Understanding Intentions to Disclose Suicidal Thoughts and Intent

Abstract: Background: Nondisclosure of suicidal thoughts is common and impedes suicide prevention. Consistent predictors of suicide disclosure have not been identified, and it is unclear how depression impacts various aspects of disclosure. Disclosure occurs within relationships, but few studies have used social network measures to understand structure, quality, and functional factors influencing disclosure. Aims: This study aimed to understand whether social network characteristics predict likelihood to disclose suicidal thoughts and intent. Methods: N = 87 adults experiencing suicidal ideation and/or depressive, anxious, or psychotic symptoms completed an egocentric social network measure assessing relationship features, likelihood to disclose suicidal thoughts and intent, and perceived benefits and risks of disclosure for each network member. Participants also completed a general suicide help-seeking scale. Generalized estimating equations with participant-level clustering evaluated associations between disclosure likelihood (thoughts and intent) and structural, functional, and quality social characteristics, as well as perceived benefits (e.g., emotional support) and risks (e.g., embarrassment) of disclosure. Spearman’s correlations assessed associations between disclosure likelihood and depression symptoms, as well as general help-seeking. Results: On average, networks had 4.7 people ( SD = 1.7). Higher closeness and emotional support, but not network size, predicted greater likelihoods of disclosing suicidal thoughts and intent. Depression severity was negatively correlated with disclosure likelihood, and the association between emotional support and disclosure likelihood was attenuated at higher depression levels. Perceived benefits, but not risks, were correlates of disclosure intentions. Limitations: Analyses were cross-sectional; it is unknown how social network changes would influence future disclosure. Most of the participants were not experiencing active suicidal ideation, which limits generalizability to more acutely distressed populations. Conclusions: Social network measurement facilitates understanding of suicide disclosure, and quality and functional aspects of relationships may be more impactful than structural aspects. Depression severity may attenuate the positive influence of emotional support on disclosure. Increasing perceived benefits of disclosure could be a novel suicide prevention strategy.