Let's Talk About Suicide Spectrum in Spanish Adolescents. "Prefer not to say": Missing Value or Clinical Data?

Background: Suicide is the second leading cause of death in young people aged 15-29 in Spain. It is imperative to detect cases with suicidal risk for early intervention. The purpose of the study was to examine the self-reported presence of suicide spectrum indicators using a trichotomous rating scale: no, yes, prefer not to say . This last alternative was intended to safeguard the sensitive nature of the phenomenon and explore its clinical character.

Method: 5,528 adolescents made up the definitive sample (12-18 years; M ± SD = 14.20 ± 1.53; 50.74% female).

Results: Prevalence reached 15.38% for ideation, 9.32% for planning, and 3.65% for previous suicide attempts. Girls' rates were twice those of men. Suicidality showed a tendency to increase with age. Adolescents with the presence of suicidal indicators (yes) and omission of response (prefer not to say) both had lower levels of socioemotional strength and subjective well-being, and higher levels of psychopathology than the group with the absence of markers (no).

Conclusions: Prefer not to say is a response category that increases the sensitivity of the self-report, allowing more accurate identification of cases with a high suicidal risk that would go unnoticed by the traditional dichotomous system (no-yes).