Ask directly about suicidal thoughts when someone seems distressed; the cited studies did not show that asking increases them

Cost: No monetary cost. Ask and take time to listen. Speaking up can be difficult because people fear introducing the idea.

In plain language: The research described by the source did not find that including suicide questions in a school survey increased distress or suicidal thoughts. Some higher-risk subgroups reported less distress or fewer thoughts after being asked. This is evidence about the studied questionnaires, not a promise about every conversation.

Findings reported by the source: In six New York State high schools, 2,342 students were randomized by class to questionnaires with or without suicide questions. Distress did not differ immediately or two days later (P=.66 and P=.41). Suicidal ideation at two days was 4.7% versus 3.9%, without a statistically significant difference (P=.49). Students with depressive symptoms reported less distress when asked (P=.01), and students with a previous attempt reported less suicidal ideation (P=.02). A 2022 review assessed 17 studies and combined eight asked-versus-not-asked comparisons. It found no significant increase in immediate or later suicidal thoughts or behaviour, nonsuicidal self-injury or psychological distress. The source describes eight randomized trials with low or unclear risk of bias as the strongest evidence. A 2014 review likewise found no study showing a significant increase in suicidal ideation after asking.

Source author's evidence grade: B; not site verification or professional approval.

Notes: These studies did not quantify a reduction in suicide deaths. The source therefore labels benefit small, relying on the surrogate outcome of no increase in thoughts rather than mortality data. Most questions were asked through research surveys or interviews; applying those findings to conversations with friends or family is an inference. If the person says they have such thoughts, the source advises staying with them, helping them call China's 12356 support line and moving medicines and pesticides away; see this chapter's entry 25. Threats involving other people or preparations for harm call for urgent help; the source points to chapter 8, entry 15 on assessment and police assistance through 110, subject to its diagnostic and risk safeguards. See entry 32 on telling someone when thoughts arise. The source emphasizes partners and close relatives, while also considering friends and colleagues.

Original source bibliography (titles retained as supplied): Gould MS, Marrocco FA, Kleinman M, Thomas JG, Mostkoff K, Cote J, Davies M (2005). Evaluating iatrogenic risk of youth suicide screening programs: a randomized controlled trial. JAMA, 293(13), 1635-1643. https://doi.org/10.1001/jama.293.13.1635；Polihronis C, Cloutier P, Kaur J, Skinner R, Cappelli M (2022). What's the harm in asking? A systematic review and meta-analysis on the risks of asking about suicide-related behaviors and self-harm with quality appraisal. Archives of Suicide Research, 26(2), 325-347. https://doi.org/10.1080/13811118.2020.1793857；Dazzi T, Gribble R, Wessely S, Fear NT (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16), 3361-3363. https://doi.org/10.1017/S0033291714001299