It is time to dethrone suicidal ideations as a risk predictor

Abstract

Objective

To evaluate the practice of using reported suicidal ideations (SI) as an important predictor of suicide and as a major indicator to decide the eligibility and priority of access to mental health services.

Findings

Examples on the widespread use of SI in triage, screening, and management protocols of mental health presentations, both in emergency and community settings, are presented. Such widespread use comes in contrast to the evidence clearly indicating the limited utility of SI as a suicide predictor. SI limitations are expected when put in the larger context of the generalized failure of suicide prediction tools. The potential detrimental effects of an exaggerated SI status on several aspects of the clinical encounter are discussed. Finally, potential systemic downsides in humanitarian and resource-limited settings are hypothesized, such as hindering mental health integration into primary care, as well as over-reporting of SI by beneficiaries seeking aid and vulnerability status.

Conclusions

SI still holds a “canonical” status as a risk indicator and triage guide. This exaggerated status, in addition to lacking evidence, can also lead to potential downsides, especially in overloaded health systems.