Circle of Life. Improving Capacity of Swampy Cree Community Members to Recognize People at Risk for Suicide

Circle of Life. Improving Capacity of Swampy Cree Community Members to Recognize People at Risk for Suicide

Circle of Life.Improving Capacity of Swampy Cree Community Members to Recognize People at Risk for Suicide: A Randomized Controlled Pilot Study

Primary Hypothesis: Participants in the Applied Suicide Intervention Skills Training (ASIST) gatekeeper training will be significantly more likely to have increased knowledge and preparedness to help people with suicidal ideation than participants who receive the resilience retreat. Secondary Hypotheses: Participants in ASIST gatekeeper training will not have higher levels of post-intervention distress or suicidal ideation compared to the resilience retreat. High levels of distress, grief, and alcohol abuse will significantly impact on the learning and retention of suicide intervention skills.

Inclusion criterion: All members of the Swampy Cree Tribal communities who are currently residing on the reserves will be eligible to participate in the study. Exclusion criterion: Exclusion criteria for the study include being less than 16 years of age, prior training in SafeTALK or ASIST, being an elected official in a First Nations community, and inability to read or write. Primary outcome: Skills in Suicide Intervention: Suicide Intervention Response Inventory.The Suicide Intervention Response Inventory (SIRI) will be used to detect enhancement of intervention skills in participants. The SIRI is a self-administered test that was designed to measure competence in choosing appropriate response to a series of clinical scenarios with suicidal individuals. Research on the SIRI has shown its good psychometric properties, freedom from social desirability effects, and responsiveness to training in suicide prevention. It contains 25 items, each of which consists of a "client" remark and two "helper" responses. Responses are judged based on response options made by highly expert suicidologists. The SIRI has shown good internal consistency with alpha of 0.834, and good test-retest reliability. Secondary Outcomes: Knowledge about suicide, attitudes toward suicide, and self-reported preparedness to intervene with suicidal behavior will be measured by a series of questions that were developed by LivingWorks Inc. Gatekeeper behaviors will be measured similar to questions utilized by Wyman in the school-based study that assess how many people had the person asked others about suicide.

Suicide Intervention, Applied Suicide Intervention Skills Training (ASIST), Resilience Retreat, First Nations, Suicide Intervention and Response Inventory (SIRI)

ASIST is a 2-day intensive, interactive and practice-dominated course aimed at enabling people to recognize risk and learn how to intervene immediately to prevent suicide. The training is designed for anyone (especially those in a position of trust), from professionals and volunteers to members of the community. Participants range from those in caring roles to people concerned about family members or friends. The theory is that suicide can be pre¬vented with the help of prepared caregivers. ASIST is designed to help all caregivers become more willing, ready and able to help persons at risk. Just as "CPR" skills make physical first aid possible, training in suicide intervention develops the skills used in suicide first aid.

The two days will be divided into cultural activities, sharing circles, small group discussions, story telling and dance. Two First Nations community leaders will be identified to lead each of the two retreats.

Applied Suicide Intervention Skills Training (ASIST) is a 2-day, 14 hour suicide intervention skills training workshop.

The Suicide Intervention Response Inventory (SIRI-2) will be used to detect enhancement of intervention skills in participants. The 25-item SIRI-2 is a self-administered test that was designed to measure competnce in choosing appropriate response to a series of clinical scenarios with suicidal individuals. Research on the SIRI-2 has shown its good psychometric properties, freedom from social desirabiity effects and responsiveness to training in suicide prevention.

Meaures the level of confidence that the individual believes they have in helping a suicidal person based on a 4 point Likert scale ranging from 1 (not at all confident) to 4 (very confident).

Measures the level of ability that the individual believes they have in helping a suicidal person based on a 4 point Likert scale ranging from 1 (not at all skilled) to 4 (very skilled).

Measures the level of knowledge about suicide that the individual believes they have based on a 4 point Likert scale ranging from 1 (not at all knowledgeable) to 4 (very knowledgeable).

Measures the level of preparedness of the individual to help someone who is suicidal based on a 4 point Likert scale ranging from 1 (not at all prepared) to 4 (very prepared).

Measures the level of distress in the participant using the K6 distress scale. The scale is comprised of six questions which are scored from 0 (none of the time) to 4 (all of the time). The sum of the scores from all six questions was used to determine a total scale score which ranges from 0 (not at all distressed) to 24 (very distressed).

Details participants' level of alcohol consumption and if it may be harmful according to the AUDIT. The AUDIT scale is comprised of ten questions with most questions being scored from 0 (never) to 4 (4 or more times per week). The sum of the scores from all ten questions was used to determine a total scale score which ranges from 0 (no risk related to alcohol) to 40 (high risk related to alcohol). Total scores of 8 or more are recommended as indicators of hazardous and harmful alcohol use, as well as possible alcohol dependence.

Assesses resiliency in the participant according to the Connor-Davidson Resilience Scale, 10-item. The CD-RISC 10 is comprised of ten questions scored from 0 (Not at all true) to 4 (True nearly all of the time). The sum of the scores from all ten questions was used to determine a total scale score which ranges from 0 (low resiliency) to 40 (highly resilient).

Number of people who endorsed having made a suicide attempt in their lifetime as measured at baseline

Number of people who endorsed having thought about suicide in the past 2 days as measured at baseline (not at all vs a little to a lot)

Number of people who endorsed having thought about suicide in the past 2 days as measured immediately post training (not at all vs a little to a lot)

Number of people who endorsed having thought about suicide since the training as measured at 6 month follow-up (not at all vs a little to a lot)

Number of people who endorsed having made a suicide attempt since the training as measured at 6 month follow-up

Number of participants who have asked someone that they thought was at risk about suicidal thoughts since the training, measured at 6 month follow-up assessment.

Number of participants who did not ask someone about their suicidal thoughts even though they thought they were at risk, measured at 6 month follow-up assessment based on time since training.

Inclusion Criteria: All members of the Swampy Cree Tribal communities who are currently residing on the reserves will be eligible to participate in the study. Exclusion Criteria: being less than 16 years of age prior training in SafeTALK or ASIST being an elected official in a First Nations community

Sareen J, Isaak C, Bolton SL, Enns MW, Elias B, Deane F, Munro G, Stein MB, Chateau D, Gould M, Katz LY. Gatekeeper training for suicide prevention in First Nations community members: a randomized controlled trial. Depress Anxiety. 2013 Oct;30(10):1021-9. doi: 10.1002/da.22141. Epub 2013 Jun 12.