A mixed-methods evaluation of a large-scale online gatekeeper training to prevent youth suicides in the Netherlands

The increasing trend in suicides among young people emphasizes the urgent need for effective prevention strategies. Gatekeeper trainings (GKTs) equip individuals in a young person's network with skills to recognize signs of suicidal thoughts and behaviors, initiate supportive conversations, and facilitate referrals to appropriate care. This study examines the reach of a large-scale Dutch online-GKT in training both informal and formal gatekeepers.

Longitudinal data were collected from Dutch adults who participated in the online-GKT between October 2022 and March 2023. Primary outcomes were self-reported knowledge and self-efficacy before and after the training. Secondary outcomes were training retention and behavior at 3-months follow-up. Repeated measures ANOVAs tested the effects of time, gatekeeper group, and interaction effects while logistic regression analyses explored predictors of gatekeeper behavior. Qualitative analysis examined emerging themes in narrative accounts of gatekeeper behavior.

In total, n = 8040 formal gatekeepers (e.g., healthcare workers, educational staff) and n = 1142 informal gatekeepers (e.g., family members, friends) participated. Gatekeepers showed significant improvements in self-reported knowledge (F(1,7555) = 8761.88, p < .001, η² = 0.54) and self-efficacy (F(1,7538) = 4376.75, p < .001, η² = 0.37) directly after the online-GKT. These improvements were maintained over time in the follow-up group (F(1.9, 1625.1) = 630.84, p < .001, η² = 0.42; F(1.9, 1632.3) = 270.07, p < .001, η² = 0.24). Having engaged in further (in-person) training predicted gatekeepers talking to (OR = 1.79[1.30-2.45]) as well as referring (OR = 1.56[1.09-2.21]) at-risk adolescents between post-training and follow-up. Qualitative accounts of gatekeeper's behavior at follow-up revealed benefits (e.g., greater ease in talking to a young person about suicide; acknowledging a young person's difficulties) alongside challenges (e.g., resistance from young people, limited availability of help).

These findings confirm the importance of online-GKTs in adolescent suicide prevention by reaching a large number of primarily formal gatekeepers and enhancing their self-reported knowledge and self-efficacy. Expanding online-GKTs reach to informal gatekeepers, particularly family members, is crucial given their pivotal role in youth suicide prevention. In addition, improving online-GKTs content to foster interpersonal bonds and promote accessible support resources (e.g., e-health, peer support) may further enhance gatekeeper responsiveness and intervention outcomes.