A caution for suicide prevention focused on help-seeking in young people

To the Editor

Over the past several years, suicide has been ranked as the second most common cause of death in adolescents and young people around the world (Lozano et al., 2012). In response, mental health strategies now emphasize the importance of research to improve access to suicide prevention interventions (World Health Organization, 2013).

A number of clinical and cross-sectional community studies, published prior to 2016, have aimed to explain why a large proportion of suicidal young people are also those who are likely to disengage or withdraw from all forms of help and support. Remarkably, none of these studies could adequately explain why suicidal young people negate help (Wilson et al., 2017).

Advances in neuroscience now point to design and measurement issues for these null results, questioning both the reliability and the validity of the results and conclusions that were reported in these earlier studies. In all cross-sectional help-negation studies that were published prior to 2016, most participants were not, in fact, suicidal – approximately 85% of participants reported no lifetime suicidal ideation or past, but not current, suicidal ideation at the time of data collection (Wilson et al., 2017).

Yet, neuroscience research confirms that suicidal ideation and behaviour indicates the presence of neurological changes that impair physical capability for cognitive, emotional and behavioural regulation and responding, regardless of co-occurring mental disorders and other social or psychological characteristics. Consequently, advances in neuroscience research now suggest that help-negation is determined more by impaired neurological capability and less, if at all, by demographic and psychological characteristics among suicidal young people (Wilson et al., 2017).

These important advances now raise questions of harm associated with cognitive interventions that are based on existing help-negation research. If suicidal young people do not have the cognitive, emotional and behavioural capacity to engage in help-seeking behaviours, are levels of guilt and suicidal risk increased through messages that aim, in all kindness, to describe how easy it is to seek help or which imply that withdrawing from help is related to perceived weakness (e.g. ‘It takes a lot of courage to seek help, reach out and take it’)?

Understanding the role of neurological change on cognitive, emotional and behavioural regulation and help-seeking responses, in relation to different types of available help-sources, must be prioritized for investigation. Until more is known, however, suicide interventions that are based on research conducted with predominantly non-suicidal samples must be treated with caution.