Asking teens questions about suicide does not prompt suicidal thoughts or
behavior in those who aren't suicidal.
Though this would seem like a foregone conclusion to many, it's a myth that
has stubbornly persisted among some school administrators and even mental
health professionals for years, according to Madelyn Gould, Ph.D., M.P.H., the
lead author on an article debunking this argument.
"Neither suicidality nor distress increased among students asked
about suicidal ideation or behavior," Gould told Psychiatric
Gould is a professor of clinical epidemiology in psychiatry at Columbia
University College of Physicians and Surgeons and a research scientist at the
New York State Psychiatric Institute. The article appeared in the April 6
Journal of the American Medical Association.
Between fall 2002 and spring 2004, Gould randomized 2,342 high school
students into two groups. The students attended six high schools in three
counties in New York state.
One group of 1,172 students completed a mental health screening survey that
included questions about suicidal ideation and suicide-attempt history, and
the other group of 1,170 students received the same survey except that it
excluded all suicide-related questions.
Two days later, both groups received a second mental health screening
survey that included questions about suicidal ideation as measured by the
Suicidal Ideation Questionnaire, which was embedded in the survey.
Both surveys incorporated a series of rating scales, including the Beck
Depression Inventory (BDI), which measured depressive symptoms, and the Drug
Use Screening Inventory, which assessed drug and alcohol problems in the
Gould and her colleagues also asked students during the second survey to
indicate whether they felt depressed or suicidal since taking the first
In both groups of students, Gould measured distress levels in students
using the Profile of Mood States at the beginning and end of the first survey
in both groups and before the second survey as well.
When she analyzed mean scores on the Suicidal Ideation Questionnaire as
part of the second survey, Gould found that levels of suicidality were no
different in the group that had been screened for suicide in the first survey
(6.5) than in the students who had not been screened for suicide (6.6).
That questionnaire uses scale ranges from 0 to 90, with 90 denoting
imminent suicide risk.
Distress levels as measured by mean scores on the Profile of Mood States,
which ranged from -12 to 60, were not significantly higher in students who had
been previously asked about suicide (5.5) than in those who weren't (5.1).
Among students in the group that answered questions about suicide in the
first survey, 4.7 percent said they had experienced some level of suicidal
ideation since completing the survey, and 3.9 percent of students who had not
been exposed to the suicide questions indicated feeling suicidal since the
completion of the first survey—a statistically insignificant difference,
according to Gould.
When Gould looked at the 544 students with elevated levels of depressive
symptoms as measured by the BDI, she found that being exposed to
suicide-related questions in the first survey did not exacerbate distress or
suicidal ideation among depressed students.
In fact, she found that fewer depressed students who had been exposed to
the suicide questions had expressed suicidal ideation (18.9 percent) than
those who had not seen those questions (23.8 percent).
"We believe that asking about suicidal ideation or behavior may have
been beneficial for students with depressive symptoms," Gould noted."
It may have been a relief to be asked about suicidal thoughts,"
she said, because in many circumstances students may be afraid or otherwise
hesitant to tell others.
"I hope that the findings we present here will encourage more schools
to implement depression and suicide screening programs," she said, and"
convince more clinicians to ask their young patients about
suicide" without fearing that such questions will upset
students—or even worse—cause them to consider suicide
An abstract of "Evaluating Iatrogenic Risk of Youth Suicide
Screening Programs" is posted online at<http://jama.ama-assn.org/cgi/content/abstract/293/13/1635>.▪