Suicide can’t be predicted by asking about suicidal thoughts

Perhaps the most important study of the week, from a psychological perspective, is one that may upend most current training in dealing with suicide.

Most people who die by suicide deny having suicidal thoughts when asked by doctors in the weeks and months leading up to their death. This is the astonishing conclusion of the new study  published in the journal BJPsych Open. 

The review of data from 70 major studies of suicidal thoughts shows that only 1.7% of people with suicidal ideas died by suicide. On the other hand, about 60% of people who died by suicide had denied having suicidal thoughts when asked by a psychiatrist or GP.

What the researchers say: “We know that suicide ideas are pretty common, and that suicide is actually a rare event, even among people with severe mental illness,” said the lead researcher. “But what we didn’t know was how frequently people who go onto suicide have denied having suicidal thoughts.”

The study showed that 80% of patients who were not undergoing psychiatric treatment and who died of suicide reported not to have suicidal thoughts when asked by a GP. 

Clinicians should not assume that patients experiencing mental distress without reporting suicidal ideas were not at elevated risk of suicide they conclude. Asking about suicidal thoughts was a central skill for health professionals but clinicians should be not be persuaded into false confidence generated by a lack of such thoughts.

“Doctors sometimes rely on what is known as suicidal ideation—being preoccupied with thoughts and planning suicide—as a crucial test for short-term suicide risk, and it has been argued it could form part of a screening test for suicide,” said the study’s lead author. “Our results show that this is not in the best interests of patients.

“Some people will try to hide their suicidal feelings from their doctor, either out of shame or because they don’t want to be stopped. We also know that suicidal feelings can fluctuate rapidly, and people may suicide very impulsively.”

The main message said the researchers was that clinicians should give less weight to suicidal ideation than had been the case. “It means clinicians need to better understand the patient’s distress rather than just ask them about ideation.”

So, what?There are so many assumptions about depression and other mood disorders and suicide that have been disproved over the last few years—many reported in TR(browse past stories here). What we are finding out is how much we don’t know.

What’s becoming clear is that suicide is neurogenetically different to, and yet in some way connected with, a range of mood disorders. Further, suicide is often a statement about life not necessarily a desire for death. It is perhaps to a large extent about the fact that our workplaces, our society and our families are diverging more and more away from how we were designed to work and live creating intolerable stress.

Interestingly those of us who have studied hunter-gatherer societies (I spent a year with an H-G band) have seldom recorded any instance of either major depressive disorder or suicide among them, and most examples noted have been in H-G bands who have had regular contact with so-called “advanced” cultures.