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Does a Gatekeeper Suicide Prevention Program
Work in a School Setting? Evaluating Training
Outcome and Moderators of Effectiveness
Tanya L. Tompkins
Linfield College, email@example.com
This Submitted Version is brought to you for free via open access, courtesy of DigitalCommons@Linfield. For more information, please contact
Tompkins, Tanya L.; Witt, Jody; and Abraibesh, Nadia, "Does a Gatekeeper Suicide Prevention Program Work in a School Setting?
Evaluating Training Outcome and Moderators of Effectiveness" (2009).Faculty Publications.Submitted Version. Submission 1.
Gatekeeper Training 1
Running head: GATEKEEPER TRAINING AND MODERATORS OF EFFECTIVENESS
Does a Gatekeeper Suicide Prevention Program Work in a School Setting? Evaluating Training
Outcome and Moderators of Effectiveness
Tanya L. Tompkins, Ph. D., Jody Witt, B. A., and Nadia Abraibesh
Gatekeeper Training 2
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.
Gatekeeper Training 3
Does a Gatekeeper Suicide Prevention Program Work in a School Setting? Evaluating Training
Outcome and Moderators of Effectiveness
Nationally, suicide is the third leading cause of death among 10- to 19-year-olds (Centers
for Disease Control [CDC], 2004) with rates increasing as youth move through adolescence (1.5
per 100,000 among 10- to 14-year-olds and 8.2 per 100,000 among 15- to 19-year-olds).
However, examining completed suicide as a sole indicator of risk provides an incomplete picture
of the problem. Oregon, being the only state in the nation to mandate reporting of youth attempts
requiring medical services, provides a unique source of data about frequency of youth suicide
attempts. Since 1987, hospitals have been required by law to report attempts to the state health
department which systematically tracks and shares the numbers in a data base called the
Adolescent Suicide Attempt Data System (ASADS). In 2004, 920 youth in the state attempted
suicide, a year in which 10 took their own lives (Oregon Department of Human Services’ Center
for Health Statistics, 2004). While attempts greatly outnumber completions, they are thought to
be drastically under-reported with surveyed emergency room personnel estimating that in this
same year at least 1,800 youth made attempts (Oregon Public Health Division, 2006) which is in
line with accepted estimates that for every one documented suicide completion, there are
approximately 100 to 200 who have attempted (National Center for Health Statistics as cited in
Recent state and national surveys provide an additional source of information about the
extent of the problem of youth suicide and generally reveal alarmingly high rates of non-lethal
suicidal behavior. For example, the Youth Risk Behavior Survey (YRBS), conducted by the
CDC revealed that during the previous year 28.5% of high school students felt “so sad or
hopeless every day for 2 weeks or more in a row” that they stopped engaging in usual activities,
Gatekeeper Training 4
16.9% “seriously considered attempting suicide,” nearly 13% made a specific plan to attempt,
8.4% reported at least one attempt, and 2.3% made an attempt which required medical attention
(CDC, 2004). Taken together, and considering the estimated participation rates in the YRBS
(67%), the magnitude of the problem becomes clear.
Although historical trends suggest a decline in youth suicide beginning in the mid 1990s,
recent data suggest these rates have stabilized or even increased giving cause for concern
(Hamilton, Minino, Martin, Kochanek, Strobino, & Guyer, 2007). The reasons for these trends
are not clear. However, some highlight the role of selective serotonin reuptake inhibitors
(SSRIs) in decreasing suicidality among youth, citing increasing rates of anti-depressant
prescriptions for adolescents prior to and decreasing rates following the 2004 FDA mandated
black-box warnings correlating with decreased and increased rates among youth, respectively
(Gibbons, Hur, Bhaumik, & Mann, 2006).
Youth suicide prevention programs share the common goals of identifying at-risk youth
and referring for treatment or decreasing risk factors while promoting protective factors. These
efforts have primarily been implemented in the schools or larger community. The National
Strategy for Suicide Prevention highlights the need for a multifaceted and collaborative response
to youth suicide, including the importance of building community and school partnerships. In
addition, it calls for increasing the number of evidence-based suicide prevention programs in
schools and for providing awareness and educational programs to key gatekeepers, where a
gatekeeper is simply anyone who may recognize and refer someone at risk of suicide.
Unfortunately, most schools do not appear to be actively engaged in prevention efforts as less
than half of all states require that suicide prevention be taught in at least one school grade (CDC,
Gatekeeper Training 5
Although an extensive empirical literature has examined risk factors, warning signs, and
precipitating factors of youth suicide (Bridge, Goldstein, & Brent, 2006; Gould, Greenberg,
Velting, & Shaffer, 2006b), relatively less is known about the efficacy of key prevention
strategies, including the extent to which potential gatekeepers possess adequate knowledge of
suicide and suicide prevention. The extant research in the area, in fact, suggests that
professionals and educators rarely recognize and/or are able to provide assistance to suicidal
youth (King, Price, Telljohann, & Wahl, 1999; Pirkis et al., 2003; Schouller & Smith, 2002).
Thus, school personnel, given their access and relationship to youth, are important targets for
One widely used gatekeeper training program is QPR (Question, Persuade, Refer). Taught
by certified instructors, the 1- to 2-hour session trains individuals to recognize warning signs,
question suicidal intent, listen to problems, and refer for help. Although limited in scope,
outcome-based research suggests that gatekeeper training may improve knowledge and skills (see
Gould, Greenberg, Velting, & Shaffer, 2003 for a review). Thus, improving school personnel’s
ability to detect and appropriately respond to potentially suicidal youth may serve an important
role in suicide prevention efforts.
Heeding the U. S. Surgeon General’s call for empirical evaluation, the current study
evaluates the short-term effectiveness of QPR in changing knowledge and attitudes toward youth
suicide prevention, improving upon past studies through inclusion of a control group thereby
sharpening interpretation of prevention effects. In addition to testing the hypothesized effect of
QPR, we sought to identify factors that may influence effectiveness including age, professional
role, prior training, and/or past experience with suicidal youth.
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Participants included 106 school personnel from a small, rural school district in the
Pacific Northwest who were recruited by school administrators to be trained in QPR as a county-
wide prevention effort. Thirty-five control group participants who self-identified as having
contact with youth were recruited from the community through emails and newspaper
announcements. The sample characteristics of both groups and statistical comparisons are
presented in Table 1.
The questionnaire was adapted from instruments previously used to evaluate gatekeeper
programs and inquired about demographics and other domains (see Table 2). Additionally, QPR
participants were asked to evaluate the program (e.g., overall evaluation, effectiveness at meeting
training objectives, helpfulness, whether they would recommend the program to others).
Not being able to randomly assign schools, or individuals within the schools, to groups,
we used a non-equivalent control group design. During an in-service training, 78 school
personnel participated in a 2-hour QPR gatekeeper suicide prevention training and completed a
paper-and-pencil measure prior to and immediately after training. The QPR certified trainer
discussed prevalence of suicide among youth, risk factors for depression and suicidality,
appropriate ways to ask if a student is considering suicide, and reviewed the steps that should be
taken when intervening and referring a suicidal person for help.
Control participants (n = 24) did not receive training, but completed similar pre- and post-
test measures online or via mail, approximately one day apart. No significant differences in
Gatekeeper Training 7
demographic variables were found between participants who completed pre-test measures only
and those who completed both pre- and post-test measures.
Additionally, approximately three months after participating in the study, both control
and QPR participants were asked to complete a follow-up measure. A limited number of
controls (n = 21) and QPR (n = 18) participants completed the follow-up measure online or via
mail. Participants who completed follow-up measures were significantly more educated and
reported more personal experience with suicidal individuals.
Outcome Evaluation: Indications of Program Effectiveness
Independent-samples t-tests and chi-square tests were used to examine possible pre-
existing differences between groups. These preliminary analyses suggested that control group
participants were older, more educated, and had more personal experience with suicidal
individuals relative to QPR participants (see Table 1). As a result, these variables were used as
covariates in all analyses evaluating training effects.
A series of Analyses of Covariance (ANCOVAs) were conducted to evaluate training
effects. Participants demonstrated significant gains relative to controls across multiple domains
from pre- to post-test, indicating improvements in knowledge, perceived skills, and self-efficacy
to intervene (Table 3).
Additionally, QPR participants generally responded positively to the training with 93%
rating the program as good to excellent in meeting its objectives, 90% indicating a belief that the
training would be helpful in assisting a suicidal individual and 97% reporting that they would
recommend the program to others.
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Moderators of Program Effectiveness
A series of repeated-measures Analyses of Variance (ANOVAs) were used to evaluate
the possible moderating influence of background factors (e.g., age, professional role, prior
training, recent contact with suicidal youth) on gains in knowledge, perceived skills and attitudes
toward suicide and suicide prevention. Factors were identified on the basis of their pragmatic
importance for informing administrative decision making about school training. There was a
significant Age x Time interaction, F(2, 73) = 3.88, p < .05 (see Figure 1A), suggesting that age
significantly influenced QPR participants’ attitudes toward identifying youth suicide as a major
issue in need of being addressed, with younger groups of school personnel showing positive
attitudinal shifts across time, t(20) = - 2.63, p < .05. As shown in Figure 1B, professional role
significantly moderated training effects on these same attitudes, F(1, 58) = 10.93, p < .01, with
teachers and administrators demonstrating positive gains, t(46) = - 2.87, p < .01, and support staff
showing negative shifts in beliefs about addressing the problem of youth suicide, t(12) = 2.31, p
< .05. Professional role also moderated training effects on perceptions of whether suicide was a
major issue in the community, F(1, 58) = 5.68, p < .05 (see Figure 1C), again with teachers and
administrators seeing it as a significantly greater problem after training, t(47) = - 4.11, p < .001,
relative to support staff who experienced no shift in attitudes, t(13) = 0.38, p > .05. Additionally,
for knowledge tapped by the QPR quiz, there was a significant Professional Role x Time
interaction, F(1, 58) = 15.67, p < .001, suggesting that teachers and administrators significantly
improved their performance on the QPR quiz, t(46) = -10.21, p < .001, while support staff
showed no change in performance (see Figure 1D).
Consistent with the one published study investigating moderating effects of prior training
(King & Smith, 2000), the main effect of time, F(1, 74) = 65.27, p < .001 was significantly
Gatekeeper Training 9
qualified by prior training, F(1, 74) = 3.17, p < .05, such that individuals with prior suicide
prevention training evidenced more modest pre-post changes in questioning about suicide, t(8) =
- 3.29, p < .05, relative to those with no prior training t(66) = - 14.36, p < .001 (see Figure 1E).
A similar pattern of results was found for general knowledge, with the main effect of time F(1,
74) = 72.39, p < .001 being qualified by prior training, F(1, 74) = 5.61, p < .05, such that
individuals with no prior training evidenced greater gains across time in their general knowledge
of suicide and suicide prevention, t(66) = - 15.93, p < .001 relative to those with some prior
training, t(8) = - 3.07, p < .05 (see Figure 1F). However, it should be noted that even for those
with prior training significant gains were still noted in both general knowledge and questioning.
Similarly, a main effect of time, F(1, 61) = 81.41, p < .001 was significantly qualified by
prior contact with suicidal youth, F(2, 61) = 4.25, p < .05, such that individuals with no prior
contact with suicidal youth in the past year demonstrated steeper gains in general knowledge,
t(42) = - 13.08, p < .001 relative to those with limited, t(4) = - 3.50, p < .05 or more extensive
contact, t(15) = - 5.95, p < .001 (see Figure 1G). Finally, a similar pattern was noted for self-
efficacy whereby a main effect of time, F(1, 61) = 26.13, p < .001 was significantly qualified by
prior contact with suicidal youth, F(2, 61) = 4.51, p < .05, such that those with no prior contact
evidenced the greatest gains in self-efficacy, t(42) = -7.74 , p < .001, relative to those with
limited, t(4) = - 2.83, p < .05 or more extensive contact, t(15) = - 2.57, p < .05 (see Figure 1H).
A series of repeated-measures ANOVAs were used to evaluate short-term durability of
prevention outcomes in the limited sub-sample that completed follow-up measures. As shown in
Table 4, prevention training gains were maintained in some domains (self-efficacy, likelihood to
intervene, questioning, perceptions of suicide as preventable), but not others (general knowledge,
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QPR knowledge quiz). Additionally, control participants also showed limited gains in
questioning and likelihood to intervene.
The present study describes a preliminary investigation of the effectiveness of a
gatekeeper training program among secondary school personnel. It is the first of its kind to
evaluate QPR using a non-equivalent control-group design. In general, QPR was positively
evaluated and significant gains in suicide-relevant knowledge and attitudes were demonstrated
from pre- to post-test, suggesting that QPR is a promising tool in school-based prevention efforts.
Although a public health saturation model of QPR is the penultimate goal (see Quinnett,
2006), pragmatic concerns with school-based intervention may necessitate targeting training to
groups who may benefit the most, as administrators are often forced to make practical decisions
based upon available resources. The results of the current study suggest that younger teachers,
who have not been previously trained in suicide prevention nor had much prior contact with
suicidal youth, are the most likely to benefit from QPR. Unpublished reports from the
Washington Youth Suicide Prevention Program similarly found that those with less experience
with suicide tended to show more substantial changes in knowledge and attitudes about suicide
and suicide prevention (Organizational Research Services [ORS], 2002).
Teachers are often identified as individuals in the community in a unique position to
identify at-risk youth and refer them for help. Supporting this view, a substantial number of
school personnel in our sample reported having had contact with at least one suicidal youth in the
past month (20%) or year (39%) and most indicated they were approachable to students who
talked with them about their thoughts and feelings. However, there is evidence to suggest that
opportunities for identification and referral may be missed due to lack of knowledge about the
Gatekeeper Training 11
signs and symptoms of suicidality (Brown, Wyman, Guo, & Peña, 2005; Schouller & Smith,
2002). Thus, if gatekeeper training is effective, adopting programs that increase knowledge of
warning signs and how to appropriately intervene may serve to substantially increase
identification and referral of at-risk youth.
Evaluations of prevention efforts typically fail to examine durability of effects. Notable
exceptions include two unpublished (Davis, 2001 as cited in Quinnettt, 2006; ORS, 2002)
evaluations of gatekeeper training that demonstrated maintenance of training gains in knowledge
and attitudes up to 18 months post-training. Although focused on training peer helpers, Stuart,
Waalen, and Haelstromm (2003) similarly found that significant gains were maintained across a
3-month period. Consistent with these prior results, we found that training gains persisted across
most domains. Changes in knowledge (e.g., warning signs, risk factors), but not attitudes or
beliefs, tended to be relatively more ephemeral among our sample. Although the number of
participants who completed pre-test and post-test measures following training were respectable,
the limited number of QPR participants (23%) who completed all three assessments, restricts
conclusions that can be drawn. Stuart et al. (2003) and the ORS group confronted similar
problems with high rates of attrition (57% and 39%, respectively) calling for the need to recruit
larger samples that are followed over time, as well as more creative ways to prevent participant
drop-out. Interestingly, most participants in the control group (75%) completed the follow-up
measure and evidenced significant gains in terms of their intent to intervene and question when
encountering suicidal youth. Although supporting evidence is anecdotal in nature (e.g., going to
online suicide-related resources after completing the online survey), it may be that enhancing
awareness can lead to improvements in circumscribed areas for those who are highly educated,
motivated, and/or experienced.
Gatekeeper Training 12
Although this study is the first to empirically evaluate QPR in the school setting there are
several limitations that should be noted. First, a non-equivalent control group design was used
and therefore we cannot attribute gains solely to training. Future studies should attempt to
evaluate QPR using a more rigorous design in which random assignment can be employed.
Additionally, the significant changes in knowledge, while a positive step toward raising
awareness of suicide and increasing opportunities for prevention, do not necessarily translate into
effective intervention. We attempted to collect follow-up data, including contact with youth and
referral practices, to answer these important questions. Unfortunately, few participants chose to
respond. Additionally, several of the follow-up responses included summer months which were
not directly comparable to post-test responses that focused on experiences and behaviors
occurring during the academic school year. Again, future research should recruit large numbers
of participants who are followed across time to examine the self-reported number of youth
identified, actual referrals to school and community resources, and the maintenance of the gains
in knowledge, attitudes, and beliefs. Such a design may also provide opportunities to incorporate
and test whether modifications to the training program (e.g., booster sessions, simulated practice,
monthly newsletter) differentially enhance outcomes and/or durability of outcomes.
While QPR training offers one promising tool, several issues highlight the need to widen
gatekeeper training to include peers and parents, and to enact additional prevention strategies.
First, recent evidence suggests that friends and parents may be particularly effective gatekeepers.
Not only are youth most likely to confide in peers, but both friends and parents of youth who
completed suicide also reported being aware of unique sets of risk factors (Moskos, Olson,
Halbern, Keller, & Gray, 2005). Recent data has also revealed low rates of both formal and
informal resource use among completers (Moskos et al., 2005) and high-risk youth (Gould,
Gatekeeper Training 13
Greenberg, Munfaksh, Kleinman, & Lubell, 2006a). Needed are ways to combat stigma and
encourage help-seeking, particularly among those who are socially isolated (Moskos et al., 2005).
In conclusion, effectively tackling the problem of youth suicide requires cooperation and
involvement from entire communities. Evaluating those efforts in scientifically meaningful ways
requires substantial trust and strong partnerships. In reference to the issue of mental health in the
schools, Howard Adelman (2006) writes, “true collaboration involves more than meeting and
talking. The point is to produce actions that yield important results.” (p. 297). Communities
must come together to talk about suicide prevention, identify their weaknesses, build upon their
strengths, and create plans of action.
Gatekeeper Training 14
Adelman, H. (2006). Mental health in schools and public health. Public Health Reports, 121,
Bridge, J.A., Goldstein, T.R., & Brent, D.A. (2006). Adolescent suicide and suicidal behavior.
Journal of Child Psychology and Psychiatry, 47, 372-394.
Brown, C., Wyman, P., Guo, J., & Peña, J. (2006). Dynamic wait-listed designs for randomized
trials: New designs for prevention of youth suicide. Clinical Trials, 3, 259-271.
Centers for Disease Control and Prevention. (2000). School health policies and programs study.
Retrieved May 1, 2007 from http://www.cdc.gov/HealthyYouth/shpps/index.htm
Centers for Disease Control and Prevention (2004). WISQARS leading causes of death reports,
2004. Retrieved May 10, 2007, from
Gibbons, R.D., Hur, K., Bhaumik, D.K., & Mann, J. J. (2006).The relationship between
antidepressant medication use and the rate of suicide. Archives of General Psychiatry,
Gould, M. S., Greenberg, T., Munfakh, J.L.H., Kleinman, M., & Lubell, K. (2006a). Teenagers’
attitudes about seeking help from telephone crisis services (hotlines). Suicide and Life-
Threatening Behavior, 36, 601-613.
Gould, M. S., Greenberg, T., Velting, D. M., & Shaffer, D. (2003). Youth suicide risk and
preventive interventons: A review of the past 10 years. Journal of the American Academy
of Child and Adolescent Psychiatry, 42, 386-405.
Gould, M. S., Greenberg, T., Velting, D. M., & Shaffer, D. (2006b). Youth suicide: A review.
The Prevention Researcher, 13, 3-7.
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Gould, M.S., & Kramer, R.A. (2001). Youth suicide prevention. Suicide and life-
threatening behavior, 31, 6-31.
Hamilton, B.E., Minino, A.M., Martin, J.A., Kochanek, K.D., Strobino, D.M., & Guyer,
B. (2007). Annual summary of vital statistics. Pediatrics, 119, 345-360.
Kalafat, J. (2006). Youth suicide prevention programs. The Prevention Researcher, 13, 12-15.
King, K. A. (2006). Practical strategies for preventing adolescent suicide. The Prevention
Researcher, 13, 8-11.
King, K.A., Price, J.H., Telljohann, S.K., & Wahl, J. (1999). High school health teachers’
knowledge of adolescent suicide. American Journal of Health Studies, 15, 156-163.
King, K. A., & Smith, J. (2000). Project SOAR: A training program to increase school
counselor’s knowledge and confidence regarding suicide prevention and intervention.
Journal of School Health, 70, 402-408.
Moskos, M., Olson, L., Halbern, S., Keller, T. & Gray, D. (2005). Utah youth suicide study:
Psychological autopsy. Suicide and Life-Threatening Behavior,35 , 536-546.
Oregon Department of Human Services’ Center for Health Statistics. (2004). Youth suicide
attempts. In Oregon vital statistics annual report (vol. 2, sect. 8). Retrieved May 1,
2007, from http://www.dhs.state.or.us/dhs/ph/chs/data/arpt/04v2/chp8toc.shtml
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Retrieved July 1, 2007, from http://www.oregon.gov/DHS/ph/ipe/ysp/docs/factsheet.pdf
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evaluation report 2001-2002: Evaluation of program training workshops. Retrieved
January 6, 2006, from http://www.yspp.org/aboutYSPP/reports/2001-2002Report.pdf
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Pirkis, J. E., Irwin, C. E., Brindis, C. D., Sawyer, M. G., Friestad, C., Biehl, M., & Patton, G. C.
(2003). Receipt of psychological or emotional counseling by suicidal adolescents.
Pediatrics, 111, 388-393.
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peer gatekeeper training in suicide risk assessment. Death Studies, 27, 321-333.
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Sample Characteristics of QPR and Control Participants
Characteristics QPR Control QPR Control
Age (in years) 42.10 47.09 - 2.26a*
.57 .89 - 2.60b*
Male 24% 26%
Female 76% 74%
Caucasian 93% 100%
Other 7% 0%
High School or General Equivalency Diploma 16% 3%
Some College (no degree) 23% 6%
Bachelor’s Degree 29% 43%
Master’s Degree (or above) 32% 48%
Note. a degrees of freedom for the t test are (132). b degrees of freedom for the t test are (127).
*p < 05. **p < .01.
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Definitions of Variables, Sample Items and Internal Consistency
Sample item (number of items) Scale
How competent would you feel helping a suicidal
person? (3 items)
1. Suicide among young people is a major issue in my
2. The problem of youth suicide should be addressed in
3. Suicide is preventable in the majority of situations.
Information about local resources for help. (6 items)
Ask someone if they are suicidal.( 5 items)b
I would encourage them to talk about their problems
and wish to die. (7 items)c
The number one contributing cause of suicide is (15
Have you participated in any sort of suicide training or
workshop prior to today? (1 item)
1=not at all to 5=fully
1=strongly disagree to 5=strongly agree .45a
General knowledge 1=very low to 5=very high .92
Questioning 1=not very likely to 3=very likely .84
& likelihood to help
QPR knowledge quiz
1=strongly disagree to 5=strongly agree .71
Gatekeeper Training 19
(Table 2 continued)
Sample item (number of items)
Have you had personal experience with suicide?
(calculated total count of close others endorsed from
list as attempting/completing) (1 item)
How many young people who showed signs of being
suicidal did you have contact with in the last month?
Last year? (2 items)
Prior contact with
Note. A copy of all study-related materials may be obtained from the first author a Due to low reliability at pre-test individual items
were used in all analyses. b Four of the five items were measured on 5-point scales (3 items rated from 1 = Very low to 5 = Very high; 1
item rated from 1 = Strongly disagree to 5 = Strongly agree). c Three of the 7 items were measured on the above 5-point scale; 4 items
were rated on a 3-point scale from 1 = Not very likely to 3 = Very likely. dContact the QPR Institute for a complete measure of the
QPR Knowledge Quiz (http://www.qprinstitute.com/)
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QPR and Control Group Participants’ Average Change in Scores from Pre-test to Post-test
(n = 76)
Variable Mean SD
(n = 24)
F (1, 99)
General knowledge 7.80 4.43 -0.71 3.01 59.98 .001
QPR test 1.97 2.31 0.13 1.30 13.58 .001
Questioning 5.21 3.12 -0.42 2.98 48.88 .001
Intervention knowledge &
likelihood to help
2.71 3.14 .92 2.77 61.59 .001
2.16 2.21 -0.29 1.60 20.20 .001
Suicide is a major issue 0.24 0.83 0.13 0.46 0.15 n.s.
Suicide is preventable 0.66 1.03 0.13 .54 4.55 .05
Suicide should be addressed 0.11 0.80 0.04 0.96 0.98 n.s.
Note. Analyses include age, education, and experience with suicide as covariates.
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Repeated Measures Analyses of Variance (ANOVA) Results Exploring 3-month Follow-up
Prevention Outcomes Across Groups
General Knowledge 15.61*** 18.89***
Pre-test 16.61 (4.22)a 18.38 (4.46)
Post-test 22.94 (3.78)a 17.67 (4.48)
Follow-up 21.00 (3.74)a 19.48 (5.79)
QPR Knowledge Quiz 7.13** 5.52**
Pre-test 11.21 (1.37)a 11.70 (1.22)
Post-test 13.36 (1.78)a, b 11.80 (1.61)
Follow-up 12.43 (1.22)b
Self-Efficacy 9.46*** 7.43***
Pre-test 8.89 (2.85)a,b 10.52 (2.48)
Post-test 10.95 (2.27)a 10.48 (2.36)
Follow-up 10.68 (2.31)b
Likelihood to Intervene 12.86*** 1.86
Pre-test 18.17 (2.66)a, b 18.05 (2.29)a
Post-test 20.11 (.83)a 18.76 (1.87)
Follow-up 20.11 (.96)b
Gatekeeper Training 22
(Table 4 continued)
M (SD) M (SD)
Questioning 20.77*** 14.44***
Pre-test 14.39 (3.11)a, b 16.95 (2.89)a
Post-test 18.67 (2.33)a 16.57 (3.40)b
Follow-up 19.28 (2.44)b 17.95 (2.94)a,b
Major Issue 1.70 1.20
Pre-test 3.39 (.98) 4.15 (.59)
Post-test 3.83 (.86) 4.25 (.64)
Follow-up 3.78 (.94) 4.10 (.55)
Address Problem 1.51 .02
Pre-test 4.17 (.51) 4.38 (.97)
Post-test 4.17 (.51) 4.43 (.60)
Follow-up 4.33 (.59) 4.57 (.51)
Preventable 9.23*** 4.87**
Pre-test 3.67 (.67)a, b
Post-test 4.39 (.50) a 4.14 (.73)
Follow-up 4.11 (.47)b 4.33 (.48)
Note. Means in the same column that share subscripts differ at p < .05 according to post-hoc
paired samples t-tests.
Gatekeeper Training 23
Gatekeeper Training 24
Tanya L. Tompkins, Jody Witt, and Nadia Abraibesh, Department of Psychology,
This research was supported by a student/faculty collaborative research grant from
Linfield College. A portion of the current study was previously presented at the meeting of the
Society for Research in Child Development in March, 2007. We gratefully acknowledge Chipo
Dendere for her assistance with data entry and Annelise Nelson for her assistance with data
collection, data entry and participant follow-up. We also thank Donna Noonan, Oregon Public
Health for providing the QPR training. Finally, we extend our deepest thanks to the individuals
who volunteer their time on the Suicide Prevention Coalition and to the participating schools, for
their willingness to be trained and/or be a part of the evaluation of the training.
Correspondence concerning this article should be addressed to Tanya L. Tompkins,
Department of Psychology, Linfield College, 900 SE Baker Street, A570, McMinnville, Oregon
97128. E-mail: firstname.lastname@example.org.
Gatekeeper Training 25
Average change in scores from pre-test to post-test assessment reported by QPR participants (n =
ranges from 34 to 40) as a function of age, professional role, prior training, and prior contact with
*p < .05. **p < .01. *** p < .001.