Suicidal thoughts can fluctuate rapidly.
Most people who die by suicide do not tell doctors they have suicidal thoughts in the weeks before their death, research finds.
The finding upends the common belief that asking about suicidal thoughts is a useful way of assessing the risk of suicide.
The study found that 60 percent of people under psychiatric care who later took their own lives told a psychiatrist they did not have suicidal thoughts.
Suicidal people may hide their thoughts out of shame or perhaps the fear of being stopped.
Suicide is a relatively rare event, though, said Professor Matthew Large, study co-author:
“We know that suicide ideas are pretty common and that suicide is actually a rare event, even among people with severe mental illness.
But what we didn’t know was how frequently people who go on to suicide have denied having suicidal thoughts when asked directly.”
The new research is a meta-analysis, a way of bringing together the results of many other studies — in this case 70.
The results showed that just 1.7 percent of people with suicidal ideas went on to take their own lives.
Among people who were not under psychiatric care, 80 percent of people who ended their own life denied having suicidal thoughts to a physician.
Dr Catherine McHugh, the study’s first author, said:
“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.
Our results show that this is not in the best interests of patients.”
Dr McHugh says suicidal thoughts can fluctuate rapidly:
“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 after only a short period of suicidal thoughts.”
Instead of relying on suicidal ideation, clinicians should focus on distress, said Professor Large:
“It means trying to better understand the patient’s distress and not making patients wait weeks for treatment or denying treatment in the absence of suicidal thoughts.”
The study was published in the journal BJPsych Open (McHugh et al., 2019).
