Importance: Suicide is a leading cause of preventable death. As a precursor to suicide attempts, disclosure of suicidal ideation provides opportunity for intervention and prevention. Objective: Meta-analyse available studies and estimate the prevalence of disclosure of suicidal ideation to others, and to whom people disclose. Data Sources: Multiple databases were searched for studies in English up to April 1st, 2022) using key word terms of ‘SUICID*’ AND ‘DISCLOS* OR NON-DISCLOSURE OR CONFESS* OR TALK* OR SHAR*’. Bibliographies were hand searched. Study Selection: Studies were included that reported a sample of people who had experienced suicidal thoughts or behaviours (including suicide decedents) and an indicator of whether they had disclosed this. Data Extraction and Synthesis: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines1. Two reviewers independently extracted data. Quality was assessed using the Joanna Briggs Institute Systematic Screening and Research Synthesis Checklist2. Data were pooled using random-effects models. Main Outcome(s) and Measure(s): The pre-registered main outcome was the proportion of people who disclosed suicidal ideation or behaviour to others. The proportion of disclosures to specific subgroups of confidants was also analysed. Results: Ninety-eight studies (N participants = 834,952) were included in analyses. Less than half of people disclosed suicidal ideation or behaviour: 46.3% (95%CI 42-50.7%, PI 10.9-84%; k=91). High heterogeneity, common to prevalence studies, was found (Q[90] = 113426, p < .001; I2 = 99.9%). No publication bias was detected, and removing outliers did not affect this finding, but did produce smaller prediction intervals: 46.3% (95%CI 44-48.5%, PI 36.1-56.6%; k = 35). There was evidence that higher prevalence of psychiatric disorder in samples, female gender, and longer timeframe for disclosure were related to a higher prevalence of disclosure, while people who died by suicide disclosed less often relative to community samples. Disclosure, and proportions of disclosures, to family members, was numerically higher than to friends or health professionals, but could not be directly compared. Conclusions and Relevance: Between 50 and 60% of people do not disclose their suicidal ideation to other people. The suicidal thoughts and behaviours of many people remain unidentified and likely untreated.
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