Selective Disclosure in Self-Reported Suicide Risk Screening

Reliance on self-reported screening for suicide risk may be contributing to a lack of progress in suicide prevention, in part, because of limitations related to stigma, ambivalence, and deception in responding. One change to potentially mitigate these issues and improve screening effectiveness is to allow for explicit selective disclosure of information, specifically by including a “prefer not to disclose” option in screening items. This study aimed to achieve the following: (1) investigate whether selective disclosure is a valid and reliable construct of suicide risk among high risk populations, (2) identify causal mechanisms and moderators of selective disclosure, and (3) investigate the relationship between selective disclosure and death/suicide implicit association (d/s-IAT). These aims were investigated using online self-report surveys across three independent samples of adults in higher-risk and lower help-seeking populations, and who reported high current distress: Military and veterans (n = 135), men over age 50, (n = 187), and LGBTQ young adults (n = 140). Across groups, results indicated that selective disclosure was highly specific to individuals who reported higher risk for suicide, and was prevalent in approximately one out of four participants who endorsed some level of suicide risk. Above and beyond explicit report of suicide risk, reported inaccuracy of risk disclosure, low help seeking, and hopelessness were the only predictors significantly associated with selective disclosure across all groups. Qualitative results also highlighted the importance of “mistrust,” “misunderstanding,” and “fear of stigmatized consequences” as drivers for selective disclosure. Personality traits and mode of assessment did not appear to affect likelihood for selective disclosure. Implicit association to death/suicide was significantly associated with explicit report of suicide risk across all groups, but was not associated with selective disclosure. These results suggest that adding explicit selective disclosure choices to suicide risk screening items is unlikely to substantially increase screening sensitivity, as nearly all selective disclosers self-reported elevated suicide risk. However, allowing for and evaluating explicit selective disclosure among suicide risk reporters may provide useful information for risk assessment and follow-up, and preemptively addressing drivers for selective disclosure before or during suicide risk screening may increase screening effectiveness.