Disclosure of suicidal thoughts and behaviors: an investigation of facilitators and barriers
Creators: name: Kim, Joanne S.
Publisher: name: No Publisher Supplied
Year: 2024

description: Effective suicide risk assessment hinges on obtaining accurate information about an individual’s history of suicidal thoughts and behaviors (STBs). However, the reliability of these assessments may be compromised by at-risk individuals’ reluctance to disclose their experiences fully. The present study aimed to: 1) examine barriers to and facilitators of accurate STB disclosure; 2) evaluate the extent to which past accuracy of STB disclosure and intention to disclose future STBs are associated with current suicide risk factors (e.g., stigma, perceived burdensomeness, thwarted belongingness, hopelessness, suicide attempt history); 3) assess the association between accuracy of STB disclosure – as well as intention to disclose future STBs – and endorsement of disclosure facilitators. Overall, when participants were asked about suicide factors by most clinicians, they were not asked about firearm possession. Furthermore, only a fraction of participants reported being comfortable accurately disclosing firearm possession across clinician types. A sample of 159 adults with past STB assessment experiences by medical or mental health professionals participated in an online survey. Findings revealed that STB disclosure inaccuracies were common, with many participants portraying STBs as less intense or frequent than they actually were, and hiding desire to die by suicide. Participants reported significantly greater accuracy of STB disclosure, as well as greater intention to disclose future STBs, to psychiatrists and psychologists/therapist, compared to non-psychiatrist medical doctors and nurses. Fear of hospitalization, embarrassment, and judgment were among the most frequently endorsed barriers to suicidal ideation disclosure, while the most endorsed facilitators included desire for emotional support and mental health treatment. Inconsistent with hypothesis, past accuracy of STB disclosure was not significantly related to suicide risk indicators such as current suicide ideation severity, hopelessness, thwarted belongingness, perceived burdensomeness, acquired capability for suicide, suicide-related stigma, help-seeking stigma, negative urgency, emotion regulation difficulty or suicide attempt history, controlling for covariates. Current intention to disclose future STBs to providers was also not significantly related to these variables, with the exception of impulse control difficulties. However, past accuracy of suicidal ideation disclosure was positively associated with current intention to disclose future ideation, suggesting a role for clinicians in using past disclosure experiences to gauge the reliability of current assessments. Current intention to disclose future STBs significantly predicted endorsement of facilitators, such that individuals with greater current intention to disclose future suicidal ideation were more likely to have endorsed wanting support in seeking mental health treatment, wanting to receive medications, and being taken seriously as factors that facilitated past suicidal ideation disclosure. These findings underscore the need for targeted interventions that reduce disclosure barriers and enhance facilitators, thereby improving the accuracy of suicide risk assessments. Future research should focus on developing brief, effective strategies for healthcare providers to encourage accurate disclosure and provide appropriate interventions.