Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff.

TLDR

Gatekeeper‑training programs, designed to increase identification and referral of suicidal individuals, are widespread but largely untested. The study aimed to test the impact of QPR training by contrasting gatekeeper surveillance and communication models in a school staff population. A group‑based randomized trial across 32 schools trained 249 staff with QPR and compared the two models over a 1‑year follow‑up. Intent‑to‑treat analyses showed training increased staff knowledge (ES = 0.41), efficacy appraisals (ES = 1.22), and service access (ES = 1.07), but effects varied: staff with low baseline appraisals and those already communicating with students saw the greatest gains, while increased knowledge alone did not raise suicide‑identification behaviors, and student surveys revealed fewer students with prior attempts reported talking to adults, underscoring the need for skill training and help‑seeking interventions.

Abstract

Gatekeeper-training programs, designed to increase identification and referral of suicidal individuals, are widespread but largely untested. A group-based randomized trial with 32 schools examined impact of Question, Persuade, Refer (QPR) training on a stratified random sample of 249 staff with 1-year average follow-up. To test QPR impact, the authors introduced and contrasted 2 models of gatekeeper-training effects in a population: gatekeeper surveillance and gatekeeper communication. Intent-to-treat analyses showed that training increased self-reported knowledge (effect size [ES] = 0.41), appraisals of efficacy (ES = 1.22), and service access (ES = 1.07). Training effects varied dramatically. Appraisals increased most for staff with lowest baseline appraisals, and suicide identification behaviors increased most for staff already communicating with students about suicide and distress. Consistent with the communication model, increased knowledge and appraisals were not sufficient to increase suicide identification behaviors. Also consistent with the communication model were results from 2,059 8th and 10th graders surveyed showing that fewer students with prior suicide attempts endorsed talking to adults about distress. Skill training for staff serving as "natural gatekeepers" plus interventions that modify students' help-seeking behaviors are recommended to supplement universal gatekeeper training.