The Web-Based Recognise and Respond Gatekeeper Training Program: Noninferiority Randomized Trial

Abstract

Background: Gatekeeper training teaches community members to identify individuals at risk of suicide and assist them with help-seeking. A new online program, Recognise and Respond (R&R), was developed to address the need for a program specific to the Australian context, created in consultation with clinicians, researchers, and people with a lived experience of suicide. Objective: This study aimed to evaluate whether the R&R gatekeeper training is noninferior to the established Question, Persuade, Refer (QPR) online program, in improving confidence to identify and support individuals experiencing suicidal thoughts. Secondary objectives examined the short- and medium-term effects of R&R on attitudes toward suicide prevention and knowledge of appropriate responses to signs of suicide. Methods: A total of 524 participants were enrolled at baseline and were then randomized to receive access to either R&R (n=263) or QPR (n=261). The primary outcome—gatekeeper confidence in identifying and supporting an individual experiencing suicidal thoughts—was assessed using a noninferiority framework. Secondary outcomes, including attitudes toward suicide prevention and knowledge of appropriate responses to signs of suicide, were assessed using superiority testing. Outcomes were assessed via online surveys at baseline, postintervention, and the 3-month follow-up. The trial was conducted entirely online, with no face-to-face contact with participants. Data were analyzed using mixed effects linear models. Results: Participants in both groups reported significant improvements in confidence across time indicating noninferiority of the R&R program. Both groups showed significant improvements on attitudes and knowledge scores at postintervention and the 3-month follow-up, 3. to baseline. Improvement in attitude scores between baseline and postintervention and follow-up were greater for the QPR group compared to the R&R group. Gains at postintervention were maintained at follow-up for both groups considering all outcomes. There were no other between-group differences. Conclusions: The findings demonstrate that R&R is as effective as QPR online in improving gatekeeper confidence to identify and support someone having thoughts of suicide.