Every researcher who studies anything emotionally loaded — trauma, abuse, depression, suicidality, bereavement — has had some version of the following conversation with an ethics board:

We’re concerned that asking participants about [topic] may cause distress, retraumatize them, or even induce [symptoms]. Could you tone the questions down? Or perhaps remove this module entirely?

The concern sounds reasonable. It is also, as far as anyone has been able to measure, wrong. There is now a fairly large empirical literature on what actually happens when you ask participants about the worst things in their lives, and the literature is unusually consistent: most people are fine, a minority feel some transient distress, more people say they got something positive out of it than say they got something negative, and there is no evidence that participation does any lasting harm — including in the studies specifically designed to look for it. This holds even when the topic is suicide.

I want to walk through the evidence, because it is genuinely striking, and then make a slightly stronger claim: at this point, the ethically interesting question is not whether it is acceptable to ask, but what it costs participants and the field when we don’t.

What the literature actually says

The single most comprehensive piece of evidence is a multilevel meta-analysis by Jaffe and colleagues (2015), which pooled 70 samples and 73,959 participants across studies asking adults about interpersonal violence, sexual and physical assault, combat, terrorist attacks, natural disasters, and so on. On a 1–5 scale, participants reported:

  • distress around 2.3 (i.e., “low to moderate”)
  • benefit around 2.4 (on a scale where lower means more beneficial, so a moderate-to-high endorsement of benefit)
  • global evaluation of the experience around 1.5 (very close to “very positive”)
  • minimal regret, minimal feelings of coercion, minimal sense that the questions were too personal

People with PTSD symptoms or a personal history of victimization reported somewhat higher distress, but their absolute level was still in the low-to-moderate range, and crucially they were just as likely as other participants to endorse benefit and to say they did not regret participating. There were no gender differences. The authors concluded that “trauma-related research can continue without harming participants.”

This is consistent with the earlier systematic review by Jorm, Kelly, and Morgan (2007), which covered 46 studies of psychiatric research and reached the same conclusions in narrative form: a minority of participants experience transient distress, positive reactions are more common than negative ones, follow-up studies find no long-term harm, and the two are largely independent — many participants report being upset and finding the experience worthwhile. One participant in a study of suicide-bereaved relatives put it well: “The same evening I was upset. I went through it all again, but I didn’t feel worse, rather I felt strengthened.”

The harder case: asking about suicide

The most common version of the IRB worry is the iatrogenic one — that asking might create the very phenomenon you’re studying. Nowhere is this fear more entrenched than for suicide. Surveys of physicians find that around 10–35% believe that asking about suicide can induce suicidal behaviour. Lakeman and Fitzgerald (2009) found that 65% of ethics committee members perceived suicide questions as potentially harmful.

This belief has been tested directly. DeCou and Schumann (2017) meta-analyzed 13 prospective studies — mostly RCTs and other controlled designs — that compared participants who completed suicide assessments to those who didn’t. Pooled effects across all time frames (immediate, 2–4 weeks, 2 months to 2 years) showed no significant iatrogenic effect on suicidal ideation, psychological distress, or suicidal behaviour. Not in the general population, not in psychiatric inpatients, not in adolescents, not in patients with borderline personality disorder, not in people with prior attempts.

The single best study in that pool is worth highlighting on its own. Gould et al. (2005) randomized 2,342 high school students to either complete a suicide screening or a control survey. Two days later both groups were re-assessed. The screened group showed no excess distress, no excess suicidal ideation — and in the subgroups with depression or prior attempts, there was actually some evidence of benefit.

So when an ethics committee tells you that asking about suicide might tip someone over, they are stating a belief that has been empirically tested, in a randomized design, on thousands of adolescents — exactly the population the worry centres on — and the test came out the other way.

The other side of the ledger

Most discussions stop here, with: “asking is safe, so the IRB can stop worrying.” But Becker-Blease and Freyd’s (2006) excellent piece in American Psychologist makes a more important point: every cost–benefit analysis the IRB performs is implicitly comparing asking against the alternative of not asking. And not asking has costs that are almost never put on the scale.

A few of them:

  • Survivors lose the opportunity to disclose. Sinclair and Gold (1997) found that wanting to tell but not telling predicted mental-health symptoms in survivors of child sexual abuse better than the abuse severity itself. Selective silence — being asked carefully about everything in your life except the worst part — is not a neutral act.
  • Estimates of the role of trauma get systematically deflated. When abuse history isn’t measured, its effects on whatever you’re studying get absorbed into other variables (Putnam et al. 1996). Read et al. (2001) made this point sharply for schizophrenia research; Nemeroff et al. (2003) showed that depression patients with early trauma respond differently to treatment than those without — a moderator you can only find if you ask.
  • It signals that the topic is unspeakable. A study that asks participants in detail about sexual behaviour, drug use, finances, and family conflict, but omits the one question about whether anyone has ever hurt them, has communicated something about what researchers think is acceptable to talk about. Becker-Blease and Freyd point out a striking pattern in the data: non-abused people are more likely than abuse survivors to object to questions about abuse. The discomfort being protected is often not the participants'.

There is also an instructive asymmetry in who tends to misestimate the experience. Marshall et al. (2001) had both psychotherapy clients and their therapists rate how disruptive and how beneficial it was for the client to participate in research that involved taping sessions. The clinicians systematically underestimated the benefit and overestimated the disruption compared to the patients’ own ratings. The same pattern shows up across the literature: the people doing the gatekeeping are more worried than the people being protected.

What participants actually say

The cleanest test of this asymmetry is to ask participants directly. The answers are remarkably consistent across studies and populations:

  • 85% of undergraduates, after answering questions about child abuse and trauma, rated including such measures in psychology research as a “somewhat good” or “very good” idea; only 3 of 481 said “bad” (DePrince & Freyd, 2006).
  • In a study by Newman et al. (1999) on abuse and PTSD, 97% of women said they would have participated even knowing what the experience would be like. Of those who reported unexpected upset, only about 11% said they would not have participated again.
  • In studies that compared trauma items to other personal items, participants rated the trauma items as the most important and as having the most favourable cost–benefit ratio (Binder, Cromer & Freyd, 2004).
  • WHO’s multi-country domestic violence study (García-Moreno et al. 2005) asked over 24,000 women across 10 countries how they felt at the end of the interview. In nearly every site, the majority reported feeling good or better, and women who disclosed violence were as likely or more likely than non-victims to report this.

This is the part of the literature that I find hardest to square with the standard ethics-committee framing. Researchers worry about participants. Participants are mostly fine, and many of them are grateful.

What the IRB is actually optimizing for

I don’t want to be unfair to ethics boards. There are good reasons to ask researchers to think carefully about consent, debriefing, referral resources, interviewer training, and follow-up — and the literature genuinely supports being thoughtful about all of these. The pattern that emerges from the recommendations sections of all four reviews is something like: ask, but ask well. Trained interviewers. Clear consent that doesn’t catastrophize. Privacy. A way out for any participant who wants one. Referral information for everyone. A protocol for the rare case of acute distress.

What the evidence does not support is the more common IRB instinct — to remove items, water down questions, exclude vulnerable groups, or refuse approval altogether because of distress risk. That instinct treats potential participant discomfort as the only ethical cost in play. It is the cost most visible to the committee and the cost most visible to the institution’s legal counsel, and so it gets all the weight. The cost to survivors of being asked about everything except their abuse, the cost to clinical research of consistently underestimating the role of trauma, the cost to society of generating less-informed policy on suicide and violence — these costs are diffuse, and nobody on a committee is paid to notice them. So they are quietly paid by the people the committee thinks it is protecting.

So, does it hurt to ask?

Across four decades of studies, tens of thousands of participants, multiple meta-analyses, and at least one well-powered randomized controlled trial on the topic researchers fear most: no, asking does not hurt, and most people are glad to be asked. A minority experience some transient distress, which is a worthwhile thing for researchers to design around, but it is not a reason to refuse to ask. The empirical question is settled to the extent that anything in this field is ever settled.

What remains is a question about institutional incentives. Ethics committees are not staffed by people who are bad at their jobs. They are staffed by people whose job is asymmetric: they get blamed when something goes wrong and they don’t get credit when good research happens. So they index hard on visible, individual-level risk and discount everything else. The empirical literature is an argument for recalibrating that index. It does not say committees should worry less in general — only that the specific worry about asking participants to talk about their lives is, in light of the evidence, the wrong worry.

If you are designing a study right now and considering dropping a trauma module, or softening a suicide item, or excluding survivors as participants, because you think it is “safer”: the data do not support you. Ask the question. Ask it carefully, debrief well, and give participants a way to follow up. But ask it.

References

  • Becker-Blease, K. A., & Freyd, J. J. (2006). Research participants telling the truth about their lives: The ethics of asking and not asking about abuse. American Psychologist, 61(3), 218–226. https://doi.org/10.1037/0003-066X.61.3.218
  • Binder, A., Cromer, L. D., & Freyd, J. J. (2004, November). What’s the harm in asking? Participant reaction to trauma history questions compared with other personal questions [Poster]. 20th Annual Meeting of the International Society for Traumatic Stress Studies, New Orleans, LA.
  • DeCou, C. R., & Schumann, M. E. (2018). On the iatrogenic risk of assessing suicidality: A meta-analysis. Suicide and Life-Threatening Behavior, 48(5), 531–543. https://doi.org/10.1111/sltb.12368
  • DePrince, A. P., & Freyd, J. J. (2006). Costs and benefits of being asked about trauma history. Journal of Trauma Practice, 3(4), 23–35. https://doi.org/10.1300/J189v03n04_02
  • García-Moreno, C., Jansen, H. A. F. M., Ellsberg, M., Heise, L., & Watts, C. (2005). WHO multi-country study on women’s health and domestic violence against women. World Health Organization. https://www.who.int/publications/i/item/924159358X
  • Gould, M. S., Marrocco, F. A., Kleinman, M., Thomas, J. G., Mostkoff, K., Cote, J., & Davies, M. (2005). Evaluating iatrogenic risk of youth suicide screening programs: A randomized controlled trial. JAMA, 293(13), 1635–1643. https://doi.org/10.1001/jama.293.13.1635
  • Jaffe, A. E., DiLillo, D., Hoffman, L., Haikalis, M., & Dykstra, R. E. (2015). Does it hurt to ask? A meta-analysis of participant reactions to trauma research. Clinical Psychology Review, 40, 40–56. https://doi.org/10.1016/j.cpr.2015.05.004
  • Jorm, A. F., Kelly, C. M., & Morgan, A. J. (2007). Participant distress in psychiatric research: a systematic review. Psychological Medicine, 37(7), 917–926. https://doi.org/10.1017/S0033291706009779
  • Lakeman, R., & FitzGerald, M. (2009). The ethics of suicide research: The views of ethics committee members. Crisis, 30(1), 13–19. https://doi.org/10.1027/0227-5910.30.1.13
  • Marshall, R. D., Spitzer, R. L., Vaughan, S. C., Mellman, L. A., MacKinnon, R. A., & Roose, S. P. (2001). Assessing the subjective experience of being a participant in psychiatric research. American Journal of Psychiatry, 158(2), 319–321. https://doi.org/10.1176/appi.ajp.158.2.319
  • Nemeroff, C. B., Heim, C. M., Thase, M. E., Klein, D. N., Rush, A. J., Schatzberg, A. F., et al. (2003). Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma. Proceedings of the National Academy of Sciences, 100(24), 14293–14296. https://doi.org/10.1073/pnas.2336126100
  • Newman, E., Walker, E. A., & Gefland, A. (1999). Assessing the ethical costs and benefits of trauma-focused research. General Hospital Psychiatry, 21(3), 187–196. https://doi.org/10.1016/S0163-8343(99)00011-0
  • Putnam, F. W., Liss, M. B., & Landsverk, J. (1996). Ethical issues in maltreatment research with children and adolescents. In K. Hoagwood, P. Jensen, & C. Fisher (Eds.), Ethical issues in mental health research with children and adolescents (pp. 113–132). Erlbaum.
  • Read, J., Perry, B. D., Moskowitz, A., & Connolly, J. (2001). The contribution of early traumatic events to schizophrenia in some patients: A traumagenic neurodevelopmental model. Psychiatry, 64(4), 319–345. https://doi.org/10.1521/psyc.64.4.319.18602
  • Sinclair, B. B., & Gold, S. R. (1997). The psychological impact of withholding disclosure of child sexual abuse. Violence and Victims, 12(2), 137–145. https://doi.org/10.1891/0886-6708.12.2.137

Citation

Persson, B. N. (2026). Does it hurt to ask? [Blog post]. https://bjorn-persson.github.io/thoughts/does-it-hurt-to-ask/

@misc{Persson2026DoesItHurtToAsk,
author = {Björn N. Persson},
year = {2026},
title = {Does It Hurt to Ask?},
note = {Blog post},
url = {https://bjorn-persson.github.io/thoughts/does-it-hurt-to-ask/}}