How Common is Recent Denial of Suicidal Ideation among Ideators, Attempters, and Suicide Decedents? A Literature Review

Six strategies to help reluctant patients to disclose their suicidal thoughts.

“…The format that psychotherapists use to ask the questions about suicide may influence the response received. Respondents may disclose sensitive behaviors in response to a written question, but deny them in a personal interview (Obegi, 2021). For example, Gao et al (2015) found that patients disclosed a higher frequency and intensity of suicidal thoughts on a self-report questionnaire than in a personal interview.…”

Hazards of Using Constant Observation With Suicidal Patients

“…Merely noting “No SI” or “Denied SI” is never adequate 44. Patients who harbor suicidal thoughts commonly deny them,45 so clinicians should always receive denials with extreme skepticism when no confirming behavioral data exist 46. A clinician might justify ending constant observation in the following way: The patient’s acute risk of suicide has decreased sufficiently that I decided to discontinue constant observation today.…”

Practical Advice for Primary Care Clinicians on the Safe and Effective Use of Vortioxetine for Patients with Major Depressive Disorder (MDD)

“…Suicidal ideation and behavior is implicated in several neuropsychiatric disorders, including borderline personality disorder, schizophrenia, and BPD. 17 , 18 Suicide risk is an important consideration for patients with MDD who initiate treatment with antidepressants, as antidepressants as a class have been associated with an increased risk of suicidal thoughts and behaviors in certain age groups. 19 As an example, when given to individuals with BPD as monotherapy, antidepressants can precipitate an unintended response, such as no response, poor response, or antidepressant misadventure, which can precipitate hypomania and mania, subsequently leading to worsening of disease and heightened suicide risk.…”

“… 22 Thus, suicide screening is important for all patients receiving treatment with antidepressant therapy, and assessment of suicidal ideation and behaviors should be a routine part of treatment monitoring. 4 , 18 Of note, denial of suicidal ideation would appear to be more common than previously acknowledged, thus presenting a formidable challenge for clinicians, since denial, by itself, is an inadequate indicator of suicide risk. 18 The USPSTF is currently updating its recommendations on screening patients for suicide.…”

“… 4 , 18 Of note, denial of suicidal ideation would appear to be more common than previously acknowledged, thus presenting a formidable challenge for clinicians, since denial, by itself, is an inadequate indicator of suicide risk. 18 The USPSTF is currently updating its recommendations on screening patients for suicide. 23 In terms of timing and frequency of assessment, it is considered ideal for PCCs to have 3 contacts with the patient within 12 weeks after the initial identification of a depressed patient, though visit frequency must be optimized based on individual patient needs.…”