What is it about?

The prevention of suicide remains one of the main missions of mental health organizations worldwide, but remains a difficult task in everyday clinical practice. Among the myths that are often cited about suicide is that “people who talk about killing themselves rarely die by suicide.” Thus, individuals may not be taken seriously by their relatives or even by clinicians when they express a wish to die. On the contrary, studies have shown that up to two thirds of individuals who died by suicide had previously given some kind of verbal clue or warning of their intentions. A joint group of investigators from Sapienza University of Rome and University of Genova, Italy, recently conducted a study to examine if completed suicide was anticipated by different forms of communication. The study has been published in Psychological Medicine; authors used a meta-analytic approach, combining the results of 36 previous studies that examined suicidal communications in 14,601 individuals who died by suicide. Overall, results show that 44.5% of suicides had previously communicated their intent (confidence interval: 35.4% – 53.8%) either giving verbal, written or other types of clues. However, the predictive value of suicidal communication might vary considerably between different age groups, with adolescents displaying the least valid association. Classical suicidology stated that individuals who have suicidal intentions provide clues to their intention, either consciously or unconsciously. Signals of distress might be explicit mention of helplessness, or pleas for intervention. However, suicidal communication can also be indirect, ambiguous, humorous or euphemistic. Thus, listeners can find it difficult to judge the true meaning of the utterances referring to suicide, and may abstain from taking preventive measures. This study is the first to provide an accurate estimate of this phenomenon by summarizing the available evidence: it reinforces the importance of taking in account patient communication to further improve suicide prevention.

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Why is it important?

Classical suicidology stated that individuals who have suicidal intentions provide clues to their intention, either consciously or unconsciously. Signals of distress might be explicit mention of helplessness, or pleas for intervention. However, suicidal communication can also be indirect, ambiguous, humorous or euphemistic. Thus, listeners can find it difficult to judge the true meaning of the utterances referring to suicide, and may abstain from taking preventive measures. This study is the first to provide an accurate estimate of this phenomenon by summarizing the available evidence: it reinforces the importance of taking in account patient communication to further improve suicide prevention.

Perspectives

Suicide is preventable. Most suicidal individuals desperately want to live; they are just unabl to see alternatives to their problems. Most suicidal individuals give definite warnings of their suicidal intentions, but others are either unaware of the significance of these warnings or do not know how to respond to them. Talking about suicide does not cause someone to be suicidal; on the contrary the individual feel relief and has the opportunity to experience an empathic contact. Reliability of suicide certification and reporting is an issue in great need of improvement. It is clear that suicide prevention requires intervention also from outside the health sector and calls for an innovative, comprehensive multi-sectoral approach, including both health and non-health sectors, e.g. education, labour, police, justice, religion, law, politics, the media.

Prof. Maurizio Pompili
Universita degli Studi di Roma La Sapienza

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This page is a summary of: The communication of suicidal intentions: a meta-analysis, Psychological Medicine, May 2016, Cambridge University Press, DOI: 10.1017/s0033291716000696.
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