The Effects of Suicide Prevention Gatekeeper Training on Behavioral Intention and Intervention Behavior: A Systematic Review and Meta-Analysis
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Date
2023-07-06
Authors
Spafford, Sarah
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Journal ISSN
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Publisher
University of Oregon
Abstract
Suicide is a major public health concern worldwide and the tenth leading cause of death for all ages in the United States. As suicidal ideation and suicide behaviors have continued to grow in the U.S., this has encouraged national and statewide efforts to implement comprehensive suicide prevention plans. A critical component of a comprehensive plan is ensuring individuals experiencing suicidal ideation receive mental health treatment. Suicide prevention gatekeeper trainings, which aim to improve knowledge regarding suicide risk as well as increase gatekeepers’ intentions to ask about suicidality and make referrals to appropriate mental health treatment, are a frequently implemented program to increase mental health help-seeking behaviors, despite the lack of evidence around effective implementation. To understand the current state of research regarding suicide prevention gatekeeper training, a systematic review and meta-analysis were conducted that synthesized evidence on the effects of suicide prevention gatekeeper training on behavioral intention to intervene and suicide intervention behaviors and whether these changes are maintained over time. A secondary aim of this meta-analysis was to examine implementation setting, training modality, and training level as moderators for the effectiveness of suicide prevention gatekeeper training on behavioral intention, and suicide intervention behaviors. Results from 43 studies revealed that suicide prevention gatekeeper training had an overall positive effect on behavioral intention and intervention behaviors. Furthermore, subgroup analyses for training level and training modality were unable to be conducted due to the lack of studies examining advanced or online trainings. Results from the implementation setting subgroup analysis revealed no significant differences in behavioral intention or intervention behavior based on the implementation setting. However, these results must be considered with caution as there were significant methodological concerns of the included studies and limited studies that conducted long-term follow-up. Although this meta-analysis reveals an overall positive effect for suicide prevention gatekeeper training on behavioral outcomes, the low methodological quality of the current available evidence limits the ability to draw conclusions from the synthesis. To inform policymakers and interventionists on best practices for suicide prevention gatekeeper training, additional rigorous research is needed.
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Keywords
gatekeeper training, intervention behavior, meta-analysis, suicide intervention, suicide prevention, systematic review