{"paper_id":"06be8bcd-f673-4c0b-94b4-c7c3ca181f1e","body_text":"Effectiveness of Simulation-Based Suicide Risk Assessment Training Among Undergraduate Medical Students in India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effectiveness of Simulation-Based Suicide Risk Assessment Training Among Undergraduate Medical Students in India Suvarna Jyothi Kantipudi, Jazeela Begam J.Hussain, Padmavathi R, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6186713/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Suicide is a major public health challenge,, particularly in low- and middle-income countries like India,where mental health training for primary care providers is limited. Simulation based training, though widely used across medical specialties, is underutilized in psychiatry. This study evaluates the effectiveness of integrating simulation videos for suicide risk assessment into the undergraduate medical student competency based curriculum in India. Methods This is a quasi-experimental study with a crossover design involving 60 Phase 2 MBBS students from Sri Ramachandra Medical College, Chennai. A self-report questionnaire assessing knowledge, attitudes, and confidence regarding suicide risk assessment was administered before and after the training sessions. All the participants received didactic lectures and simulated based sessions in varying sequence. Results At baseline, there were no significant differences between the groups. Both groups showed significant improvement, with greater confidence gains in students exposed to simulation first..Simulation based training using recorded videos demonstrated pedagogical utility in low resource educational settings. Conclusion Integrating simulation videos into the undergraduate medical curriculum is both feasible and potentially effective way in enhancing students' competency in suicide risk assessment. This approach provides a practical, low-resource solution for improving training in suicide prevention, particularly in settings with limited access to specialized mental health education. Future work should evaluate long term retention of knowledge, behavioural and patient outcomes in real world clinical settings. Suicide risk assessment Medical education Simulation-based training Crossover study design Mental health training Figures Figure 1 Figure 2 INTRODUCTION Suicide is a preventable public health issue and remains one of the leading causes of death globally[ 1 ] , [ 2 ]. Approximately 800,000 individuals die by suicide each year, with India contributing nearly 18% of these deaths [ 3 , 4 ]. Identifying and timely managing risk factors is essential for preventing suicide. Among the most critical indicators of imminent risk are suicidal ideation and the formulation of a concrete suicide plan. Other contributing factors include underlying psychiatric illnesses, substance use disorders, a family history of suicide, certain personality traits, and previous suicide attempts. Additionally, traits such as impulsivity, hopelessness, self-harm behaviors, and feelings of being a burden to others further increase the risk of suicide[ 5 ]. Previous studies report that nearly 45% of individuals who die by suicide visit a primary healthcare provider within the month preceding their death[ 6 ]. This highlights a critical opportunity for the early detection of risk factors across health care settings. Although traditionally mental health professions have led the suicide prevention efforts, primary health care providers and clinicians across various specialties have a key role in suicide prevention [ 7 ]. However, owing to a lack of adequate training during medical education, and limited access to ongoing professional development in suicide assessment and intervention, many health care professionals face challenges in identifying and addressing these risk factors effectively. For example, depression, a widely prevalent common mental disorder and a significant risk factor for suicide, often remains undetected in primary care settings, particularly in low- and middle-income countries[ 8 ]. In India, where there is a significant shortage of psychiatrists, training primary care physicians to recognize and manage depression is extremely crucial for suicide prevention[ 9 ]. To bridge this gap, brief screening tools such as the Primary Care Screening Questionnaire for Depression (PSQ4D) have been developed in the Indian population. The PSQ4D, a four-item tool, has high sensitivity (0.96) and specificity (0.87), making it a valuable assessment tool in primary care [ 10 ]. Other validated tools, including the PHQ-9, WHO-5 Wellbeing Index, and GHQ-12, offer effective options for identifying depression in primary care settings[ 11 ]. Although these screening tools for depression enable primary care physicians to identify individuals at risk of clinical depression, their effectiveness in preventing suicide ultimately depends on healthcare professionals’ ability to conduct suicide risk assessments. However, many healthcare professionals, including nurses and physicians, lack formal training in suicide prevention despite having experience managing suicidal patients[ 12 ]. For example, a study in urban India reported that fewer than half of surveyed physicians felt competent in treating suicidal patients[ 13 ]. Many primary care physicians feel unprepared or even hesitant to conduct comprehensive suicide risk assessments or to refer individuals at risk to mental health professionals [ 3 , 14 , 15 ]. Considering these lacunae, integrating suicide risk assessment training into medical undergraduate education is crucial. The development of competency in this area during undergraduate medical training can equip future health care professionals with the necessary skills to increase patient safety and strengthen suicide prevention across diverse healthcare settings. The effectiveness of such training depends on how well it is integrated into the broader medical curriculum. Historically, Indian medical education has adopted a compartmentalized approach that separates biological, psychological, and social factors rather than integrating them. Although there have been frequent attempts at innovative reforms to improve training, these initiatives often remain theoretical, with limited practical implementation in most educational settings. Traditional methods, which rely predominantly on didactic lectures, prioritize content delivery over shaping attitudes or developing skills. Conversely, essential competencies such as approaching patients with empathy, dignity and respect are not effectively acquired until they have an opportunity to observe or practice these skills in clinical settings [ 16 , 17 ]. However, the recent adoption of a competency-based approach by the National Medical Commission is a significant step toward a more integrated model in the Indian education system[ 16 ]. Suicide risk assessment is now a mandatory competency for MBBS students under this new curriculum. According to the Suicide Prevention Resource Centre (SPRC), this competency of suicide risk assessment includes an approach to risk assessment, the formulation of risk, history collection, management planning, and the legal aspects of suicide evaluation[ 18 ]. Training students in supervised settings can help them learn the necessary skills for suicide risk assessment and enhance their confidence in providing essential care. Suicide risk assessment involves not only identifying suicidal ideation but also establishing rapport, demonstrating empathy, and maintaining confidentiality to create a comfortable and safe environment for the patient. However, training with real-life patients with active suicidal ideation can present significant risks, both for the patient and the student, and can be potentially anxiety-provoking. The ethical dilemma of placing a highly distressed patient through multiple interviews poses another challenge. While observing specialists’ interviews may be helpful, young undergraduate trainees best learn interviewing skills and risk assessment through practice. The lack of psychological safety mandates the need for a more practical approach to simulate clinical experiences in a controlled, risk-free environment [ 3 , 7 ]. As Eppich and Reedy pointed, simulation training has been extensively embraced across many medical and surgical disciplines, but its application in mental health and social work is at a very nascent stage, especially in low- and middle-income countries (LMICs)[ 19 ]. Given the value of diagnostic and communication skills in psychiatric consultations, this underutilization is remarkable. With India's recent move to competency-based medical education, this a timely opportunity to include simulation into undergraduate psychiatry training.Simulation, as a pedagogical approach, allows students to engage with depictions of real-life scenarios and offers opportunities for practice and skill enhancement[ 3 ]This experiential learning helps students understand the suicide risk evaluation process and attain the necessary skills to handle sensitive and complex situations[ 20 ]. However, resource limitations such as obtaining high-fidelity simulation equipment or employing standardized actors for practice make recorded simulation roleplay videos a practical alternative. These videos, featuring experienced clinicians with professional acting skills enacting realistic patient scenarios, provide a consistent, cost-effective, and accessible training method for training in psychiatry. They allow medical students to observe and analyze critical aspects of suicide risk assessment, including verbal and nonverbal communication, empathetic responses, and risk stratification techniques. This study addresses this educational gap by evaluating the effectiveness of integrating simulation videos of suicide risk assessment into the undergraduate medical students curriculum in India.Specifically,it examines whether the simulation based training improves the knowledge, attitudes and confidence of medical students with regard to suicide risk assessment.Conisdering the underutilization of simulation based training in psychiatry in LMIC, this study aims to demonstrate the feasibility and utility of a practical and easy accessible simulation training. METHODS Study design This is a quasi-experimental study that employs a crossover design with a pre–post approach to evaluate the effectiveness of integrating simulation videos of suicide risk assessment into the medical student training curriculum of undergraduate medical students. The quasi-experimental design was chosen because it facilitates the assessment of interventions in real-world educational settings where random assignment or blinding may not be feasible. Study setting and participants The study was approved by the Institutional Ethics Committee, Sri Ramachandra Institute of Higher Education and Research (CSP-MED/24/JAN/97/10) and conducted at Department of Psychiatry, Sri Ramachandra Medical College, a tertiary care teaching hospital in Chennai,Tamilnadu,India. MBBS students in Phase II (i.e., second- and third-year MBBS), who voluntarily agreed to participate and provide informed consent, were included in the study. As part of their regular clinical posting schedule, the students attended psychiatry clinical rotations in small groups. Those who had previously undergone training in suicide risk assessment were excluded. Sample size The study recruited 60 MBBS students in Phase II (years 2 and 3). Convenience sampling was used, considering logistical feasibility, the availability of students during their psychiatry clinical rotations, and the need for small groups to ensure debriefing after simulation sessions. Previous studies employing similar designs in educational settings have used comparable sample sizes[ 21 ]. Study tools & procedure Eligible participants were approached, and the study purpose, procedures and potential benefits were explained. Informed consent was obtained from all participants, who were assured of confidentiality and their right to withdraw from the study at any point without any consequences. A self-report questionnaire was developed to assess the students' existing knowledge and confidence in suicide risk assessment. The questionnaire was adapted from the \"Suicide Knowledge and Skills Questionnaire\" (SKSQ), which contains 16 items evaluating knowledge, attitudes, and confidence in suicide evaluation [ 22 ][ 23 ]. A previous study conducted in India also adapted this scale, demonstrating its relevance and applicability in the Indian context for assessing suicide-related competencies[ 12 ]. This study recruited two batches of MBBS students in their Phase II MBBS (years 2 & 3), with each batch divided into Group A and Group B. The division of groups was based on preexisting batch divisions for small group teaching. Group A received a traditional didactic lecture followed by simulation video demonstrations with a debriefing session. Group B received simulation video demonstrations with a debriefing session, followed by traditional didactic lectures. The simulation-based intervention was designed to improve experiential learning through observation, collaborative reflection and peer discussion, without compromising psychological safety. The simulation recorded roleplay video used for demonstration was developed based on a validated script, focusing on the assessment and evaluation of suicidal ideation in a depressive patient (Jazeela et al., Manuscript in preparation). This scenario depicts identifying and responding to suicidal risk in patients with diagnosed depression, particularly demonstrating how to sensitively suicide risk assessment. Participants were introduced to the simulation videos through a structured 5-minute briefing session. The session outlined the method, content, and duration of the videos, emphasizing key learning objectives and expectations. Students were familiarized with the classroom setup, which included a high-definition projector and audio-visual equipment. The orientation covered the logistics of the training space and the expected interaction with the simulation materials. The simulation videos were professionally produced using high-definition recording equipment and featured trained actors depicting real-world clinical scenarios.The simulation video portrays a detailed clinician‒patient interaction, highlighting key communication strategies, risk assessment techniques, and empathetic responses, which are critical for fostering a therapeutic alliance and ensuring a comprehensive evaluation of suicidal ideation. The simulation-based training was conducted in a designated medical classroom within the university, ensuring a controlled learning environment. The training utilized a high-definition projector, speakers, and video playback software to facilitate an immersive learning experience. Background noise was minimized to maintain focus and engagement during the training. The simulation was conducted in groups, allowing students to discuss and reflect on their observations. The training incorporated discussion-based debriefings following video session. The facilitators were experienced mental health educators with prior training in suicide prevention strategies. The assessments were done at three points: baseline, after the first training session, and after the second training session. Each session, i.e., either a didactic lecture or simulation video with a debriefing session, lasted 45 minutes. There was a 30-minute gap before the second session was delivered. The groups then crossed over for the second session, with Group A receiving simulation video training followed by a traditional didactic lecture, and Group B receiving the opposite sequence. Both groups were reassessed via the same questionnaire to evaluate any changes in knowledge, attitudes, or confidence in suicide risk assessment after the sessions. (Fig. 1 ) Statistical analysis The statistical analysis for this study aimed to evaluate the effectiveness of the two training methods (traditional didactic teaching versus simulation video-based training) in improving medical students' knowledge, skills, and confidence in recognizing and managing suicide risk. Since the responses were ordinal, chi-square tests were conducted via SPSS Version 27 [ 24 ]to compare the distribution of responses between Group A and Group B at baseline (pretest), and any significant differences in their initial knowledge and understanding of suicide risk assessment were assessed. The level of significance was set at 5%. To visualize changes in responses across the three time points (pretest, posttest 1, and posttest 2), stacked bar charts were created via R version 4.3.3[ 25 ]. RESULTS A total of 60 medical students from the second and third years of study participated in the study. At baseline, their knowledge and attitudes regarding suicide risk assessment were evaluated via a self-report questionnaire. Baseline comparison At baseline, the responses to all the questions indicated comparable knowledge and attitudes between the groups (Table 1 ). No statistically significant differences were observed for any of the questions (p > 0.05), ensuring that both groups had similar levels of knowledge and attitudes prior to the interventions. Table 1 BASELINE DISTRIBUTION OF THE RESPONSES Questions Responses Group Total N (%) Chi-square value p value Group A N (%) Group B N (%) Q1 Few individuals intend to self harm True 29(96.7) 30(100.0) 59(98.3) 1.01 0.31 False 1(3.3) 0(0.0) 1(1.7) Q2 Younger population have higher risk of suicide True 30(100.0) 30(100.0) 60(100.0) - - False 0(0.0) 0(0.0) 0(0.0) Q3 Suicide is more common in mental illness True 21(70.0) 26(86.7) 47(78.3) 2.45 0.12 False 9(30.0) 4(13.3) 13(21.7) Q4 Difficult to prevent suicide True 15(50.0) 17(56.7) 32(53.3) 0.26 0.60 False 15(50.0) 13(43.3) 28(53.3) Q5 Discussing suicide encourages it True 12(40.0) 10(33.3) 22(36.7) 0.28 0.59 False 18(60.0) 20(66.7) 38(63.3) Q6 Depression indicates suicide risk True 27(90.0) 24(80.0) 51(85.0) 1.18 0.28 False 3(10.0) 6(20.0) 9(15.0) Q7 Suicide is always unpredictable True 20(66.7) 18(60.0) 38(63.3) 0.29 0.59 False 10(33.3) 12(40.0) 22(36.7) Q8 All suicidal thoughts reflect a desire to die True 18(60.0) 19(63.3) 37(61.7) 0.07 0.79 False 12(40.0) 11(36.7) 23(38.3) Q9 Suicidal threats may be to manipulate others True 21(70.0) 26(86.7) 47(78.3) 2.45 0.12 False 9(30.0) 4(13.3) 13(21.7) Q10 Received training to engage and assist those at risk Agree 3(10.0) 1(3.3) 4(6.7) 1.37 0.50 Disagree 15(50.0) 15(50.0) 27(45.0) Neither 12(40.0) 15(50.0) 27(45.0) Q11 Skills to engage those with suicidal desire Agree 3(10.0) 2(6.7) 5(8.3) 3.36 0.19 Disagree 9(30.0) 16(53.3) 25(41.7) Neither 18(60.0) 12(40.0) 30(50.0) Q12 Comfortable in asking direct and open ended questions Agree 17(56.7) 14(46.7) 31(51.7) 2.34 0.31 Disagree 2(6.7) 6(20.0) 8(13.3) Neither 11(36.7) 10(33.3) 21(35.0) Q13 Have the support to assist those with suicide intent Agree 5(16.7) 6(20.0) 11(18.3) 3.54 0.17 Disagree 8(26.7) 14(46.7) 22(36.7) Neither 17(56.7) 10(33.3) 27(45.0) Q14 Confidence in assessing risk Agree 5(16.7) 8(26.7) 13(21.7) 2.45 0.29 Disagree 8(26.7) 11(36.7) 19(31.7) Neither 17(56.7) 11(36.7) 28(46.7) Q15 Confidence in identifying referral sources for those at risk Agree 10(33.3) 13(43.3) 23(38.3) 1.21 0.55 Disagree 7(23.3) 4(13.3) 11(18.3) Neither 13(43.3) 13(43.3) 26(43.3) Q16 Confidence in screening risk. Agree 9(30.0) 7(23.3) 16(26.7) 2.86 0.24 Disagree 6(20.0) 12(40.0) 18(30.0) Neither 15(50.0) 11(36.7) 26(43.3) After the first session After the first intervention session, Group A, which initially attended the didactic lecture, showed greater improvements in attitude-related questions than did Group B, which underwent the simulation video and debriefing session, although the differences were not statistically significant (Table 2 ). (Question 14 “I am confident in my ability to further assess a patient’s suicide risk” , Group A = 70%, Group B = 66.7%; Question 15 “I am confident in my ability to help find referral resources for patients with suicide risk” , Group A = 76.7%, Group B = 70%; Question 16 “I am confident that I have the skills to screen patients for suicide risk” , Group A = 70%, Group B = 63.3%). Table 2 DISTRIBUTION OF THE RESPONSES AFTER THE FIRST SESSION Questions Responses Group Total N (%) Chi-square value p value Group A N (%) Group B N (%) Q1 Few individuals intend to self harm True 27(90.0) 28(93.3) 55(91.7) 0.22 0.64 False 3(10.0) 2(6.7) 5(8.3) Q2 Younger population have higher risk of suicide True 27(90.0) 30(100.0) 57(95.0) 3.16 0.08 False 3(10.0) 0(0.0) 3(5.0) Q3 Suicide is more common in mental illness True 22(73.3) 27(90.0) 49(81.7) 2.78 0.09 False 8(26.7) 3(10.0) 11(18.3) Q4 Difficult to prevent suicide True 15(50.0) 14(46.7) 29(48.3) 0.67 0.80 False 15(50.0) 16(53.3) 31(51.7) Q5 Discussing suicide encourages it True 10(33.3) 14(46.7) 24(40.0) 1.11 0.29 False 20(66.7) 16(53.3) 36(60.0) Q6 Depression indicates suicide risk True 25(83.3) 27(90.0) 52(86.7) 0.58 0.45 False 5(16.7) 3(10.0) 8(13.3) Q7 Suicide is always unpredictable True 19(63.3) 15(50.0) 34(56.7) 1.09 0.30 False 11(36.7) 15(50.0) 26(43.3) Q8 All suicidal thoughts reflect a desire to die True 16(53.3) 22(73.3) 38(63.3) 2.58 0.11 False 14(46.7) 8(26.7) 22(36.7) Q9 Suicidal threats may be to manipulate others True 20(66.7) 26(86.7) 46(76.7) 3.35 0.07 False 10(33.3) 4(13.3) 14(23.3) Q10 Received training to engage and assist those at risk Agree 22(73.3) 20(66.7) 42(70.0) 0.99 0.61 Disagree 3(10.0) 2(6.7) 5(8.3) Neither 5(16.7) 8(26.7) 13(21.7) Q11 Skills to engage those with suicidal desire Agree 21(70.0) 20(66.7) 41(68.3) 1.38 0.50 Disagree 4(13.3) 2(6.7) 2(10.0) Neither 5(16.7) 8(26.7) 13(21.7) Q12 Comfortable in asking direct and open ended questions Agree 22(73.3) 23(76.7) 45(75.0) 0.10 0.95 Disagree 1(3.3) 1(3.3) 2(3.3) Neither 7(23.3) 6(20.0) 13(21.7) Q13 Have the support to assist those with suicide intent Agree 22(73.3) 19(63.3) 41(68.3) 2.89 0.23 Disagree 3(10.0) 1(3.3) 4(6.7) Neither 5(16.7) 10(33.3) 15(25.0) Q14 Confidence in assessing risk Agree 21(70.0) 20(66.7) 41(68.3) 0.51 0.77 Disagree 3(10.0) 2(6.7) 5(8.3) Neither 6(20.0) 8(26.7) 14(23.3) Q15 Confidence in identifying referral sources for those at risk Agree 23(76.7) 21(70.0) 44(73.3) 0.38 0.83 Disagree 2(6.7) 3(10.0) 5(8.3) Neither 5(16.7) 6(20.0) 11(18.3) Q16 Confidence in screening risk. Agree 21(70.0) 19(63.3) 40(66.7) 3.31 0.19 Disagree 5(16.7) 2(6.7) 7(11.7) Neither 4(13.3) 9(30.0) 13(21.7) After the second session After the crossover sessions, significant improvements were observed in both groups, as reflected in the bar charts (Fig. 1 , stacked bar charts) and Table 3 ​. After the second session, the majority of the participants from both groups agreed that they had received training for suicide risk assessment (Question 10 “I have received the training to engage and assist those with suicidal desire” , Group A = 63.3%, Group B = 80%) and increased their confidence in their ability to screen and help with referral sources for the patients (Question 14 “I am confident in my ability to further assess a patient’s suicide risk” , Group A = 73.3%, Group B = 80%; Question 15 “I am confident in my ability to help determine referral resources for patients with suicide risk” , Group A = 80%, Group B = 86.7%; Question 16 “I am confident that I have the skills to screen patients for suicide risk” , Group A = 73.3%, Group B = 80%). Question 9 “Individuals with borderline personality disorder frequently discuss or gesture suicide but do not intend to kill themselves instead; instead, they intend to provoke or manipulate others” : A statistically significant difference emerged (p = 0.001), with a greater proportion of \"true\" responses in Group B (86.7%) than in Group A (43.3%). Question 10 “I have received the training to engage and assist those with suicidal desire” : Group B reported higher agreement (80%) than Group A did (63.3%). With respect to confidence in screening and referral, Group B had more “agree” responses than Group A, Question 14 “I am confident in my ability to further assess a patient’s suicide risk” , Group B (80%), Group A (73.3%), Question 15 “I am confident in my ability to help find referral resources for patients with suicide risk” , Group B (86.7%), Group A (80%), and Question 16 “I am confident that I have the skills to screen patients for suicide risk” , Group B (80%), and Group A (73.3%). Table 3 DISTRIBUTION OF THE RESPONSES AFTER THE SECOND SESSION Questions Responses Group Total N (%) Chi-square value p value Group A N (%) Group B N (%) Q1 Few individuals intend to self harm True 24(80.0) 28(93.3) 52(86.7) 2.3 0.13 False 6(20.0) 2(6.7) 8(13.3) Q2 Younger population have higher risk of suicide True 28(93.3) 27(90.0) 55(91.7) 0.22 0.64 False 2(6.7) 3(10.0) 5(8.3) Q3 Suicide is more common in mental illness True 23(76.7) 26(86.7) 49(81.7) 1.00 0.32 False 7(23.3) 4(13.3) 11(18.3) Q4 Difficult to prevent suicide True 11(36.7) 14(46.7) 25(41.7) 0.62 0.43 False 19(63.3) 16(53.3) 35(58.3) Q5 Discussing suicide encourages it True 9(30.0) 14(46.7) 23(38.3) 1.76 0.18 False 21(70.0) 16(53.3) 37(61.7) Q6 Depression indicates suicide risk True 25(83.3) 29(96.7) 54(90.0) 2.96 0.08 False 5(16.7) 1(3.3) 6(10.0) Q7 Suicide is always unpredictable True 17(56.7) 19(63.3) 36(60.0) 0.27 0.60 False 13(43.3) 11(36.7) 24(40.0) Q8 All suicidal thoughts reflect a desire to die True 20(66.7) 24(80.0) 44(73.3) 1.36 0.24 False 10(33.3) 6(20.0) 16(26.7) Q9 Suicidal threats may be to manipulate others True 13(43.3) 26(86.7) 39(65.0) 12.38 0.001* False 17(56.7) 4(13.3) 21(35.0) Q10 Received training to engage and assist those at risk Agree 19(63.3) 24(80.0) 43(71.7) 2.05 0.36 Disagree 2(6.7) 1(3.3) 3(5.0) Neither 9(30.0) 5(16.7) 14(23.3) Q11 Skills to engage those with suicidal desire Agree 21(70.0) 23(76.7) 44(73.3) 2.09 0.35 Disagree 2(6.7) 0(0.0) 2(3.3) Neither 7(23.3) 7(23.3) 14(23.3) Q12 Comfortable in asking direct and open ended questions Agree 20(66.7) 20(66.7) 40(66.7) 0.39 0.82 Disagree 2(6.7) 1(3.3) 3(5.0) Neither 8(26.7) 9(30.0) 17(28.3) Q13 Have the support to assist those with suicide intent Agree 24(80.0) 23(76.7) 47(78.3) 1.02 0.6 Disagree 0(0.0) 1(3.3) 1(1.7) Neither 6(20.0) 6(20.0) 12(20.0) Q14 Confidence in assessing risk Agree 22(73.3) 24(80.0) 46(76.7) 0.40 0.82 Disagree 3(10.0) 2(6.7) 5(8.3) Neither 5(16.7) 4(13.3) 9(15.0) Q15 Confidence in identifying referral sources for those at risk Agree 24(80.0) 26(86.7) 50(83.3) 2.08 0.35 Disagree 0(0.0) 1(3.3) 1(1.7) Neither 6(20.0) 3(10.0) 9(15.0) Q16 Confidence in screening risk. Agree 22(73.3) 24(80.0) 46(76.7) 1.16 0.56 Disagree 1(3.3) 0(0.0) 1(1.7) Neither 7(23.3) 6(20.0) 13(21.7) *suggests p value less than 0.05 The stacked bar charts illustrate a consistent improvement in agreement and confidence levels across both groups over time, with Group B demonstrating slightly higher agreement percentages after the second session (Fig. 2 ). DISCUSSION This study evaluated the effectiveness of integrating simulation videos into the undergraduate medical curriculum in improving the knowledge, attitudes, and confidence related to suicide risk assessment competency in a LMIC with limited mental health access and training oppurtuniites.The results suggest that simulation based learning, when given prior to didactic lecture can significantly enhance the confidence in suicide risk assessment. This finding is relevant given the underutilization of simulation in psychiatry training and the critical need for low cost effective and accessible training resources in resource constrained LMIC settings like India [ 19 ]. The effectiveness of teaching learning methods was evaluated in the first two domains of the Kirkpatrick model, i.e., participant reactions and learning[ 26 ]. The reaction domain was assessed through student feedback on relevance and engagement, whereas the learning domain was evaluated via pre- and post tests to determine the effectiveness of the teaching methods in improving the competency of suicide risk assessment. At the baseline assessment, there were no statistically significant differences in the responses related to knowledge, attitudes, or confidence between Group A and Group B. This finding shows that both groups were comparable in their skills at baseline, ensuring a reliable evaluation of teaching methods despite the absence of randomization. After the first training session, Group A showed moderate improvements in response to knowledge-based questions with didactic lectures. Group B, which received the simulation video and debriefing session, demonstrated a better improvement in knowledge, suggesting the immediate efficacy of simulation-based training for knowledge enhancement. The attitude scores also improved in both groups, with Group B exhibiting slightly better responses than Group A, although the differences were not statistically significant. The interactive and experiential nature of the simulation video with the debriefing session contributed to this change in attitudes, which is consistent with studies highlighting the positive impact of simulation on attitudes[ 3 ]. Group B had better scores for confidence questions following the simulation training, reflecting its potential role in enhancing confidence in clinical settings. After the second training session, Group A showed significant improvement in knowledge, outperforming their performance in the didactic lecture. After being exposed to simulation training in the previous session, Group B experienced a decline in knowledge scores, potentially due to a less engaging and interactive format of didactic lectures. These results highlight the importance of order in teaching learning methods, with simulation-based teaching appearing more effective when it is delivered after a didactic lecture. Both groups reported increases in confidence levels after the second session, with Group A showing greater confidence than Group B did. This aligns with the view that experiential learning further strengthened confidence after learning theoretical concepts. This finding is consistent with evidence from simulation-based education nursing professionals.[ 27 ] This effectiveness of simulation-based training is explained by Kolb’s experiential learning theory, where active participation and reflection on one’s experiences plays a role in learning[ 28 ]. Also, simulation videos provide a safe environment to observe realistic scenarios and debriefing sessions that followed facilitate collaborative reflection, deeper understanding of the concepts and peer learning in a relatively stress-free environment[ 29 ]. Social cognitive theory also supports the effectiveness of simulation in this context, as the students observe expert mental health professionals (actors in the videos) effectively conduct suicide risk assessment[ 30 ]. This observational learning helps students not only gain new knowledge but also develop self-efficacy as the simulation videos demonstrated establishing rapport, asking sensitive questions, and responding with empathy[ 31 ]. The study findings highlight the importance of integrating simulation-based teaching into medical curricula. Compared with traditional lectures alone, simulation-based methods appear to enhance students' confidence and practical skills more effectively. Additionally, the study underscores the importance of conducting multiple sessions, using different teaching-learning methods to reinforce skills related to suicide risk assessment. The results also emphasize the need for thoughtful sequencing, as combining theoretical knowledge with experiential learning in a structured manner yields optimal outcomes. Simulation-based teaching could become an integral part of the regular curriculum, offering experiential learning that complements the knowledge-driven nature of traditional medical education. One of the key strengths of this study is its design, which allowed both groups to experience both teaching methods. This approach has provided the opportunity to conduct within-group comparisons without randomization. The study included 60 medical students, providing enough participants for initial comparisons between simulation-based and traditional didactic teaching methods. Although the sample is not large enough to detect subtle differences, it allowed for meaningful exploratory analysis and the identification of salient trends across knowledge, attitudes, and confidence domains. Furthermore, the study was conducted in real-world clinical teaching settings, enhancing its generalizability. The LMIC context strengthens the study’s relevance, as primary care providers in India often serve as the first line of contact for those with suicidal intent. Considering the suboptimal training in psychiatry for undergraduate medical students, a study that uses frameworks like experiential learning, reflective practice, psychological safety and collaborative meaning-making through debriefing could further enhance simulation research in LMIC settings[ 19 ]. This study also emphasizes the critical relevance of scalable, low-cost educational interventions in LMICs where there is a scarcity of psychiatry training resources. The results suggest that simulation can be an effective pedagogical and public health tool in resource constrained countries. These findings have implications for medical curriculum design and mental health workforce development in LMICs. However, this study has several limitations. Group allocation was based on preexisting sections rather than randomization, which may have introduced selection bias. The 30-minute gap between the didactic and simulation sessions was likely too short to allow participants sufficient time for cognitive processing and reflection, which may have hindered information retention and skill transfer. Another key limitation was the lack of long-term follow-up, making it difficult to assess the durability of any observed improvements or whether they translated into clinical practice over time. Finally, the content covered in the training sessions did not address emergency steps or referral pathways for high-risk patients, which were identified as gaps in current practice. Despite these limitations, the findings highlight the potential value of simulation-based teaching as a supplement to traditional methods. Conclusion and future directions Integrating simulation-based teaching into undergraduate psychiatric education, particularly in LMIC contexts, is both feasible and pedagogically sound. Simulation videos offer a practical and scalable solution to provide standardized, high-quality training to future health professionals during undergraduate medical education and potentially serve as an effective professional development program for practicing primary care health providers Future research should investigate its long-term impact, changes in behaviors and patient outcomes in clinical contexts, to inform policy and design integration to medical curriculum Declarations Human ethics and consent to Participate: The study was conducted in accordance with the Declaration of Helsinki. Ethics approval was obtained from Institutional Ethics Committee, Sri Ramachandra Institute of Higher Education and Research (CSP-MED/24/JAN/97/10). All participants provided informed consent before participation. Participants were informed of their right to opt out at any stage without any consequences. Consent for publication: Consent for publication was obtained from all participants. All data used in the study were anonymized to ensure participant confidentiality. Clinical trial number : Not applicable. Availability of data and materials: The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This study was supported by a fluid research grant from the MUST Enrich Psychiatry Education Research Grant, provided by Minds United for Health Sciences & Humanity Trust, Mysore, with funding support from the Infosys Foundation. Authors' contributions: SJK : Conceptualized the study, contributed to study design, conducted data analysis, and drafted the manuscript. JBH : Data collection, contributed to data analysis and manuscript preparation. PR : Contributed to study design, methodology, data interpretation, and manuscript revisions. MJ : Provided methodological insights, contributed to study design. JKM : Conceptualized the study, contributed to study design, supervised the study, and contributed to the final manuscript review. All authors read and approved the final manuscript. Acknowledgements: The authors would like to thank the participants for their time in this study. Financial support: This study was funded by the MUST Enrich Psychiatry Education Research Grant from Minds United for Health Sciences & Humanity Trust, which is supported by the Infosys Foundation. References Stone DM, Crosby AE. Suicide Prevention. Am J Lifestyle Med. 2014;8(6):404–20. World Health Organization. Suicide [Internet]. 2024 [cited 2025 Feb 2]. Available from: https://www.who.int/news-room/fact-sheets/detail/suicide Richard O, Jollant F, Billon G, Attoe C, Vodovar D, Piot MA. Simulation training in suicide risk assessment and intervention: a systematic review and meta-analysis. Med Educ Online. 28(1):2199469. Arya V. Suicide prevention in India. Ment Health Prev. 2024 Mar 1;33:200316. Schwartz-Lifshitz M, Zalsman G, Giner L, Oquendo MA. Can We Really Prevent Suicide? Curr Psychiatry Rep. 2012 Dec;14(6):624. Luoma JB, Martin CE, Pearson JL. Contact With Mental Health and Primary Care Providers Before Suicide: A Review of the Evidence. Am J Psychiatry. 2002 Jun 1;159(6):909–16. O’Brien KHM, Fuxman S, Humm L, Tirone N, Pires WJ, Cole A, Goldstein Grumet J. Suicide risk assessment training using an online virtual patient simulation. mHealth. 2019 Aug 28;5:31. Fekadu A, Demissie M, Birhane R, Medhin G, Bitew T, Hailemariam M, Minaye A, Habtamu K, Milkias B, Petersen I, Patel V, Cleare AJ, Mayston R, Thornicroft G, Alem A, Hanlon C, Prince M. Under detection of depression in primary care settings in low and middle-income countries: a systematic review and meta-analysis. Syst Rev. 2022 Dec;11(1):1–10. Pattanayak RD, Sagar R. Depressive Disorders in Indian Context : A Review and Clinical Update for Physicians. J Assoc Physicians India. 2014 Sep;62(9):827–32. Indu PS, Anilkumar TV, Pisharody R, Russell PSS, Raju D, Sarma PS, Remadevi S, Amma KRLI, Sheelamoni A, Andrade C. Primary care Screening Questionnaire for Depression: Reliability and validity of a new four-item tool. BJPsych Open. 2017 Mar;3(2):91–5. Lakkis NA, Mahmassani DM. Screening instruments for depression in primary care: a concise review for clinicians. Postgrad Med [Internet]. 2015 Jan 2 [cited 2025 Jan 7]; Available from: https://www.tandfonline.com/doi/abs/10.1080/00325481.2015.992721 Vaghela PV, Shah S, D DN, H SS. Knowledge, Attitude, and Practice of Nursing Staff Toward Patients Who Attempted Suicide at Tertiary Care Hospital of Central Gujarat, India. Indian J Psychol Med [Internet]. 2024 Sep 11 [cited 2025 Jan 7]; Available from: https://journals.sagepub.com/doi/10.1177/02537176241273710 Eynan R, Reiss L, Links P, Shah R, Sathyanarayana Rao TS, Parkar S, Dutt L, Kadam K, De Souza A, Shrivastava A. Suicide prevention competencies among urban Indian physicians: A needs assessment. Indian J Psychiatry. 2015 Dec;57(4):397. Chu C, Klein KM, Buchman-Schmitt JM, Hom MA, Hagan CR, Joiner TE. Routinized Assessment of Suicide Risk in Clinical Practice: An Empirically Informed Update. J Clin Psychol. 2015 Dec;71(12):1186–200. Rothes I, Henriques M. Health Professionals Facing Suicidal Patients: What Are Their Clinical Practices? Int J Environ Res Public Health. 2018 Jun 8;15(6):1210. Kulkarni P, Pushpalatha K, Bhat D. Medical education in India: Past, present, and future. APIK J Intern Med. 2019 Sep;7(3):69. Menon J, Kantipudi SJ. Crossroads in postgraduate psychiatry training in India. Indian J Ment Health Neurosci. 2019 Jul 1;2(2):4–7. SAMSHA. Suicide Prevention Resource Center (SPRC) [Internet]. 2019 [cited 2025 Jan 7]. Available from: https://www.samhsa.gov/suicide-prevention-resource-center-sprc Eppich W, Reedy G. Advancing healthcare simulation research: innovations in theory, methodology, and method. Adv Simul. 2022 Jul 27;7(1):23. Kowalski C, Sathanandan S. The use of simulation to develop advanced communication skills relevant to psychiatry. BMJ Simul Technol Enhanc Learn. 2015 Apr 23;1(1):29. Richard O, Jollant F, Billon G, Attoe C, Vodovar D, Piot MA. Simulation training in suicide risk assessment and intervention: a systematic review and meta-analysis. Med Educ Online. 2023 Dec 31;28(1):2199469. Erbuto D, Berardelli I, Sarubbi S, Rogante E, Sparagna A, Nigrelli G, Lester D, Innamorati M, Pompili M. Suicide-Related Knowledge and Attitudes among a Sample of Mental Health Professionals. Int J Environ Res Public Health. 2021 Aug 5;18(16):8296. Smith AR, Silva C, Covington DW, Joiner Jr. TE. An assessment of suicide-related knowledge and skills among health professionals. Health Psychol. 2014;33(2):110–9. IBM Corp. (2020). IBM SPSS Statistics for Windows (Version 27.0) [Computer software]. IBM Corp. RStudio Team. RStudio: Integrated Development Environment for R. Version 2023.06.1 Build 524. Posit Software, PBC; 2023. Smidt A, Balandin S, Sigafoos J, Reed VA. The Kirkpatrick model: A useful tool for evaluating training outcomes. J Intellect Dev Disabil. 2009 Sep;34(3):266–74. Davison J, Mackay B, McGivern MJ. The Potential of Simulation to Enhance Nursing Students’ Preparation for Suicide Risk Assessment: A Review. Open J Nurs. 2017 Feb 7;7(2):129–44. Kolb DA. Experiential Learning: Experience as the Source of Learning and Development. FT Press; 2014. 417 p. Rudolph JW, Simon R, Raemer DB, Eppich WJ. Debriefing as formative assessment: closing performance gaps in medical education. Acad Emerg Med Off J Soc Acad Emerg Med. 2008 Nov;15(11):1010–6. Bandura A. Social Cognitive Theory: An Agentic Perspective. Annu Rev Psychol. 2001 Feb 1;52(Volume 52, 2001):1–26. Cheng A, Grant V, Dieckmann P, Arora S, Robinson T, Eppich W. Faculty Development for Simulation Programs: Five Issues for the Future of Debriefing Training. Simul Healthc J Soc Simul Healthc. 2015 Aug;10(4):217–22. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6186713\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":452291469,\"identity\":\"49140390-1a39-4cf9-83ec-f271958aac3a\",\"order_by\":0,\"name\":\"Suvarna Jyothi Kantipudi\",\"email\":\"data:image/png;base64,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\",\"orcid\":\"\",\"institution\":\"Sri Ramachandra Institute of Higher Education and Research\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Suvarna\",\"middleName\":\"Jyothi\",\"lastName\":\"Kantipudi\",\"suffix\":\"\"},{\"id\":452291470,\"identity\":\"e695879b-316a-4b90-be1c-184399a8f5af\",\"order_by\":1,\"name\":\"Jazeela Begam J.Hussain\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Sri Ramachandra Institute of 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methodology\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6186713/v1/86c3358e6e43b30027f3ef97.jpeg\"},{\"id\":82276996,\"identity\":\"21d26b56-6ce9-4f89-aea4-dbcfe310c831\",\"added_by\":\"auto\",\"created_at\":\"2025-05-08 14:49:13\",\"extension\":\"jpeg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":265850,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eResponse distribution across questions and time points for Group A and B.\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage2.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6186713/v1/8febf77dd6ff0df1b73b14a6.jpeg\"},{\"id\":95120796,\"identity\":\"0e222a30-ab54-44b6-950e-1b875b904ca2\",\"added_by\":\"auto\",\"created_at\":\"2025-11-04 13:54:12\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1498272,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6186713/v1/1cbaa944-f62f-4db1-8c61-77fa34983f13.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003eEffectiveness of Simulation-Based Suicide Risk Assessment Training Among Undergraduate Medical Students in India\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eSuicide is a preventable public health issue and remains one of the leading causes of death globally[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]\\u003csup\\u003e,\\u003c/sup\\u003e[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. Approximately 800,000 individuals die by suicide each year, with India contributing nearly 18% of these deaths [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Identifying and timely managing risk factors is essential for preventing suicide. Among the most critical indicators of imminent risk are suicidal ideation and the formulation of a concrete suicide plan. Other contributing factors include underlying psychiatric illnesses, substance use disorders, a family history of suicide, certain personality traits, and previous suicide attempts. Additionally, traits such as impulsivity, hopelessness, self-harm behaviors, and feelings of being a burden to others further increase the risk of suicide[\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003ePrevious studies report that nearly 45% of individuals who die by suicide visit a primary healthcare provider within the month preceding their death[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. This highlights a critical opportunity for the early detection of risk factors across health care settings. Although traditionally mental health professions have led the suicide prevention efforts, primary health care providers and clinicians across various specialties have a key role in suicide prevention [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. However, owing to a lack of adequate training during medical education, and limited access to ongoing professional development in suicide assessment and intervention, many health care professionals face challenges in identifying and addressing these risk factors effectively.\\u003c/p\\u003e \\u003cp\\u003eFor example, depression, a widely prevalent common mental disorder and a significant risk factor for suicide, often remains undetected in primary care settings, particularly in low- and middle-income countries[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. In India, where there is a significant shortage of psychiatrists, training primary care physicians to recognize and manage depression is extremely crucial for suicide prevention[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. To bridge this gap, brief screening tools such as the Primary Care Screening Questionnaire for Depression (PSQ4D) have been developed in the Indian population. The PSQ4D, a four-item tool, has high sensitivity (0.96) and specificity (0.87), making it a valuable assessment tool in primary care [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. Other validated tools, including the PHQ-9, WHO-5 Wellbeing Index, and GHQ-12, offer effective options for identifying depression in primary care settings[\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. Although these screening tools for depression enable primary care physicians to identify individuals at risk of clinical depression, their effectiveness in preventing suicide ultimately depends on healthcare professionals\\u0026rsquo; ability to conduct suicide risk assessments. However, many healthcare professionals, including nurses and physicians, lack formal training in suicide prevention despite having experience managing suicidal patients[\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. For example, a study in urban India reported that fewer than half of surveyed physicians felt competent in treating suicidal patients[\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Many primary care physicians feel unprepared or even hesitant to conduct comprehensive suicide risk assessments or to refer individuals at risk to mental health professionals [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. Considering these lacunae, integrating suicide risk assessment training into medical undergraduate education is crucial. The development of competency in this area during undergraduate medical training can equip future health care professionals with the necessary skills to increase patient safety and strengthen suicide prevention across diverse healthcare settings.\\u003c/p\\u003e \\u003cp\\u003eThe effectiveness of such training depends on how well it is integrated into the broader medical curriculum. Historically, Indian medical education has adopted a compartmentalized approach that separates biological, psychological, and social factors rather than integrating them. Although there have been frequent attempts at innovative reforms to improve training, these initiatives often remain theoretical, with limited practical implementation in most educational settings. Traditional methods, which rely predominantly on didactic lectures, prioritize content delivery over shaping attitudes or developing skills. Conversely, essential competencies such as approaching patients with empathy, dignity and respect are not effectively acquired until they have an opportunity to observe or practice these skills in clinical settings [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. However, the recent adoption of a competency-based approach by the National Medical Commission is a significant step toward a more integrated model in the Indian education system[\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. Suicide risk assessment is now a mandatory competency for MBBS students under this new curriculum. According to the Suicide Prevention Resource Centre (SPRC), this competency of suicide risk assessment includes an approach to risk assessment, the formulation of risk, history collection, management planning, and the legal aspects of suicide evaluation[\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. Training students in supervised settings can help them learn the necessary skills for suicide risk assessment and enhance their confidence in providing essential care.\\u003c/p\\u003e \\u003cp\\u003eSuicide risk assessment involves not only identifying suicidal ideation but also establishing rapport, demonstrating empathy, and maintaining confidentiality to create a comfortable and safe environment for the patient. However, training with real-life patients with active suicidal ideation can present significant risks, both for the patient and the student, and can be potentially anxiety-provoking. The ethical dilemma of placing a highly distressed patient through multiple interviews poses another challenge. While observing specialists\\u0026rsquo; interviews may be helpful, young undergraduate trainees best learn interviewing skills and risk assessment through practice. The lack of psychological safety mandates the need for a more practical approach to simulate clinical experiences in a controlled, risk-free environment [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eAs Eppich and Reedy pointed, simulation training has been extensively embraced across many medical and surgical disciplines, but its application in mental health and social work is at a very nascent stage, especially in low- and middle-income countries (LMICs)[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]. Given the value of diagnostic and communication skills in psychiatric consultations, this underutilization is remarkable. With India's recent move to competency-based medical education, this a timely opportunity to include simulation into undergraduate psychiatry training.Simulation, as a pedagogical approach, allows students to engage with depictions of real-life scenarios and offers opportunities for practice and skill enhancement[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]This experiential learning helps students understand the suicide risk evaluation process and attain the necessary skills to handle sensitive and complex situations[\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eHowever, resource limitations such as obtaining high-fidelity simulation equipment or employing standardized actors for practice make recorded simulation roleplay videos a practical alternative. These videos, featuring experienced clinicians with professional acting skills enacting realistic patient scenarios, provide a consistent, cost-effective, and accessible training method for training in psychiatry. They allow medical students to observe and analyze critical aspects of suicide risk assessment, including verbal and nonverbal communication, empathetic responses, and risk stratification techniques.\\u003c/p\\u003e \\u003cp\\u003eThis study addresses this educational gap by evaluating the effectiveness of integrating simulation videos of suicide risk assessment into the undergraduate medical students curriculum in India.Specifically,it examines whether the simulation based training improves the knowledge, attitudes and confidence of medical students with regard to suicide risk assessment.Conisdering the underutilization of simulation based training in psychiatry in LMIC, this study aims to demonstrate the feasibility and utility of a practical and easy accessible simulation training.\\u003c/p\\u003e\"},{\"header\":\"METHODS\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy design\\u003c/h2\\u003e \\u003cp\\u003eThis is a quasi-experimental study that employs a crossover design with a pre\\u0026ndash;post approach to evaluate the effectiveness of integrating simulation videos of suicide risk assessment into the medical student training curriculum of undergraduate medical students. The quasi-experimental design was chosen because it facilitates the assessment of interventions in real-world educational settings where random assignment or blinding may not be feasible.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eStudy setting and participants\\u003c/h3\\u003e\\n\\u003cp\\u003e The study was approved by the Institutional Ethics Committee, Sri Ramachandra Institute of Higher Education and Research (CSP-MED/24/JAN/97/10) and conducted at Department of Psychiatry, Sri Ramachandra Medical College, a tertiary care teaching hospital in Chennai,Tamilnadu,India. MBBS students in Phase II (i.e., second- and third-year MBBS), who voluntarily agreed to participate and provide informed consent, were included in the study. As part of their regular clinical posting schedule, the students attended psychiatry clinical rotations in small groups. Those who had previously undergone training in suicide risk assessment were excluded.\\u003c/p\\u003e\\n\\u003ch3\\u003eSample size\\u003c/h3\\u003e\\n\\u003cp\\u003eThe study recruited 60 MBBS students in Phase II (years 2 and 3). Convenience sampling was used, considering logistical feasibility, the availability of students during their psychiatry clinical rotations, and the need for small groups to ensure debriefing after simulation sessions. Previous studies employing similar designs in educational settings have used comparable sample sizes[\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e].\\u003c/p\\u003e\\n\\u003ch3\\u003eStudy tools \\u0026 procedure\\u003c/h3\\u003e\\n\\u003cp\\u003eEligible participants were approached, and the study purpose, procedures and potential benefits were explained. Informed consent was obtained from all participants, who were assured of confidentiality and their right to withdraw from the study at any point without any consequences. A self-report questionnaire was developed to assess the students' existing knowledge and confidence in suicide risk assessment. The questionnaire was adapted from the \\\"Suicide Knowledge and Skills Questionnaire\\\" (SKSQ), which contains 16 items evaluating knowledge, attitudes, and confidence in suicide evaluation [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. A previous study conducted in India also adapted this scale, demonstrating its relevance and applicability in the Indian context for assessing suicide-related competencies[\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThis study recruited two batches of MBBS students in their Phase II MBBS (years 2 \\u0026amp; 3), with each batch divided into Group A and Group B. The division of groups was based on preexisting batch divisions for small group teaching. Group A received a traditional didactic lecture followed by simulation video demonstrations with a debriefing session. Group B received simulation video demonstrations with a debriefing session, followed by traditional didactic lectures.\\u003c/p\\u003e \\u003cp\\u003eThe simulation-based intervention was designed to improve experiential learning through observation, collaborative reflection and peer discussion, without compromising psychological safety. The simulation recorded roleplay video used for demonstration was developed based on a validated script, focusing on the assessment and evaluation of suicidal ideation in a depressive patient (Jazeela et al., Manuscript in preparation). This scenario depicts identifying and responding to suicidal risk in patients with diagnosed depression, particularly demonstrating how to sensitively suicide risk assessment. Participants were introduced to the simulation videos through a structured 5-minute briefing session. The session outlined the method, content, and duration of the videos, emphasizing key learning objectives and expectations. Students were familiarized with the classroom setup, which included a high-definition projector and audio-visual equipment. The orientation covered the logistics of the training space and the expected interaction with the simulation materials. The simulation videos were professionally produced using high-definition recording equipment and featured trained actors depicting real-world clinical scenarios.The simulation video portrays a detailed clinician‒patient interaction, highlighting key communication strategies, risk assessment techniques, and empathetic responses, which are critical for fostering a therapeutic alliance and ensuring a comprehensive evaluation of suicidal ideation. The simulation-based training was conducted in a designated medical classroom within the university, ensuring a controlled learning environment. The training utilized a high-definition projector, speakers, and video playback software to facilitate an immersive learning experience. Background noise was minimized to maintain focus and engagement during the training. The simulation was conducted in groups, allowing students to discuss and reflect on their observations. The training incorporated discussion-based debriefings following video session. The facilitators were experienced mental health educators with prior training in suicide prevention strategies.\\u003c/p\\u003e \\u003cp\\u003eThe assessments were done at three points: baseline, after the first training session, and after the second training session. Each session, i.e., either a didactic lecture or simulation video with a debriefing session, lasted 45 minutes. There was a 30-minute gap before the second session was delivered. The groups then crossed over for the second session, with Group A receiving simulation video training followed by a traditional didactic lecture, and Group B receiving the opposite sequence. Both groups were reassessed via the same questionnaire to evaluate any changes in knowledge, attitudes, or confidence in suicide risk assessment after the sessions. (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical analysis\\u003c/h2\\u003e \\u003cp\\u003eThe statistical analysis for this study aimed to evaluate the effectiveness of the two training methods (traditional didactic teaching versus simulation video-based training) in improving medical students' knowledge, skills, and confidence in recognizing and managing suicide risk. Since the responses were ordinal, chi-square tests were conducted via SPSS Version 27 [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]to compare the distribution of responses between Group A and Group B at baseline (pretest), and any significant differences in their initial knowledge and understanding of suicide risk assessment were assessed. The level of significance was set at 5%. To visualize changes in responses across the three time points (pretest, posttest 1, and posttest 2), stacked bar charts were created via R version 4.3.3[\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e].\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cp\\u003eA total of 60 medical students from the second and third years of study participated in the study. At baseline, their knowledge and attitudes regarding suicide risk assessment were evaluated via a self-report questionnaire.\\u003c/p\\u003e\\n\\u003ch3\\u003eBaseline comparison\\u003c/h3\\u003e\\n\\u003cp\\u003eAt baseline, the responses to all the questions indicated comparable knowledge and attitudes between the groups (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). No statistically significant differences were observed for any of the questions (p\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05), ensuring that both groups had similar levels of knowledge and attitudes prior to the interventions.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eBASELINE DISTRIBUTION OF THE RESPONSES\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQuestions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eResponses\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eGroup\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003cp\\u003eN (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eChi-square value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003ep value\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eGroup A\\u003c/p\\u003e \\u003cp\\u003eN (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eGroup B\\u003c/p\\u003e \\u003cp\\u003eN (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ1 Few individuals intend to self harm\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e29(96.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e30(100.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e59(98.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e1.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.31\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1(3.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0(0.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1(1.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ2 Younger population have higher risk of suicide\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e30(100.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e30(100.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e60(100.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0(0.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0(0.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0(0.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ3 Suicide is more common in mental illness\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e21(70.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e26(86.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e47(78.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e2.45\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.12\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9(30.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4(13.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e13(21.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ4 Difficult to prevent suicide\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e15(50.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e17(56.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e32(53.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.26\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.60\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e15(50.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e13(43.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e28(53.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ5 Discussing suicide encourages it\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e12(40.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10(33.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e22(36.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.28\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.59\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18(60.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e20(66.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e38(63.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ6 Depression indicates suicide risk\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e27(90.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e24(80.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e51(85.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e1.18\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.28\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3(10.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6(20.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e9(15.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ7 Suicide is always unpredictable\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e20(66.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e18(60.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e38(63.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.29\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.59\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10(33.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12(40.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e22(36.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ8 All suicidal thoughts reflect a desire to die\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18(60.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e19(63.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e37(61.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.07\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.79\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e12(40.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e11(36.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e23(38.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ9 Suicidal threats may be to manipulate others\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e21(70.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e26(86.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e47(78.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e2.45\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.12\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9(30.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4(13.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e13(21.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ10 Received training to engage and assist those at risk\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3(10.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1(3.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4(6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e1.37\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.50\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e15(50.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15(50.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e27(45.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e12(40.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15(50.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e27(45.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ11 Skills to engage those with suicidal desire\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3(10.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2(6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5(8.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e3.36\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.19\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9(30.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16(53.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e25(41.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18(60.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12(40.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e30(50.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ12 Comfortable in asking direct and open ended questions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17(56.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14(46.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e31(51.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e2.34\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.31\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2(6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6(20.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e8(13.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11(36.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10(33.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e21(35.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ13 Have the support to assist those with suicide intent\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5(16.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6(20.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e11(18.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e3.54\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.17\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8(26.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14(46.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e22(36.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17(56.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10(33.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e27(45.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ14 Confidence in assessing risk\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5(16.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8(26.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e13(21.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e2.45\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.29\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8(26.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e11(36.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e19(31.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17(56.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e11(36.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e28(46.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ15 Confidence in identifying referral sources for those at risk\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10(33.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e13(43.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e23(38.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e1.21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.55\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7(23.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4(13.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e11(18.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13(43.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e13(43.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e26(43.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ16 Confidence in screening risk.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9(30.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7(23.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e16(26.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e2.86\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.24\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6(20.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12(40.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e18(30.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e15(50.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e11(36.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e26(43.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e\\n\\u003ch3\\u003eAfter the first session\\u003c/h3\\u003e\\n\\u003cp\\u003eAfter the first intervention session, Group A, which initially attended the didactic lecture, showed greater improvements in attitude-related questions than did Group B, which underwent the simulation video and debriefing session, although the differences were not statistically significant (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). (Question 14 \\u003cem\\u003e\\u0026ldquo;I am confident in my ability to further assess a patient\\u0026rsquo;s suicide risk\\u0026rdquo;\\u003c/em\\u003e, Group A\\u0026thinsp;=\\u0026thinsp;70%, Group B\\u0026thinsp;=\\u0026thinsp;66.7%; Question 15 \\u003cem\\u003e\\u0026ldquo;I am confident in my ability to help find referral resources for patients with suicide risk\\u0026rdquo;\\u003c/em\\u003e, Group A\\u0026thinsp;=\\u0026thinsp;76.7%, Group B\\u0026thinsp;=\\u0026thinsp;70%; Question 16 \\u003cem\\u003e\\u0026ldquo;I am confident that I have the skills to screen patients for suicide risk\\u0026rdquo;\\u003c/em\\u003e, Group A\\u0026thinsp;=\\u0026thinsp;70%, Group B\\u0026thinsp;=\\u0026thinsp;63.3%).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eDISTRIBUTION OF THE RESPONSES AFTER THE FIRST SESSION\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQuestions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eResponses\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eGroup\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003cp\\u003eN (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eChi-square value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003ep value\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eGroup A\\u003c/p\\u003e \\u003cp\\u003eN (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eGroup B\\u003c/p\\u003e \\u003cp\\u003eN (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ1 Few individuals intend to self harm\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e27(90.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e28(93.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e55(91.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.22\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.64\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3(10.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2(6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5(8.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ2 Younger population have higher risk of suicide\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e27(90.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e30(100.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e57(95.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e3.16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.08\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3(10.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0(0.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3(5.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ3 Suicide is more common in mental illness\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22(73.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e27(90.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e49(81.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e2.78\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.09\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8(26.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3(10.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e11(18.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ4 Difficult to prevent suicide\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e15(50.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14(46.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e29(48.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.67\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.80\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e15(50.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16(53.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e31(51.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ5 Discussing suicide encourages it\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10(33.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14(46.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e24(40.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e1.11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.29\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e20(66.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16(53.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e36(60.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ6 Depression indicates suicide risk\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e25(83.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e27(90.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e52(86.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.58\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.45\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5(16.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3(10.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e8(13.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ7 Suicide is always unpredictable\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e19(63.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15(50.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e34(56.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e1.09\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.30\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11(36.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15(50.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e26(43.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ8 All suicidal thoughts reflect a desire to die\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e16(53.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e22(73.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e38(63.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e2.58\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.11\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e14(46.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8(26.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e22(36.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ9 Suicidal threats may be to manipulate others\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e20(66.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e26(86.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e46(76.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e3.35\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.07\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10(33.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4(13.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e14(23.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ10 Received training to engage and assist those at risk\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22(73.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e20(66.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e42(70.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.99\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.61\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3(10.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2(6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5(8.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5(16.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8(26.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e13(21.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ11 Skills to engage those with suicidal desire\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e21(70.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e20(66.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e41(68.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e1.38\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.50\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4(13.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2(6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2(10.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5(16.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8(26.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e13(21.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ12 Comfortable in asking direct and open ended questions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22(73.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e23(76.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e45(75.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.95\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1(3.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1(3.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2(3.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7(23.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6(20.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e13(21.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ13 Have the support to assist those with suicide intent\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22(73.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e19(63.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e41(68.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e2.89\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.23\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3(10.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1(3.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4(6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5(16.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10(33.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e15(25.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ14 Confidence in assessing risk\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e21(70.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e20(66.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e41(68.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.51\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.77\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3(10.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2(6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5(8.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6(20.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8(26.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e14(23.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ15 Confidence in identifying referral sources for those at risk\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e23(76.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e21(70.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e44(73.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.38\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.83\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2(6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3(10.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5(8.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5(16.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6(20.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e11(18.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ16 Confidence in screening risk.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e21(70.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e19(63.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e40(66.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e3.31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.19\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5(16.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2(6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e7(11.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4(13.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9(30.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e13(21.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eAfter the second session\\u003c/h2\\u003e \\u003cp\\u003eAfter the crossover sessions, significant improvements were observed in both groups, as reflected in the bar charts (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e, stacked bar charts) and Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e​.\\u003c/p\\u003e \\u003cp\\u003eAfter the second session, the majority of the participants from both groups agreed that they had received training for suicide risk assessment (Question 10 \\u003cem\\u003e\\u0026ldquo;I have received the training to engage and assist those with suicidal desire\\u0026rdquo;\\u003c/em\\u003e, Group A\\u0026thinsp;=\\u0026thinsp;63.3%, Group B\\u0026thinsp;=\\u0026thinsp;80%) and increased their confidence in their ability to screen and help with referral sources for the patients (Question 14 \\u003cem\\u003e\\u0026ldquo;I am confident in my ability to further assess a patient\\u0026rsquo;s suicide risk\\u0026rdquo;\\u003c/em\\u003e, Group A\\u0026thinsp;=\\u0026thinsp;73.3%, Group B\\u0026thinsp;=\\u0026thinsp;80%; Question 15 \\u003cem\\u003e\\u0026ldquo;I am confident in my ability to help determine referral resources for patients with suicide risk\\u0026rdquo;\\u003c/em\\u003e, Group A\\u0026thinsp;=\\u0026thinsp;80%, Group B\\u0026thinsp;=\\u0026thinsp;86.7%; Question 16 \\u003cem\\u003e\\u0026ldquo;I am confident that I have the skills to screen patients for suicide risk\\u0026rdquo;\\u003c/em\\u003e, Group A\\u0026thinsp;=\\u0026thinsp;73.3%, Group B\\u0026thinsp;=\\u0026thinsp;80%).\\u003c/p\\u003e \\u003cp\\u003eQuestion 9 \\u003cem\\u003e\\u0026ldquo;Individuals with borderline personality disorder frequently discuss or gesture suicide but do not intend to kill themselves instead; instead, they intend to provoke or manipulate others\\u0026rdquo;\\u003c/em\\u003e: A statistically significant difference emerged (p\\u0026thinsp;=\\u0026thinsp;0.001), with a greater proportion of \\\"true\\\" responses in Group B (86.7%) than in Group A (43.3%). Question 10 \\u003cem\\u003e\\u0026ldquo;I have received the training to engage and assist those with suicidal desire\\u0026rdquo;\\u003c/em\\u003e: Group B reported higher agreement (80%) than Group A did (63.3%). With respect to confidence in screening and referral, Group B had more \\u0026ldquo;agree\\u0026rdquo; responses than Group A, Question 14 \\u003cem\\u003e\\u0026ldquo;I am confident in my ability to further assess a patient\\u0026rsquo;s suicide risk\\u0026rdquo;\\u003c/em\\u003e, Group B (80%), Group A (73.3%), Question 15 \\u003cem\\u003e\\u0026ldquo;I am confident in my ability to help find referral resources for patients with suicide risk\\u0026rdquo;\\u003c/em\\u003e, Group B (86.7%), Group A (80%), and Question 16 \\u003cem\\u003e\\u0026ldquo;I am confident that I have the skills to screen patients for suicide risk\\u0026rdquo;\\u003c/em\\u003e, Group B (80%), and Group A (73.3%).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eDISTRIBUTION OF THE RESPONSES AFTER THE SECOND SESSION\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQuestions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eResponses\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eGroup\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003cp\\u003eN (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eChi-square value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003ep value\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eGroup A\\u003c/p\\u003e \\u003cp\\u003eN (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eGroup B\\u003c/p\\u003e \\u003cp\\u003eN (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ1 Few individuals intend to self harm\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e24(80.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e28(93.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e52(86.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e2.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.13\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6(20.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2(6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e8(13.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ2 Younger population have higher risk of suicide\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e28(93.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e27(90.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e55(91.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.22\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.64\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2(6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3(10.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5(8.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ3 Suicide is more common in mental illness\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e23(76.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e26(86.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e49(81.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e1.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.32\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7(23.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4(13.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e11(18.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ4 Difficult to prevent suicide\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11(36.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14(46.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e25(41.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.62\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.43\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e19(63.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16(53.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e35(58.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ5 Discussing suicide encourages it\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9(30.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14(46.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e23(38.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e1.76\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.18\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e21(70.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16(53.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e37(61.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ6 Depression indicates suicide risk\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e25(83.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e29(96.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e54(90.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e2.96\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.08\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5(16.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1(3.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e6(10.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ7 Suicide is always unpredictable\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17(56.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e19(63.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e36(60.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.27\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.60\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13(43.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e11(36.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e24(40.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ8 All suicidal thoughts reflect a desire to die\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e20(66.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e24(80.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e44(73.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e1.36\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.24\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10(33.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6(20.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e16(26.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eQ9 Suicidal threats may be to manipulate others\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTrue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13(43.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e26(86.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e39(65.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e12.38\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFalse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17(56.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4(13.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e21(35.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ10 Received training to engage and assist those at risk\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e19(63.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e24(80.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e43(71.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e2.05\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.36\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2(6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1(3.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3(5.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9(30.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5(16.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e14(23.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ11 Skills to engage those with suicidal desire\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e21(70.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e23(76.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e44(73.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e2.09\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.35\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2(6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0(0.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2(3.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7(23.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7(23.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e14(23.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ12 Comfortable in asking direct and open ended questions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e20(66.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e20(66.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e40(66.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.39\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.82\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2(6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1(3.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3(5.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8(26.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9(30.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e17(28.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ13 Have the support to assist those with suicide intent\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e24(80.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e23(76.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e47(78.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e1.02\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0(0.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1(3.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1(1.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6(20.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6(20.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e12(20.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ14 Confidence in assessing risk\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22(73.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e24(80.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e46(76.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.40\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.82\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3(10.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2(6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5(8.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5(16.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4(13.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e9(15.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ15 Confidence in identifying referral sources for those at risk\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e24(80.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e26(86.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e50(83.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e2.08\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.35\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0(0.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1(3.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1(1.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6(20.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3(10.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e9(15.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eQ16 Confidence in screening risk.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAgree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22(73.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e24(80.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e46(76.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e1.16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0.56\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDisagree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1(3.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0(0.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1(1.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeither\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7(23.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6(20.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e13(21.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"7\\\"\\u003e*suggests p value less than 0.05\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e The stacked bar charts illustrate a consistent improvement in agreement and confidence levels across both groups over time, with Group B demonstrating slightly higher agreement percentages after the second session (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eThis study evaluated the effectiveness of integrating simulation videos into the undergraduate medical curriculum in improving the knowledge, attitudes, and confidence related to suicide risk assessment competency in a LMIC with limited mental health access and training oppurtuniites.The results suggest that simulation based learning, when given prior to didactic lecture can significantly enhance the confidence in suicide risk assessment. This finding is relevant given the underutilization of simulation in psychiatry training and the critical need for low cost effective and accessible training resources in resource constrained LMIC settings like India [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe effectiveness of teaching learning methods was evaluated in the first two domains of the Kirkpatrick model, i.e., participant reactions and learning[\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]. The reaction domain was assessed through student feedback on relevance and engagement, whereas the learning domain was evaluated via pre- and post tests to determine the effectiveness of the teaching methods in improving the competency of suicide risk assessment.\\u003c/p\\u003e \\u003cp\\u003eAt the baseline assessment, there were no statistically significant differences in the responses related to knowledge, attitudes, or confidence between Group A and Group B. This finding shows that both groups were comparable in their skills at baseline, ensuring a reliable evaluation of teaching methods despite the absence of randomization.\\u003c/p\\u003e \\u003cp\\u003eAfter the first training session, Group A showed moderate improvements in response to knowledge-based questions with didactic lectures. Group B, which received the simulation video and debriefing session, demonstrated a better improvement in knowledge, suggesting the immediate efficacy of simulation-based training for knowledge enhancement. The attitude scores also improved in both groups, with Group B exhibiting slightly better responses than Group A, although the differences were not statistically significant. The interactive and experiential nature of the simulation video with the debriefing session contributed to this change in attitudes, which is consistent with studies highlighting the positive impact of simulation on attitudes[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. Group B had better scores for confidence questions following the simulation training, reflecting its potential role in enhancing confidence in clinical settings.\\u003c/p\\u003e \\u003cp\\u003eAfter the second training session, Group A showed significant improvement in knowledge, outperforming their performance in the didactic lecture. After being exposed to simulation training in the previous session, Group B experienced a decline in knowledge scores, potentially due to a less engaging and interactive format of didactic lectures. These results highlight the importance of order in teaching learning methods, with simulation-based teaching appearing more effective when it is delivered after a didactic lecture. Both groups reported increases in confidence levels after the second session, with Group A showing greater confidence than Group B did. This aligns with the view that experiential learning further strengthened confidence after learning theoretical concepts. This finding is consistent with evidence from simulation-based education nursing professionals.[\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]\\u003c/p\\u003e \\u003cp\\u003eThis effectiveness of simulation-based training is explained by Kolb’s experiential learning theory, where active participation and reflection on one’s experiences plays a role in learning[\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e]. Also, simulation videos provide a safe environment to observe realistic scenarios and debriefing sessions that followed facilitate collaborative reflection, deeper understanding of the concepts and peer learning in a relatively stress-free environment[\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eSocial cognitive theory also supports the effectiveness of simulation in this context, as the students observe expert mental health professionals (actors in the videos) effectively conduct suicide risk assessment[\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]. This observational learning helps students not only gain new knowledge but also develop self-efficacy as the simulation videos demonstrated establishing rapport, asking sensitive questions, and responding with empathy[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe study findings highlight the importance of integrating simulation-based teaching into medical curricula. Compared with traditional lectures alone, simulation-based methods appear to enhance students' confidence and practical skills more effectively. Additionally, the study underscores the importance of conducting multiple sessions, using different teaching-learning methods to reinforce skills related to suicide risk assessment. The results also emphasize the need for thoughtful sequencing, as combining theoretical knowledge with experiential learning in a structured manner yields optimal outcomes. Simulation-based teaching could become an integral part of the regular curriculum, offering experiential learning that complements the knowledge-driven nature of traditional medical education.\\u003c/p\\u003e \\u003cp\\u003eOne of the key strengths of this study is its design, which allowed both groups to experience both teaching methods. This approach has provided the opportunity to conduct within-group comparisons without randomization. The study included 60 medical students, providing enough participants for initial comparisons between simulation-based and traditional didactic teaching methods. Although the sample is not large enough to detect subtle differences, it allowed for meaningful exploratory analysis and the identification of salient trends across knowledge, attitudes, and confidence domains. Furthermore, the study was conducted in real-world clinical teaching settings, enhancing its generalizability.\\u003c/p\\u003e \\u003cp\\u003eThe LMIC context strengthens the study’s relevance, as primary care providers in India often serve as the first line of contact for those with suicidal intent. Considering the suboptimal training in psychiatry for undergraduate medical students, a study that uses frameworks like experiential learning, reflective practice, psychological safety and collaborative meaning-making through debriefing could further enhance simulation research in LMIC settings[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThis study also emphasizes the critical relevance of scalable, low-cost educational interventions in LMICs where there is a scarcity of psychiatry training resources. The results suggest that simulation can be an effective pedagogical and public health tool in resource constrained countries. These findings have implications for medical curriculum design and mental health workforce development in LMICs.\\u003c/p\\u003e \\u003cp\\u003eHowever, this study has several limitations. Group allocation was based on preexisting sections rather than randomization, which may have introduced selection bias. The 30-minute gap between the didactic and simulation sessions was likely too short to allow participants sufficient time for cognitive processing and reflection, which may have hindered information retention and skill transfer. Another key limitation was the lack of long-term follow-up, making it difficult to assess the durability of any observed improvements or whether they translated into clinical practice over time. Finally, the content covered in the training sessions did not address emergency steps or referral pathways for high-risk patients, which were identified as gaps in current practice. Despite these limitations, the findings highlight the potential value of simulation-based teaching as a supplement to traditional methods.\\u003c/p\\u003e \"},{\"header\":\"Conclusion and future directions\",\"content\":\"\\u003cp\\u003eIntegrating simulation-based teaching into undergraduate psychiatric education, particularly in LMIC contexts, is both feasible and pedagogically sound. Simulation videos offer a practical and scalable solution to provide standardized, high-quality training to future health professionals during undergraduate medical education and potentially serve as an effective professional development program for practicing primary care health providers\\u003c/p\\u003e\\u003cp\\u003eFuture research should investigate its long-term impact, changes in behaviors and patient outcomes in clinical contexts, to inform policy and design integration to medical curriculum\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eHuman ethics and consent to Participate:\\u003c/em\\u003e\\u003c/strong\\u003e The study was conducted in accordance with the Declaration of Helsinki. Ethics approval was obtained from Institutional Ethics Committee, Sri Ramachandra Institute of Higher Education and Research (CSP-MED/24/JAN/97/10). All participants provided informed consent before participation. Participants were informed of their right to opt out at any stage without any consequences.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eConsent for publication:\\u003c/em\\u003e\\u003c/strong\\u003e Consent for publication was obtained from all participants. All data used in the study were anonymized to ensure participant confidentiality.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eClinical trial number\\u003c/em\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003e:\\u003c/strong\\u003e Not applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eAvailability of data and materials:\\u003c/em\\u003e\\u003c/strong\\u003e The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eCompeting interests:\\u003c/em\\u003e\\u003c/strong\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eFunding:\\u003c/em\\u003e\\u003c/strong\\u003e This study was supported by a fluid research grant from the MUST Enrich Psychiatry Education Research Grant, provided by Minds United for Health Sciences \\u0026amp; Humanity Trust, Mysore, with funding support from the Infosys Foundation.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eAuthors\\u0026apos; contributions:\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSJK\\u003c/strong\\u003e: Conceptualized the study, contributed to study design, conducted data analysis, and drafted the manuscript. \\u003cstrong\\u003eJBH\\u003c/strong\\u003e: Data collection, contributed to data analysis and manuscript preparation.\\u003cstrong\\u003ePR\\u003c/strong\\u003e: Contributed to study design, methodology, data interpretation, and manuscript revisions.\\u003cstrong\\u003eMJ\\u003c/strong\\u003e: Provided methodological insights, contributed to study design.\\u003cstrong\\u003eJKM\\u003c/strong\\u003e: Conceptualized the study, contributed to study design, supervised the study, and contributed to the final manuscript review. All authors read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements:\\u003c/strong\\u003e The authors would like to thank the participants for their time in this study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFinancial support:\\u003c/strong\\u003e This study was funded by the MUST Enrich Psychiatry Education Research Grant from Minds United for Health Sciences \\u0026amp; Humanity Trust, which is supported by the Infosys Foundation.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eStone DM, Crosby AE. Suicide Prevention. Am J Lifestyle Med. 2014;8(6):404\\u0026ndash;20. \\u003c/li\\u003e\\n\\u003cli\\u003eWorld Health Organization. Suicide [Internet]. 2024 [cited 2025 Feb 2]. Available from: https://www.who.int/news-room/fact-sheets/detail/suicide\\u003c/li\\u003e\\n\\u003cli\\u003eRichard O, Jollant F, Billon G, Attoe C, Vodovar D, Piot MA. Simulation training in suicide risk assessment and intervention: a systematic review and meta-analysis. Med Educ Online. 28(1):2199469. \\u003c/li\\u003e\\n\\u003cli\\u003eArya V. Suicide prevention in India. Ment Health Prev. 2024 Mar 1;33:200316. \\u003c/li\\u003e\\n\\u003cli\\u003eSchwartz-Lifshitz M, Zalsman G, Giner L, Oquendo MA. Can We Really Prevent Suicide? Curr Psychiatry Rep. 2012 Dec;14(6):624. \\u003c/li\\u003e\\n\\u003cli\\u003eLuoma JB, Martin CE, Pearson JL. Contact With Mental Health and Primary Care Providers Before Suicide: A Review of the Evidence. Am J Psychiatry. 2002 Jun 1;159(6):909\\u0026ndash;16. \\u003c/li\\u003e\\n\\u003cli\\u003eO\\u0026rsquo;Brien KHM, Fuxman S, Humm L, Tirone N, Pires WJ, Cole A, Goldstein Grumet J. Suicide risk assessment training using an online virtual patient simulation. mHealth. 2019 Aug 28;5:31. \\u003c/li\\u003e\\n\\u003cli\\u003eFekadu A, Demissie M, Birhane R, Medhin G, Bitew T, Hailemariam M, Minaye A, Habtamu K, Milkias B, Petersen I, Patel V, Cleare AJ, Mayston R, Thornicroft G, Alem A, Hanlon C, Prince M. Under detection of depression in primary care settings in low and middle-income countries: a systematic review and meta-analysis. Syst Rev. 2022 Dec;11(1):1\\u0026ndash;10. \\u003c/li\\u003e\\n\\u003cli\\u003ePattanayak RD, Sagar R. Depressive Disorders in Indian Context : A Review and Clinical Update for Physicians. J Assoc Physicians India. 2014 Sep;62(9):827\\u0026ndash;32. \\u003c/li\\u003e\\n\\u003cli\\u003eIndu PS, Anilkumar TV, Pisharody R, Russell PSS, Raju D, Sarma PS, Remadevi S, Amma KRLI, Sheelamoni A, Andrade C. Primary care Screening Questionnaire for Depression: Reliability and validity of a new four-item tool. BJPsych Open. 2017 Mar;3(2):91\\u0026ndash;5. \\u003c/li\\u003e\\n\\u003cli\\u003eLakkis NA, Mahmassani DM. Screening instruments for depression in primary care: a concise review for clinicians. Postgrad Med [Internet]. 2015 Jan 2 [cited 2025 Jan 7]; Available from: https://www.tandfonline.com/doi/abs/10.1080/00325481.2015.992721\\u003c/li\\u003e\\n\\u003cli\\u003eVaghela PV, Shah S, D DN, H SS. Knowledge, Attitude, and Practice of Nursing Staff Toward Patients Who Attempted Suicide at Tertiary Care Hospital of Central Gujarat, India. Indian J Psychol Med [Internet]. 2024 Sep 11 [cited 2025 Jan 7]; Available from: https://journals.sagepub.com/doi/10.1177/02537176241273710\\u003c/li\\u003e\\n\\u003cli\\u003eEynan R, Reiss L, Links P, Shah R, Sathyanarayana Rao TS, Parkar S, Dutt L, Kadam K, De Souza A, Shrivastava A. Suicide prevention competencies among urban Indian physicians: A needs assessment. Indian J Psychiatry. 2015 Dec;57(4):397. \\u003c/li\\u003e\\n\\u003cli\\u003eChu C, Klein KM, Buchman-Schmitt JM, Hom MA, Hagan CR, Joiner TE. Routinized Assessment of Suicide Risk in Clinical Practice: An Empirically Informed Update. J Clin Psychol. 2015 Dec;71(12):1186\\u0026ndash;200. \\u003c/li\\u003e\\n\\u003cli\\u003eRothes I, Henriques M. Health Professionals Facing Suicidal Patients: What Are Their Clinical Practices? Int J Environ Res Public Health. 2018 Jun 8;15(6):1210. \\u003c/li\\u003e\\n\\u003cli\\u003eKulkarni P, Pushpalatha K, Bhat D. Medical education in India: Past, present, and future. APIK J Intern Med. 2019 Sep;7(3):69. \\u003c/li\\u003e\\n\\u003cli\\u003eMenon J, Kantipudi SJ. Crossroads in postgraduate psychiatry training in India. Indian J Ment Health Neurosci. 2019 Jul 1;2(2):4\\u0026ndash;7. \\u003c/li\\u003e\\n\\u003cli\\u003eSAMSHA. Suicide Prevention Resource Center (SPRC) [Internet]. 2019 [cited 2025 Jan 7]. Available from: https://www.samhsa.gov/suicide-prevention-resource-center-sprc\\u003c/li\\u003e\\n\\u003cli\\u003eEppich W, Reedy G. Advancing healthcare simulation research: innovations in theory, methodology, and method. Adv Simul. 2022 Jul 27;7(1):23. \\u003c/li\\u003e\\n\\u003cli\\u003eKowalski C, Sathanandan S. The use of simulation to develop advanced communication skills relevant to psychiatry. BMJ Simul Technol Enhanc Learn. 2015 Apr 23;1(1):29. \\u003c/li\\u003e\\n\\u003cli\\u003eRichard O, Jollant F, Billon G, Attoe C, Vodovar D, Piot MA. Simulation training in suicide risk assessment and intervention: a systematic review and meta-analysis. Med Educ Online. 2023 Dec 31;28(1):2199469. \\u003c/li\\u003e\\n\\u003cli\\u003eErbuto D, Berardelli I, Sarubbi S, Rogante E, Sparagna A, Nigrelli G, Lester D, Innamorati M, Pompili M. Suicide-Related Knowledge and Attitudes among a Sample of Mental Health Professionals. Int J Environ Res Public Health. 2021 Aug 5;18(16):8296. \\u003c/li\\u003e\\n\\u003cli\\u003eSmith AR, Silva C, Covington DW, Joiner Jr. TE. An assessment of suicide-related knowledge and skills among health professionals. Health Psychol. 2014;33(2):110\\u0026ndash;9. \\u003c/li\\u003e\\n\\u003cli\\u003eIBM Corp. (2020). IBM SPSS Statistics for Windows (Version 27.0) [Computer software]. IBM Corp. \\u003c/li\\u003e\\n\\u003cli\\u003eRStudio Team. RStudio: Integrated Development Environment for R. Version 2023.06.1 Build 524. Posit Software, PBC; 2023. \\u003c/li\\u003e\\n\\u003cli\\u003eSmidt A, Balandin S, Sigafoos J, Reed VA. The Kirkpatrick model: A useful tool for evaluating training outcomes. J Intellect Dev Disabil. 2009 Sep;34(3):266\\u0026ndash;74. \\u003c/li\\u003e\\n\\u003cli\\u003eDavison J, Mackay B, McGivern MJ. The Potential of Simulation to Enhance Nursing Students\\u0026rsquo; Preparation for Suicide Risk Assessment: A Review. Open J Nurs. 2017 Feb 7;7(2):129\\u0026ndash;44. \\u003c/li\\u003e\\n\\u003cli\\u003eKolb DA. Experiential Learning: Experience as the Source of Learning and Development. FT Press; 2014. 417 p. \\u003c/li\\u003e\\n\\u003cli\\u003eRudolph JW, Simon R, Raemer DB, Eppich WJ. Debriefing as formative assessment: closing performance gaps in medical education. Acad Emerg Med Off J Soc Acad Emerg Med. 2008 Nov;15(11):1010\\u0026ndash;6. \\u003c/li\\u003e\\n\\u003cli\\u003eBandura A. Social Cognitive Theory: An Agentic Perspective. Annu Rev Psychol. 2001 Feb 1;52(Volume 52, 2001):1\\u0026ndash;26. \\u003c/li\\u003e\\n\\u003cli\\u003eCheng A, Grant V, Dieckmann P, Arora S, Robinson T, Eppich W. Faculty Development for Simulation Programs: Five Issues for the Future of Debriefing Training. Simul Healthc J Soc Simul Healthc. 2015 Aug;10(4):217\\u0026ndash;22. \\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Suicide risk assessment, Medical education, Simulation-based training, Crossover study design, Mental health training\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6186713/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6186713/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eSuicide is a major public health challenge,, particularly in low- and middle-income countries like India,where mental health training for primary care providers is limited. Simulation based training, though widely used across medical specialties, is underutilized in psychiatry. This study evaluates the effectiveness of integrating simulation videos for suicide risk assessment into the undergraduate medical student competency based curriculum in India.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eThis is a quasi-experimental study with a crossover design involving 60 Phase 2 MBBS students from Sri Ramachandra Medical College, Chennai. A self-report questionnaire assessing knowledge, attitudes, and confidence regarding suicide risk assessment was administered before and after the training sessions. All the participants received didactic lectures and simulated based sessions in varying sequence.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eAt baseline, there were no significant differences between the groups. Both groups showed significant improvement, with greater confidence gains in students exposed to simulation first..Simulation based training using recorded videos demonstrated pedagogical utility in low resource educational settings.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eIntegrating simulation videos into the undergraduate medical curriculum is both feasible and potentially effective way in enhancing students' competency in suicide risk assessment. This approach provides a practical, low-resource solution for improving training in suicide prevention, particularly in settings with limited access to specialized mental health education. Future work should evaluate long term retention of knowledge, behavioural and patient outcomes in real world clinical settings.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Effectiveness of Simulation-Based Suicide Risk Assessment Training Among Undergraduate Medical Students in India\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-05-08 14:49:08\",\"doi\":\"10.21203/rs.3.rs-6186713/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"7a443874-d729-4492-8dae-7f291866cc16\",\"owner\":[],\"postedDate\":\"May 8th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-11-04T13:54:04+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-05-08 14:49:08\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6186713\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6186713\",\"identity\":\"rs-6186713\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}