Does a Gatekeeper Suicide Prevention Program Work in a School Setting? Evaluating Training Outcome and Moderators of Effectiveness

The current study sought to evaluate the suicide prevention gatekeeper training program QPR (Question, Persuade, and Refer) among school personnel using a non‐equivalent control group design. Substantial gains were demonstrated from pre‐ to post‐test for attitudes, knowledge, and beliefs regarding suicide and suicide prevention. Exploratory analyses revealed the possible moderating effects of age, professional role, prior training, and recent contact with suicidal youth on QPR participants' general knowledge, questioning, attitudes toward suicide and suicide prevention, QPR quiz scores, and self‐efficacy. The need for replication using a more rigorous experimental design in the context of strong community collaboration is discussed.     

Change Pathways in Indigenous and Nonindigenous Youth Suicide

Multivariate dynamic relationships among suicide attempts, anxiety and/or depressive symptoms, hope, and help‐seeking were examined across time in Native Hawaiian and non‐Hawaiian adolescents, using data from a 5‐year longitudinal cohort study (N = 7,317). The rate of suicide attempts decreased over time, but this reduction was significantly less among Native Hawaiian youth than their non‐Hawaiian peers. There were also significant differences between groups in hope and help‐seeking, with Native Hawaiian youth increasing help‐seeking and decreasing hope to a greater degree. Youth‐centered, cultural approaches to suicide prevention are essential in enhancing well‐being in indigenous communities.     

Epidemiologic Characteristics and Trends of Fatal Suicides among the Elderly in Taiwan

Taiwan has one of the highest suicide rates in the world, especially among its elderly. The epidemiologic characteristics and trends of the surging elderly suicide rates from 1993 to 2003 are described, with a special emphasis on the risk groups, the methods used in suicide, and their geographical variations. Data on annual mortality for persons over 65 years of age with external cause‐of‐death codes E950–E959 were obtained from the Death Certification data file provided by the Department of Health and used in the analysis. The suicide rate for each 5‐year age group over 65 years old increased during the 11‐year period. Elderly males had the highest suicide rate and experienced an increased rate of 49% during the decade. The average suicide ratio between elderly males and females was about 2:1. Never‐married males had the highest age‐adjusted as well as sex‐ and marital status‐specific suicide rates, and showed an increased rate of 66% over the 11‐year period. Geographical variations in suicide rates were significant, with the lest urbanized eastern Taiwan having a higher rate than other regions. Hanging, strangulation, and suffocation were the most used methods for committing suicide by the elderly, but their use had decreased from 63% to 54% during the decade; but jumping off a building and drowning increased significantly. Variation in suicide rate among months was not significant. With the increase in the elderly suicide rate, more governmental and societal interventions are needed to alleviate this social and human problem.     

Suicide across the Life Span: Pathways to Prevention

As reflected in a recent series of highly visible suicide awareness and prevention activities, the call for a comprehensive suicide prevention strategy has never been stronger, nor more unified. Using the framework provided by the transactional model of human development, the author illustrates the central implications that a developmental perspective has for suicide prevention, emphasizing the need to consider multiple pathways to prevention, to place renewed emphasis on prevention strategies that have their impact earlier in the life course and earlier in the course of mental disorder, and to collaborate with prevention specialists and advocates in related fields.     

Demographic,Clinical, and Service Utilization Factors Associated with Suicide‐Related Visits among Alaska Native and American Indian Adults

Alaska Native and American Indian people (AN/AIs) are disproportionately affected by suicide. Within a large AN/AI health service organization, demographic, clinical, and service utilization factors were compared between those with a suicide‐related health visit and those without. Cases had higher odds of a behavioral health diagnosis, treatment for an injury, behavioral health specialty care visits, and opioid medication dispensation in the year prior to a suicide‐related visit compared to gender‐, age‐, and residence‐ (urban versus rural) matched controls. Odds of a suicide‐related visit were lower among those with private insurance and those with non‐primary care ambulatory clinic visits.     

Bridging the Gap: Connecting Resident Assistants and Suicidal Residents Through Gatekeeper Training

One hundred sixty‐two resident assistants (RA s) at a large southeastern university were randomly assigned to attend either a specialized 1‐hr training program in suicide prevention (intervention group) or a stress and time management skills training program (control group). The results failed to show the suicide prevention training program had any impact on RA intervention behaviors, resident help‐seeking behaviors, or RA perceptions of resident distress and suicidality 4 months following training. Results are interpreted and discussed in relation to strengthening suicide prevention training programs on college campuses.     

Predicting Suicide Attempts for Racial and Ethnic Groups of Patients During Routine Clinical Care

The aim of this study was to examine variation in suicide ideation and its relationship to risk of suicide attempt in the subsequent 90 days by race and ethnicity. Participants were adults who completed the Patient Health Questionnaire depression module (PHQ9) during an outpatient encounter between January 10, 2010, and December 12, 2012 (N = 509,945 patients; N = 1,228,308 completed PHQ9). Data came from the Virtual Data Warehouse from four health care systems in the Mental Health Research Network. The sample was majority female (73.7%), primarily 30–64 years old (60.1%), healthy (64.5% comorbidity index = 0), and over half were non‐Hispanic White (52.9%). Only Asian patients (OR: 1.31; 95% CI: 1.24, 1.39) had higher odds of reporting suicide ideation when compared to non‐Hispanic White people. All racial and ethnic groups had increased risk for suicide attempt with increased frequency of suicide ideation. The PHQ9 item 9 can be used as an indicator of suicide ideation and risk for suicide attempt up to 90 days after the reported ideation in racial and ethnic minority patients during routine clinical care.     

Measuring Associations of the Department of Veterans Affairs' Suicide Prevention Campaign on the Use of Crisis Support Services

Campaigns have become popular in public health approaches to suicide prevention; however, limited empirical investigation of their impact on behavior has been conducted. To address this gap, utilization patterns of crisis support services associated with the Department of Veterans Affairs' Veterans Crisis Line (VCL) suicide prevention campaign were examined. Daily call data for the National Suicide Prevention Lifeline, VCL, and 1‐800‐SUICIDE were modeled using a novel semi‐varying coefficient method. Analyses reveal significant increases in call volume to both targeted and broad resources during the campaign. Findings underscore the need for further research to refine measurement of the effects of these suicide prevention efforts.     

自杀“守门人”培训研究述评

在西方国家,自杀“守门人”培训被认为是最有效的自杀预防策略之一.自杀“守门人”培训的具体内容包括传授基础知识、识别自杀征兆、初步评估自杀风险和转介自杀高危个体等4个方面;研究发现自杀“守门人”培训对受训者的知识、态度和干预技能有显著的积极影响,但其对自杀率的影响仍需今后的研究详细探讨;目前的研究存在以下不足:1)随机对照研究少;2)难以评估培训对自杀率的真实影响;3)评价指标单一,缺乏统一的评估工具.未来的研究应弥补现有研究的不足,并重视自杀“守门人”培训的跨文化研究.     

Seasonality of Violent Suicides in the Athens Greater Area

The aim of the study was to ascertain suicide seasonality in the Greek population and to associate this seasonal variation with age, sex, and suicide method. Studying seasonality can be of help in establishing a public health policy, related with suicide prevention. This is an epidemiologic study based on forensic evidence. We studied the deaths caused by self‐injury (trauma), namely deaths by violent suicide (not self‐poisoning). Statistically significant suicide seasonality was established with a peak in May. This seasonal variation is attributed mainly to males. As for the method, suicide by hanging peaks in June and by shooting in April. It was also observed that seasonality for individuals above the age of 45 peaks in early May.     

Prévention du suicide de la personne âgée : la place des interventions communautaires

Although elders’ social isolation has been a topic of interest for public policies in the recent years, its prevention, specifically in relation to suicide prevention, has not stimulated the interest of researchers, yet. This paper present the results from a literature review aiming to identify the actions in elders’ suicide prevention. From the 425 initial papers identified on elders’ suicide prevention, only 57 describe “actions” in suicide prevention, 47 of which are actions targeting individuals, with psychological, psychiatric or psychotherapeutic interventions. Only eight researches integrate the social environment as a facilitator for suicide prevention. We discuss the particularity of this field, the limits of an individual-centred approach, and the interests of community, integrative interventions.     

Urban American Indian Community Perspectives on Resources and Challenges for Youth Suicide Prevention

American Indian (AI) youth have some of the highest rates of suicide of any group in the United States, and the majority of AI youth live in urban areas away from tribal communities. As such, understanding the resources available for suicide prevention among urban AI youth is critical, as is understanding the challenges involved in accessing such resources. Pre‐existing interview data from 15 self‐identified AI community members and staff from an Urban Indian Health Organization were examined to understand existing resources for urban AI youth suicide prevention, as well as related challenges. A thematic analysis was undertaken, resulting in three principal themes around suicide prevention: formal resources, informal resources, and community values and beliefs. Formal resources that meet the needs of AI youth were viewed as largely inaccessible or nonexistent, and youth were seen as more likely to seek help from informal sources. Community values of mutual support were thought to reinforce available informal supports. However, challenges arose in terms of the community's knowledge of and views on discussing suicide, as well as the perceived fit between community values and beliefs and formal prevention models.     

Suicide and suicidology in the Soviet Union

This study was conducted in order to obtain information on suicide in the Soviet Union, an important subject for which we have no scientific literature. Studies of attempted suicide in Soviet psychiatric journals were analyzed. This information was supplemented by interviews with Soviet psychiatrists now living abroad. The results of this inquiry show that suicide is a subject that clearly has become of increasing concern in the Soviet Union. Furthermore, in spite of the absence of essential statistical data on mortality, there is evidence indicating that the rate of Soviet suicide may be rising in certain parts of the country. Finally, growing concern about suicide has led to expanded prevention programs and to a new emphasis on social and psychological etiological explanations. In particular, the role of the Soviet family in crisis has been emphasized as a major influence in understanding the causes of suicidal attempts.     

Relative Difficulty of Understanding Foreign Accents as a Marker of Proficiency

Foreign‐accented speech is generally harder to understand than native‐accented speech. This difficulty is reduced for non‐native listeners who share their first language with the non‐native speaker. It is currently unclear, however, how non‐native listeners deal with foreign‐accented speech produced by speakers of a different language. We show that the process of (second) language acquisition is associated with an increase in the relative difficulty of processing foreign‐accented speech. Therefore, experiencing greater relative difficulty with foreign‐accented speech compared with native speech is a marker of language proficiency. These results contribute to our understanding of how phonological categories are acquired during second language learning.     

Suicide Prevention from a Public Health Perspective

The public health approach to health problems provides a strong framework and rationale for developing and implementing suicide prevention programs. This approach consists of health-event surveillance to describe the problem, epidemiologic analysis to identify risk factors, the design and evaluation of interventions, and the implementation of prevention programs. The application of each of these components to suicide prevention is reviewed. Suggestions for improving surveillance include encouraging the use of appropriate coding, reviewing suicide statistics at the local level, collecting more etiologically useful information, and placing greater emphasis on analysis of morbidity data. For epidemiologic analysis, greater use could be made of observational studies, and uniform definitions and measures should be developed and adopted. Efforts to develop interventions must include evaluating both the process and the outcome. Finally, community suicide prevention programs should include more than one strategy and, where appropriate, should be strongly linked with the community's mental health resources. With adequate planning, coordination, and resources, and the public health approach can help reduce the emotional and economic costs imposed on society by suicide and suicidal behavior.     

Feasibility of a Web‐based Gatekeeper Training: Implications for Suicide Prevention

Web‐based training programs have advantages such as increased scheduling flexibility and decreased training costs. Yet the feasibility of applying them to injury prevention programs such as suicide prevention gatekeeper training has not been empirically verified. Two studies were conducted to assess the feasibility and effectiveness of a web‐based version of the Question, Persuade, and Refer (QPR) gatekeeper training program. Results of Study 1 revealed that participants in a web‐based training demonstrated significant gains in knowledge of suicide prevention, self‐efficacy for suicide prevention, and behavioral intentions to engage in suicide prevention, as compared to those in a control group. Results of Study 2 further showed that the web‐based training may be as effective as the face‐to‐face QPR training across pre‐ (T1) and post training (T2); however, knowledge, self‐efficacy, and behavioral intentions in both groups generally declined from T2 to 6‐months after the training. Overall, these results provide initial evidence to support the feasibility of adopting web‐based media to deliver gatekeeper training. Moreover, the present findings suggest the need to understand how to maintain gatekeepers’ knowledge, confidence, motivation, and skills after training.     

An Economic Evaluation of the Garrett Lee Smith Memorial Suicide Prevention Program

For more than a decade, the Garrett Lee Smith Youth Suicide Prevention Program has provided funding for community‐based suicide prevention programs to states, tribes, and colleges across the United States. Recent studies provided evidence of the program's effectiveness in reducing suicide mortality and suicide attempts among youth. This study compares the cost of implementing the program with the estimated savings resulting from avoided hospitalization and emergency department visits associated with the averted suicide attempts. The findings suggest that the cost of implementing multifaceted community‐based suicide prevention strategies may be more than outweighed by savings in the health sector.     

Miseries Suffered,Unvoiced, Unknown? Communication of Suicidal Intent by Men in “Rural” Queensland,Australia

It has long been argued that suicide prevention efforts in rural locations face not only structural barriers, such as a lack of accessible health care and specialized mental health services, but also a range of cultural barriers. A commonly discussed cultural factor that may contribute to higher rural suicide rates is low levels of help‐seeking behavior, which in turn act as a barrier to accessing and receiving care. However, the assumption that suicide by rural men is more likely to be accompanied by low help‐seeking behavior, relative to urban men, has not been well tested. Using data from the Queensland Suicide Register, this study evaluates one form of help‐seeking behavior—communication of suicidal intent—among men who died by suicide. Contrary to the expectation that suicide in rural areas would be associated with lower levels of help‐seeking behavior than suicide in urban areas, it was found that communication of suicidal intent was broadly comparable across rural and urban settings. The implications for suicide prevention policies and service delivery strategies are discussed.     

Current and Military‐Specific Gender Minority Stress Factors and Their Relationship with Suicide Ideation in Transgender Veterans

Research suggests the prevalence of suicide ideation and suicide attempts in the transgender veteran community may be upwards of 20 times higher than nontransgender veterans, who are known to be at increased risk than the general US population. This study aimed to understand the potential influence of external and internal minority stress experienced during and after military service on past‐year and recent suicide ideation in a sample of 201 transgender veterans. Nonparametric bootstrapping analyses indicated past‐year transgender‐specific discrimination and rejection (external minority stress) indirectly predicted frequency of both past‐year and past 2‐week suicide ideation through past‐year shame related to gender identity (internal minority stress). This result was significant when controlling for symptoms of depression and demographics. Similar patterns emerged when examining relationships among military external and internal minority stress on suicide outcomes. These results suggest that attempts to reduce both the experience and impact of minority stressors related to gender identity during and after military service may be an important avenue for suicide prevention.