Many people who die by suicide denied having suicidal thoughts when asked directly by doctors in the months leading up to their deaths, according to a new meta-analysis at the University of New South Wales (UNSW) in Australia.
The findings, published in the journal BJPsych Open, question the widely held belief that suicide can be predicted by psychiatrists and clinicians via a patient-risk assessment, especially in the short-term.
For the analysis, the researchers reviewed data from 70 major studies of suicidal thoughts and found that, as a stand-alone test, only 1.7 percent of people with suicidal ideas died by suicide. Also, around 60 percent of those who died by suicide had denied having suicidal thoughts when asked by a psychiatrist or general practitioner (GP).
“We know that suicide ideas are pretty common and that suicide is actually a rare event, even among people with severe mental illness,” said Professor Matthew Large from UNSW’s School of Psychiatry and international expert on suicide risk assessment.
“But what we didn’t know was how frequently people who go on to suicide have denied having suicidal thoughts when asked directly.”
The findings show that 80 percent of patients who were not receiving psychiatric treatment and who died of suicide reported not having suicidal thoughts when asked by a GP.
“This study proves we can no longer ration psychiatric care based on the presence of suicidal thoughts alone. Hospital and community care teams in Australia are extremely under-resourced, and this needs to change,” said Large.
“We need to provide high-quality, patient-centered care for everyone experiencing mental illness, whether or not they reveal they are experiencing suicidal thoughts.”
Large said that clinicians should not assume that mentally distressed patients who don’t report suicidal thoughts are not at greater risk of suicide. Asking about suicidal thoughts was a central skill for health professionals, he said, but clinicians should be not be persuaded into false confidence due to a lack of ideation.
“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, training psychiatrist Dr. Catherine McHugh. “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 after only a short period of suicidal thoughts.”
The main message, said Large, is that clinicians should give less weight to suicidal ideation than before. “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.”
Large also emphasizes an important message for people bereaved of a loved one after a suicide. “Even if they knew their relative was suicidal, the risk of death was low. And it was not their fault if they did not know someone was suicidal.”
Source: University of New South Wales