Citation

Courtet P, Baca-Garcia E. J. Clin. Psychiatry 2024; 85(1): 23com15205.

Copyright

(Copyright © 2024, Physicians Postgraduate Press)

DOI

10.4088/JCP.23com15205

PMID

38236048

Abstract

There is currently a resurgence of interest in the study of suicidal ideation (SI), a main risk factor for suicidal behavior.1 This resurgence may be explained by the net increase in the incidence of SI in the population during the COVID-19 pandemic, especially in young people.2 Also, the research interest in new drugs capable of treating SI effectively and immediately indicates that this is a genuine therapeutic target, with the potential to reduce the incidence of suicidal acts.3 Finally, with a view to prevention, several theories have focused in recent years on distinguishing between the processes involved in the generation of SI and those involved in the acts themselves, leading to question the "transition from ideas to acts."4 At the same time, recent US guidelines stated that whereas the screening of depression is recommended in primary care, such is not the case for SI.5 This lack of recommendation has been justified by the fact that neither the validity nor the usefulness of detecting suicidal ideas were evidence based. This set of concerns raises questions about how to assess SI and its relevance to improving care with a view to preventing suicidal behavior. Indeed, it is unclear whether the clinicians or the patients themselves are the most reliable reporters of suicidal risk. When comparing clinicians' reports to 649 patients' self-reports, a majority of clinicians classified the patients as containing no death-related ideas, although on self-report the patient did state that they had no desire to live.6 In a study of a large cohort of bipolar patients,7 SI was reported concordantly in both self- and clinician-rated questionnaires in only 26% of the cases, whereas it was discordant in three-fourths of the cases, mainly in cases in which SI was endorsed by the patient but not the provider. The issue is that patients for whom SI remains undetected by the clinician may remain at risk of suicide when they themselves report SI. In fact, consistent with the DSM-5, the main driver for the clinician to detect SI is the severity of the depressive episode, often leading to the health care provider's failing to assess and detect SI in less severely depressed patients.

Recent literature, including studies made possible by the rise of digital health, enables investigators to raise several questions to explore more precisely the clinical assessment of SI. Ecological momentary assessment (EMA) using smartphones allows the capture of everyday experiences of individuals through repeated measurements in naturalistic environments, potentially providing a more reliable evaluation than is usually done in clinical practice.

Language: en

Keywords

Humans; *Suicidal Ideation