Study looks at teens who deny suicidal thoughts, but later die by suicide

By Bernard Turk On Apr 28, 2024

Nearly 1 in 3 teens with depression who deny having thoughts of suicide or self-harm on a commonly used mental health screening questionnaire go on to kill or harm themselves in the following months, a new analysis suggests.

The study, published in JAMA Psychiatry, looked at 13-to-17-year-olds with depression diagnoses who answered Question 9 of the Personal Health Questionnaire (PHQ), which is used to screen for depression severity, before intentionally harming or killing themselves between 2009 and 2017.

The researchers split the teens into two groups: a cohort of 691 who completed the questionnaire within 30 days before self-harm or suicide, and another 1,024 who completed the questionnaire within 90 days of self-harm or suicide.

In the 30-day cohort, adolescents who gave themselves a score of 0 on the question about thoughts of suicide and self-harm were “significantly” less likely to have depression than those who said they were experiencing thoughts of suicide and self-harm. However, those with a history of inpatient mental health treatment were twice as likely to deny such thoughts as those with no history of mental health hospitalization.

Among the 90-day cohort, teens were less likely to report thoughts of death or self-harm if they had less severe depression, were older or were screened at a primary care provider’s office. Those with eating disorders were 60 percent less likely to deny thoughts of suicide or self-harm, however. Teens with a previous mental health inpatient stay, substance use disorder or a diagnosis of ADHD were likelier to score 0 on the questionnaire.

Overall, the researchers found, 30 percent of teens screened with the PHQ-9 who later intentionally self-harmed or died by suicide had reported they had no thoughts of suicide or self-harm on the questionnaire within the previous 30 or 90 days.

The researchers note that the questionnaire is used to screen for depression, not suicide specifically, and that the questionnaire became more common during the study period, which could account for some of the findings.

To better address surging suicides and self-harm among teens, they write, it’s important to figure out why adolescents deny having such thoughts. Adolescents with a history of mental health hospitalization may be reluctant because they fear rehospitalization, the researchers note, or are afraid that caregivers will overreact. The same fears could explain why older teens were less likely to disclose.

“Understanding reasons why many at-risk adolescents do not endorse thoughts of death and self-harm should be given high priority,” the researchers conclude. According to the Centers for Disease Control and Prevention, youths and young adults make up 15 percent of all suicides, and suicide is the second-leading cause of death among 10-to-24-year-olds.

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