Predictors of Peer Referral Intentions for Individuals at Risk for Suicide Related Behavior: An Application of the Theory of Planned Behavior

The role of peer gatekeepers is crucial in connecting individuals at risk for suicide related behaviors to mental health service providers. However, limited research has focused on the role of peers as potential helpers for those at-risk. The current study utilized a mixed experimental and correlational design to examine predictors of female college students’ referral intentions following hypothetical interactions with peers at-risk for suicide related behavior. More specifically, the current project examined the utility of an extended Theory of Planned Behavior (TPB) model of peer-referral intentions. In addition to the original TPB constructs of attitudes, subjective norms, and perceived behavioral control associated with referring a peer to a mental health professional, attitudes towards seeking professional help, perceived stigma associated with receiving professional psychological help, emotional competence, and symptom severity were incorporated into an extended TPB model. The sample included 284 female college students. Participants completed computer-based questionnaires both before and after the presentation of a theoretically and empirically informed vignette describing a peer who was characterized as low, moderate, or high risk for suicide related behavior. The results of this study suggest the utility of applying an extended TPB model to intentions to refer at-risk peers for mental health services. The final trimmed model, which included all of the aforementioned constructs except symptom severity, accounted for 78.9% of the variance in referral intentions. The findings indicate that, in particular, preventative interventions would likely benefit from emphasizing the role of attitudes towards receiving mental health services, attitudes towards peer referral, and subjective norms regarding peer referral, in order to maximize the role of peers as gatekeepers for college students in distress. Incorporating the findings from this study with findings from future research will hopefully lead to more informed, empirically-based interventions for enhancing peer referrals

The Judgment of Future Suicide-Related Behavior: Helpline Counselors\u27 Accuracy and Agreement

Background: Judging whether a youth is at risk for suicide-related behavior (SRB) is considered an extremely challenging task. There are only few studies of helpline counselors, and little is known about their ability to accurately determine the level of risk for SRB. Aims: To examine whether helpline counselors can agree on judgments of risk for SRB, and whether their judgments are consistent with youths’ actual behavior in a 6-month period following intake. Methods: 34 helpline counselors, recruited from three helplines, were studied. Information was collected on their judgments of risk for SRB for each of 45 youths over a 6-month period following initial intake. Results: Contrary to expectations, the counselors had a high rate of agreement (k = .56), and their risk judgments could be used quite successfully (80.0% correct classification) in identifying youths who later engaged in SRB. Conclusions: Unlike most other groups represented in the decision-making literature, helpline counselors agree and are accurate in their judgments of risk for SRB. Our findings suggest that it might be beneficial to apply some of the procedures used to train helpline clinicians to other types of clinicians. Further studies of helpline clinicians are suggested

Revisiting the Concept of Knowledge

Background: Although gatekeeper training is effective at increasing knowledge, some question the effectiveness of these programs due to high pretraining knowledge levels. However, knowledge scores may be artificially inflated when students guess answer options correctly but lack information needed to assist suicidal peers. Aims: To use free-recall questions to evaluate suicide prevention knowledge and compare levels of knowledge using this methodology with established assessment methods in the literature. Method: Free-recall knowledge questions were examined before and after participation in a student gatekeeper training program. Focus groups with students enriched interpretation of quantitative results. Results: Unlike in studies using forced-choice assessment, students’ baseline knowledge was markedly low using free-recall questions and, despite making significant improvement from pretraining levels, posttraining knowledge barely approached passable levels. Focus group findings suggest that training sessions may need to be more engaging and interactive in order to improve knowledge transfer. Conclusion: Free-recall questions may provide a less inflated measure of accessible knowledge learned from school-based suicide prevention curricula. Evaluators and programmatic partners should be cognizant of this methodological issue and consider using a mix of assessment methodologies to determine students’ actual levels of knowledge after participation in gatekeeper training

Revisiting the Concept of Knowledge

BACKGROUND: Although gatekeeper training is effective at increasing knowledge, some question the effectiveness of these programs due to high pretraining knowledge levels. However, knowledge scores may be artificially inflated when students guess answer options correctly but lack information needed to assist suicidal peers. AIMS: To use free-recall questions to evaluate suicide prevention knowledge and compare levels of knowledge using this methodology with established assessment methods in the literature. METHOD: Free-recall knowledge questions were examined before and after participation in a student gatekeeper training program. Focus groups with students enriched interpretation of quantitative results. RESULTS: Unlike in studies using forced-choice assessment, students’ baseline knowledge was markedly low using free-recall questions and, despite making significant improvement from pretraining levels, posttraining knowledge barely approached passable levels. Focus group findings suggest that training sessions may need to be more engaging and interactive in order to improve knowledge transfer. CONCLUSION: Free-recall questions may provide a less inflated measure of accessible knowledge learned from school-based suicide prevention curricula. Evaluators and programmatic partners should be cognizant of this methodological issue and consider using a mix of assessment methodologies to determine students’ actual levels of knowledge after participation in gatekeeper training