Gatekeeper Training as a Preventative Intervention for Suicide: A Systematic Review

Abstract

Suicide prevention remains a challenge across communities in North America and abroad. We examine a suicide prevention effort that is widely used, termed gatekeeper training. There are 2 aims: review the state of the evidence on gatekeeper training for suicide prevention, and propose directions for further research. Method: Studies were identified by searching MEDLINE (PubMed) and PsycINFO from inception to the present for the key words suicide, suicide prevention, and gatekeeper. In addition, a manual scan of relevant articles' bibliographies was undertaken. Results: Gatekeeper training has been implemented and studied in many populations, including military personnel, public school staff, peer helpers, clinicians, and Aboriginal people. This type of training has been shown to positively affect the knowledge, skills, and attitudes of trainees regarding suicide prevention. Large-scale cohort studies in military personnel and physicians have reported promising results with a significant reduction in suicidal ideation, suicide attempts, and deaths by suicide. Conclusions: Gatekeeper training is successful at imparting knowledge, building skills, and molding the attitudes of trainees; however, more work needs to be done on longevity of these traits and referral patterns of gatekeepers. There is a need for randomized controlled trials. In addition, the unique effect of gatekeeper training on suicide rates needs to be fully elucidated.

A decision-support tool to inform Australian strategies for preventing suicide and suicidal behaviour

“…14 In comparisons of the simulated effects of prevention strategies, the largest estimated impacts on declines in suicide were for GP training 17 and coordinated aftercare. 18 Simulated reductions in lethality of method by 20% for selected methods of suicidal behaviour (that is, assuming that interventions were available to reduce lethality of method) also suggested that the largest declines would be achieved with reductions in the lethality of hanging.…”

Review of suicide-prevention programs in Queensland: state- and community-level activities

“…13 In addition to programs for health professionals, who constitute the primary group of gatekeepers, a substantial number of programs also targeted so-called 'emergent' gatekeepers, that is, community members or staff who have not been formally trained to intervene with someone at risk of suicide but are likely to come into contact with at-risk individuals. 16 These programs were directed to school teachers, professionals such as journalists, family members and other carers, and members of specific regional communities. Gatekeeper education is effective in suicide prevention.…”

Gatekeeper-modellen i skolen - erfaringer fra et pilotprosjekt om selvmordsforebygging

“…Gatekeeper-programmer implementert i skoler har fokusert på å trene laerere og skolepersonell (Zenere & Lazarus, 1997;Burnette, Ramchand & Ayer, 2015) mens andre programmer har fokusert på å trene jevnaldrende elever til å vaere gatekeepere (Wyman et al, 2010). Unge selvskadere kan ofte kjennetegnes ved sterke følelsesmessige belastninger kombinert med svakere kommunikasjonsferdigheter (Isaac, Katz, Belik, Deane, Enns & Sareen, 2009). Foruten foreldre og foresatte er laerere og skolepersonell de som oftest er i daglig kontakt med barn og unge, og de har dermed mulighet til tidlig å observere endringer hos elever, ta initiativ til samtale og kontakte helsehjelp ved behov.…”