Is suicide assessment harmful to participants? Findings from a randomized controlled trial

Abstract

There is considerable debate on whether suicide assessment carries an iatrogenic risk for participants/patients. A double-blind randomized controlled trial (registration: R000022314) tested the emotional impact of suicide assessment on participants (n = 259) randomly assigned to experimental (n = 122) or control conditions (n = 137). The experimental condition included the Suicidal Affect-Behavior-Cognition Scale and intensive death-related questions, the control condition a quality of life scale. Both included measures of depression, social support and loneliness. Affective states were assessed immediately before and after testing, and research biases minimized. Post-test debriefing interviews collected qualitative reactions. Experimental participants ranged from nonsuicidal to highly suicidal. Between-groups ANCOVAs and repeated measures ANOVAs showed no differences by study condition, and no pre-post-test affect changes for either condition or suicidal participants (P > 0.10), supporting the null hypothesis of no iatrogenic effects. However, depressive participants in both conditions showed significant decreases in positive affect (P < 0.05). Smallest real difference (SRD) scores approximated clinically meaningful differences and showed 20% of participants had a significant positive survey reaction, 24% a negative reaction, with the rest neutral. Linear regressions revealed depressive symptoms and perceived family support, but not suicidality or other factors, predicted negative affect changes, which was supported by qualitative findings. Social desirability bias was also found in qualitative survey responses. No evidence of iatrogenic effects of suicide assessment were found. Recommendations are made to counter possible negative assessment effects on depressive participants/patients, and nurses and other caregivers are encouraged to talk to patients about suicidal symptoms.

Assessing Suicide Risk and Emotional Distress in Chinese Social Media: A Text Mining and Machine Learning Study

“…However, distressed or suicidal people often have low motivation to seek help from professionals [10-12]. In addition, a recent study found that taking a suicide assessment may lead to negative affect changes on individuals with depressive symptoms [13]. From the suicide prevention point of view, a tool that can assess one’s suicide risk and emotional distress in a natural setting without costing his or her efforts and attention is preferable and can increase the opportunities for early identification and intervention.…”

Examining the Unanticipated Adverse Consequences of Youth Suicide Prevention Strategies: A Literature Review with Recommendations for Prevention Programs

“…The authors suggest having safeguards in place to accommodate any youth who find the screening distressing (Robinson et al., ). Several other studies have examined the possibilities of iatrogenic effects as a result of screening programs and have not found evidence of such effects (Ballard et al., ; Crawford et al., ; Gould et al., ; Harris & Goh, ; Mathias et al., ). One study in particular found that the high‐risk students exposed to suicide screening actually appeared to be less distressed and suicidal than high‐risk students who were not exposed to the screening (Gould et al., ).…”

“…It is important to recognize the variability in methodological rigor and evaluation approach represented in the studies reviewed. For example, Eggert and Eggert (2009) suggested that some of the problems with the implementation of the Hallfors et al (2006) study were attributable to a lack of readiness of the program and lack of preparation by the school, district, and administration. Additionally, the Shaffer et al (1990Shaffer et al ( , 1991 studies found possible negative effects of early-generation awareness programs among at-risk youth.…”

“…Although not a replicated finding, there also is evidence suggesting the possibility that in some settings, there is a potential for adults involved in suicide prevention activities to be negatively affected themselves (e.g., with increased suicide ideation; Sareen et al, 2013). A potential for adverse consequences also exists when youth are identified as at risk through suicide prevention activities, but there are insufficient resources for supporting these youths or addressing this risk (Hallfors et al, 2006).…”

“…Studies of screening programs found such interventions can increase the burden or perceived burden on referral systems by causing increases in referrals beyond the capacity of the system when adequate procedures have not been put in place for handling referral increases due to positive screens (Robinson et al, 2011). As part of a broader indicated prevention program for at-risk youth, a screening program in high schools within two school districts was discontinued because of the overburden on school personnel when 29% of youth identified as high risk were found to be at presumed risk of suicide and it became infeasible to follow up with each identified youth (Hallfors et al, 2006).…”