Three Suicide Prevention Trainings: Six-Month Effects on Suicide Prevention Knowledge, Confidence and Behavior

Purpose and Background: Suicide is a major public health problem: it is the third leading cause of death among 15-24 year olds in the US. A primary youth suicide prevention effort is “gatekeeper training”: educating adults about suicide and training them to be able to identify youth at risk, to ask about suicide, and to connect at-risk youth with help. Gatekeeper trainings have been amply demonstrated to improve trainees' knowledge and confidence they can help at-risk youth, but the few studies that tested behavior changes have not shown changes in trainee behavior with at-risk youth. As part of a federally-funded youth suicide prevention public health intervention, the current study tested two gatekeeper trainings, QPR and RESPONSE, and a more involved training, ASIST, for suicide prevention knowledge, confidence and 6 month suicide prevention behaviors.

Methods: A quasi-experimental design was employed with three groups (QPR, RESPONSE, ASIST) and three measurement points (pre-training, post-training, 6 month follow-up). “Question, Persuade, Refer” (QPR) is a widely disseminated two-hour gatekeeper training. RESPONSE is a school based program that includes two hour gatekeeper training.. ASIST is a 2 day training that teaches gatekeeper skills as well as suicide interventions for at-risk youth, and includes role-play of key behaviors. Using proven mail survey methods, response rate for the 6 month follow-up exceeded 60%. The responders and non-responders differed only in a modest difference in age. There were 180 participants: 77 men (43%) and 101 women (57%); approximately 85% of the sample identified as White; roughly one-third were clinicians and one-third were teachers. The average age was 42.8 years old (SD = 12.0). Seventy-six attended RESPONSE (42%); QPR had 59 trainees (33%); and 44 in ASIST (24%). Measures were adapted from a published clinical trial of QPR and showed excellent reliability. Changes between the three time points were tested with t-tests and between trainings with one-way ANOVA.

Results: There were large, significant changes for all groups in suicide prevention knowledge and confidence from pre to post training, changes that were maintained or grew slightly by the 9 month follow-up. Likert scale ratings of suicide prevention behaviors showed medium size changes, with larger changes for ASIST. Participant counts of six-month behaviors did not change from pre-training to follow-up. Across trainings, an empathic relationship with youth was correlated with more suicide prevention behaviors.

Conclusions and Implications: Consistent with clinical trials of brief gatekeeper trainings, all trainings showed large effects on knowledge and confidence, and QPR and RESPONSE had no or small effects on suicide prevention behaviors. ASIST, however, showed larger changes on ratings of prevention behaviors. Trainees who reported higher levels of empathic connection with youth showed more change from trainings, convergent with previous research. Suicide prevention training should target those who are skilled and capable in relating and communicating with youth. More intensive training that includes modeling and behavioral rehearsal may be needed to change trainee suicide prevention behavior. Improved gatekeeper trainings can advance societal efforts to identify and help youth at-risk of suicide.