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      Efficacy of Adolescent Suicide Prevention E-Learning Modules for Gatekeepers: A Randomized Controlled Trial

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          Abstract

          Background

          Face-to-face gatekeeper training can be an effective strategy in the enhancement of gatekeepers’ knowledge and self-efficacy in adolescent suicide prevention. However, barriers related to access (eg, time, resources) may hamper participation in face-to-face training sessions. The transition to a Web-based setting could address obstacles associated with face-to-face gatekeeper training. Although Web-based suicide prevention training targeting adolescents exists, so far no randomized controlled trials (RCTs) have been conducted to investigate their efficacy.

          Objective

          This RCT study investigated the efficacy of a Web-based adolescent suicide prevention program entitled Mental Health Online, which aimed to improve the knowledge and self-confidence of gatekeepers working with adolescents (12-20 years old). The program consisted of 8 short e-learning modules each capturing an important aspect of the process of early recognition, guidance, and referral of suicidal adolescents, alongside additional information on the topic of (adolescent) suicide prevention.

          Methods

          A total of 190 gatekeepers (ages 21 to 62 years) participated in this study and were randomized to either the experimental group or waitlist control group. The intervention was not masked. Participants from both groups completed 3 Web-based assessments (pretest, posttest, and 3-month follow-up). The outcome measures of this study were actual knowledge, and participants’ ratings of perceived knowledge and perceived self-confidence using questionnaires developed specifically for this study.

          Results

          The actual knowledge, perceived knowledge, and perceived self-confidence of gatekeepers in the experimental group improved significantly compared to those in the waitlist control group at posttest, and the effects remained significant at 3-month follow-up. The overall effect sizes were 0.76, 1.20, and 1.02, respectively, across assessments.

          Conclusions

          The findings of this study indicate that Web-based suicide prevention e-learning modules can be an effective educational method to enhance knowledge and self-confidence of gatekeepers with regard to adolescent suicide prevention. Gatekeepers with limited time and resources can benefit from the accessibility, simplicity, and flexibility of Web-based training.

          Trial Registration

          Netherlands Trial Register NTR3625; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3625 (Archived by WebCite at http://www.webcitation.org/6eHvyRh6M)

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          Most cited references24

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            Youth suicide risk and preventive interventions: a review of the past 10 years.

            To review critically the past 10 years of research on youth suicide. Research literature on youth suicide was reviewed following a systematic search of PsycINFO and Medline. The search for school-based suicide prevention programs was expanded using two education databases: ERIC and Education Full Text. Finally, manual reviews of articles' reference lists identified additional studies. The review focuses on epidemiology, risk factors, prevention strategies, and treatment protocols. There has been a dramatic decrease in the youth suicide rate during the past decade. Although a number of factors have been posited for the decline, one of the more plausible ones appears to be the increase in antidepressants being prescribed for adolescents during this period. Youth psychiatric disorder, a family history of suicide and psychopathology, stressful life events, and access to firearms are key risk factors for youth suicide. Exciting new findings have emerged on the biology of suicide in adults, but, while encouraging, these are yet to be replicated in youths. Promising prevention strategies, including school-based skills training for students, screening for at-risk youths, education of primary care physicians, media education, and lethal-means restriction, need continuing evaluation studies. Dialectical behavior therapy, cognitive-behavioral therapy, and treatment with antidepressants have been identified as promising treatments but have not yet been tested in a randomized clinical trial of youth suicide. While tremendous strides have been made in our understanding of who is at risk for suicide, it is incumbent upon future research efforts to focus on the development and evaluation of empirically based suicide prevention and treatment protocols.
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              Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff.

              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.
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                Author and article information

                Contributors
                Journal
                JMIR Ment Health
                JMIR Ment Health
                JMH
                JMIR Mental Health
                JMIR Publications Inc. (Toronto, Canada )
                2368-7959
                Jan-Mar 2016
                29 January 2016
                : 3
                : 1
                : e8
                Affiliations
                [1] 1Department of Clinical Developmental Psychology Faculty of Behavioural and Movement Sciences VU University Amsterdam AmsterdamNetherlands
                [2] 2EMGO+ Institute for Health and Care Research AmsterdamNetherlands
                [3] 3College of Physicians and Surgeons Department of Psychiatry Columbia University New York, NYUnited States
                [4] 4New York State Psychiatric Institute New York, NYUnited States
                [5] 5VU University Medical Center Department of Epidemiology and Biostatistics AmsterdamNetherlands
                [6] 6Department of Clinical Psychology Faculty of Behavioural and Movement Sciences VU University Amsterdam AmsterdamNetherlands
                Author notes
                Corresponding Author: Rezvan Ghoncheh ghonchehr@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-5968-0405
                http://orcid.org/0000-0002-2881-9152
                http://orcid.org/0000-0001-9617-1020
                http://orcid.org/0000-0003-1701-5332
                http://orcid.org/0000-0002-9643-2363
                Article
                v3i1e8
                10.2196/mental.4614
                4752692
                26825006
                6bb87d34-fc9f-48a8-818b-2c94e3226e06
                ©Rezvan Ghoncheh, Madelyn S Gould, Jos WR Twisk, Ad JFM Kerkhof, Hans M Koot. Originally published in JMIR Mental Health (http://mental.jmir.org), 29.01.2016.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Mental Health, is properly cited. The complete bibliographic information, a link to the original publication on http://mental.jmir.org/, as well as this copyright and license information must be included.

                History
                : 6 May 2015
                : 26 July 2015
                : 25 September 2015
                : 26 November 2015
                Categories
                Original Paper
                Original Paper

                adolescent,e-learning,gatekeepers,learning,modules,online systems,suicide,prevention,training,web-based,referral and consultation

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