Efficacy of Question, Persuade, and Refer Gatekeeper Training and Emotional First Aid in the Indian Population

Background: India reported 1,70,924 suicide deaths in 2022, with suicide ranking as the second leading cause of death among individuals aged 15–29 years. Despite national recommendations for gatekeeper training (GKT), limited evidence exists on the impact of combining Question, Persuade, and Refer (QPR) with emotional first aid (EFA) in the Indian context, where stigma and a large treatment gap persist. Aim: The aim of this study was to evaluate the efficacy of combined QPR gatekeeper and EFA training on participants’ suicide-related knowledge, attitudes, and self-reported likelihood to intervene. Settings and Design: A pre–post intervention study was conducted through a 3-h live webinar with 200 participants recruited through opportunity sampling. Methods: The first step involved completing a 16-item questionnaire assessing knowledge (6 items), attitudes (6 items), and likelihood to intervene (4 items), rated on a 5-point Likert scale. Participants then attended a 3-h webinar featuring QPR training with embedded EFA content, interactive discussion, and role-play exercises. Finally, they completed the 1-h self-paced QPR module and the same 16-item questionnaire within 5 days of the session. Additional resources were also shared. Statistical Analysis: Paired samples t -tests compared pre- and posttraining scores on knowledge, attitudes, and likelihood to intervene. Results: Posttraining scores improved significantly on all measures: knowledge (t[199= −25.150, P < 0.001), attitudes (t[199] = −16.565, P < 0.001), and likelihood to intervene (t[199] = −20.305, P < 0.001). These findings indicated that combined QPR + EFA training effectively increases suicide-related knowledge, reduces stigmatizing attitudes, and strengthens intent to help. Conclusion: Further studies on gatekeeper training in larger samples are needed to validate the findings of our study.