The Crisis Text Line analyzed 75 million texts to pinpoint the best way to ask if someone's suicidal

Research shows that asking someone if they're suicidal doesn't make them more likely to attempt suicide. Still, starting that conversation can feel intimidating for people worried about offending or embarrassing a loved one.

That's why Crisis Text Line, a free, nonprofit emotional support texting service, has released new data suggesting that one way of framing that question is more effective than another.

After using artificial intelligence to analyze its dataset of 75 million text messages, collected since the service's launch in 2013, Crisis Text Line found that assessing suicide risk with an "expression of care" was most likely to reduce a texter's suicidal feelings.

Texters were nearly twice as likely to feel less suicidal when a counselor used a compassionate approach as opposed to a blunt one.

In the former scenario, a counselor would repeat the texter's reason for reaching out, then ask about suicide risk by explicitly mentioning care and concern for their safety.

A counselor speaking to a texter dealing with a breakup, for example, would say this: "Sometimes when people go through a breakup, they may have thoughts of ending their life. I want to check in, have you had any of these thoughts?"

Another example might look like this: “With all of your sadness about the breakup, I just want to check in about your safety. Have you had any thoughts about death or dying?”

By contrast, language like, "Are you feeling suicidal?," "Do you want to hurt yourself?" and, "Are you having suicidal thoughts?" was less effective.

Nearly 6 percent of texters reported feeling less suicidal in a post-conversation survey when they'd experienced an explicitly caring approach, compared to 3.3 percent who were asked outright about suicidal thoughts or behavior.

In addition to analyzing 75 million messages, Crisis Text Line's clinical staff reviewed about 400 transcripts to evaluate how texters responded to counselors' different approaches. As a result, they found that an "apology" method — saying sorry, expressing hesitancy, or implying they'd rather not ask about suicide — was also less effective.

That reflected phrasing like, “I’m sorry, but I have to ask, are you thinking of killing yourself?” and “Since you mentioned feeling depressed, I need to ask, are you planning to kill yourself?”

The findings led Crisis Text Line to institute a new policy of always asking texters whether they feel suicidal, and training counselors to always use the "expression of care" method. Previously, counselors only asked the question when they felt someone was at risk of suicide.

"Let’s give people the words to use and show them it’s not hard to use, and you will do more good than harm," said Shairi Turner, an internist, pediatrician, and chief medical officer of Crisis Text Line.

For someone contemplating suicide, an apology that precedes a question about whether they're thinking of taking their life may invoke feelings of shame and isolation, Turner added. An affirmative, caring tone, on the other hand, normalizes the conversation and makes it easier for someone to share their suicidal thoughts.

"How you set up that conversation is actually critically important," said Christine Moutier, a member of Crisis Text Line's clinical advisory board and chief medical officer of the American Foundation for Suicide Prevention.

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While Moutier believes the new insights from Crisis Text Line add to existing knowledge about how to ask a loved one if they're experiencing suicidal thoughts or behavior, she notes that the best practices are based on a population of people who've reached out to a stranger for help. It's possible that a different approach might work better with people who don't seek help, but there's no way the Crisis Text Line data can answer that question.

In general, though, Moutier urges people to be empathetic when asking a loved one about suicide.

"When the receiving person can simply tolerate it, hold it in a way that doesn’t judge, and doesn’t jump in with a solution or quick fix, but receives it in a loving, compassionate way, that’s the ideal," says Moutier.

Turner says that while we may not ever understand why a suicidal person attempts to take their life, we can get better at asking them before it's too late.

"[I]f we can arm people to be the experts to help each tother," she says, "then I think we’ll make tremendous headway into helping those who are in pain."

If you want to talk to someone or are experiencing suicidal thoughts, text the Crisis Text Line at 741-741 or call the National Suicide Prevention Lifeline at 1-800-273-8255. Here is a list of international resources.