Effectiveness of Diagnostic vs. Symptom-Only Suicide Crisis Syndrome Assessment (SCS-A) for Post-Discharge Suicide Prevention.

Asking directly about suicidal thoughts is an important part of suicide prevention, but even a well-conducted assessment depends on whether someone is able and willing to share what they are experiencing. Research suggests that many people experiencing suicidal thoughts do not disclose them to clinicians, family members, friends, or anyone else. Some may fear judgment, hospitalization, or loss of autonomy, while others may feel ashamed, isolated, or unsure how to put their experience into words. In some cases, a suicidal crisis may also develop so quickly that there is little opportunity to tell someone beforehand. Understanding why people remain silent is therefore critical—not because disclosure can perfectly predict who will attempt suicide, but because reducing barriers to honest conversations can create more opportunities for connection, support, and intervention.

With AFSP funding, Dr. Igor Galynker and colleagues examined disclosure among 39 adults hospitalized in New York City following a suicide attempt, asking participants within seven days of their attempt whether they had previously shared their suicidal thoughts or intent with anyone. Nearly half (46%) reported that they had not. Among participants who described their reasons not to disclose, four themes emerged: fear of stigma or negative reactions, fear of consequences such as hospitalization or being stopped, isolation or having no one they felt able to talk to, and the sudden or impulsive nature of the attempt. Because participants were interviewed shortly after an attempt, the study offers a rare look at nondisclosure close to the time a suicidal crisis occurred rather than relying on memories months or years later. Although these findings require further research, they reinforce that asking about suicide is essential but may not always be enough. Creating environments where people feel safe disclosing, strengthening trusted social connections, and developing prevention strategies that do not depend solely on someone identifying and communicating their own risk may help create additional pathways to safety.

Citation: Garagiola, E. R., Bhatt, Y., Lawrence, H., Witerska, V., Rosen, T., Galynker, I., & Bloch-Elkouby, S. (2026). Patterns of suicidal ideation disclosure among acute psychiatric inpatients. Annals of general psychiatry, 25(1), 60. https://doi.org/10.1186/s12991-026-00669-y

The Suicide Crisis Syndrome (SCS) is a psychological state identified as a potential precursor to suicidal behavior, particularly in individuals experiencing acute mental health crises. It was conceptualized by Dr. Igor Galynker as a framework to better predict imminent suicide risk and is characterized by a cluster of symptoms (e.g., feelings of entrapment, cognitive disturbance, extreme hopelessness, hyperarousal, social withdrawal) that are distinct from other mental health conditions, such as depression and anxiety. While many factors may influence the development of SCS, researchers have wondered if there is a relationship between global crises, such as the COVID-19 pandemic, and the incidence of SCS.

To explore the relationship between different aspects of the COVID-19 pandemic (e.g., peak daily cases and deaths, government responses and interventions) and SCS prevalence, Dr. Galynker collected data from 5528 adults across 10 countries using an anonymous web-based survey between June 2020 and January 2021. Participants with high SCS scores were more likely to be from countries with higher peak daily cases and deaths during the pandemic’s first wave. Additionally, longer exposure to the pandemic severity markers, such as prolonged lockdowns, were linked to a higher likelihood of screening positive for SCS. These findings were consistent across different countries and show that both the pandemic itself, and government responses to it, were associated with Suicide Crisis Syndrome.

Citation: Cohen, L. J., Liang, Y., Peterkin, D., McGibbon, K., Rappa, F., Rogers, M. L., You, S., Chistopolskaya, K., Enikolopov, S., Barzilay, S., Menon, V., Husain, M. I., Dudeck, M., Streb, J., Çinka, E., Yilmaz, F. K., Kuśmirek, O., Valvassori, S. S., Blum, Y., & Galynker, I. (2024). Relationship Between Severity and Length of Exposure to COVID-19 Parameters and Resulting Government Responses and the Suicide Crisis Syndrome (SCS). Disaster Medicine And Public Health Preparedness, 18, e68, Article e68. https://doi.org/10.1017/dmp.2023.235