Evaluating suicide prevention gatekeeper training designed to identify and support people from asylum-seeking and refugee backgrounds

Article


MacDonald Hart, S., Colucci, E. and Marzano, L. 2024. Evaluating suicide prevention gatekeeper training designed to identify and support people from asylum-seeking and refugee backgrounds. BMC Public Health. 24. https://doi.org/10.1186/s12889-024-20304-3
TypeArticle
TitleEvaluating suicide prevention gatekeeper training designed to identify and support people from asylum-seeking and refugee backgrounds
AuthorsMacDonald Hart, S., Colucci, E. and Marzano, L.
Abstract

Background: Suicide-related behaviours and individual risk factors for suicide differ between ethnicities and demonstrate additional variation based on voluntary and forced migration. People forcibly displaced by violence and conflict, such as those seeking asylum and refugees, are likely to face stressors that can increase suicide risk. Research into evidenced-based suicide prevention strategies among people from asylum-seeking and refugee backgrounds is scarce. However, early, contextually-appropriate, identification and intervention may be a promising way to facilitate support for people in these groups. This research proposes that a contextually-responsive gatekeeper training is an appropriate strategy to increase the identification and support for people from asylum-seeking and refugee backgrounds.

Methods: The present article relates to the statistical findings of a larger mixed-method study used to validate and refine a contextually-responsive gatekeeper training program. The qualitative results of this research will be published separately. The outcome measures - knowledge about suicide in multicultural contexts, attitudes towards suicide and prevention, and self-efficacy to intervene were measured quantitatively, adopting a similar pre- and post-training procedure used in previous training evaluations. Using Generalised Estimating Equations, statistical comparisons were made between three identical self-report surveys completed by participants across three consecutive time points - pre-training, immediately post-training, and three months following training completion - known in this investigation as time-point zero (T0), time-point one (T1), and time-point two (T2). Lastly, during the T2 follow-up, additional open-ended questions were included to understand which areas of training they feel prepared them effectively and how the program could have better prepared them to intervene.

Results: A total of 28 participants took part in the study. Quantitative analysis indicated the program's capacity to exert a significant favourable and lasting influence on knowledge about suicide and self-efficacy to intervene. In addition, follow-up measurements suggest that the content delivered to participants transferred effectively into real-world suicide prevention behaviours.

Conclusions: Findings suggest that tailored suicide prevention training can have a significant influence on knowledge about suicide in multicultural contexts, self-efficacy to intervene in a crisis, and that course content translates effectively into real-world suicide prevention behaviour. Modifying training practices, based on feedback from contextually-experienced attendees, appears to be a pivotal factor in promoting the support of people from asylum-seeking and refugee backgrounds.

KeywordsAsylum-seekers; Forced Migration; Gatekeeper training; Marginalized populations; Refugees; Suicide Prevention; Tailored
Sustainable Development Goals3 Good health and well-being
Middlesex University ThemeHealth & Wellbeing
Research GroupCentre for Abuse and Trauma Studies (CATS)
PublisherBioMed Central
JournalBMC Public Health
ISSN
Electronic1471-2458
Publication dates
Online25 Oct 2024
Print25 Oct 2024
Publication process dates
Submitted22 Feb 2024
Accepted07 Oct 2024
Deposited08 Nov 2024
Output statusPublished
Publisher's version
License
File Access Level
Open
Copyright Statement

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Digital Object Identifier (DOI)https://doi.org/10.1186/s12889-024-20304-3
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Exploring the potential of civic engagement to strengthen mental health systems in Indonesia (IGNITE): a study protocol
Brooks, H., James, K., Irmansyah, I., Keliat, B., Utomo, B., Rose, D., Colucci, E. and Lovell, K. 2018. Exploring the potential of civic engagement to strengthen mental health systems in Indonesia (IGNITE): a study protocol. International Journal of Mental Health Systems. 12 (1). https://doi.org/10.1186/s13033-018-0227-x
Behaviours preceding suicides at railway and underground locations: a multimethodological qualitative approach
Mackenzie, J., Borrill, J., Hawkins, E., Fields, B., Kruger, A., Noonan, I. and Marzano, L. 2018. Behaviours preceding suicides at railway and underground locations: a multimethodological qualitative approach. BMJ Open. 8 (4), pp. 1-8. https://doi.org/10.1136/bmjopen-2017-021076
Cross-cultural generalizability of suicide first aid actions: an analysis of agreement across expert consensus studies from a range of countries and cultures
Jorm, A., Ross, A. and Colucci, E. 2018. Cross-cultural generalizability of suicide first aid actions: an analysis of agreement across expert consensus studies from a range of countries and cultures. BMC Psychiatry. 18. https://doi.org/10.1186/s12888-018-1636-8
Forgiveness in PTSD after man-made traumatic events: a systematic review
Cerci, D. and Colucci, E. 2018. Forgiveness in PTSD after man-made traumatic events: a systematic review. Traumatology. 24 (1), pp. 47-54. https://doi.org/10.1037/trm0000130
Digital technology: coming of age?
Marzano, L., Hollis, C., Cipriani, A. and Malhi, G. 2017. Digital technology: coming of age? Evidence-Based Mental Health. 20 (4), p. 97. https://doi.org/10.1136/eb-2017-102821
Breaking the chains: ethnographic film-making in mental health
Colucci, E. 2016. Breaking the chains: ethnographic film-making in mental health. The Lancet Psychiatry. 3 (6), pp. 509-510. https://doi.org/10.1016/S2215-0366(16)30034-7
A web-based clinical decision tool to support treatment decision-making in psychiatry: a pilot focus group study with clinicians, patients and carers
Henshall, C., Marzano, L., Smith, K., Attenburrow, M., Puntis, S., Zlodre, J., Kelly, K., Broome, M., Shaw, S., Barrera, A., Molodynski, A., Reid, A., Geddes, J. and Cipriani, A. 2017. A web-based clinical decision tool to support treatment decision-making in psychiatry: a pilot focus group study with clinicians, patients and carers. BMC Psychiatry. 17 (1). https://doi.org/10.1186/s12888-017-1406-z
Mother-infant separations in prison. A systematic attachment-focused review of the academic and grey literature
Powell, C., Ciclitira, K. and Marzano, L. 2017. Mother-infant separations in prison. A systematic attachment-focused review of the academic and grey literature. The Journal of Forensic Psychiatry & Psychology. 28 (6), pp. 790-810. https://doi.org/10.1080/14789949.2017.1324580
Should compulsory admission to hospital be part of suicide prevention strategies?
Wang, D. and Colucci, E. 2017. Should compulsory admission to hospital be part of suicide prevention strategies? BJPsych Bulletin. 41 (3), pp. 169-171. https://doi.org/10.1192/pb.bp.116.055699
Improving access to and engagement with mental health services among young people from refugee backgrounds: service user and provider perspectives
Colucci, E., Valibhoy, M., Szwarc, J., Kaplan, I. and Minas, H. 2017. Improving access to and engagement with mental health services among young people from refugee backgrounds: service user and provider perspectives. International Journal of Culture and Mental Health. 10 (2), pp. 185-196. https://doi.org/10.1080/17542863.2017.1279674
A suicide research agenda for people from immigrant and refugee backgrounds
Colucci, E., Too, L. and Minas, H. 2017. A suicide research agenda for people from immigrant and refugee backgrounds. Death Studies. 41 (8), pp. 502-511. https://doi.org/10.1080/07481187.2017.1332912
A sanctuary of tranquillity in a ruptured world: evaluating long-term counselling at a women’s community health centre
Ciclitira, K., Starr, F., Payne, N., Clarke, L. and Marzano, L. 2017. A sanctuary of tranquillity in a ruptured world: evaluating long-term counselling at a women’s community health centre. Feminism & Psychology. 27 (4), pp. 530-552. https://doi.org/10.1177/0959353516685344
Promoting responsible portrayal of suicide: lessons from the UK and the Republic of Ireland
Fraser, L., Marzano, L. and Hawton, K. 2017. Promoting responsible portrayal of suicide: lessons from the UK and the Republic of Ireland. in: Niederkrotenthaler, T. and Stack, S. (ed.) Media and Suicide: International Perspectives on Research, Theory, and Policy Routledge. pp. 227-240
Non-suicidal self-harm amongst incarcerated men: a qualitative study
Marzano, L., Ciclitira, K. and Adler, J. 2016. Non-suicidal self-harm amongst incarcerated men: a qualitative study. Journal of Criminal Psychology. 6 (4), pp. 157-172. https://doi.org/10.1108/JCP-04-2016-0017
Mother-infant separations in prison. A systematic attachment-focused policy review
Powell, C., Marzano, L. and Ciclitira, K. 2017. Mother-infant separations in prison. A systematic attachment-focused policy review. The Journal of Forensic Psychiatry & Psychology. 28 (2), pp. 274-289. https://doi.org/10.1080/14789949.2016.1204465
Prevention of suicidal behaviour in prisons: An overview of initiatives based on a systematic review of research on near-lethal suicide attempts
Marzano, L., Hawton, K., Rivlin, A., Smith, E., Piper, M. and Fazel, S. 2016. Prevention of suicidal behaviour in prisons: An overview of initiatives based on a systematic review of research on near-lethal suicide attempts. Crisis: The Journal of Crisis Intervention and Suicide Prevention. 37 (5), pp. 323-334. https://doi.org/10.1027/0227-5910/a000394
Police and suicide prevention: Evaluation of a training programme
Marzano, L., Smith, M., Long, M., Kisby, C. and Hawton, K. 2016. Police and suicide prevention: Evaluation of a training programme. Crisis: The Journal of Crisis Intervention and Suicide Prevention. 37 (3), pp. 194-204. https://doi.org/10.1027/0227-5910/a000381
Making a difference with ‘smartphone psychology’: can mobile digital technologies help create new insights into self-harming behaviours?
Marzano, L., Al-Ayoubi, L., Bardill, A., Herd, K., Vale, D., Grey, N. and Moran, P. 2017. Making a difference with ‘smartphone psychology’: can mobile digital technologies help create new insights into self-harming behaviours? in: Niven, K., Lewis, S. and Kagan, C. (ed.) Making a Difference with Psychology United Kingdom Richard Benjamin Trust. pp. 139-147
Suicide first aid guidelines for Sri Lanka: a Delphi consensus study
De Silva, S., Colucci, E., Mendis, J., Kelly, C., Jorm, A. and Minas, H. 2016. Suicide first aid guidelines for Sri Lanka: a Delphi consensus study. International Journal of Mental Health Systems. 10. https://doi.org/10.1186/s13033-016-0085-3
Exploring domestic violence and social distress in Australian-Indian migrants through community theater
O'Connor, M. and Colucci, E. 2016. Exploring domestic violence and social distress in Australian-Indian migrants through community theater. Transcultural Psychiatry. 53 (1), pp. 24-44. https://doi.org/10.1177/1363461515599327
Being young feminists: discussions and (dis)contents
Adams, E., DelBusso, L., Foster, N., Majumdar, A., Marzano, L. and Papadima, M. 2007. Being young feminists: discussions and (dis)contents. Feminism & Psychology.
Is my work ‘feminist’ enough? Tensions and dilemmas in researching male prisoners who self-harm
Marzano, L. 2007. Is my work ‘feminist’ enough? Tensions and dilemmas in researching male prisoners who self-harm. Feminism & Psychology.
Psychosocial characteristics and social networks of suicidal prisoners: towards a model of suicidal behaviour in detention
Rivlin, A., Hawton, K., Marzano, L. and Fazel, S. 2013. Psychosocial characteristics and social networks of suicidal prisoners: towards a model of suicidal behaviour in detention. PLoS ONE. 8 (7), pp. 1-11. https://doi.org/10.1371/journal.pone.0068944
A typology of male prisoners making near-lethal suicide attempts
Rivlin, A., Ferris, R., Marzano, L., Fazel, S. and Hawton, K. 2013. A typology of male prisoners making near-lethal suicide attempts. Crisis. 34 (5), pp. 335-347.
In or out? Barriers and facilitators to refugee-background young people accessing mental health services
Colucci, E., Minas, H., Szwarc, J., Guerra, C. and Paxton, G. 2015. In or out? Barriers and facilitators to refugee-background young people accessing mental health services. Transcultural Psychiatry. 52 (6), pp. 766-790. https://doi.org/10.1177/1363461515571624
Evaluation of long-term counselling at a community health service for women who are on a low income
Payne, N., Ciclitira, K., Starr, F., Marzano, L. and Brunswick, N. 2015. Evaluation of long-term counselling at a community health service for women who are on a low income. Counselling and Psychotherapy Research. 15 (2), pp. 79-87. https://doi.org/10.1080/14733145.2013.877513
The application of mHealth to mental health: opportunities and challenges
Marzano, L., Bardill, A., Fields, B., Herd, K., Veale, D., Grey, N. and Moran, P. 2015. The application of mHealth to mental health: opportunities and challenges. The Lancet Psychiatry. 2 (10), pp. 942-948. https://doi.org/10.1016/S2215-0366(15)00268-0
Hard-to-get-at data from difficult-to-access users
Fields, B., Bardill, A., Marzano, L. and Herd, K. 2015. Hard-to-get-at data from difficult-to-access users. Abascal, J., Barbosa, S., Fetter, M., Gross, T., Palanque, P. and Winckler, M. (ed.) 15th IFIP TC 13 International Conference on Human-Computer Interaction. Bamberg, Germany 14 - 18 Sep 2015 Springer. pp. 409-416 https://doi.org/10.1007/978-3-319-22723-8_32
Improving cultural responsiveness in mental health services: development of a consensus around the role of cultural portfolio holders
Colucci, E., Chopra, P., McDonough, S., Kouzma, N. and Minas, H. 2014. Improving cultural responsiveness in mental health services: development of a consensus around the role of cultural portfolio holders. International Journal of Culture and Mental Health. 7 (3), pp. 339-355. https://doi.org/10.1080/17542863.2013.812130
Responding to repetitive, non-suicidal self-harm in an English male prison: staff experiences, reactions, and concerns
Marzano, L., Adler, J. and Ciclitira, K. 2013. Responding to repetitive, non-suicidal self-harm in an English male prison: staff experiences, reactions, and concerns. Legal and Criminological Psychology. https://doi.org/10.1111/lcrp.12025
Self-harm in prisons: dominant models and (mis)understandings
Marzano, L. 2010. Self-harm in prisons: dominant models and (mis)understandings. in: Adler, J. and Gray, J. (ed.) Forensic psychology: concepts, debates and practice Willan. pp. 486-507
Interviewing survivors of near-lethal self-harm: a novel approach for investigating suicide amongst prisoners
Marzano, L., Rivlin, A., Fazel, S. and Hawton, K. 2009. Interviewing survivors of near-lethal self-harm: a novel approach for investigating suicide amongst prisoners. Journal of Forensic and Legal Medicine. 16 (3), pp. 152-155. https://doi.org/10.1016/j.jflm.2008.08.011
The suicidal process in male prisoners making near-lethal suicide attempts
Rivlin, A., Fazel, S., Marzano, L. and Hawton, K. 2013. The suicidal process in male prisoners making near-lethal suicide attempts. Psychology, Crime and Law. 19 (4), pp. 305-327. https://doi.org/10.1080/1068316X.2011.631540
Psychosocial influences on prisoner suicide: a case-control study of near-lethal self-harm in women prisoners
Marzano, L., Hawton, K., Rivlin, A. and Fazel, S. 2011. Psychosocial influences on prisoner suicide: a case-control study of near-lethal self-harm in women prisoners. Social Science & Medicine. 72 (6), pp. 874-883. https://doi.org/10.1016/j.socscimed.2010.12.028
Near-lethal self-harm in women prisoners: contributing factors and psychological processes
Marzano, L., Fazel, S., Rivlin, A. and Hawton, K. 2011. Near-lethal self-harm in women prisoners: contributing factors and psychological processes. The Journal of Forensic Psychiatry & Psychology. 22 (6), pp. 863-884. https://doi.org/10.1080/14789949.2011.617465
Impact on prisoners of participating in research interviews related to near-lethal suicide attempts
Rivlin, A., Marzano, L., Hawton, K. and Fazel, S. 2012. Impact on prisoners of participating in research interviews related to near-lethal suicide attempts. Journal of Affective Disorders. 136 (1), pp. 54-62. https://doi.org/10.1016/j.jad.2011.09.009
Studying survivors of near-lethal suicide attempts as a proxy for completed suicide in prisons
Rivlin, A., Fazel, S., Marzano, L. and Hawton, K. 2012. Studying survivors of near-lethal suicide attempts as a proxy for completed suicide in prisons. Forensic Science International. 220 (1), pp. 19-26. https://doi.org/10.1016/j.forsciint.2012.01.022
Comfort and challenge: A thematic analysis of female clinicians’ experiences of supervision
Starr, F., Ciclitira, K., Marzano, L., Brunswick, N. and Costa, A. 2013. Comfort and challenge: A thematic analysis of female clinicians’ experiences of supervision. Psychology and Psychotherapy: Theory, Research and Practice. 86 (3), pp. 334-351. https://doi.org/10.1111/j.2044-8341.2012.02063.x
Women counsellors' experiences of personal therapy: A thematic analysis
Ciclitira, K., Starr, F., Marzano, L., Brunswick, N. and Costa, A. 2012. Women counsellors' experiences of personal therapy: A thematic analysis. Counselling and Psychotherapy Research. 12 (2), pp. 136-145. https://doi.org/10.1080/14733145.2011.645050
The impact of prison staff responses on self-harming behaviours: prisoners’ perspectives
Marzano, L., Ciclitira, K. and Adler, J. 2011. The impact of prison staff responses on self-harming behaviours: prisoners’ perspectives. British Journal of Clinical Psychology. 51 (1), pp. 4-18. https://doi.org/10.1111/j.2044-8260.2010.02007.x
Self-harm in a men's prison: staff's and prisoners' perspectives.
Marzano, L. 2007. Self-harm in a men's prison: staff's and prisoners' perspectives. PhD thesis Middlesex University School of Health and Social Sciences
Visuo-spatial ability and dyslexia: is there a male global advantage?
Brunswick, N., Martin, G. and Marzano, L. 2008. Visuo-spatial ability and dyslexia: is there a male global advantage? British Dyslexia Association International Conference, 2008 [Dyslexia: making links]. Harrogate, York 27 - 29 Mar 2008
Visuo-spatial ability, handedness and developmental dyslexia: just how sinister was Andy Warhol?
Brunswick, N., Martin, G. and Marzano, L. 2007. Visuo-spatial ability, handedness and developmental dyslexia: just how sinister was Andy Warhol? 25th European Workshop on Cognitive Neuropsychology. Bressanone, Italy 21 - 26 Jan 2007
To be or not to be … a psychologist: critical and feminist dilemmas.
Ciclitira, K., Capdevila, R., Marzano, L. and Adams, E. 2008. To be or not to be … a psychologist: critical and feminist dilemmas. 2008 BPS Annual Conference.. Dublin 04 Feb 2008
Counsellors’ experiences of working as volunteers at a women’s service.
Costa, A., Ciclitira, K. and Marzano, L. 2008. Counsellors’ experiences of working as volunteers at a women’s service. 2008 Psychology of Women Section 21st Anniversary Conference on 'Rights and Changes'.. Cumberland Lodge, The Great Park, Windsor.
The impact of personal psychotherapy and supervision on volunteer counsellors.
Ciclitira, K., Marzano, L., Starr, F., Brunswick, N., Costa, A. and Berger, S. 2009. The impact of personal psychotherapy and supervision on volunteer counsellors. 2009 BPS Annual Conference. Brighton, UK 01 - 03 Apr 2009
Supporting staff working with prisoners who self harm: a survey of support services for staff dealing with self-harm in prisons in England and Wales
Marzano, L. and Adler, J. 2007. Supporting staff working with prisoners who self harm: a survey of support services for staff dealing with self-harm in prisons in England and Wales. International Journal of Prisoner Health. 3 (4), pp. 268-282. https://doi.org/10.1080/17449200701682501
Afghan nationals in the UK: professional capacity and views on return
Sales, R., Blitz, B. and Marzano, L. 2002. Afghan nationals in the UK: professional capacity and views on return. Research commissioned by Refugee Action and the International Organization for Migration, London..
Psychiatric disorders in male prisoners who made near-lethal suicide attempts: case-control study
Rivlin, A., Hawton, K., Marzano, L. and Fazel, S. 2010. Psychiatric disorders in male prisoners who made near-lethal suicide attempts: case-control study. The British Journal of Psychiatry. 197 (4), pp. 313-319. https://doi.org/10.1192/bjp.bp.110.077883
Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case–control study
Marzano, L., Fazel, S., Rivlin, A. and Hawton, K. 2010. Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case–control study. The British Journal of Psychiatry. 197 (3), pp. 219-226. https://doi.org/10.1192/bjp.bp.109.075424
Visuospatial superiority in developmental dyslexia: myth or reality?
Brunswick, N., Martin, G. and Marzano, L. 2010. Visuospatial superiority in developmental dyslexia: myth or reality? Learning and Individual Differences. 20 (5), pp. 421-426. https://doi.org/10.1016/j.lindif.2010.04.007
Justice and care: theorising the 'new man' and the 'caring father.'
Marzano, L., Capdevila, R., Ciclitira, K. and Lazard, L. 2009. Justice and care: theorising the 'new man' and the 'caring father.'. Psychology of Women Secton Review. 11 (2), pp. 11-20.
Theoretical and ethical issues in conducting research at a women’s centre.
Ciclitira, K. and Marzano, L. 2004. Theoretical and ethical issues in conducting research at a women’s centre. Proceedings of the British Psychological Society. 12 (2).
Being a man: justice and care.
Capdevila, R., Ciclitira, K., Lazard, L. and Marzano, L. 2006. Being a man: justice and care. Psychology of Women Section Annual Conference 2005.. University of Huddersfield. The British Psychological Society.
Theoretical and ethical issues in conducting research at a women’s health centre.
Ciclitira, K., Marzano, L., Brunswick, N., Starr, F. and Berger, S. 2004. Theoretical and ethical issues in conducting research at a women’s health centre. Psychology of Women Section Review. 6 (1), pp. 60-69.
Non voluntary return? The politics of refugee return to Afghanistan
Sales, R., Blitz, B. and Marzano, L. 2005. Non voluntary return? The politics of refugee return to Afghanistan. Political Studies. 53 (1), pp. 182-200.