Ask someone close to you who seems off, directly: “Have you thought about suicide?” Asking does not make the thoughts stronger

The worry that mentioning suicide plants the thought has not shown up in research. When suicide questions were added to a questionnaire for high-school students, those asked did not feel worse, and no more of them reported thinking about suicide. Students who were already depressed felt less distressed after being asked, and students who had attempted suicide before were less likely to report suicidal thoughts.

Cost

Free. One sentence, then some time to listen. The hard part is getting the words out: many people fear that asking will put the idea into someone’s head.

Benefit

In New York State, 2,342 students in 6 high schools were randomly assigned by class to two groups. One group’s questionnaire included suicide questions; the other group’s did not. Distress did not differ between the groups right after completion or 2 days later (P = 0.66 and P = 0.41; a P above 0.05 means no detectable difference). Among those who reported suicidal thoughts at 2 days, 4.7% were in the asked group and 3.9% in the not-asked group, with no detectable difference (P = 0.49). Students with depressive symptoms were less distressed after being asked (P = 0.01). Students with a previous suicide attempt were less likely to have suicidal thoughts after being asked (P = 0.02). A 2022 meta-analysis assessed 17 studies and pooled 8 comparisons of “asked” versus “not asked”. After being asked, neither immediately nor later were suicidal thoughts and behaviors, non-suicidal self-harm, or psychological distress significantly increased. The strongest evidence is 8 randomized controlled trials, with low or unclear risk of bias. A 2014 literature review also states that no study found a significant increase in suicidal thoughts after asking

Notes

Grade B because these studies only show that asking does no harm; none calculated how many suicide deaths asking prevents. The benefit is rated small for the same reason: there is no mortality figure, only the substitute endpoint “thoughts did not increase”. The studies mostly asked through questionnaires and research interviews, not family or friends asking face to face, so carrying the result over to face-to-face asking is an inference. If it turns out they have thought about it, do not walk away: stay with them, call 12356 together, and move medicines and pesticides out of reach; see item 25 in this section (call 12356 when having suicidal thoughts). If they say they will take others with them, or have already prepared the means, close relatives may take them straight to a hospital, or call 110; see item 15 in Section 8 (close relatives may take someone directly for medical care). From the thought appearing to acting often takes only a few dozen minutes; see item 32 in this section (tell one person nearby as soon as suicidal thoughts arise). The beneficiaries are mainly spouse and direct relatives; asking friends and colleagues works the same way.

Sources · 3

1. Gould MS, Marrocco FA, Kleinman M, Thomas JG, Mostkoff K, Cote J, Davies M (2005). Evaluating iatrogenic risk of youth suicide screening programs: a randomized controlled trial. JAMA, 293(13), 1635-1643. doi.org/10.1001/jama.293.13.1635
2. Polihronis C, Cloutier P, Kaur J, Skinner R, Cappelli M (2022). What's the harm in asking? A systematic review and meta-analysis on the risks of asking about suicide-related behaviors and self-harm with quality appraisal. Archives of Suicide Research, 26(2), 325-347. doi.org/10.1080/13811118.2020.1793857
3. Dazzi T, Gribble R, Wessely S, Fear NT (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16), 3361-3363. doi.org/10.1017/S0033291714001299