Ask someone close to you who seems off, directly, “Have you thought about suicide?” Asking does not make them think about it more

Cost

Free. Ask one question, then spend some time listening. The hard part is starting; many people fear that asking will plant the idea.

What you get

2342 students at 6 high schools in New York State were randomized by class into two groups. One group's questionnaire included a question about suicide and the other's did not. Right after the questionnaire and 2 days later, distress did not differ between the groups (P = .66 and P = .41; a P above 0.05 means no difference was seen). Among those who said 2 days later that they had thought about suicide, it was 4.7% in the group asked and 3.9% in the group not asked, no difference seen (P = .49). Students who had depressive symptoms to begin with were actually less distressed after being asked (P = .01). Students who had previously attempted suicide actually had fewer suicidal thoughts after being asked (P = .02). A 2022 meta-analysis reviewed 17 studies and pooled 8 of them that compared “asked” with “not asked.” After being asked, suicidal thoughts and behaviors, non-suicidal self-harm and psychological distress, both right then and later, did not increase significantly. The firmest evidence is 8 randomized controlled trials with low or unclear risk of bias. Another literature review in 2014 also stated that no study found a significant increase in suicidal thoughts after asking.

Notes

Why grade B: these studies show only that asking does no harm; no study has calculated how many suicide deaths asking prevents. The size of benefit is set at small for the same reason: there is no death-rate figure, only the substitute end point of “thoughts did not increase.” The way of asking in the research was mostly questionnaires and research interviews, not a family member or friend asking face to face, so carrying it over to asking in person is an inference. If it comes out that they have indeed thought about it, don't walk away; stay with them, call 12356 (China's national mental-health hotline) together, and move medicine and pesticide out of reach; see §1.25 (call 12356 when you have suicidal thoughts). If they say they will take others with them, or have already prepared a means, close relatives can take them straight to a doctor, or report to 110; see §8.15 (close relatives can take them directly for medical treatment). The time from a thought appearing to acting is often only a few dozen minutes; see §1.32 (when a suicidal thought comes up, tell one person near you first). The beneficiary is mainly spouses and immediate family, and you can ask friends and colleagues in the same way.

Evidence grade

B : Supported by research but without a precise number, or based on small or single studies.

Sources

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. https://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. https://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. https://doi.org/10.1017/S0033291714001299

Translated from the Chinese original. Original book, section 1, tip 43. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer