Sustaining the effect of gatekeeper training: an empirical examination of two post-training interventions

Abstract

Introduction: There is ample evidence supporting the application of gatekeeper training programs toward suicide prevention efforts (e.g., Cross, Mattieu, Cerel, & Knox, 2007; Wyman, Inman, Brown, Cross, Schmeelk-Cone, & Pena, 2008). However, recent studies (e.g., Chen, Gibbs, & Moore, 2009; Keller et al., 2009) suggest that knowledge and self-efficacy may significantly decline over time. The purpose of this study was to develop and evaluate two interventions that could boost gatekeepers' confidence in their ability to intervene. Two different intervention videos were created in collaboration with key members of the suicide prevention community in Colorado. The interventions were rooted in self-efficacy theory (SET; Bandura, 1977) which has been found to improve self-efficacy. Method: Data were collected at pre-test and post-test. Gatekeepers (N = 783) who took part in gatekeeper training (e.g., Applied Suicide Intervention Skills Training, ASIST; and Question, Persuade, Refer, QPR) were randomly assigned into one of three groups: (a) 6-minute treatment video, (b) 10-minute treatment video, and (c) 6-minute control webinar. Four scales were developed for this study and included questions adapted from similar studies (e.g., Lent, Lopez, & Bieschke, 1991; Usher & Pajares, 2006). To handle missing data at the post-test (n = 24), an expectation maximization (EM) algorithm was utilized for this study. Results: The majority of participants (N = 124) were female (83.1%), were more likely to have taken ASIST training (57.3%), and ranged in age from 23 to 81 years old. Findings indicate that there were no significant differences in self-efficacy between the treatment groups (F(3, 120) = .07, p = .935, ηp2= .001) or within the treatment groups (λ= 0.99, F(1, 122) = 0.36, p = .696. Despite the ineffective treatments developed for this study, the multiple linear regression models that were conducted support the application of self-efficacy theory in the context of suicide prevention training. For instance, one of the models explained 62% of the variance in self-efficacy outcomes. Furthermore, physiological and affective states and vicarious experience were found to make independent contributions to self-efficacy outcomes. These findings suggest that SET is relevant for suicide prevention. Discussion and Implications: This study created and evaluated two post-training interventions. Given that SET was found to significantly contribute to self-efficacy outcomes, this theory may be useful in the development of future gatekeeper post-training interventions. In spite of the limitations of this study (e.g., low sample size, demand characteristics), these findings may help researchers and the suicide prevention community better understand and develop interventions that may increase gatekeepers' confidence to intervene with individuals at risk for suicide.