01-043 · EVIDENCE B · SOURCE-SENSITIVE
Ask someone in distress directly whether they have thought about suicide
直接问身边情绪不对的人「你有没有想过自杀」，问了不会让他更想
No money; it takes a question, time to listen, and the courage to begin a difficult conversation.
Research has not found that asking about suicide creates more suicidal thoughts or distress. Some studies found less distress among students already at elevated risk.
B
Move “Ask someone in distress directly whether they have thought about suicide” to Future Me's calendar
The excuse
The routine already works until the day the source says it may not.
What feels good now
Today I keep a few minutes, a bit of persistence and avoid interrupting my default routine.
What the source says
The source summarizes the return this way: “Research has not found that asking about suicide creates more suicidal thoughts or distress. Some studies found less distress among students already at elevated risk.” Evidence grade B. The original states the population, caveats, and sources; this is not a personal forecast.
Use the original facts and limits. For an urgent medical, safety, financial, or legal issue, contact a qualified local professional or service.
THE ENGLISH EDITION
Original recommendation and evidence
43. Ask someone in distress directly whether they have thought about suicide
Cost: No money; it takes a question, time to listen, and the courage to begin a difficult conversation.
In plain terms: Research has not found that asking about suicide creates more suicidal thoughts or distress. Some studies found less distress among students already at elevated risk.
Applicability and limits: The cited studies mainly tested questionnaires and research interviews, not conversations between friends. If someone says they may be in immediate danger, stay with them and connect them to crisis or emergency help.
Translation note: This concise English edition was prepared for this site; the full Chinese source and its original evidence remain available below.
Source links
- Gould MS, Marrocco FA, Kleinman M, Thomas JG, Mostkoff K, Cote J, Davies M (2005). Evaluating iatrogenic risk of youth suicide screening programs: a randomized controlled trial. JAMA, 293(13), 1635-1643. ↗
- Polihronis C, Cloutier P, Kaur J, Skinner R, Cappelli M (2022). What's the harm in asking? A systematic review and meta-analysis on the risks of asking about suicide-related behaviors and self-harm with quality appraisal. Archives of Suicide Research, 26(2), 325-347. ↗
- Dazzi T, Gribble R, Wessely S, Fear NT (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16), 3361-3363. ↗
- Pinned original chapter on GitHub ↗
Read the complete Chinese source and notes
43. 直接问身边情绪不对的人「你有没有想过自杀」，问了不会让他更想
成本: 不花钱。问一句话，再花点时间听他说。难在开口，很多人怕一问反倒把念头勾出来。
说人话: 怕一提自杀就把念头勾出来，研究里没看到这回事。给中学生的问卷里加上自杀的问题，被问的人没有更难受，想自杀的也没有变多。本来就抑郁的孩子被问了反而没那么难受，自杀过的孩子想自杀的反而少些。
收益: 纽约州 6 所高中的 2342 名学生按班级随机分成两组。一组的问卷里有自杀问题，另一组没有。做完问卷当场和 2 天后，两组的难受程度都没有差别（P = .66 和 P = .41，P 大于 0.05 就是看不出差别）。2 天后说自己想过自杀的，被问那组 4.7%，没被问那组 3.9%，看不出差别（P = .49）。原本有抑郁症状的学生，被问了反而没那么难受（P = .01）。以前自杀未遂过的学生，被问了反而没那么想自杀（P = .02）。2022 年一篇荟萃分析评了 17 项研究，把其中 8 项「问了」和「没问」的比较合起来算。问了以后，当场和之后的自杀念头与自杀行为、不为寻死的自伤、心理痛苦，都没有显著增加。最硬的证据是 8 项随机对照试验，偏倚风险低或不清楚。2014 年另一篇文献综述也写着，没有一项研究发现问了以后自杀念头显著增加
证据等级: B
来源: Gould MS, Marrocco FA, Kleinman M, Thomas JG, Mostkoff K, Cote J, Davies M (2005). Evaluating iatrogenic risk of youth suicide screening programs: a randomized controlled trial. JAMA, 293(13), 1635-1643. <https://doi.org/10.1001/jama.293.13.1635>；Polihronis C, Cloutier P, Kaur J, Skinner R, Cappelli M (2022). What's the harm in asking? A systematic review and meta-analysis on the risks of asking about suicide-related behaviors and self-harm with quality appraisal. Archives of Suicide Research, 26(2), 325-347. <https://doi.org/10.1080/13811118.2020.1793857>；Dazzi T, Gribble R, Wessely S, Fear NT (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16), 3361-3363. <https://doi.org/10.1017/S0033291714001299>
备注: 给 B 的原因：这些研究只证明问了没有害处，没有研究算过问了能让自杀死亡少多少。收益量级定为小，也是因为没有死亡率数字，只有「念头没有变多」这个替代终点。研究里问的方式多是问卷和研究访谈，不是家人朋友当面问，搬到当面问是推论。问出来他确实想过，先别走开，陪他打 12356，把药和农药挪远，见本节第 25 条（有自杀念头时打 12356）。他说要带上别人，或者已经准备好了手段，近亲属可以直接送医，也可以报 110，见第 8 节第 15 条（近亲属可以直接送诊）。念头冒出来到动手往往只有几十分钟，见本节第 32 条（自杀念头一冒出来先告诉身边的一个人）。受益人主要是配偶和直系亲属，对朋友同事一样可以问。
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