Ask someone whose mood seems wrong directly, “Have you thought about suicide?” Asking does not make them want it more

No money needed. Ask one question, then spend some time listening. Starting the conversation is the hard part: many people fear that asking will plant the idea.

In 6 high schools in New York State, 2342 students were randomized by classroom into two groups. One questionnaire included suicide questions; the other did not. Immediately afterward and 2 days later, distress did not differ between groups (P = .66 and P = .41; P above 0.05 means no statistically detectable difference). After 2 days, 4.7% of the group asked and 3.9% of the group not asked reported suicidal thoughts, with no statistically detectable difference (P = .49). Students with pre-existing depressive symptoms were less distressed after being asked (P = .01). Students with a previous suicide attempt had less suicidal ideation after being asked (P = .02). A 2022 meta-analysis appraised 17 studies and pooled 8 comparisons between being asked and not being asked. Asking did not significantly increase immediate or subsequent suicidal thoughts or behaviors, nonsuicidal self-injury, or psychological distress. The strongest evidence came from 8 randomized controlled trials with low or unclear risk of bias. A 2014 literature review likewise reported that no study found a significant increase in suicidal ideation after asking.

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

Grade B: these studies establish only that asking did not cause harm; none calculated how much asking reduces suicide deaths. The benefit is rated small because there are no mortality figures, only the surrogate endpoint “thoughts did not increase.” Most studies used questionnaires or research interviews rather than face-to-face questions from relatives or friends; applying the findings to such conversations is an inference. If the person says they have indeed thought about it, do not leave them alone: stay with them while calling 12356 and move medicines and pesticides out of reach. See item 25 of this section (call 12356 when you have suicidal thoughts). If they say they intend to take others with them, or have already prepared the means, close relatives can take them directly for medical assessment; you can also call 110. See Section 8, item 15 (close relatives can take someone directly for assessment). The interval between the first thought and acting is often only tens of minutes; see item 32 of this section (tell someone nearby as soon as suicidal thoughts arise). The main beneficiaries counted here are spouses and direct relatives; you can also ask friends and colleagues.