Characterizing direct and indirect suicide-related disclosure in the proximal period surrounding an attempt: A qualitative analysis

Background: Research estimates that only 50% of suicide decedents disclosed their suicidal ideation or intent before death. However, past research has only assessed on direct disclosure (i.e., explicitly telling somebody about thoughts of suicide), and thus may not capture more indirect forms of disclosure, whereby disclosure occurs euphemistically or vaguely (e.g., “I’m worried I might do something dumb”). Preliminary evidence has shown that indirect disclosure may serve as a proximal risk factor for suicide, indicating its importance as a potential point of intervention. Methods: The current study examines direct and indirect disclosure in a sample of 35 adult inpatients hospitalized following a medically severe suicide attempt. Participants completed narrative interviews describing the day preceding their attempt. Instances of suicide-related disclosure were extracted from the interview transcripts and characterized by two coders using qualitative content analysis. Several features of disclosure were coded, including content, directness, function, recipient, and consequences.Results: Results showed that about half of participants engaged in some form of disclosure (direct or indirect) preceding their attempt. About one-third of reported disclosures were considered indirect, and included behaviors such as communicating distress, asking for help, expressing love, and saying goodbye. For 85% of participants, disclosure was at least partially responsible for the receipt of crisis intervention.Conclusion: Our findings suggest that indirect disclosure is relatively common in the 24 hours surrounding an attempt, indicating its importance as a proximal risk factor for suicide. Moreover, disclosure appears to be a critical precursor to the receipt of life-saving intervention. Future research into indirect suicide-related disclosure is warranted.