Does it hurt to ask? An analysis of iatrogenic risk during suicide risk assessment

Background: There remains concern regarding whether suicide risk screening is harmful despite literature suggesting that it is not. The present study aimed to replicate and extend literature demonstrating that suicide risk assessment does not influence immediate or persistent distress, and examine its impact on implicit suicidality. Further, it examined whether having a suicide attempt history, higher depression symptoms, and high alcohol use yielded a beneficial effect of suicide risk assessment on distress and implicit suicidality. Methods: Undergraduates (N = 147) were randomized to undergo suicide risk assessment or not. Distress was measured before and after survey/interviews, and again two days later along with implicit suicidality via The Suicide Implicit Association Task. Results: The two groups did not differ in immediate or persistent distress, nor implicit suicidality. Individuals with high alcohol use comparable exhibited less immediate distress reduction following suicide risk assessment than those with low alcohol use, but comparable reductions in persistent distress. Those with a suicide attempt history who underwent suicide risk assessment exhibited lower levels of implicit suicidality than those who did not, but suicide risk assessment did not influence implicit sucidality for those without an attempt history. Limitations: This study is limited by its small predominantly Caucasian and college sample, with a low base rate of suicidal behavior. Conclusions: These findings add to a literature suggesting that suicide risk assessment may not be iatrogenic, even implicitly, and may be beneficial for those with a suicide attempt history. Clinicians are urged to continue suicide risk assessment.