James Donaldson on Mental Health – New Research Uncovers Why Suicide Is So Hard to Predict

The difficulty faced by health professionals in trying to identify which patients will go on to suicide has been laid bare by new research which shows just how hard it is to foresee.

Eighty per cent of people who take their own lives deny having suicidal thoughts when asked by their doctors in the months leading up to their deaths.

And yet, just 1.7 per cent of people who do admit to thinking about taking their lives carry it through.

The findings cast doubt on current clinical methods for identifying the patients most at risk and raises questions about rationing stretched psychiatric services based on suicidal thoughts.

WA recorded its highest suicide toll in 2017, with 409 people taking their own lives, according to the most recent figures available.

The sobering statistic comes on the back of a 10 per cent increase in the number of people who died by suicide in WA between 2016 to 2017. WA recorded 15.8 deaths per 100,000 people, compared with 12.6 nationally.

The new research, which reviewed 70 major studies of suicidal thoughts, found 80 per cent of people who were not undergoing psychiatric treatment and who died by suicide had not admitted to thinking about suicide when asked by their GP.

Of those who were under psychiatric care, 60 per cent of patients who went on to commit suicide had denied thinking about killing themselves.

Research co-author Matthew Large, a clinical psychiatrist and conjoint professor from the University of NSW, said the findings should offer some relief from the guilt and stigma experienced by those left behind when a loved one takes their own life.

“Professionals can’t elicit this information so how in the hell can relatives,” he said.

“If you had suicidal ideation and you didn’t want the relative to act any differently and you weren’t wanting to alarm then you probably would keep pretty quiet about it.”

“One of the reasons people don’t tell their doctors is because they are afraid they will be classified as a suicidal patient, that they will be stigmatised and, worse maybe, that they will even be hospitalised.

“I think the over-concern about suicidal ideation that exists has caused a lot of problems.”

Professor Large said asking about suicidal thoughts had diagnostic value as an indication of depression and emotional stress.

“But what it isn’t is a prophecy: there are much stronger statistical tests of whether someone will suicide than whether you have suicidal ideation,” he said.

“The most obvious being whether you have recently been discharged from a psychiatric hospital which confers a risk of suicide about 100 times (higher) than suicidal ideation.”

“Every patient who you come across, who you are worried about feeling suicidal deserves respectful, thorough, individual assessment and a follow up plan.”

Lifeline WA chief executive officer Lorna MacGregor said suicide was a complex human behaviour that was difficult to predict.

“What brings a person to a point where they are contemplating suicide is not just mental health – that would contribute partly to the findings,” she said.

“If (doctors) are using those clinical tools, it is around mental health but there are lots of other reasons that people see suicide as a viable option in a moment.”

Thoughts of suicide could also fluctuate and people could genuinely not be contemplating it when asked by a health professional.

Ms MacGregor said Lifeline’s helpers were trained in how to ask people whether they were having thoughts of suicide and how to support them through a crisis.

“Our position is that you should ask the question,” she said.

“Of course, whether or not people will answer is another matter and sometimes they are not ready to answer in that moment and sometimes the answer isn’t as clear as yes, it might be well I wonder, I’ve been thinking, it might be an ambiguous answer,” she said.

“While the clinical tools may not provide a 100 per cent response they have undoubtedly identified and saved some people at risk.”

Professor Large said the suicide rate was substantially lower among women and young people, however young women were the most likely section of the community to think about and attempt suicide.

It was older men, people living in country areas and indigenous people who were more likely to actually take their own lives.