Impact of screening for risk of suicide: randomised controlled trial
Open accessAbstract
Background: Concerns have been expressed about the impact that screening for risk of suicide may have on a person's mental health. Aims: To examine whether screening for suicidal ideation among people who attend primary care services and have signs of depression increases the short-term incidence of feeling that life is not worth living. Method: In a multicentre, single-blind, randomised controlled trial, 443 patients in four general practices were randomised to screening for suicidal ideation or control questions on health and lifestyle (trial registration: ISRCTN84692657). The primary outcome was thinking that life is not worth living measured 10–14 days after randomisation. Secondary outcome measures comprised other aspects of suicidal ideation and behaviour. Results: A total of 443 participants were randomised to early (n = 230) or delayed screening (n = 213). Their mean age was 48.5 years (s.d. = 18.4, range 16–92) and 137 (30.9%) were male. The adjusted odds of experiencing thoughts that life was not worth living at follow-up among those randomised to early compared with delayed screening was 0.88 (95% CI 0.66–1.18). Differences in secondary outcomes between the two groups were not seen. Among those randomised to early screening, 37 people (22.3%) reported thinking about taking their life at baseline and 24 (14.6%) that they had this thought 2 weeks later. Conclusions: Screening for suicidal ideation in primary care among people who have signs of depression does not appear to induce feelings that life is not worth living.
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Screening for suicidal ideation does not induce subsequent suicidal ideation.
“Although it does not induce subsequent suicidal ideation,(38, 147) screening a non-help-seeking population for suicidal ideation and nonfatal suicide attempts, beyond screening for major depression, remains a debated approach.(40)”
From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [38]
The Conclusions report that screening among primary-care patients with signs of depression “does not appear to induce” feelings that life is not worth living. The Clinical implications also report no apparent increase in subsequent suicidal ideation over the short follow-up. The citing clause states this more definitively and without the study’s population and time limits; the nearby discussion of a non-help-seeking population is not established by this trial. (LLM, conf=0.86)
Experimental — accuracy not yet measuredScreening for suicide risk coupled with effective referral for evaluation and treatment was found by some studies to prevent suicidal behavior.
“Screening for suicide risk to identify otherwise undetected at-risk individuals,(30, 37) if coupled with effective referral for evaluation and treatment, was found by some studies to prevent suicidal behavior.(15–17, 37, 38)”
From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [38]
The Methods and Clinical implications sections describe screening and limited follow-up assistance, but do not evaluate screening coupled with effective referral and treatment as a way to prevent suicidal behavior. The Strengths and limitations section says the trial lacked sufficient power to detect differences in self-harm; its conclusion concerns whether screening induced suicidal thoughts, not whether it prevented suicidal behavior. (LLM, conf=0.76)
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References 34 · Cited by 95
Research works printed but not linked: 1
- [20]20. Goldberg D. The Detection of Psychiatric Illness. Oxford University Press, 1972.
- Authors
- Crawford, M. J., Thana, L., Methuen, C., Ghosh, P., Stanley, S. V., Ross, J., Gordon, F., Blair, G., & Bajaj, P.
- Affiliations
- Centre for Mental Health (GB)
- Imperial College London (GB)
- Central and North West London NHS Foundation Trust (GB)
- West London Mental Health NHS Trust (GB)
- Corresponding author
- Crawford, Mike J.
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2011-05
- Volume
- 198
- Issue
- 5
- Pages
- 379-384
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2009998831
- Cited by
- 95
- References
- 34
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 2 · 2023: 9 · 2022: 11 · 2021: 2 · 2020: 6 · 2019: 6 · 2018: 6 · 2017: 7 · 2016: 6 · 2015: 14 · 2014: 7 · 2013: 5 · 2012: 5
- FWCI
- 6.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Imperial College London
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- suicide risk screening, suicidal ideation, depression, primary care, general practice, suicide prevention
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Depression, Family Practice, Female, Humans, London, Male, Mass Screening, Middle Aged, Risk Factors, Suicide, Urban Health, Single-Blind Method, Outcome Assessment, Health Care, Young Adult, Intention to Treat Analysis, Suicidal Ideation
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