Clinical Question: Does asking about suicidal ideation increase a patient's feelings that life is not worth living?

Bottom Line: Asking about suicide -- even asking 6 questions on the topic -- does not increase depressed patients' thoughts that life is not worth living. (Level of Evidence: 2b)

Reference: Crawford MJ, Thana L, Methuen C, et al. Impact of screening for risk of suicide: randomised controlled trial. Br J Psychiatry 2011;198(5):379-384.

Study Design: Randomized controlled trial (single-blinded)

Funding Source: Self-funded or unfunded

Allocation: Unconcealed

Setting: Outpatient (primary care)

Synopsis: These investigators enrolled 443 patients (90% of screened patients) of 4 urban general practices in London who screened positive for depression. The patients were, on average, 48.5 years old, and 69% were women. The patients were randomized (unconcealed randomization) to be asked either about suicidal ideation or about general health and lifestyle via telephone immediately after enrollment.To mask the purpose of the study, the patients were told that the study was a screening for health and emotional problems. The authors asked a total of 6 questions of each group; obviously, in the suicide ideation group, this goes far beyond the typical, "Do you have any thoughts about harming yourself or others?" Follow-up occurred in 79.2% of patients. Analysis was by intention to treat. At follow-up, a similar proportion of patients in both groups answered yes to the question, "On the past two weeks, have you felt your life is not worth living?" (28.0% vs 24.1%, difference not signfiicant). Similar responses to the other questions occurred in both groups. One person in the control group attempted suicide. The study had an 80% power of finding a 50% increase in suicidal ideation if one existed.