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Is suicide assessment harmful to participants? Findings from a randomized controlled trial


Harris, KM and Goh, MTT, Is suicide assessment harmful to participants? Findings from a randomized controlled trial, International Journal of Mental Health Nursing, 26, (2) pp. 181-190. ISSN 1445-8330 (2017) [Refereed Article]

Copyright Statement

Copyright 2016 Australian College of Mental Health Nurses Inc.

DOI: doi:10.1111/inm.12223


There is considerable debate on whether suicide assessment carries an iatrogenic risk for participants/patients. A double-blind randomized controlled trial (registration: R000022314) tested the emotional impact of suicide assessment on participants (n = 259) randomly assigned to experimental (n = 122) or control conditions (n = 137). The experimental condition included the Suicidal Affect-Behavior-Cognition Scale and intensive death-related questions, the control condition a quality of life scale. Both included measures of depression, social support and loneliness. Affective states were assessed immediately before and after testing, and research biases minimized. Post-test debriefing interviews collected qualitative reactions. Experimental participants ranged from nonsuicidal to highly suicidal. Between-groups ANCOVAs and repeated measures ANOVAs showed no differences by study condition, and no pre-post-test affect changes for either condition or suicidal participants (P > 0.10), supporting the null hypothesis of no iatrogenic effects. However, depressive participants in both conditions showed significant decreases in positive affect (P < 0.05). Smallest real difference (SRD) scores approximated clinically meaningful differences and showed 20% of participants had a significant positive survey reaction, 24% a negative reaction, with the rest neutral. Linear regressions revealed depressive symptoms and perceived family support, but not suicidality or other factors, predicted negative affect changes, which was supported by qualitative findings. Social desirability bias was also found in qualitative survey responses. No evidence of iatrogenic effects of suicide assessment were found. Recommendations are made to counter possible negative assessment effects on depressive participants/patients, and nurses and other caregivers are encouraged to talk to patients about suicidal symptoms.

Item Details

Item Type:Refereed Article
Keywords:assessment, depression, research bias, suicide prevention, survey
Research Division:Psychology
Research Group:Biological psychology
Research Field:Behavioural neuroscience
Objective Division:Health
Objective Group:Provision of health and support services
Objective Field:Mental health services
UTAS Author:Harris, KM (Dr Keith Harris)
ID Code:110317
Year Published:2017 (online first 2016)
Web of Science® Times Cited:26
Deposited By:Medicine
Deposited On:2016-07-24
Last Modified:2017-12-12

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