Suicide can't be predicted by asking about suicidal thoughts, major Australian study shows

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The majority of people who die by suicide deny having suicidal thoughts when asked by doctors in the weeks and months leading up to their death, a ground-breaking UNSW Sydney study has found.

The research questions a widely held belief that suicide can be accurately predicted by psychiatrists and clinicians by assessing a patient's risk, especially in the short-term.

The , co-authored by clinical psychiatrist and Conjoint Professor Matthew Large from UNSW's School of Psychiatry, is published today in the journal BJPsych Open.

The review of data from 70 major studies of shows that, as a stand-alone test, only 1.7% of people with suicidal ideas died by suicide. About 60% of people who died by suicide had denied having suicidal thoughts when asked by a psychiatrist or 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 Large, an international expert on suicide risk assessment who also works in the emergency department of a major Sydney hospital.

"But what we didn't know was how frequently people who go on to suicide have denied having suicidal thoughts when asked directly," he said.

The study showed that 80% of patients who were not undergoing and who died of suicide reported not to have suicidal thoughts when asked by a GP.

"This study proves we can no longer ration based on the presence of suicidal thoughts alone. Hospital and community care teams in Australia are extremely under-resourced, and this needs to change. We need to provide high-quality, patient-centred care for everyone experiencing mental illness, whether or not they reveal they are experiencing suicidal thoughts."

Professor Large said that clinicians should not assume that patients experiencing mental distress without reporting suicidal ideas were not at elevated 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 generated by 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, Dr. Catherine McHugh, a registrar psychiatrist. "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 Professor Large, was that clinicians should give less weight to suicidal ideation than had been the case."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."

There was also an important message for people bereaved of a loved one after a , said Professor Large. "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."

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More information: Catherine M. McHugh et al. Association between suicidal ideation and suicide: meta-analyses of odds ratios, sensitivity, specificity and positive predictive value, BJPsych Open (2019). DOI: 10.1192/bjo.2018.88
Citation: Suicide can't be predicted by asking about suicidal thoughts, major Australian study shows (2019, February 1) retrieved 21 October 2019 from
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Feb 01, 2019
Questioning patients about suicidal thoughts is now standard practice in many medical offices, despite evidence like this

Feb 02, 2019
When I was under treatment for prostate cancer, one of the questions on the sheet they gave me was obviously (and clearly) suicide-related.

Considering what brought me to the clinic, it seemed reasonable to me.

I do agree that there seems little point in asking it as a routine question.

Feb 02, 2019
The results of this study come as no surprise at all to me. I've been intermittently suicidal for several years, and since I lost my family doctor of 19 years in mid-2016, I've had zero interest in seeking medical treatment. I have no dependents, and I consider whether I choose to die or not entirely up to me.

Feb 03, 2019
It's a very tough topic. Persons who commit suicide obviously have huge mental issues. And those kind of people are not always very truthful. But even more importantly they find it hard to acknowledge that they have any serious mental issue. Go to a prison and you will find maybe >90% of inmates blame others for their incarceration. "I am not at fault!" How do we solve this issue? Really, each one of us should stop blaming others and finding fault with others, and rather take a deep, humble look at our own selves, and acknowledge our own sinfulness. This is the start of being set free.

Feb 04, 2019
The really sad thing is that so many humans are unable to look at themselves introspectively to find out what are the causes of their unhappiness, depression and dissatisfaction with their life. Instead of asking theirselves, "where did I personally go wrong?", they wonder, "who did this to me?" and often blame 'society' for their troubles. It takes personal strength to survive and get over the hurdles that life is full of, and to recognise that those hurdles are only fleeting if one has enough courage, self-love and self-respect. Seeking out good people for lasting friendships is important - not only for good companionship, but also for good fellowship where life-saving advice may be found.

Feb 04, 2019
Hiya bart
those kind of people are not always very truthful. But even more importantly they find it hard to acknowledge that they have any serious mental issue
-But your savior by his very example encourages martyrdom. Martyrdom is suicide - knowingly sacrificing ones own life for no good reason. I'd call that a mental issue.

Who says xians arent violent? Martyrdom is the worst, most disgusting form of violence there is.
Go to a prison and you will find maybe >90% of inmates blame others for their incarceration
-Hey bart did you know that maybe >90% of inmates claim to be religious, and were raised in religious families? It's TRUE- look it up.

All those kids taught that unbelievers should be victimized because their very existence threatens a believers eternity in heaven. Us vs them - tribalism, as codified in your book.

Would you consider the ethnic cleansing of the holy land a crime? Men, women, children, cattle, olive trees... ok as long as god says so-

Feb 04, 2019
acknowledge our own sinfulness. This is the start of being set free
-Hey you forgot the phrase ' accepting jesus christ as your personal savior." Because, of course, if you cant then you're doomed whether you kill yourself or not.


Re your inmate comment, the tribalist perception is that they have every right to victimize their enemies. Eye for an eye. So of course they're going to blame their enemies for having to victimize them.

After all, god repeatedly punished Israel for NOT finishing their holy mission. It's why he sent gideon, no?

Feb 14, 2019
Humans had been given "choices" - the ability to choose in which path each human decides to follow. Nobody is twisting arms to live their life this way or that. Except for dictatorial governments, of course, where government or church leaders have the power to demand, intimidate, even the decision of life or death. But in a free society such as the USA, the choices that humans make most often have consequences, whether good or bad. It isn't always known immediately what the consequences are of one's choices.
Religion is manmade and is supposed to help its adherents to live a good, fruitful life that is free of sin and the consequences of sin. But humans, being as they are once they have reached the age of majority (or maturity, whichever comes first) most often believe that they have become sages and know almost everything there is to know. So that they find it almost impossible to blame theirselves when things go wrong for them. They have to blame someone else.

Feb 14, 2019
Inmates of any prison have made their choices already, bad choices which is why they are in prison. But even after choosing to do or say something that will surely have them wind up incarcerated, they cannot bring theirselves to place the blame for their horrid situation squarely where it belongs. And so they fester and moan about how terrible society is, and how they were in the wrong place at the wrong time; and how they didn't mean to hurt anyone or to steal that item; or to attack that innocent person. They will claim that it was a case of momentary craziness - they were drunk or high on drugs or needed to take out their frustrations on anyone.
But there is hardly ever any self-introspection to find out what is the "root cause" of their bad attitude and bad behaviour. What happened to make them this way? Was it parents, siblings, teachers, church leaders, or society in general? Always someone else to blame - never "I have a rotten attitude and I just don't care"

Feb 14, 2019
The One that is referred to as Jesus Christ was a Holy Angel. Christ was the One who took the place of Satan/Lucifer as First Son of God, where Satan/Lucifer no longer qualified for that position/role and was, instead, condemned to 'roam through the world, seeking the ruin of Souls'. And he does just that.
Satan's greatest power is his ability to convince the humans that he doesn't exist. And many humans are very accommodating in helping Satan to perpetuate that lie. And that is their choice.

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