Past Levels of Mental Health Intervention and Current Nondisclosure of Suicide Risk Among Men Older Than Age 50

Abstract

Suicide risk screening depends heavily on accurate patient self-report. However, past negative experiences with mental health care may contribute to intentional nondisclosure of suicide risk during screening. This study investigated among 282 men older than age 50 whether likelihood for current explicit risk nondisclosure was associated with previous highest level of mental health care received. This sample was selected post hoc out of a larger sample of participants from higher risk and lower help-seeking populations (i.e., military service members and veterans, men older than age 50, and lesbian gay bisexual, transgender, and queer young adults), however, the other groups were underpowered for analysis. Among these men, history of psychiatric hospitalization was significantly associated with likelihood for explicit nondisclosure of current suicide risk, while history of receiving only outpatient therapy for suicidal thoughts or behaviors was significantly associated with likelihood for full reporting of suicide risk. Severity of suicidal ideation and internalized stigma against mental illness were significant indirect contributors to the effect. Although causality could not be determined, results suggest that a potential cost to consider for psychiatric hospitalization may be future nondisclosure of suicide risk. Conversely, outpatient interventions that appropriately manage suicidal thoughts or behaviors may encourage future full reporting of suicide risk and improve screening detection.

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

“…Some patients may withhold information about their suicidal thoughts because they fear "punishment" or other adverse consequences (such as involuntarily hospitalization, forced medication, loss of privacy, or other negative consequences; Blanchard & Farber, 2020;Drum et al, 2009;Farber et al, 2019;Ganzini et al, 2013;Hom et al, 2015;Hom et al, 2017;Kyron et al, 2020;Sheehan, Oexle, Armas, et al, 2019). For example, Podlogar et al (2021) found that respondents who had been in a hospital in the past were more likely to deny suicidal thoughts than respondents who had outpatient psychotherapy only-consistent with an interpretation that a fear of hospitalization reduced willingness to be honest. Also, youths (ages 16 to 27) reported the selective nondisclosure of suicidal thoughts following an involuntary hospitalization (Jones et al, 2021).…”

“…Other patients may deny suicidal thoughts because of shame, internalized stigma, or perceptions of personal weakness (Blanchard & Farber, 2020; Fulginiti & Frey, 2019; Han et al, 2018; Hom et al, 2015; Hom et al, 2017; Kyron et al, 2020; Podlogar et al, 2021; Sheehan, Oexle, Armas, et al, 2019). They may have internalized myths or negative stereotypes about suicidal persons as being weak, selfish, or cowardly (Joiner, 2010).…”

Generalisability of the interpersonal theory of suicide to latent profiles of young people attending treatment in a suicide prevention service

“…depression, history of suicidal ideation and self‐harm), but there was a lack of detail in other known areas of risk (e.g. externalising behaviours, Bertuccio et al., 2021; Podlogar et al., 2021) and protective factors (e.g. family cohesion or involvement in therapy, Baiden et al., 2017; Love & Durtschi, 2021; Pisani et al., 2016; Wong et al., 2020).…”

“…family cohesion or involvement in therapy, Baiden et al., 2017; Love & Durtschi, 2021; Pisani et al., 2016; Wong et al., 2020). Likewise, since the varying severity and constellation of these factors may be indicative of other underlying psychopathology (Boyda et al., 2020; Case et al., 2020; Klonsky, 2007; Nock, 2008; Podlogar et al., 2021; for example, personality disorder, bipolar disorder, psychosis, Weintraub et al., 2020), this dataset was not able to adequately determine any psychiatric conditions that could influence the allocation of individuals to profiles. In other words, there may be additional factors that could be moderating the severity of suicide risk not measured here.…”

Personality Assessment Inventory suicidality scales: Suicidal Ideation (SUI), Suicide Potential Index (SPI), and S_Chron in an Afghanistan/Iraq‐era active and Veteran military sample

“…Underreporting has been minimally studied with respect to suicidality. Two recent studies evaluated non‐disclosure in two different samples, via adding a “prefer not to disclose” option to all items on the Beck Scale for Suicide Ideation (BSS; Podlogar et al, 2022; Podlogar & Joiner, 2020). However, underreporting on broad‐band measures typically employs a detection strategy of denying minor faults, which contrasts to choosing a prefer‐not‐to‐answer option when available on direct questions about suicidality.…”