feel reluctant to ask a teen if they've been thinking about
Suicide is the 8th leading cause of death in Oregon, and the second leading cause of death for 10 to 24 year olds. Still, suicide remains a taboo topic, is highly stigmatized and is surrounded by myth and mystery.
Myth: Asking someone Are you thinking about suicide? or Are you thinking about killing yourself? will put that idea into someone's head.
Studies show that
if they are suicidal does not increase suicides or suicidal
thoughts. In fact, studies suggest the opposite: findings
suggest acknowledging and talking about suicide "may in fact
reduce rather than increase" suicidal ideation.
Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence?
There is a commonly held perception in psychology that enquiring about suicidality, either in research or clinical settings, can increase suicidal tendencies. While the potential vulnerability of participants involved in psychological research must be addressed, apprehensions about conducting studies of suicidality create a Catch-22 situation for researchers. Ethics committees require evidence that proposed studies will not cause distress or suicidal ideation, yet a lack of published research can mean allaying these fears is difficult. Concerns also exist in psychiatric settings where risk assessments are important for ensuring patient safety. But are these concerns based on evidence? We conducted a review of the published literature examining whether enquiring about suicide induces suicidal ideation in adults and adolescents, and general and at-risk populations. None found a statistically significant increase in suicidal ideation among participants asked about suicidal thoughts. Our findings suggest acknowledging and talking about suicide may in fact reduce, rather than increase suicidal ideation, and may lead to improvements in mental health in treatment-seeking populations. Recurring ethical concerns about asking about suicidality could be relaxed to encourage and improve research into suicidal ideation and related behaviours without negatively affecting the well-being of participants.
to the editor: Suicidal ideation and research ethics
[Psychol Med. 2015]
So, ask the question
Ask directly about suicide. Ask the question in such a way that is natural and flows over the course of the conversation. Ask the question in a way that gives you a "yes" or "no" answer. Don't wait to ask the question when the person is halfway out the door. Asking directly and using the word "suicide" establishes that you and the at-risk person are talking about the same thing, and lets them know you are not afraid to talk about it. Ask: "Are you thinking about killing yourself?" or "Are you thinking about ending your life?"
How NOT to Ask the Question "You're not thinking about killing yourself, are you?"
Do not ask the question as
though you are looking for a "no" answer. Asking the
question in this manner tells the person that although you
assume they are suicidal, you want and will accept a
Start a conversation. Directly and gently ask the question, Are you thinking about suicide? or Are you thinking about killing yourself? This step can be particularly difficult for many people. Sometimes people worry if they ask if someone is feeling suicidal that they might put the idea in their head. Worry not. There is no research that supports this idea. Asking the question will not increase the risk of someone completing suicide. If anything the person will be grateful you expressed what they have been thinking about. Google "Know When to Get Help Suicide rarely happens without warning." Oregon Dept of Education
not be afraid to talk about suicide. Some cultures or
families treat suicide as a taboo and avoid talking about
it.. You may also be afraid that if you talk to
someone about suicide, you will prompt them to act on their
suicidal thoughts. These factors or others may lead you to
hesitate to speak openly about suicide. However, you should
fight this instinct because the opposite is actually true;
speaking openly about suicide often prompts someone in
crisis to think about and reconsider their choices.
Preventing Suicide: A Global Perspective by the World
Health Organization (2014)
issue of suicide among young people, by inviting youth to
take the lead. We recognize the need for student involvement
and ideas in shaping the campaign against suicide. By
engaging young adults and providing the facts, the NCPYS
seeks to help those most at risk..."
we bravely have open and honest conversations about mental
illness and suicide, we potentially make life-saving
connections. Without those conversations, we only have
loneliness, silence and unanswered questions. We might
consider overcoming our reluctance to speak of suicide to
break apart the taboo that encloses it. Until we start
talking, healing cannot happen.
Suicide rarely happens without warning. Dont be afraid to talk about suicide. You might save a life by talking about it. Never agree to keep suicidal thoughts or plans a secret; most important thing you can do is get help with the person. Google "Know When to Get Help Suicide rarely happens without warning." Oregon Dept of Education
about suicidal thoughts or feelings won't push someone into
doing something self-destructive. In fact, offering an
opportunity to talk about feelings may reduce the risk of
acting on suicidal feelings.
Myth: Talking about suicide or asking someone if they have thoughts of suicide will encourage suicide attempts. Fact: Suicide is the second leading cause of death for young people age 1524. Talking about suicide does not increase the risk of suicide. Rather, openly talking about fears is the first step in encouraging a suicidal person to live. That conversation can simply be asking the person if they intend to end their life. The danger is in not asking when you feel there is a risk. aix-xweb1p.state.or.us/es_xweb/DHSforms/Served/le8282.pdf (page 17)
you suspect that your teen might be thinking about suicide,
talk to him or her immediately. Don't be afraid to use the
word "suicide." Talking about suicide won't plant ideas in
your teen's head. Ask your teen to talk about his or her
feelings and listen. Don't dismiss his or her problems.
Instead, reassure your teen of your love. Remind your teen
that he or she can work through whatever is going on
and that you're willing to help.
may be concerned about your son or daughter, a student, or
another youth. It is important to know "Are you thinking
about killing yourself?" Talking about suicide does not
cause suicide. If you have difficulty asking the youth about
his or her thoughts, enlist another adult to help you. Or
call the National Suicide Prevention Lifeline at
1-800-273-TALK (8255) or text "SOS" to the National Crisis
Text Line 741741.
Risk Assessment "Have you been having thoughts about killing
yourself either now or in the past? Do you ever feel that
life isnt worth living? Have you ever wished you could
just go to sleep and not wake up? Have you ever tried to
hurt yourself, wishing you would die? Have you ever tried to
shy away from the subject: Just talking about suicide isn't
going to lead anybody to kill themselves. "We know that is
just not the case," Karim said. "You will not put that idea
into somebodys head by talking about suicide." Said
Oshel: "Just because you ask the question doesn't mean
youve planted a seed in their head. It is far worse to
ignore it than to openly address it."
people (both teens and adults) are reluctant to ask teens if
they have been thinking about suicide or hurting themselves.
That's because they're afraid that, by asking, they may
plant the idea of suicide. This is not true. It is always a
good thing to ask.
is difficult to talk about, there's no denying that. If you
think someone close to you is having suicidal thoughts, you
might feel reluctant to bring the subject of suicide up in
case it gives them the idea to do it. This is not so. In
fact, most people say talking directly about their
experiences can be a huge relief, and helps them to discover
other ways of getting through the pain they feel. Don't let
this person carry their feelings around in silence -
instead, give them a chance to release them.
interrelated factors contribute to suicide among AI/AN
people. Risk factors include mental health disorders,
substance abuse, intergenerational trauma, and
community-wide issues. Be an active part of your loved
ones support systems and check in with them often. If
a they show any warning
for suicide, be direct. Tell them its OK to talk about
suicidal feelings. Practice active
and let them talk without judgment.
be afraid to ask whether the person is considering suicide
and whether they have a particular plan in mind. These
questions will not push the person toward suicide if they
werent considering it.
suicide attempts go unrecognized, but if you are aware of a
previous attempt, pay attention to warning signs. If your
friend is expressing some thoughts about suicide, it's okay
to ask, "have you ever had these thoughts before?" and if
so, "have you ever done anything about them?"
items close to you that you could use to harm yourself can
create a dangerous situation. Its important to remove
items that you may use impulsively. What items do you have
nearby that you could use to harm yourself? How can you
safely remove them for the time being?
is important to be straight forward," Foster said. "We say,
'Are you thinking about hurting yourself? Are you thinking
about killing yourself?' ... Most of the time, asking them
is going to be a relief for them. They don't have to say it.
They didn't have to bring it up. You have opened the door
for them to come to you because they know that you are
paying attention and they know you care about them enough to
know that those at risk for suicide do not necessarily want
to die, but do want help in reducing the pain they are
experiencing so that they can go on to lead productive,
fulfilling lives. There is a lot of ambivalence surrounding
the decision to take ones own life, and by recognizing
this, and discussing it, we can help the suicidal person
start to recognize alternative options for managing their
suffering. Often suicidal people are experiencing
intolerable emotional pain, which they believe to be
unrelenting. They often feel hopeless and trapped. By
helping them to recognize and explore alternatives to dying,
you are planting the seeds of hope that things can
the Harm in Asking About Suicidal Ideation?
It's ok to say, "I'm not ok.'
A conversation could change a life.