Assessment Of Suicidal Ideation Research Articles

A cross-sectional observational study of suicidal behavior among people in prison at Lajpore Central district jail, India

ABSTRACT Suicidal ideation assessment can help reduce the suicide rate among people in prison. Studies for the assessment of suicidal ideation and risk factors for suicide among inmates have been done in Western countries, but in India, data is lacking regarding the assessment of suicidal ideation among the people in prison. 1. To assess the prevalence of suicidal ideationin people in prison. 2. To identify aggravating factors for suicidal behavior. It was a cross Sectional Observational Study at a district jail, Lajpore, Surat, Gujarat. After permission from the jail authority, people in prison with or without conviction, who were willing to give consent for participation, were enrolled in the study. Semi-structured questionnaires are used to assess socio-demographic profiles. Modified Suicide Ideation scale (MSSI) and General Health Questionnaire (GHQ) and PatientHealth Questionnaire (PHQ) scales were used as materials to assess suicidal ideation and psychiatric comorbidity. Frequency analysis and Pearson correlation among various factors with the use of appropriate statistical methods. Descriptive and qualitative analysis of data was done on 140 incarcerated persons in prison. Analysis showed that 10 (7.1%) people in prison had moderate suicidal ideation in the last 48 hours while 58 (41.4%) people in prison had suicidal ideation at any point in their life. The prevalence of depressive symptoms was high among people in prison. 57.9% had minimal depressive symptoms, while 9.3% had moderate to severe symptoms. Non-convicted inmates from urban areas were having significantly more psychological distress and depressive symptoms than other inmates. Advanced ageof the inmates, negative impact of imprisonment on life, depressive symptoms, and psychosocial distress emerged as risk factors correlated with suicidal ideation. During suicide risk assessment, inmate’s age, the impact of imprisonment, psychosocial distress, and depressive symptoms should be considered as risk factors among people in prison.

Ecological momentary assessments of cognitive dysfunction and passive suicidal ideation among college students

Cognitive dysfunction (CD), inclusive of specific cognitive content (e.g., hopelessness, unbearability) or impaired cognitive processes (e.g., attentional fixation on suicide, rumination), is a key risk factor for suicidal ideation (SI). This study aimed to evaluate multiple forms of CD using ecological momentary assessment (EMA) to determine the unique contributions of CD to concurrent and prospective SI. Fifty-five college students with a history of SI or non-suicidal self-injury completed EMA surveys measuring momentary CD and passive SI (“Wish to Die” [WTD], “Wish to Stay Alive” [WTL]) four times a day for 14 days (2149 total observations). Passive SI and CD variables showed notable within-person variability. Multiple CD variables were significant predictors of concurrent ideation when examined simultaneously in multilevel models with random intercepts and fixed slopes, and associations were stronger when participants were around others. Controlling for concurrent passive SI, between-person rumination was a significant predictor of prospective WTD, and both within-person unbearability and between-person hopelessness were each predictive of prospective WTL. These findings provide evidence for the roles of specific types of CD in conferring risk for passive SI and highlight potentially malleable factors that can be changed through targeted interventions.

479. Optimal Assessment of Preadolescent Suicidal Ideation: Insights From Neural Activation During Reward Processing

479. Optimal Assessment of Preadolescent Suicidal Ideation: Insights From Neural Activation During Reward Processing

Borderline Personality Traits Do Not Moderate the Relationship Between Depression, Beliefs, and Suicidal Thoughts and Behaviors

Adults with clinically significant borderline personality disorder traits (BPTs) are at high risk of experiencing suicidal thoughts and behaviors (STBs). STBs among those with BPTs have been associated with suicidal beliefs (e.g., that one is unlovable or that distress is intolerable). However, the extent to which suicidal beliefs uniquely mediate the relationship between emotional distress and STBs among individuals with BPTs is not known. Individuals admitted to an inpatient unit (N = 198) with recent STBs completed assessments of BPTs, depression, suicidal beliefs, suicidal ideation, and suicide attempt history. Moderated mediation models were used to explore whether suicidal beliefs mediated the relationship between depression and STBs conditional on BPTs. Suicidal patients with versus without BPTs reported stronger suicidal beliefs and more severe STBs (i.e., suicidal ideation, lifetime attempts). Exploratory moderated mediation analysis demonstrated that suicidal beliefs mediated the relationship between depression and suicidal ideation as well as suicide attempts. The mediation effect of suicidal beliefs on the depression-ideation and depression-attempt relationship was not significantly moderated by BPTs. This study was cross-sectional and therefore the estimated mediation models must be considered exploratory. Longitudinal research will be needed to assess the potential causal mediation of suicidal beliefs on the relationship between depression and STBs. The results of this study suggest that suicidal beliefs may play a significant role in the relationship between depression and STBs for inpatients with a history of suicidality regardless of BPTs. This suggests suicidal beliefs may be an important treatment target for adults with a history of STBs.

IJCM_334A: The struggle within: suicidal ideation and its risk factors among the undergraduate medical students

Background: Suicide is one of the top three causes of death among the adults worldwide, which is increasingly seen among students. Medical education is often considered highly stressful, in addition to the usual psychological issues in the youth. Mental health issue is a subject of taboo even among the medical students leading to non-help seeking behaviour. Studies report a high prevalence of suicidal ideation among medical students in India, ranging from 1.8% to 53.6%. Objectives: 1. To assess the prevalence of ‘suicidal ideation’ and associated risk factors among undergraduate medical students Methodology: A descriptive cross-sectional study was conducted among Phase 2 and 3 undergraduate students of a government medical college after taking IEC approval. Information on socio demographic details along with known risk factors was obtained. Beck scale for suicide ideation was used for screening and assessment of suicidal ideation. Data was analysed as proportions and percentages and chi square was applied to test the significance of association. Results: Out of the total 192 participants 118 (61.4%) were boys and 74 (38.6%) were girls. History of mental illness was present among 33 (16.6%) students. Fourteen students (7.2%) had high BSS score on screening. Within this subgroup of students reporting suicide ideation (n=14), 9 students (69.2%) had seriously contemplated suicide, while 2 students (15.3%) had attempted suicide at least once in their life time. Students who had previous history of mental illness showed higher prevalence of suicide ideation which was statistically significant (p<0.001). However, no significant associations were identified between gender of the student, mother’s occupation, or a history of mental illness among family members and suicide ideation among the medical students. Conclusion: Medical students need to be assessed for their mental health and appropriate care and support should be provided to the needy to prevent fatal outcomes among them.

The Effects of a Chatbot-Based Interpretation Bias Modification on Early Adulthood Depression

IntroductionDepression, particularly in early adulthood, presents a significant mental health challenge with far-reaching implications. Innovative approaches to address and alleviate depressive symptoms are of paramount importance in this context. One such approach involves the utilization of technology, specifically chatbot-based programs, to target specific cognitive biases associated with depression.ObjectivesThe central objective is to empirically examine whether this program can effectively influence depressive mood and negative cognition in individuals grappling with depressive symptoms.MethodsTo ascertain the program’s efficacy, participants were divided into two groups: the CBM-I group (n=20), which underwent interpretation bias modification training, and the Mood Check group(n=20), which served as a control and engaged in a simple mood-checking exercise. A battery of psychological measures was employed, including assessments of depression, interpretation bias, suicidal ideation, resilience, and attention control.ResultsAnalysis results showed that the CBM-I group had a significant reduction in depression (PHQ-9, CES-D) compared to the Mood Check group in the post-measurement. Moreover, resilience (CD-RISC) and attention control (ACQ) significantly improved in the CBM-I group.ConclusionsThis research serves as a stepping stone towards a deeper understanding of how chatbot-based interventions can contribute to the management of early adulthood depression, offering new perspectives and possibilities in the realm of mental health support and treatment.Disclosure of InterestNone Declared

A Pilot Predictive Model for Indirect Assessment of Suicidal Ideation

IntroductionIn recent years, there has been a concerning increase in suicidal thoughts and, in some countries, completed suicides, amplified by the COVID-19 pandemic. Screening for suicidal ideation (SI) in the general population is limited due to ethical, effectiveness, and feasibility concerns. Identifying individuals at risk of suicide remains a complex challenge. Our study aimed to develop a predictive model using COVID-19 data, gathering psychometric information from 1790 respondents in Slovenia via an online survey conducted between July 2020 and December 2020, with a second wave of data (ne=1200) collected from January 2022 to February 2022.ObjectivesWith 9.7% of respondents reporting recent SI in the first wave of data, our primary goal was to estimate SI indirectly using SIDAS. We examined changes in habits, demographics, coping strategies, and satisfaction in key life aspects to discreetly identify potential risk factors.MethodsWe employed four machine learning algorithms (logistic regression, random forest, XGBoost, and support vector machines) and assessed model performance using the area under the receiver operating characteristic curve (AUC). Initial assessment used a held-out dataset, followed by validation with a new cohort of 1,200 users from the late COVID-19 period.ResultsLogistic regression, random forest, and XGBoost achieved comparable AUCs, reaching 0.83 on unseen data. Our analysis revealed significant associations between Brief-COPE subscales and SI. Self-Blame emerged as a strong SI indicator, followed by increased Substance Use, reduced Positive Reframing, Behavioral Disengagement, dissatisfaction with relationships, and younger age, in both 2020 and 2022 models. The model consistently performed well, even with varying population characteristics.Conclusions These results suggest that SI presence can be reasonably estimated using selected indicators, offering promise for developing an indirect screening tool without explicit questioning about suicidal thoughts. However, individuals flagged as at-risk should undergo clinical examination, as this model serves as an initial step in identifying SI risk factors in the context of the stressful event’s (COVID-19 pandemic) impact on mental health.Disclosure of InterestNone Declared

Enriching the Assessment of Suicidal Ideation: Learning From Digital Studies.

Enriching the Assessment of Suicidal Ideation: Learning From Digital Studies.

Examination of Acceptability, Feasibility, and Iatrogenic Effects of Ecological Momentary Assessment (EMA) of Suicidal Ideation.

Ecological momentary assessment (EMA) can be used to examine the dynamics of suicidal ideation in daily life. While the general acceptability and feasibility of EMA in suicide research has been established, further examination of potential iatrogenic effects (i.e., negative reactivity) and identifying those more likely to react negatively is needed. Participants (N = 82) with current suicidal ideation completed 21 days of EMA (4×/day) and filled in M = 78% (Med = 84%) of the EMA. No positive or negative affect reactivity was observed in EMA ratings over the study period. Retrospectively, most participants rated their experience as positive (69%); 22% indicated mood worsening, and 18% suicidal ideation reactivity. Those with more borderline personality traits, posttraumatic stress disorder (PTSD), and higher depressive, anxiety, and suicidal ideation symptoms, were more likely to report iatrogenic effects. In conclusion, while high compliance rates and lack of affect reactivity during EMA indicate that EMA is well tolerated in suicide research, a minority of participants may report subjective mood effects in retrospect.

Intramuscular ketamine vs. midazolam for rapid risk-reduction in suicidal, depressed emergency patients: Clinical trial design and rationale

Emergency department (ED) visits for suicidal ideation or behavior have been increasing in all age groups, particularly younger adults. A rapid-acting treatment to reduce suicidal thinking, adapted for ED use, is needed. Previous studies have shown a single dose of ketamine can improve depression and suicidal ideation within hours. However, most studies used 40 min intravenous infusions which can be impractical in a psychiatric ED. The ER-Ketamine study we describe here is a randomized midazolam-controlled clinical trial (RCT; NCT04640636) testing intramuscular (IM) ketamine's feasibility, safety, and effectiveness to rapidly reduce suicidal ideation and depression in a psychiatric ED. A pre-injection phase involves screening, informed consent, eligibility confirmation, and baseline assessment of suicidal ideation, depression, and comorbidities. The randomized double-blind IM injection is administered in the ED under research staff supervision, vital sign monitoring, pharmacokinetic blood sampling, and clinical assessments. The post-injection phase occurs on a psychiatric inpatient unit with follow-up research assessments through four weeks post-discharge. Outcome measures are feasibility, safety, and effects on suicidal ideation and depression at 24 h post-injection, and through follow-up. The target sample is N = 90 adults in a major depressive episode, assessed by ED clinicians as warranting hospitalization for suicide risk. Here we report design, rationale, and preliminary feasibility and safety for this ongoing study. Demographics of the 53 participants (ages 18 to 65 years) randomized to date suggest a diverse sample tending towards younger adults.

Assessment of suicidal ideation via telemedicine: a case report and management suggestions

BackgroundNowadays, we find ourselves in very unexpected and challenging circumstances facing the COVID-19 pandemic. The impact of the new coronavirus pandemic probably affected everyone’s mental health, and people with pre-existing mental disorders may have an aggravated disease condition, leading to a suicide attempt. Pandemic also increased the use of direct-to-consumer telemedicine (TM) exponentially, and consequently, it was expected that cases of attempted suicide could be evaluated remotely. Some TM centers have adapted safety protocols from psychiatric guidelines for managing these patients. However, there is a lack of evidence of the effectiveness of follow-up by TM for patients at high risk for suicide, and there is no consensus on what action should be taken vis-à-vis the patient who requests immediate help remotely.Case presentationHere, we reported a case of a TM evaluation of a patient’s suicidal ideation in a direct-to-consumer telemedicine emergency center, describing the conduct taken in the face of this situation. We also discuss the importance of planning the emergency telemedicine center for situations of risk of suicide.ConclusionsTelemedicine centers should be prepared for direct consumer assessment of suicidal ideation. Current management suggestions include recognizing the risk profile through institutional training and software skills and immediate referral for face-to-face assessment, encouraging continuous monitoring until the admission and active recruitment of family members or closest friends.

Induced optimism to lessen hopelessness-related cognitions among young adults at risk for suicidal thoughts and behavior

BackgroundHopelessness is one of the best-studied cognitive predictors of depression and suicide. Previous research suggests that hopelessness may develop through repetitive thinking about the occurrence of positive and negative future outcomes. The present study sought to investigate whether mental rehearsal in making optimistic future-event predictions, or induced optimism, would lead to reductions in hopelessness, particularly among individuals with a history of suicide ideation or suicide attempts. MethodsParticipants with (n = 58) and without (n = 76) a history of suicide ideation or attempts were randomly assigned to either practice making optimistic future-event predictions or to a control condition in which they practiced making a lexical decision (using the same stimuli) over three study sessions, each separated by one week. ResultsFindings offered modest support for the hypothesis that induced optimism would decrease hopelessness but not improve mood; this was regardless of history of suicide ideation or attempts. LimitationsThe sample was predominantly female, and assessment of suicide ideation and attempt history was not confirmed by clinical interview, which may limit generalizability. ConclusionPractice in making optimistic future-event predictions over time may be one way to reduce the hopelessness-related cognitions that confer vulnerability to suicide ideation and behavior.

Measurement invariance and response consistency of single-item assessments for suicidal thoughts and behaviors.

The present study aimed to expand the literature on single-item assessments for suicidal thoughts and behaviors (STBs) by examining measurement invariance of commonly used single-item assessments of suicidal ideation (SI), planning (SP), and attempts (SA) with respect to race and ethnicity. Predictive invariance with respect to depression, and multi-item measures of passive and active SI were also explored. Measurement invariance was examined across (a) Black and White respondents and (b) Hispanic/Latinx and non-Hispanic/-Latinx respondents. Participants (N = 1,624; 51.66% male) were recruited from Mechanical Turk and Prime Panels. Participants were administered four distinct single-item measures each for SI, SP, and SA across three timeframes (past month, past year, lifetime). Items were drawn from well-known large-scale studies (e.g., National Comorbidity Survey) and common suicide risk assessments. Multiple group confirmatory factor analysis was used to examine measurement invariance; regression with group by measure interactions were used to evaluate predictive invariance. Measurement invariance was observed for both Black (N = 534) and White (N = 1,089) respondents as well as Hispanic/Latinx (N = 335) and non-Hispanic/-Latinx (N = 1,288) respondents across single-item outcomes. Thus, SI, SP, and SA rates can be defensibly compared between Black and White and Hispanic/Latinx and non-Hispanic/-Latinx respondents within studies; however, comparison of SI and SP rates across studies with differing assessment prompts should be met with caution. Multiple single-item STB measures demonstrated predictive bias across race and ethnicity suggesting potential differential screening capabilities. Elevated SI, SP, and SA rates for Hispanic/Latinx individuals were also observed. Findings reiterate the importance of minor language differences in single-item STB assessments. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Suicidal Ideation as a Risk Factor of Suicide in Asian Countries: A Systematic Review and Meta-Analysis of Case-Control Studies

Introduction: Suicide has become the third leading cause of death among individuals in their productive years, underscoring the pressing requirement for effective preventive measures and risk assessment strategies. Earlier studies have indicated that suicidal ideation may play a role as a risk factor of completing suicide. To bolster this understanding, we conducted a systematic review and meta-analysis focusing on the relationship between suicidal ideation and completed suicide within Asian populations.
 Methods: This review adopted a systematic approach, adhering to the four-phased PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram and checklist. Case-control studies were selected, focusing on samples of individuals aged 15-44 years who had received psychiatric care. Exclusion criteria included language barriers, incomplete or inaccessible texts, publications older than 2000, and participants with co-existing medical conditions that could interfere with the results. To assess the quality and potential bias of the included studies, the Oxford’s Critical Appraisal Skills Programme (CASP) Case-Control Checklist and critical appraisal worksheet were utilized.
 Result: The search process yielded a total of 641 records, from which six studies were finally included in the meta-analysis. We found a statistically significant association between suicidal ideation and suicide (aOR 4.20; 95%CI 3.00-5.88, p<0.00001) with low heterogenity among the studies. The most common bias identified was related to the acceptability of case recruitment.
 Conclusion: Suicidal ideation can act as a predictor of suicide risk in Asian populations. Incorporating the assessment of suicidal ideation in suicide prevention initiatives is critical for promptly identifying and intervening with individuals at risk.

Suicide risk assessment and suicide risk management protocol for the Texas Youth Depression and Suicide Research Network

IntroductionSuicide prevention research is a national priority, and national guidance includes the development of suicide risk management protocols (SRMPs) for the assessment and management of suicidal ideation and behavior in research trials. Few published studies describe how researchers develop and implement SRMPs or articulate what constitutes an acceptable and effective SRMP. MethodsThe Texas Youth Depression and Suicide Research Network (TX-YDSRN) was developed with the goal of evaluating screening and measurement-based care in Texas youth with depression or suicidality (i.e., suicidal ideation and/or suicidal behavior). The SRMP was developed for TX-YDSRN through a collaborative, iterative process, consistent with a Learning Healthcare System model. ResultsThe final SMRP included training, educational resources for research staff, educational resources for research participants, risk assessment and management strategies, and clinical and research oversight. ConclusionThe TX-YDSRN SRMP is one methodology for addressing youth participant suicide risk. The development and testing of standard methodologies with a focus on participant safety is an important next step to further the field of suicide prevention research.

Influencing factors of suicidal ideation in lung cancer patients in Midland China: A mixed-method study.

The suicide risk of lung cancer patients is higher than that of patients with other cancers. However, as China is a large country for lung cancer, there are no relevant reports on lung cancer suicides. This study aimed to investigate the prevalence of suicidal ideation and explore its influencing factors in lung cancer patients. In this cross-sectional study, between July to November 2019, 366 lung cancer patients from the oncology department of a general hospital in Wuhan were chosen as participants. Of these, eight with lung cancer and suicidal ideation were selected for in-depth interviews. A total of 22.68% of lung cancer patients reported suicidal ideation. Sex, cancer stage, number of uncomfortable symptoms, and satisfaction with treatment were independently associated with suicidal ideation. This qualitative study found that the experience of suicidal ideation in lung cancer patients includes physiological (heavy burden of symptoms),psychological (bad mood, thwarted belongingness, perceived burdensomeness, and stigma), and social factors (high economic pressure and negative life events). These findings suggest that the incidence of suicidal ideation in lung cancer patients is higher than that of other cancers and is affected by many factors. Therefore, there should be routine screening and assessment of suicidal ideation among lung cancer patients, and related mental health and suicide prevention education should be provided.

A validation of adult suicidal ideation questionnaire among Nigerian University students.

To prevent completed suicide among young adults in the university, assessment of suicidal ideation should be encouraged. This study aims to investigate the reliability, exploratory factor analysis, and validity of adult suicidal ideation questionnaire among Nigerian university students. Descriptive cross-sectional survey was the preferred choice of research design for this study utilizing convenience sampling technique to recruit participants. 6 universities divided into two equal numbers between federal-funded and state-funded ones in Nigeria were selected, and 2,702 students were sampled to fill the questionnaires. Instruments for data collection included Rosenberg Self-esteem questionnaire and Kessler Psychological distress scale to validate ASIQ. Ethical clearance for this study was collected from Olabisi Onabanjo University Teaching Hospital, Nigeria. The results of the study showed that internal consistency of ASIQ was .951 while validity analyses proved that self-esteem and psychological distress diverged and converged respectively with the three subdomains of suicidal ideation as measured by ASIQ. This study concludes that ASIQ has slight modification from the original version among young adults in Nigeria. The scale is reliable and valid but as a 22-item instrument on a 5-point Likert scale.

Metacognitions about suicidal thoughts

BackgroundRumination about suicide has recently been identified as a risk factor for suicidal behavior. According to the metacognitive model of emotional disorders, the activation and maintenance of rumination is dependent on specific metacognitive beliefs. On this background, the current study is concerned with the development of a questionnaire to assess suicide-specific positive and negative metacognitive beliefs. MethodsFactor structure, reliability and validity of the Scales for Suicide-related Metacognitions (SSM) were investigated in two samples comprised of participants suffering from lifetime suicide ideation. Participants of sample 1 (N = 214; 81.8% female; Mage = 24.9, SDage = 4.0) took part in a single assessment using an online survey. Participants of sample 2 (N = 56; 71.4% female; Mage = 33.2, SDage = 12.2) took part in two online assessments within a two week time-period. To establish convergent validity questionnaire-based assessments of suicidal ideation, general and suicide specific rumination and depression were used. Furthermore, it was analyzed whether suicide-related metacognitions predict suicide-specific rumination cross-sectionally and prospectively. ResultsFactor analyses revealed a two-factor structure of the SSM. Results indicated good psychometric properties, and provided evidence for construct validity and stability of the subscales. Positive metacognitions predicted concurrent and prospective suicide-specific rumination beyond the effect of suicide ideation and depression and rumination predicted concurrent and prospective negative metacognitions. ConclusionTaken together the results provide initial evidence that the SSM is a valid and reliable measure of suicide-related metacognitions. Furthermore, findings are in line with a metacognitive conceptualization of suicidal crises and provide first indications of factors that might be relevant for the activation and maintenance of suicide-specific rumination.

Suicidal Ideation, Planning, and Attempts Among new Royal Canadian Mounted Police Cadets.

Royal Canadian Mounted Police (RCMP) report diverse occupational stressors and repeated exposures to potentially psychologically traumatic events, which may increase the odds of screening positive for a mental disorder, and increase the risk of death by suicide. The current study was designed to provide prevalence information regarding suicidal behaviours (i.e., ideation, planning, attempts) and assess for sociodemographic differences among cadets at the start of the RCMP Cadet Training Program (CTP). Cadets (n = 736, 74.0% male) were administered the structured Mini International Neuropsychiatric Interview by a mental health clinician or a supervised clinical psychologist trainee. The interview includes an assessment of past month suicidal ideation, planning, attempts and lifetime suicide attempts. Within 1 month of starting the CTP, a small percentage of cadets reported past month suicidal ideation (1.6%) and no cadets reported any suicidal planning (0%) or attempts (0%). Lifetime suicide attempts were reported by (1.5%) of cadets. The current results provide the first information describing the prevalence of suicidal ideation, planning, and attempts among RCMP cadets starting the CTP. The estimates of suicidal behaviours appear lower than the general population and lower than reports from serving RCMP. Higher prevalence estimates of suicidal behaviours reported by serving RCMP, relative to lower estimates among cadets starting the CTP in the current study, may be related to age, cumulative experiences or protracted exposures to operational and organizational stressors, rather than insufficient screening of recruits.

A discourse analysis of suicide ideation assessment among first year health professional students enrolled in a communications course

Background: Suicide risk assessments require a complex set of skills around a sensitive matter which can be difficult for providers. Aim: Research investigating communication techniques and the language choices used to assess for suicide ideation is limited. Methods: We analyzed 121 video-recorded and transcribed final exams from a communication skills course for first year health professional students to identify patterns and variation in the language choices made to assess for suicidal ideation in standardized patients exhibiting symptoms of depression. Results: We found that 66 of the 121 (55%) interviews included a suicide assessment. We noted key patterns and variation around when the assessments took place (while exploring depressive symptoms or as a topic shift), how they were prefaced (with ubiquity statements, normalization statements, or expressions of care and concern), and how the question itself was structured (with a negative preference structure, in a non-polar format, or ambiguously). Conclusions: Assessing for suicide is a delicate task for both patients and providers, both of whom may be reluctant to engage around the topic. Utilizing normalization statements as well as statements of care and concern is a good approach to assess suicide idation while exploring depressive symptoms.