Elsevier

Journal of Affective Disorders

Volume 165, 20 August 2014, Pages 142-150
Journal of Affective Disorders

Research report
Effectiveness of community facilitator training in improving knowledge, attitudes, and confidence in relation to depression and suicidal behavior: Results of the OSPI-Europe intervention in four European countries

https://doi.org/10.1016/j.jad.2014.04.052Get rights and content

Abstract

Background

Community facilitators (CFs), such as teachers, nurses and social workers, are well placed as gatekeepers for depression and suicidal behavior, but not properly prepared to provide preventive and supportive services. The current study aimed: (1) to improve CFs’ attitudes toward depression, knowledge on suicide, and confidence to detect suicidal behavior in four European countries and (2) to identify specific training needs across regions and CF groups.

Methods

A standardized training program was provided to 1276 CFs in Germany, Hungary, Ireland, and Portugal. Attitudes toward depression, knowledge about suicide, and confidence in identifying suicidal persons were assessed before training, after training, and at three to six months follow-up. Additionally, several participants’ characteristics were registered.

Results

At baseline, CFs showed relatively favorable attitudes toward depression, but limited knowledge on suicide, and little confidence to identify suicidal behavior. Basic skills strongly differed across CF groups and countries. For example, in Germany, carers for the elderly, nurses, teachers, and managers were most in need of training, while in Portugal pharmacists and the clergy appeared to be important target groups. Most importantly, the training program improved the competencies of CF groups across countries and these improvements were sustained after three to six months. CFs with low basic skills benefited most of the training.

Limitations

The observed training effects could be influenced by other external factors as our results are based upon a pre–post comparison with no control group.

Conclusions

Gatekeeper trainings in community settings are successful in improving knowledge, reshaping attitudes, and boosting the confidence of gatekeepers. The most effective strategy to achieve the preferred objectives is to target those CF groups that are most in need of training and to tailor the content of the training program to the individual needs of the target group.

Section snippets

Background

According to the World Health Organization, worldwide approximately one million people die from suicide every year (World Health Organization, 2003). About 90% of all suicides occur in the context of psychiatric disorders, with depression being the most prominent risk factor (Hegerl et al., 2009, Mann et al., 2005, Yoshimasu et al., 2008). Given the close relationship between depression and suicidal behavior, community-based action programs targeting simultaneously the improvement of care for

Design

As part of the OSPI-Europe multilevel intervention, standardized training programs on depression and suicide were provided to CFs in the following four OSPI-Europe intervention regions: Amadora (Portugal), Leipzig (Germany), Limerick (Ireland), and Miskolc (Hungary). The research design was a prospective single group pre–post test evaluation. In order to determine pre–post training effects among participants of the OSPI-Europe training program, semi-structured self-report questionnaires

Response rate

The analyses reported in the current article were performed on 1276 CFs who attended training. Immediately after training the response rate reached 73% (n=928), while at three to six months follow-up 35% of the CFs completed the questionnaires (n=451).

Participants’ characteristics

Table 1 provides an overview of the distribution of participants according to gender, age, years of schooling, professional experience, country, occupational group, previous training in suicide, and experience with suicide. Most of the

Discussion

The current international study reports on the results of the OSPI-Europe training program, implemented in eight different CF groups in four European countries. To assess the effectiveness of the training program we focused on intermediate outcomes that are linked directly to the operational goals and the content of the intervention, such as change in attitude toward depression, improved knowledge about suicide, and increased confidence to identifying persons at-risk of suicide. The effects of

Limitations and future research

Although the current findings provide strong support for the hypothesis that gatekeeper training programs can improve competencies for intervening with depressive and suicidal persons, the study has two limitations. First, the results are based on pre–post comparisons with no control group. Therefore, we cannot rule out the possibility that apart from the training program other external factors contributed to the observed change in competencies in CFs. Possibly, the CFs participating in the

Conclusions

The study outcomes provide evidence indicating that gatekeeper trainings in community settings are successful in improving knowledge, reshaping attitudes, and boosting the confidence of gatekeepers. Overall, our findings demonstrate that these acquired traits are sustained after three to six months. Moreover, we argue that targeting those CF groups that are most in need of training and tailoring the content of the training program to the individual needs of the target group is the most

Role of funding source

Funding for this study was provided by the European Community׳s Seventh Framework Program (FP7/2007–2013) under grant agreement no. 223138. The funding partner had no role in the design of the study; in the data collection; in the analyses and interpretation of the data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.

Conflict of interest

The authors declare that they have no conflicts of interest.

Acknowledgements

The OSPI-Europe project has received funding from the European Community׳s Seventh Framework Program (FP7/2007-2013) under grant agreement no. 223138. Thanks to Gert Scheerder who was involved in the early stages of the OSPI-Europe research and who prepared the statistical analysis.

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