Research & Theory

The QPR Theory

To: Colleagues, grant writers, and those interested in QPR

From: Paul Quinnett, Ph.D.


Over the summer of 2006 I wrote, rewrote (many times), and revised the theory and supporting evidence for the QPR approach to suicide prevention. Since the initial manuscript was drafted, new data arrived monthly via the internet as well as a variety of journal publications. With the constant updates and edits, the manuscript has become a work-in-progress. The manuscript has also become too long for a journal publication. The draft manuscript has been submitted to several members of the American Association of Suicidology, as well as members of the International Association of Suicidology for peer review, and I wish to thank all those who have contributed their time, ideas and observations to this paper. As Dr. Mort Silverman observed, "This should be in a book."


But a book is a long term horizon. Suicide prevention is now.


Every author reluctantly "finishes" his or her manuscript. Montague, James Joyce, and many others rewrote and republished major works to reflect their later thinking and ideas.


In the age of the internet and the instantaneous exchange of human knowledge, this is no longer necessary; what we write today, we can (and sometimes must) revise tomorrow.


Therefore, I have elected to publish the QPR theory paper here on our website where, as new data arrives, the paper can be updated and modified accordingly. Publishing the paper here will make it available to readers, researchers, and grant writers everywhere now, not months or years from now.


This document will evolve over time. Each time a significant or substantive alteration is made, notification will be dated and the copyright date will be changed accordingly.


We at the QPR Institute look forward to collaborating with all researchers and invite every independent evaluator or reviewer who wishes to submit data for review or inclusion in this paper to do so. In a word, QPR will adapt and change according to the best scientific input we can find: supportive, challenging, or critical.


Please feel free to cite this article as an independent online publication of the QPR Institute with the following copyright notice: © Paul Quinnett, 2013, QPR Institute.


The QPR Theory Paper

The Research

Program adopters must often justify their decision to use one program over another by the application of due diligence in exploring the scientific basis that supports the proposed training.

Below is a brief summary of major studies that support the QPR Gatekeeper Training for Suicide Prevention program.


97% of participants rated QPR "Above Average" or "Outstanding"
92% of health care professionals found QPR relevant to their work
  • QPR meets the requirements for listing in the National Registry of Evidence-based Practices and Policies (NREPP). Detailed review at NREPP listing
  • An optional version of QPR training also includes a developer-approved, abridged module of the best practice registered CALM training program (Counseling on Access to Lethal Means). Detailed CALM review at SPRC.ORG listing


Official QPR training outcomes as determined by independent research reviewers of published studies for National Registry of Evidence-based Practice and Policies found that trained gatekeepers have increased knowledge, confidence and gatekeeper skills per these measures:

  • Increased declarative knowledge
  • Increased perceived knowledge
  • Increased self-efficacy
  • Increased diffusion of Gatekeeper training information
  • Increased Gatekeeper skills (ability to engage in active listening, ask clarifying questions, make an appropriate referral)


Findings reported an immediate increase in declarative knowledge, perceived knowledge, self-efficacy, diffusion of gatekeeper training information and gatekeeper skills. Results persisted in the 3-month and 1-year follow up with marginal decrements.


Cross, W.F., Seaburn, D., Gibbs, D., Schmeelk-Cone, K. et al. (2011);
Matthieu, M.M., Cross, W., Batres. A.R., Flora et al. (2008);
Wyman, P.A., Brown, C.H. Inman, J., Cross W., et al (2008).

See NREPP website for full descriptions of support research and citations.


Three randomized studies conducted in school, outpatient and workplace settings examined the impact of the Question, Persuade, Refer (QPR) training on stratified samples of (1) 340 teachers and parents in a US public school community and (2) 602 community based counseling center staff from the US Department of Veteran Affairs. One study included a 1-year average follow-up assessment and a second study included a 3-month follow-up assessment.