Predictors of Response to Suicide Prevention Trainings: Towards Maximizing Training Impact

Purpose and Background: Suicide is the third leading cause of death among youth aged 10-24 years old in the United States. Gatekeeper trainings are designed to educate adults who have frequent contact with young people to recognize the warning signs for suicidal behaviors and to make appropriate referrals. The effectiveness of gatekeeper training on prevention attitudes and knowledge has been well demonstrated, but little is known about what trainee characteristics are associated with greater training effect. The current study used data from an evaluation of the gatekeeper trainings QPR and RESPONSE, and the suicide intervention skill training, ASIST. This study tested the association of trainee characteristics with change from pre-training to follow-up in suicide prevention attitudes, knowledge and behavior. Methods: A 3 group quasi-experimental design was used, with 3 measurement points (pre – and post-training, and a 6 month follow-up). This study evaluates the 2 hour gatekeeper training component of RESPONSE (a comprehensive high school suicide prevention program), the 2 hour gatekeeper training QPR, and the 2 day suicide intervention skill training ASIST. Of the 180 participants, 77(43%) were male and 101 (57%) were female. Eighty-five percent identified as white; about one-third of the sample were teachers and one-third were clinicians. The average age of the trainees was 42.8 years old (SD=12.0). Seventy six (42%) of the trainees participated in the RESPONSE training, 59 (33%) in QPR, and 44 (24%) in ASIST. Measures were adapted from a previous clinical trial and showed excellent reliability. Regression residualized change scores were computed of pretraining to 6 month follow-up change in prevention attitudes, knowledge and behavior. The association of trainee characteristics and change scores was tested with bivariate correlation and partial correlation, controlling for training condition. Results: The relationships that emerged in both bivariate and partial correlation analyses included: medium to small-medium effects that showed weaker training effects for teachers on 4 of 7 outcomes; and female trainees showed stronger training effects on three outcomes. Significant correlates, not controlling for training type, included small to moderate, positive correlations for clinicians on half of the prevention behavior variables and one attitude variable, and hours of previous suicide prevention training had small to moderate, positive correlations on the majority of prevention behavior variables, and small, positive correlations on attitude and efficacy. While the sample was largely White, no differences were found by race. Conclusions and Implications: Teachers experienced dampening effects on change in suicide prevention behaviors and attitudes, indicating that trainings might be better tailored to teachers. Previous suicide prevention training appears to prime trainees for greater change in suicide prevention outcomes, supporting continued prevention trainings. Gatekeeper trainings have been shown to be an effective component of suicide prevention trainings. The results of this study some areas of modification of prevention trainings to maximize the impact on participants. Despite the public health importance of suicide, it has received little attention in social work training. Further steps for research and implications for social work training and practice are discussed.