Randomized Trial of a Gatekeeper Program for Suicide Prevention: 1-Year Impact on Secondary School Staff

Peter A. Wyman*, C. Hendricks Brown, Jeff Inman, Wendi Cross, Karen Schmeelk-Cone, Jing Guo, Juan B. Pena

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

318 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)104-115
Number of pages12
JournalJournal of Consulting and Clinical Psychology
Issue number1
StatePublished - Feb 2008


  • adolescents help seeking
  • gatekeeper training
  • group randomized trial
  • suicide prevention

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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