Asking Teens About Suicidal Feelings Can Be Helpful, Not Harmful

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 News.

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 students.

Gould and her colleagues also asked students during the second survey to indicate whether they felt depressed or suicidal since taking the first survey.

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 themselves.

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>.▪

JAMA 2005 293 1635