Does assessing suicidality frequently and repeatedly cause harm? A randomized control study.

Abstract

Assessing suicidality is common in mental health practice and is fundamental to suicide research. Although necessary, there is significant concern that such assessments have unintended harmful consequences. Using a longitudinal randomized control design, we evaluated whether repeated and frequent assessments of suicide-related thoughts and behaviors negatively affected individuals, including those at-risk for suicide-related outcomes. Adults (N = 282), including many diagnosed with Borderline Personality Disorder (BPD), were recruited through psychiatric outpatient clinics and from the community at large, and were randomly assigned to assessment groups. A Control Assessment group responded to questions regarding negative psychological experiences several times each day during a 2-week Main Observation phase. During the same observation period, an Intensive Suicide Assessment group responded to the same questions, along with questions regarding suicidal behavior and ideation. Negative psychological outcomes were measured during the Main Observation phase (for BPD symptoms unrelated to suicide and for BPD-relevant emotions) and/or at the end of each week during the Main Observation phase and monthly for 6 months thereafter (for all outcomes, including suicidal ideation and behavior). Results revealed little evidence that intensive suicide assessment triggered negative outcomes, including suicidal ideation or behavior, even among people with BPD. A handful of effects did reach or approach significance, though these were temporary and non-robust. However, given the seriousness of some outcomes, we recommend that researchers or clinicians who implement experience sampling methods including suicide-related items carefully consider the benefits of asking about suicide and to inform participants about possible risks.

Short‐term change and prediction of suicidal ideation among adolescents: a daily diary study following psychiatric hospitalization

“…Recent advances in technology, particularly with respect to mobile phones, have made it increasingly possible to investigate the occurrence and precursors of SI and behavior in real‐time via Ecological Momentary Assessment (EMA), which involves repeated and frequent assessment of behavior in the person's natural environment (Moskowitz & Young, ; Shiffman, Stone, & Hufford, ). Existing studies involving repeated assessment of suicide risk‐related constructs have demonstrated that EMA data collection is feasible (Davidson, Anestis, & Gutierrez, ) and that repeated assessment of suicidal thoughts was not associated with any iatrogenic increase in suicidal thinking (Husky et al., ; Law et al., ). Additional EMA studies with adults have indicated that suicidal thoughts are dynamic over short periods of time, sometimes fluctuating over an interval of only a few hours (Hallensleben et al., ; Kleiman et al., ).…”

Real-time monitoring of nonlinear suicidal dynamics: methodology and a demonstrative case report

“…The patient especially stressed the fact that the SNS did in no way increase her suicide risk. This is in line with studies not reporting harmful effects of monitoring suiciderelated variables in high-risk patients (Clum and Curtin, 1993;Husky et al, 2014;Law et al, 2015). Instead, the patient experienced the daily completion of the questionnaire as a helpful routine, sometimes as an obligation, sometimes as a pastime, and sometimes it was difficult to find the appropriate answers.…”

“…In some suiciderelated monitoring studies there were several (2-6) assessments per day (Links et al, 2007;Nock et al, 2009;Palmier-Claus et al, 2012Husky et al, 2014;Law et al, 2015). Several other relevant studies used a daily sampling scheme (Clum and Curtin, 1993;Witte et al, 2006;Thompson et al, 2014;Restifo et al, 2015).…”

“…These methods have already been used in suicidological applications (Nock et al, 2009;Ben-Zeev et al, 2012;Palmier-Claus et al, 2012Thompson et al, 2014), but not from a nonlinear dynamic systems background. For ethical reasons it is important to note that the few available studies do not hint at a potential iatrogenic effects of high-frequency monitoring of suicidality (Clum and Curtin, 1993;Husky et al, 2014;Law et al, 2015). However, only the study of Law et al (2015) was a randomized controlled trial and thus provided an appropriate study design; therefore, more studies are needed to find out if a negative side-effect of monitoring can be ruled out.…”

Conducting Research with Individuals at Risk for Suicide: Protocol for Assessment and Risk Management

“…One aspect included in the UWRAP is the pre-to postassessment procedure, which is designed to evaluate potential distress and suicidal urges that may have been elicited by the assessment. Indeed, while previous research has consistently found that participation in research, even in-depth interviews, may temporarily increase emotional distress for some participants, but does not increase suicide risk (e.g., Eynan et al, 2014;Jorm, Kelly, & Morgan, 2007;Law et al, 2015;Reynolds et al, 2006), there are instances in which individuals may experience elevated suicidal urges, for which suicide risk management procedures should be implemented. Therefore, given the urgent need to bring more researchers into the field of suicide research, we describe the implementation of a suicide risk and management protocol (the UWRAP) in the context of two different randomized clinical trials.…”