Sample
In India, 30 panel members were involved in Round 1 (i.e. 68% of the experts who were invited to participate), 25 in Round 2 and 23 in Round 3. All panel members were currently working in India. The majority were psychiatrists (63%) and psychologists (27%). Two participants were social workers and one was an occupational therapist. The panel comprised of 17 males and 13 females. The majority (57%) of the participants were in the age range 40-49 years, 3 were aged 18-29 years, 6 aged 30-39 years, and 4 aged 50-59 years.
Some information was also collected on the clinical experience of the panel members. On average participants reported that they had practiced in mental health/psychiatry for 15 years (the shortest time was 2 years and the longest 30 years). Less of a quarter of the participants (23%) received some formal education related to their profession overseas (mainly in UK and one in Australia). Slightly over a third of the participants (37%) reported having received a formal training specifically on suicide prevention/intervention. However, when asked to state how well prepared they felt to assist a suicidal person, 3.3% answered "Not at all", 23% "somewhat prepared", 47% "mostly prepared" and 27% "very prepared". Although participants generally felt prepared to assist a suicidal person, in their opinion most people in India are not at all prepared (53%) or somewhat prepared (43%). Only one person believed others are mostly prepared to assist.
Items endorsement
After three Delphi rounds, there were 71 items that were rated as "essential" or "important" by 80% or more of the panel members.
At Round 2, 30 new items suggested by participants were added to the questionnaire. The followings are examples of such items:
An important warning sign for suicide is if a person is saying they wish or intend to see or speak to someone who is dead (e.g., a deceased family member).
An important warning sign for suicide is if a person is expressing in words or actions a sense of shame (e.g. from failure or loss).
The first aider should not offer false hope, or make unrealistic promises.
The first aider should not dismiss the person's feelings or compare their problems to the problems of others.
When talking to the suicidal person, the first aider should use the person's belief systems and values to encourage them to change their mind about suicide.
The first aider should contact the elders in the person's community.
A number of responses to the Round 1 open-ended questions did not meet criteria for creation of a new item (e.g. they did not fit the definition of first aid or did not suggest a clear action) or were comments/suggestions. The following are examples of the comments and suggestions that did not generate new items:
" The idea of suicide first aid does not exist in our country. It should be strongly encouraged at all levels, especially in schools as the prevalence of suicide among school kids is alarming (...)".
" I think that there should be more awareness about "suicide" in our country so that people are sensitized about the "warning signs" of this person even before he can attempt suicide. In my culture, since the family is such an important support system, they must be informed right from the start".
" Psychiatrists, psychologists and other mental health professionals should receive training in how to handle suicidal individuals, victims of attempted suicide, and survivors of suicide".
"In our society individual freedom and opinion is not as important as collective opinion. Hence it is not difficult to dissuade suicide by involving other individuals in the family and society. However, the motivation of "others" is not always high".
"In eastern culture, people are less likely to take the issue seriously when one discloses one's intention to commit suicide".
See the Additional file
1 for a complete list of rated statements, including the percentage of panel members endorsing each item.
At the end of the survey, participants were asked their opinions about the likely effectiveness of suicide first aid, using a 5-point Likert scale (from "definitely yes" to "definitely no"). All of them believed that if the first aider does the right thing the risk of suicide can be reduced. Substantial proportions of the respondents thought that if the first aider does the wrong thing the risk of suicide can definitely (27%) or probably (45%) be increased (21% answered "Don't know/depends" and 14% "Probably no").
The longer-term goal of the project is to use the guidelines to develop, implement and evaluate a training program on suicide first aid in India. When asked if they thought members of the public should receive such training, 69% of panel members responded "definitely yes" and 27% "probably yes". Only one respondent answered "don't know/depends".