Suicidal ideation among outpatients attending a public mental health clinic in Norway: rates, treatment effect, and associated characteristics

Suicidal ideation is frequently reported by outpatients in mental health care. The aim of this study was to describe the rates of suicidal ideation (SI) in a heterogenous outpatient sample, the effect of treatment as usual (TAU) on SI, and characteristics of patients who report SI. Participants were outpatients receiving TAU at a public mental health clinic. They completed measures assessing levels of depression, anxiety, functioning, and health-related quality of life before (N = 2475) and after treatment (n = 559). More than half of the sample (57%) reported SI before treatment. For participants with SI, 55% experienced a reduction in SI, 38% reported no change, while 7% had increased SI. The overall reduction in SI reflected a moderate to large effect size. SI at pre-treatment was associated with more symptoms of depression and anxiety, impaired functioning, lower health-related quality of life, male sex, lower age, and not being in a relationship. SI is common among psychiatric outpatients and is more prevalent among patients with higher symptom severity, males, and people who are young and single. Treatment as usual is associated with moderate to large improvements for SI. However, a large proportion of patients report unchanged or increased SI, which indicates that additional interventions may be needed.