicate that online training may reach participants that in-person programs do not. This study provides evidence that Online GKT has significant utility in addressing a crucial need for online alternatives to evidence-based suicide prevention training.

Evaluation of the outcomes of the Quebec provincial suicide prevention gatekeeper training on knowledge, recognition of attitudes, perceived self-efficacy, intention to help, and helping behaviors

INTRODUCTION

Gatekeeper (GK) training is a suicide prevention strategy in which community members learn to identify individuals at risk of suicide and refer them for appropriate help. Despite its widespread use, few studies have investigated its effects, including changes in helping behaviors.

AIMS

To assess the impact of GK training on participants' knowledge, recognition of the influence of attitudes, perceived self-efficacy, intention to help and helping behaviors, and to identify variables associated with GK behaviors.

METHODS

Mixed linear effects and forward stepwise logistic regressions were used to analyze data from 159 participants receiving the Quebec Provincial GK Training program offered by five different suicide prevention centers using pretest, posttest and 6-month follow-up questionnaires.

RESULTS

Participants' knowledge of the GK role and suicide prevention, intention to help, self-efficacy, knowledge of services, and recognition of the influence of attitudes significantly increased following training. Most changes decreased at follow-up but remained higher than at pretest. Lower levels of education and higher intention to help were significant predictors of engaging in helping behaviors in the first 6 months after receiving training.

CONCLUSIONS

The Quebec GK training appears to be effective in preparing participants for their role but does not appear to significantly increase helping behaviors.

Preliminary Evaluation of Lived Experience of Suicide Training: Short-, Medium- and Longer-Term Impacts of Our Voices in Action Training

Despite increased participation and multiple workforce roles of those with lived experience in suicide prevention, there are no evaluated training programs to support this population. This study evaluated a training program aimed to prepare people for these important roles. Survey data at pre-, post- and at three- and 12-month follow-up were used measuring knowledge, attitudes, and self-efficacy, as well as psychological distress as a safety measure. Participants experienced significant gains in knowledge after training, although not all aspects of knowledge were maintained at follow-up. Self-efficacy was examined through confidence and empowerment. Confidence gains were significant at immediate and longer-term follow-up but gains in empowerment were not maintained over time. Participants' positive attitudes improved but this was not significant. There was no indication of increases in psychological distress in participants throughout the training and follow-up periods. Implications of these outcomes are discussed.

What Works in Community-Led Suicide Prevention: Perspectives of Wesley LifeForce Network Coordinators

Community coalitions have been recognised as an important vehicle to advance health promotion and address relevant local health issues in communities, yet little is known about their effectiveness in the field of suicide prevention. The Wesley Lifeforce Suicide Prevention Networks program consists of a national cohort of local community-led suicide prevention networks. This study drew on a nationally representative survey and the perspectives of coordinators of these networks to identify the key factors underpinning positive perceived network member and community outcomes. Survey data were analysed through descriptive statistics and linear regression analyses. Networks typically reported better outcomes for network members and communities if they had been in existence for longer, had a focus on the general community, and had conducted more network meetings and internal processes, as well as specific community-focused activities. Study findings strengthen the evidence base for effective network operations and lend further support to the merit of community coalitions in the field of suicide prevention, with implications for similar initiatives, policymakers, and wider sector stakeholders seeking to address suicide prevention issues at a local community level.