Suicide prevention training in older men: a cluster randomised controlled trial of the Conversations about Suicide course in Australian Men’s Sheds

Older men (aged ≥65 years) have high suicide rates relative to other ages and there are major gaps in understanding how to improve suicide prevention knowledge and skills as a potential pathway to reduce suicide risk in this group. This study aimed to evaluate the effectiveness of a suicide prevention training course in a community sample of older men. We conducted a cluster randomised controlled trial evaluating the Mental Health First Aid Conversations about Suicide course, which teaches community members to recognise when someone is experiencing suicidal thoughts and how to provide appropriate support. Australian Men's Sheds(ie, community organisations that provide communal spaces for men to meet, socialise, learn new skills, and work on meaningful projects with other men) in the state of Victoria (from study onset) and additionally in New South Wales, Queensland, and Western Australia (from Oct 31 2022) were randomised (1:1) in clusters (single sheds or groups of sheds, if fewer than eight men per shed)with minimisation to the course or a waitlist control and all shed members who were men were eligible to participate. The primary outcome was participant intended actions (recommended or not recommended) towards a suicidal person, measured at baseline, 1-month follow-up and 7-month follow-up (primary timepoint), analysed by intention to treat. This trial is registered with ANZCTR, ACTRN12621000756820. Between July 14, 2021 and Sept 27, 2023, ten clusters were allocated to the intervention and ten to the control, with 19 clusters analysed as one intervention cluster withdrew before baseline. Following exclusion of participants who did not provide data or withdrew consent, 261 participants were included: 92 in the intervention group and 169 in the control group. The mean age of participants was 71·6 years (SD 8·8). For the primary outcome of intended actions to support a suicidal person, the intervention group showed a larger improvement than the control group on recommended actions at 1-month follow-up (mean difference 4·42, 95% CI 3·19 to 5·64, p<0·0001) and 7-month follow-up (3·31, 2·06-4·57, p<0·0001). For non-recommended actions, the intervention group showed small, non-significant reductions at both timepoints relative to the control group (1-month follow-up: -0·48, -1·20 to 0·24, p<0·19; 7-month follow-up: -0·58, -1·32 to 0·16, p<0·12). Delivering the Conversations about Suicide course in Men's Sheds could improve the suicide prevention skills of older men in the community. Australian Medical Research Future Fund.