(PS9-C58) Endorsement of Suicidal Ideation Among American Adults: Considering Discrepancies Across Self-report Measures

The prevalence rate of suicidal ideation in the US is estimated to be ~5% (Ivey-Stephenson et al., 2022); however, assessing for suicidal thoughts is not always simple. Prior research has indicated that different assessments of suicidal ideation yield different rates of endorsement within the same sample (Ammerman et al., 2021). More research is needed to understand the extent to which current measurements of suicide risk capture what they are designed to.

The present study sought to understand differences in how individuals interpret questions about suicidal ideation using a population-based sample. Specifically, we examined differences in ideation endorsement on the Self-Injurious Thoughts and Behaviors Interview-Revised (SITBI) and a follow up question in which participants could select “I have never experienced suicidal ideation” within a set of questions regarding suicidal ideation disclosures.

Of the total sample, 181 individuals were categorized as discrepant in their responses as they endorsed having suicidal ideation based on the SITBI and, on the other hand, said no to the follow up question asking about suicidal ideation. 881 individuals consistently reported suicidal ideation on the SITBI and suicidal ideation in the follow up question. Individuals in the discrepant group were more likely to endorse the thought “I wish I could disappear or not exist” (72.7% vs. 63.2%, Χ²=6.3, p< .05) compared to the consistent group. However, they were less likely than the consistent group to endorse all other thoughts including: “I wish I was never born” (27.7% vs. 41%,Χ²=11.4, p< .01), “My life is not worth living” (25.6% vs. 48.5%,Χ²=32.5, p< .01), “I wish I could go to sleep and never wake up” (43% vs. 56.9%,Χ²=11.5, p< .01), “I wish I were dead” (16.9% vs. 45.9%,Χ²=51.4, p< .01), “Maybe I should kill myself” (1.3% vs. 44.5%,Χ²=121.1, p< .01), and “I should kill myself” (1.3% vs. 24.1%,Χ²=49.3, p< .01). No one within the discrepant group endorsed thinking “I am going to kill myself” whereas 17.2% of the consistent group endorsed this thought. Interestingly, those who were discrepant in reporting suicidal ideation were less likely to have lifetime mental health services relative to the consistent group (41.9% vs 62.9% ,Χ²=28.1, p< .01).

These results suggest that some individuals who would be categorized as having suicidal ideation based on the SITBI do not self-identify with this experience. When assessing for suicidal ideation in treatment, it may be important to ask about experiences of specific thoughts and/or use measures such as the SITBI which include a variety of suicidal ideations. Further, these results suggest those who do not self-identify are more likely to experience the mildest of suicidal thoughts and less likely to experience all other thoughts. Differences in treatment seeking between the groups suggest that those who are not self-identifying as having suicidal ideation may not be seeking treatment despite having thoughts of suicide and as such, psychoeducation programs outside of the therapy room may also be needed.