Effectiveness of suicide prevention gatekeeper training programs in low- and middle-income countries: A systematic...

Suicide prevention gatekeeper training programs in low- and middle-income countries (LMICs) remain underexamined. This systematic review and meta-analysis synthesized evidence on their effectiveness for trainees and community suicide-related outcomes. Forty-six studies involving 8,569 trainees across 20 LMICs were included. Repeated-measures meta-analyses showed immediate improvements after training in attitudes (Hedges' g = 0.90), knowledge (g = 1.07), confidence (g = 1.27), competence (g = 0.57), and behavior (g = 0.92). A multilevel pooled meta-analysis of 47 immediate post-intervention effect sizes from 26 repeated-measures studies indicated a large overall improvement across trainee-level outcomes (g = 1.02, 95% CI [0.69, 1.36]), with substantial heterogeneity. Attitudes, knowledge, and confidence gains were sustained at 12 months, whereas competence gains were not sustained at 6 months. Controlled studies were sparse. Only one repeated-measures study assessed community-level outcomes and found no significant reduction in suicide attempts. Evidence for sustained behavior change and population-level impact remains limited.