Skip to main content

Peer Leaders as Gatekeepers and Agents of Change: Understanding How Sources of Strength Reduces Suicide Risk and Promotes Wellness

Abstract

Background

Gatekeeper training (GKT) is a common strategy in suicide prevention that educates informal helpers (e.g., friends) about warning signs and risk factors for suicide as well as strategies to support distressed peers. Sources of Strength (Sources) is an effective intervention model that combines GKT with school-wide prevention activities and relies on trained gatekeepers—peer leaders—to diffuse intervention elements into their social networks to reduce peer distress and promote wellness.

Objective

The present study identified internal characteristics of peer leaders that make them successful gatekeepers for Sources and explored how Sources skills are successfully transmitted into peer leader networks.

Method

Using qualitative interview data from two cohorts of peer leaders, we investigated diffusion and intervention efforts during high school and in post-high school environments.

Results

Results support the use of the Theory of Planned Behavior (TPB) in understanding behavioral precursors that encourage effective gatekeeping (GK) behavior. Findings also suggest that Sources diffusion was robust in high school but declined post-high school. However, there were important inherent characteristics that appeared to spur greater uptake of Sources’ GKT, including optimism, empathy, kindness, and extraversion.

Conclusions

TPB offers well-defined constructs that can be targeted to promote GK behavior in the context of Sources or similar suicide prevention programming. Specific internal traits may reinforce gatekeepers’ behavioral intentions, which then may support greater engagement in GK behavior. However, declines in GK behavior may occur over time, which suggests post-high school booster activities may be important to offset such declines.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

Availability of Data and Material

Due to confidentiality and approved IRB procedures, qualitative data cannot be made available. The first and second authors take responsibility for the integrity of the data and the accuracy of the data analysis.

Code Availability

Codebooks will be made available upon request.

References

  • Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.

    Article  Google Scholar 

  • Ajzen, I., & Fishbein, M. (2005). The Influence of Attitudes on Behavior. In D. Albarracín, B. T. Johnson, & M. P. Zanna (Eds.) The Handbook of Attitudes (pp. 173–221). Lawrence Erlbaum Associates Publishers.

  • Aldrich, R. S. (2015). Using the theory of planned behavior to predict college students’ intention to intervene with a suicidal individual. Crisis, 36, 332–337. https://doi.org/10.1027/0227-5910/a000330

    Article  PubMed  Google Scholar 

  • Aldrich, R. S., & Cerel, J. (2009). The development of effective message content for suicide intervention: Theory of planned behavior. Crisis, 30(4), 174–179.

    Article  Google Scholar 

  • Aseltine, R. H., & DeMartino, R. (2004). An outcome evaluation of the SOS suicide prevention program. American Journal of Public Health, 94(3), 446–451. https://doi.org/10.2105/AJPH.94.3.446

    Article  PubMed  PubMed Central  Google Scholar 

  • Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191

    Article  PubMed  Google Scholar 

  • Boeije, H. A. (2002). Purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality & Quantity, 36, 391–409. https://doi.org/10.1023/A:1020909529486

  • Bohon, L., Cotter, K., Kravitz, R., Cello, P., Fernandez, Y., & Garcia, E. (2016). The theory of planned behavior as it predicts potential intention to seek mental health services for depression among college students. Journal ofAmerican College Health, 64(8), 593–603.

    Article  Google Scholar 

  • Centers for Disease Control (2020). Web-based Injury Statistics Query and Reporting System (WISQARS). Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Injury Prevention and Control. https://www.cdc.gov/injury/wisqars/index.html

  • Chen, L.-Y.A., Chai-Yi, W., Lee, M.-B., & Yang, L.-T. (2020). Suicide and associated psychosocial correlates among university students in Taiwan: A mixed-methods study. Journal of Formosan Medical Association, 119(5), 957–967. https://doi.org/10.1016/j.jfma.2020.01.012

    Article  Google Scholar 

  • Clark, T. R., Matthieu, M. M., Ross, A., & Knox, K. L. (2010). Training outcomes from the Samaritans of New York suicide awareness and prevention programme among community-and school-based staff. The British Journal of Social Work, 40(7), 2223–2238. https://doi.org/10.1093/bjsw/bcq016

    Article  PubMed  Google Scholar 

  • Cox, M. M. (2021). Framing messages for suicide gatekeepers through the theory of planned behavior. Southwestern Mass Communication Journal. https://journals.tdl.org/swecjmc/index.php/swecjmc/article/view/90

  • Cross, W. F., Seaburn, D., Gibbs, D., Schmeelk-Cone, K., White, A. M., & Caine, E. D. (2011). Does practice make perfect? A randomized control trial of behavioral rehearsal on suicide prevention gatekeeper skills. The Journal of Primary Prevention, 32(3–4), 195. https://doi.org/10.1007/s10935-011-0250-z

    Article  PubMed  PubMed Central  Google Scholar 

  • Cusimano, M. D., & Sameem, M. (2011). The effectiveness of middle and high school-based suicide prevention programmes for adolescents: A systematic review. Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention, 17(1), 43–49. https://doi.org/10.1136/ip.2009.025502

    Article  Google Scholar 

  • Fulginiti, A., & Hsu, H. T. (2021). Gatekeeping beliefs, intent, and behavior among homeless youth. Death Studies. https://doi.org/10.1080/07481187.2021.1922543

  • Hall-Lande, J. A., Eisenberg, M. E., Christenson, S. L., & Neumark-Sztainer, D. (2007). Social isolation, psychological health, and protective factors in adolescence. Adolescence, 42(166), 265–286.

    PubMed  Google Scholar 

  • Holmes, G., Clacy, A., Hermens, D., & Lagopoulos, J. (2019). The long-term efficacy of suicide prevention gatekeeper training: A systematic review. Archives of Suicide Research. https://doi.org/10.1080/13811118.2019.1690608

    Article  PubMed  Google Scholar 

  • Holmes, G., Clacy, A., Hermens, D. F., & Lagopoulos, J. (2020). The long-term efficacy of suicide prevention gatekeeper training: A systematic review. Archives of suicide research, 1–31.

  • Hom, M. A., Stanley, I. H., & Joiner, T. E., Jr. (2015). Evaluating factors and interventions that influence help-seeking and mental health service utilization among suicidal individuals: A review of the literature. Clinical Psychology Review, 40, 28–39.

    Article  PubMed  Google Scholar 

  • Johnson, L. A., & Parsons, M. E. (2012). Adolescent suicide prevention in a school setting use of a gatekeeper program. NASN School Nurse, 27, 312–317.

    Article  PubMed  Google Scholar 

  • King, C. A., Arango, A., & Foster, C. E. (2018). Emerging trends in adolescent suicide prevention research. Current Opinion in Psychology, 22, 89–94. https://doi.org/10.1016/j.copsyc.2017.08.037

    Article  PubMed  Google Scholar 

  • Kuhlman, S. T., Walch, S. E., Bauer, K. N., & Glenn, A. D. (2017). Intention to enact and enactment of gatekeeper behaviors for suicide prevention: An application of the theory of planned behavior. Prevention Science, 18(6), 704–715.

    Article  PubMed  Google Scholar 

  • Kuhlman, S. T. W., Smith, P. N., Marie, L., Fadoir, N. A., & Hudson, K. (2020). A pilot randomized controlled trial of the alliance project gatekeeper training for suicide prevention. Archives of Suicide Research. https://doi.org/10.1080/13811118.2020.1767246

    Article  PubMed  Google Scholar 

  • Lapinski, M. K., & Rimal, R. N. (2005). An explication of social norms. Communication Theory, 15(2), 127–147. https://doi.org/10.1111/j.1468-2885.2005.tb00329.x

    Article  Google Scholar 

  • Lee, R. M., Dean, B. L., & Jung, K. (2008). Social connectedness, extraversion, and subjective wellbeing: testing a mediation model. Personality and Individual Differences, 45(5), 414–419.

    Article  Google Scholar 

  • Lei, N., & Pellitteri, J. (2017). Help-seeking and coping behaviors among Asian Americans: The roles of Asian values, emotional intelligence, and optimism. Asian American Journal of Psychology, 8(3), 224–234. https://doi.org/10.1037/aap0000086

    Article  Google Scholar 

  • Meisel, M. K., & Barnett, N. P. (2017). Protective and risky social network factors for drinking during the transition from high school to college. Journal of Studies on Alcohol and Drugs, 78(6), 922–929.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mo, P. K., Ko, T. T., & Xin, M. Q. (2018). School-based gatekeeper training programmes in enhancing gatekeepers’ cognitions and behaviours for adolescent suicide prevention: A systematic review. Child and Adolescent Psychiatry and Mental Health, 12(1), 29. https://doi.org/10.1186/s13034-018-0233-4

    Article  PubMed  PubMed Central  Google Scholar 

  • Padgett, D. K. (2008). Qualitative Methods in Social Work Research (2nd ed.). Sage.

    Google Scholar 

  • Petrova, M., Wyman, P. A., Schmeelk-Cone, K., & Pisani, A. R. (2015). Positive-themed suicide prevention messages delivered by adolescent peer leaders: Proximal impact on classmates’ coping attitudes and perceptions of adult support. Suicide and Life-Threatening Behavior, 45(6), 651–663.

    Article  PubMed  Google Scholar 

  • Pickering, T. A., Wyman, P. A., Schmeelk-Cone, K., Hartley, C., Valente, T. W., Pisani, A. R., & LoMurray, M. (2018). Diffusion of a peer-led suicide preventive intervention through school-based student peer and adult networks. Frontiers in Psychiatry. https://doi.org/10.3389/fpsyt.2018.00598

    Article  PubMed  PubMed Central  Google Scholar 

  • Rogers, E. M. (2003). Diffusion of innovations (5th ed.). Free Press.

    Google Scholar 

  • Rubin, A., & Bellamy, J. (2012). Practitioner’s guide to using research for evidence-based practice. John Wiley & Sons.

    Google Scholar 

  • Saldana, J. (2016). The Coding Manual for Qualitative Researchers (3rd ed.). Thousand Oaks, CA: Sage Publishing.

    Google Scholar 

  • Smillie, L. D. (2013). Extraversion and reward processing. Current Directions in Psychological Science, 22(3), 167–172. https://doi.org/10.1177/0963721412470133

    Article  Google Scholar 

  • Spencer, R., Pryce, J., Barry, J., Walsh, J., & Basualdo-Delmonico, A. (2020). Deconstructing empathy: A qualitative examination of mentor perspective-taking and adaptability in youth mentoring relationships. Children & Youth Services Review. https://doi.org/10.1016/j.childyouth.2020.105043

    Article  Google Scholar 

  • Sun, J., Harris, K., & Vazire, S. (2019). Is well-being associated with the quantity and quality ofsocial interactions?. Journal of Personality and Social Psychology. Advance online publication. https://doi.org/10.1037/pspp0000272

  • Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357.

    Article  PubMed  Google Scholar 

  • Totura, C. M. W., Labouliere, C. D., Gryglewicz, K., & Karver, M. S. (2019). Adolescent decision-making: The value of perceived behavioral control in predicting engagement in suicide prevention behaviors. Journal of Youth and Adolescence, 48, 1784–1795. https://doi.org/10.1007/s10964-019-01066-3

    Article  PubMed  PubMed Central  Google Scholar 

  • Wolfe, K. L., Foxwell, A., & Kennard, B. (2014). Identifying and treating risk factors for suicidal behaviors in youth. International Journal of Behavioral Consultation and Therapy, 9(3), 11–14. https://doi.org/10.1037/h0101634

    Article  Google Scholar 

  • Wrzus, C., Hänel, M., Wagner, J., & Neyer, F. J. (2013). Social network changes and life events across the life span: A meta-analysis. Psychological Bulletin, 139(1), 53.

    Article  PubMed  Google Scholar 

  • Wyman, P. A., Brown, C. H., Inman, J., Cross, W., Schmeelk-Cone, K., Guo, J., & Pena, J. B. (2008). Randomized trial of a gatekeeper program for suicide prevention: One-year impact on secondary school staff. Journal of Counseling and Clinical Psychology, 76, 104–115.

    Article  Google Scholar 

  • Wyman, P. A., Brown, C. H., LoMurray, M., Schmeelk-Cone, K., Petrova, M., Yu, Q., Walsh, E., Tu, X., & Wang, W. (2010). An outcome evaluation of the sources of strength suicide prevention program delivered by adolescent peer leaders in high schools. American Journal of Public Health, 100, 1653–1661.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wyman, P. A., Pickering, T. A., Pisani, A. R., Rulison, K., Schmeelk-Cone, K., Hartley, C., Gould, M., Caine, E. D., LoMurray, M., Brown, C. H., & Valente, T. W. (2019). Peer-adult network structure and suicide attempts in 38 high schools: Implications for network-informed suicide prevention. Journal of Child Psychology and Psychiatry, 60, 1065–1075. https://doi.org/10.1111/jcpp.13102

    Article  PubMed  Google Scholar 

Download references

Funding

The present study was supported by two awards from the Spencer Foundation (#201800127 and # 5341588) to the PI of this study (first author).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anne Williford.

Ethics declarations

Conflicts of interest

There are no conflicts of interest to report.

Consent to Participate

All participants under the age of 18 years obtained active parental consent to participate and provided assent at the beginning of the interview. All participants over the age of 18 years provided verbal consent at the beginning of the phone interviews.

Ethics Approval

All study procedures were approved by the Institutional Review Board at the sponsoring university.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Williford, A., Yoder, J., Fulginiti, A. et al. Peer Leaders as Gatekeepers and Agents of Change: Understanding How Sources of Strength Reduces Suicide Risk and Promotes Wellness. Child Youth Care Forum 51, 539–560 (2022). https://doi.org/10.1007/s10566-021-09639-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10566-021-09639-9

Keywords

  • Suicide prevention
  • Gatekeeper training
  • Adolescence
  • Emerging adulthood
  • Theory of planned behavior