title: 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.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: LUCAS, Centre for Care Research and Consultancy, University of Leuven, Leuven, Belgium.
authors.forename: Evelien
authors.initials: E
authors.lastname: Coppens
authors.affiliation: LUCAS, Centre for Care Research and Consultancy, University of Leuven, Leuven, Belgium. Electronic address: Chantal.Vanaudenhove@med.kuleuven.be.
authors.forename: Chantal
authors.initials: C
authors.lastname: Van Audenhove
authors.affiliation: Biostatistics and Statistical Bioinformatics Centre, University of Leuven, Leuven, Belgium; Department of Statistics, University of Ghana, Ghana.
authors.forename: Samuel
authors.initials: S
authors.lastname: Iddi
authors.affiliation: National Suicide Research Foundation & Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
authors.forename: Ella
authors.initials: E
authors.lastname: Arensman
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Gottlebe
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Koburger
authors.affiliation: National Suicide Research Foundation & Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
authors.forename: Claire
authors.initials: C
authors.lastname: Coffey
authors.affiliation: CEDOC, Departamento de Saúde Mental, Faculdade de Ciências Médicas da Universidade NOVA de Lisboa, Lisboa, Portugal; Serviço de Psiquiatria, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gusmão
authors.affiliation: CEDOC, Departamento de Saúde Mental, Faculdade de Ciências Médicas da Universidade NOVA de Lisboa, Lisboa, Portugal.
authors.forename: Sónia
authors.initials: S
authors.lastname: Quintão
authors.affiliation: CEDOC, Departamento de Saúde Mental, Faculdade de Ciências Médicas da Universidade NOVA de Lisboa, Lisboa, Portugal.
authors.forename: Susana
authors.initials: S
authors.lastname: Costa
authors.affiliation: Institute of Behavioral Sciences, Semmelweis University Budapest, Budapest, Hungary.
authors.forename: András
authors.initials: A
authors.lastname: Székely
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hegerl
mesh_terms: D000328:Adult; D003156:Community Mental Health Services; D003866:Depressive Disorder / Q000523:psychology*; D005060:Europe; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D013405:Suicide / Q000523:psychology*; D000078329:Workforce
keywords: Depression; Gatekeeper training; Prevention; Suicide