The other day, a research participant questioned me about the usefulness of asking clients whether or not they feel suicidal. He was completing the Beck Depression Inventory (BDI), a popular research and clinical measure of depressive symptoms, including suicidal thoughts. Question 9 of the BDI requires the respondent to choose from the following:
a) I don't have any thoughts of killing myself,
b) I have thoughts of killing myself but I would not carry them out
c) I would like to kill myself
d) I would kill myself if I had the chance
My participant wanted to know, who would actually admit to wanting to kill himself or herself? Given all the stigma surrounding suicide, wouldn't most people just lie?
Good question: Is it effective to ask clients flat out whether or not they are considering suicide?
The answer is yes. Doctors, psychiatrists, and psychologists are trained to ask the suicide question, without hesitation and without euphemisms. We ask it in a sensitive but straightforward manner, and clients invariably respond honestly. They either express surprise and say "What? Oh, no, I'm not at that point," or admit that yes, they've thought about it, at which point we empathize with their suffering and follow up with questions to determine whether or not they have a plan or a timeline.
I've never witnessed or heard of a client who reacted to the suicide question with shock or anger, and I've never heard of a client who lied (i.e., said he/she wasn't suicidal and then committed suicide). Rather, clients are relieved to be able to address the issue candidly. When a health care professional asks about suicidal thoughts in the same tone of voice used to ask about sleep and appetite, it removes the stigma, allowing the client to bring the dark, scary secret out into the open. To this end, some psychologists have their depressed clients complete the BDI at every session, providing a weekly measure of suicidal ideation, as well as of mood, sleep, appetite, and activity level.
Frequently asked question: Won't asking about suicide plant the idea if the person wasn't already considering it? This is a common fear, especially for non-professionals who aren't sure whether or not to broach the suicide question with a loved one. The answer is no. If someone isn't contemplating suicide, he or she won't start considering it because you asked; and if someone is thinking about it, he or she will probably be relieved that you brought it up, even if it's uncomfortable.
If you think that someone you know is contemplating suicide, ask the question.