Meta-Analysis Finds Asking About Suicidal Thoughts Does Not Predict Suicide

A recent meta-analysis finds that the association between reported suicidal ideation and later suicide is low.

Zenobia Morrill
8
1338

New data from a meta-analysis published in BJPsych Open found that the presence or absence of suicide-related thoughts or expressions of suicidal ideation does not predict later suicide. A team of researchers in Australia, led by Catherine M. McHugh, assessed the strength of this association by synthesizing the findings across 70 relevant empirical studies.

These findings provide insight into the common practice of asking about suicidal ideation and thoughts to predict whether or not one will later complete suicide. McHugh and team highlight that common practice hinges upon the ability to assess suicide risk based on suicidal ideation screenings accurately:

“Clinicians sometimes rely on suicidal ideation as a crucial test for short-term suicide risk, and it has been argued that asking about suicidal ideation could form part of a screening test for later suicide.”

Health professionals are expected to conduct careful assessment and risk planning when service-users present with suicidal ideation. Suicidal ideation is defined differently within the research literature. Some studies consider it to include the presence of both suicide-related thoughts and behaviors. Others consider suicidal ideation to include suicidal plans or an expression of one’s wish to die.

In this meta-analysis, all definitions of suicidal ideation were included. Data were reviewed across 70 studies that examine suicidal thoughts. Results found that 60% of people who have died by suicide did not express suicidal ideation when asked at a specific time beforehand. A subgroup analysis that examined the association between suicidal ideation and later suicide in a non-psychiatric setting found that 80% of people did not express suicidal ideation when questioned by the general practitioner.

Moreover, the study suggests that although it may seem that further questioning about suicidal ideation would elicit more information to facilitate accuracy in assessment, it is also associated with a higher false positive rate. In other words, detailed questioning increases the likelihood of inaccurately assessing people as at-risk for suicide when that is not the case.

The authors summarize their findings:

“Our study suggests that suicidal ideation is not sensitive enough to be very helpful as a stand-alone screening test for suicide in psychiatric or non-psychiatric settings.”

 

****

McHugh, C. M., Corderoy, A., Ryan, C. J., Hickie, I. B., & Large, M. M. (2019). Association between suicidal ideation and suicide: meta-analyses of odds ratios, sensitivity, specificity and positive predictive value. BJPsych open5(2). (Link) 

8 COMMENTS

  1. Today’s doctors believe that if you might have had a suicidal thought 30 years ago, that means you’re in immediate danger of suicide, and have a “lifelong, incurable, genetic,” invalid, and made up “mental illness.” Yes, asking that question does result in false positives. But this is really good for business for the satanic ‘mental health’ gas lighters.

  2. As the first set of automatic doors opened and slowly closed, I realized my children, husband, friends, and family were no longer available to me. When the second set of locked doors clicked shut, my freedom of movement and privacy left. As the third set of doors slammed behind me, dignity, respect, and even intelligence were stripped from me. Read more https://www.goodtherapy.org/blog/five-lessons-i-learned-from-visiting-er-with-suicidal-ideation-0920137

    I searched Google “what happens if you say your suicidal” and the above was first page results.

    These Meta-analysis will always be wrong cause people know after the first time to deny feeling suicidal cause of what happens when they do.

    I think the problem is if you were treated nicely many people would say they are suicidal when they are not.

    • Your final sentence packs a powerful punch. I said I was suicidal when I wasn’t. Why? People quit treating me so horribly–as they had since the quack told friends and family I was hopeless.

      Without psychiatry I never would have done this to start with since I was viewed as a human being before.

  3. “Moreover, the study suggests that although it may seem that further questioning about suicidal ideation would elicit more information to facilitate accuracy in assessment, it is also associated with a higher false positive rate. In other words, detailed questioning increases the likelihood of inaccurately assessing people as at-risk for suicide when that is not the case.”

    “Clinicians sometimes rely on suicidal ideation as a crucial test for short-term suicide risk, and it has been argued that asking about suicidal ideation could form part of a screening test for later suicide.”

    I think these paragraphs highlight the real problem with this kind of questioning. The clinician is “assessing” or “screening” or “testing” for “short-term suicide risk.” They aren’t having a real conversation with the client – there is nothing here about establishing rapport, about finding out what is going on in this person’s life, about exploring why the client would feel that ending his/her life was a good or necessary idea. It is no small wonder that their clients/patients aren’t willing to share the truth with them. Would you tell someone whom you knew was “assessing” you that you were considering suicide, when that their “assessment” could get you locked up if it went the wrong way?

    There is nothing wrong with asking someone if they’re thinking about suicide, IF you have a sufficiently trusting relationship and have the clear intent of listening and helping rather than “evaluating” the person you’re talking to from some elevated pseudo-“objective” viewpoint. The problem isn’t the question, it’s the intent of the person asking it that causes the difficulty.

  4. Suicide is the last resort “emotional pain reliever” so maybe it would be better to ask them to describe their feelings and how intense they are and how they usually deal with them as they come and go. That might lead to a discussion of what happened to them in the past that is causing their pain. Most doctors wouldn’t have time for that, but maybe they need to decide if they really want to help people or not.

    • Exactly. If they don’t have time to do that kind of work, they should not be pretending they are in a position to help. They should be honest and admit they are not qualified to help, and refer the person to someone who has the inclination and the skills to be a patient listener and an interested friend in time of need.

  5. They should also check whether the person is rational and wants to be “saved”. If the person is rational and doesn’t want to be saved, no coercion should be exercised. I think forcing a person to exist is unethical.
    The other question is whether the psychiatrist would want to suicide if they were in the position of the suicidal patient. Treating a patient worse (limiting their freedom) than you would like to be treated in the patient’s position is unethical, too.