Knowledge, attitudes, and self-efficacy on suicide prevention gatekeeper training in a sample of young Malaysian adults

Gatekeeper training programs have emerged as evidence-based suicide prevention interventions, but limited research exists within Malaysian contexts. This study assessed the effectiveness of Advanced C.A.R.E. gatekeeper training in improving knowledge, attitudes, and self-efficacy related to suicide prevention among young adults in Miri, Sarawak. A single-arm pre-post study design was employed with 138 young adults (n = 138) aged 18–25 years from educational institutions in Miri, Sarawak. The Advanced C.A.R.E. training program was delivered in 4-h sessions over two separate workshop days. Primary outcomes were measured using the Advanced C.A.R.E. Questionnaire (AdCARE-Q) and Stigma of Suicide Scale (SOSS). Participants showed significant improvements in suicide prevention knowledge (β = 4.78, 95% CI: 4.26–5.29, p < 0.001) and self-efficacy (β = 2.43, 95% CI: 1.61–3.24, p < 0.001). Stigmatizing attitudes toward suicide showed significant reduction (β = − 0.12, 95% CI: − 0.22 to − 0.02, p = 0.024). Attribution of suicide to isolation and depression increased significantly (β = 0.20, 95% CI: 0.10–0.30, p < 0.001), indicating improved recognition of psychological risk factors, a positive educational outcome, while no significant change was observed for glorification/normalization attitudes (β = − 0.03, 95% CI: − 0.13–0.08, p = 0.605). The training was highly rated by participants (median importance score 4.0/5.0). Limitations include the single-arm design precluding causal inference and reliance on self-report measures without behavioral outcome assessment. These findings support the implementation of culturally appropriate gatekeeper training programs as effective suicide prevention strategies in Malaysian educational settings, with demonstrated effectiveness across diverse ethnic and religious groups.