Rates and Reasons for Concealing Suicidal Ideation From Clinicians: A Cross-National Examination

Introduction: Nondisclosure of suicidal ideation (SI) presents a challenge to assessing suicide risk, as assessments often rely on self-reported SI. Cross-national comparisons of rates of, and reasons for, SI nondisclosure remain understudied. The present study examined whether rates of SI nondisclosure from clinicians differed, and if there were differences in rates of reasons for SI nondisclosure, across 12 countries. Method: A subset of adult participants (n = 6770) who reported a lifetime history of SI from 12 countries responded to the question: “Have you ever denied or concealed thinking about suicide from a doctor or clinician?” Those who selected “Yes” provided reason(s) for SI nondisclosure. Responses were coded according to inductively and deductively derived reasons for SI nondisclosure. Results: Rates of nondisclosure among participants who reported lifetime SI ranged from 7.2% (Taiwan) to 48.2% (United States). Among those participants, rates of reasons for SI nondisclosure ranged from 2.0% (participant was unsure/did not know why they concealed SI) to 35.6% (negative internal experiences). Conclusions: Findings provide insight into the frequency of and reasons for SI nondisclosure from clinicians at a country-specific level. Results could serve as a rationale for clinicians to incorporate indirect suicide risk factors into risk assessments.