Suicidal ideation means thoughts about ending one’s life. It can range from wishing not to be alive to active thoughts, intent, or a plan. All of these deserve a compassionate response and support.
If you might act on these thoughts, have taken an overdose, or cannot keep yourself safe, call emergency services now (112 in Spain and the EU; 911 in the US) or go to an emergency department. Stay with a trusted person and move away from anything you could use to harm yourself. In the US, call or text 988 for crisis support; immediate danger still requires emergency services.
This article explores suicidal thoughts, including their signs, causes, susceptible groups, and predisposing factors for suicidal ideation.
Suicidal ideation is defined by the ICD-11 as the thoughts, ideas, or ruminations on the prospect of terminating one’s life, spanning from the belief that the individual would be better off dead to the deposition of detailed planning.
Suicidal thoughts involve thoughts of ending one’s life. Self-harm without an intention to die is distinct, but also requires care and may occur alongside suicidal thoughts.
Suicidal ideation is defined by the Centers for Disease Control and Prevention as “thinking about, considering, or planning suicide.”
Suicidal ideation, often known as suicidal thoughts, refers to having ideas, thoughts, or ruminations about taking one’s own life. It is not a medical diagnosis, but rather a sign of certain mental diseases, and it can also be a response to unfavorable circumstances in the absence of a mental disorder.
Passive thoughts may involve wishing to be dead; active thoughts involve thinking about taking one’s life. A person can have active thoughts without a detailed plan. These descriptions do not reliably separate people into safe and unsafe groups.
The majority of individuals who experience suicidal ideation do not attempt suicide, yet suicidal thoughts are deemed a risk factor. In 2008–09, an approximated 8.3 million adults aged 18 or older in the U.S., or 3.7 percent of the adult population, have been shown to have suicidal thoughts, while an approximated 2.2 million reported having made suicide plans.
In 2019, 12 million adults in the United States had significant suicidal thoughts, 3.5 million organized, constructed, and planned a suicide attempt, 1.4 million made a suicide attempt, and more than 47,500 committed suicide and died as a result of it. Teenagers frequently have suicidal ideation.
Depression, mood disorders, and other mental illnesses are connected with suicidal ideation; nevertheless, many other mental diseases, life events, and familial events might raise the risk of suicidal thoughts. Due to the danger of suicidal acts and repeated issues linked with suicidal thoughts, mental health researchers assert that health systems should provide therapy and treatment for those with suicidal ideation, irrespective of diagnosis. There are a variety of therapeutic alternatives for those who have suicidal thoughts.
These changes can be warning signs of distress and reasons to ask directly about suicide. No single sign proves suicidal intent, and someone may need help without showing these signs:
- Isolating yourself from family and friends
- Feeling helpless or restricted
- Discussing suicide or death
- Giving up belongings and possessions
- A rise in the use or abuse of substances
- Increased fluctuations in mood, wrath, rage, and/or irritation
- Involving in risk-taking activities such as the use of drugs or having unprotected sex
- Having access to lethal means, like medication, narcotics, or a firearm.
- Acting as if you are bidding farewell to others
- Feeling intense anxiety
If you suspect that a loved one is considering or plotting suicide, you should inquire. It is a fallacy that you may inspire someone else to commit suicide. Asking expresses your interest and care for the individual.
Be mindful that passive suicidal thoughts, such as longing to die in an accident or your sleep rather than by your hand, is not always less serious than active suicidal ideation.
It can rapidly turn into active suicidal ideation and may comprise both active and passive aspects.
Additionally, it is vital to recognize that suicidal ideation fluctuates. Thoughts are said to “wax and wane,” which indicates that one day they could be clear, powerful, and persistent, while the next day they may be less clear and less frequent.
Nevertheless, it is always crucial to take suicidal thoughts seriously and seek treatment, even if they appear to have subsided.
If a loved one admits to contemplating suicide, you should do everything possible to ensure their safety.
Listen without judgment and help the person obtain professional support. If they have immediate intent, a plan they may act on, or cannot stay safe, call emergency services and stay with them until help arrives if safe to do so. Do not rely on your own impression that they seem calm again.
Suicidal thoughts can be associated with overlapping factors, including mental health conditions, distressing experiences, substance use, medication effects, and family history.
Psychiatric conditions
Suicidal ideation is a sign of a variety of mental diseases, and it can also result from unfavorable life circumstances in the absence of a mental disorder.
Suicidal thoughts can occur with several mental health conditions, including borderline personality disorder. Risk varies between individuals; a diagnosis or a statistic cannot predict what a particular person will do.
Adverse effects of drugs
Depression itself can increase suicide risk. Antidepressants can be beneficial, but some people develop new or worsening suicidal thoughts, especially early in treatment or after a dose change. Monitoring and prompt communication with the prescriber are important.
New or worsening agitation, suicidal thoughts, or unusual behavioral changes during antidepressant treatment require prompt medical advice. Do not stop or change medication abruptly without advice; seek emergency help if there is immediate danger.
FDA antidepressant labeling warns of an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults in short-term studies. This is not a reason to assume antidepressants cause suicide in everyone or to leave depression untreated. Prescribers weigh benefits and risks and arrange follow-up.
Individuals with anxiety problems who self-medicate with alcohol or drugs may also be more likely to entertain suicidal thoughts.
Life experiences
Significant predictors of higher suicidal thoughts are life events. In addition, life experiences can cause or be associated with previously stated psychiatric diseases, and can thus be used to predict suicidal ideation. The list of life events that increase a person’s risk can differ between adults and children, as a result of the differences between adult and child life circumstances. The life events that have been demonstrated to significantly increase risk are:
- Alcohol use disorder
- Studies have indicated that binge drinkers generally have higher incidences of suicidal ideation compared to social drinkers.
- Some research studies have linked suicidal ideation with increased alcohol consumption.
- Not only do certain studies indicate that isolated binge drinking might enhance suicide ideation, but there is also a positive feedback loop that causes those with more suicidal ideation to consume more drinks per day in a single setting.
- Discrimination, rejection, bullying, or lack of support related to sexual orientation or gender identity; identity itself is not a disorder
- Joblessness
- Chronic pain or disease
- Death of relatives or acquaintances
- Relationship termination or rejection by a love interest
- A significant shift in life standards (e.g. Relocation abroad)
- Some studies have revealed a correlation between tobacco use and depression and suicidal ideation.
- Unintended pregnancy
- Bullying includes cyberbullying and bullying in the workplace
- Prior suicide attempts
- Military experience
- Suicidal ideation is more prevalent among military personnel with symptoms of PTSD, alcohol use disorder, major depressive illness, and generalized anxiety disorder.
- Community conflicts
- Unwanted variations in body weight
- Exposure and focus on pictures or phrases relating to suicide
Family history
- Depression-prone parents
- Valenstein et al. examined 340 adult offspring of formerly depressed parents. They discovered that 7 percent of the children had suicidal thoughts in the previous month.
- Abuse
- This includes emotional, physical, and sexual abuse in childhood and adolescent years
- Family or domestic violence
- Volatility in a child’s home life
- Several research studies link suicidal ideation to familial instability. Zappulla and Pace discovered in a 2010 article that parental alienation exacerbates suicidal thoughts in teen boys with depression.
- Suicidal thoughts occur in some adolescents and should always be taken seriously. Estimates vary by population, wording, and time period; the unsupported claim that 60–75% of all teenagers experience them should not be used.
Strictly speaking, suicidal ideation is not a mental disorder, but rather a severe potential outcome of treatable mental disorders such as major depression, posttraumatic stress disorder, bipolar disorder, schizophrenia, borderline personality disorder, anxiety disorders, substance use disorders, and eating disorders such as anorexia and bulimia nervosa.
- Certain acts may suggest a person’s imminent risk of suicide.
- Discussing one’s desire to die or to commit suicide
- Looking for a means to commit suicide, like searching online or acquiring a firearm
- Discussing hopelessness or having no reason to be alive
- Certain behaviors may also suggest a significant danger, particularly if they are new, have escalated, and/or appear to be tied to a traumatic event, loss, or transition.
- Discussing feelings of confinement or excruciating suffering
- Discussing being a nuisance to others
- Increasing alcohol or drug consumption
- Acting worried or irritated; engaging in risky behavior
- Sleeping inadequately or excessively
- Withdrawal and sensation of isolation
- Displaying anger or expressing a desire for vengeance
- Exhibiting severe emotional swings
Any of the following may be possible warning signs:
Extreme grief or moodiness. Long-lasting melancholy, mood swings, and sudden wrath.
Hopelessness. Possessing a profound sense of despair toward the future, with little hope that conditions would change.
Sleep issues.
Sudden calmness. After a time of melancholy or irritability, a sudden return to serenity may indicate a choice to end one’s life.
Withdrawal from friends or usual activities can signal distress or depression. Suicide has multiple interacting contributors and cannot be explained by a single cause.
Personality or physical modifications. A person who is suicidal may demonstrate a shift in attitude or conduct, like speaking or moving with an atypical rate of speed or slowness. In addition, the individual may suddenly become less worried about how they look.
Increasingly risky behavior or substance use can signal distress and deserves a supportive conversation. It does not prove that someone no longer values their life.
Recent trauma or catastrophe in life. A significant life crisis may prompt a suicide attempt. Crises include the death of a dear one or pet, the dissolution of a relationship, the revelation of a serious illness, the loss of a career, or significant financial difficulties.
Suicide rates differ by country, age, sex, and year. Population rates do not determine an individual’s risk. Additional support may be especially important for:
- Those over 65 have ended up losing a spouse through divorce or death.
- People who have previously tried suicide
- Those having a suicide history in their family
- Individuals with a friend or colleague who has committed suicide.
- Individuals who have a history of physical, psychological, or sexual abuse
- People facing unemployment, financial strain, social isolation, or barriers to support
- People with chronic discomfort or a debilitating or fatal condition
- People predisposed to aggressive or impulsive behavior
- Individuals who have just been discharged from a psychiatric facility (Often a very scary period of transition.)
- Certain professionals, such as police officers and medical personnel, work with terminally ill patients including police officers and physicians.
- Individuals with substance abuse issues
Individuals belonging to these susceptible groups need to be looked after with extra attention. A simple approach for a loved one is to inquire about their mental, physical and emotional health regularly, be alongside them or be easily available, offer them help, and if need be, ask them to seek professional help or assist them in seeking professional help of a doctor or a mental health expert.
Assessment explores current thoughts, intent, plans, access to means, past attempts, current stressors, mental and physical health, substance use, strengths, and support. It should lead to a collaborative safety and treatment plan.
A clinician asks direct, compassionate questions and may use a structured interview. With appropriate consent, information from family or other professionals can help. Immediate safety needs take priority.
The following tools may help structure questions, but scores must not be used alone to predict suicide, label someone low or high risk, or decide who receives treatment:
- Beck Suicide Ideation Scale
- Suicidal Affect–Behavior–Cognition Scale (SABCS)
- Nurses’ Global Assessment of Suicide Risk
- Columbia Suicide Severity Rating Scale
Resource References:
- What is suicidal ideation? Verywell Mind. Available at: https://www.verywellmind.com/suicidal-ideation-380609.
- Suicide and suicidal thoughts (2022) Mayo Clinic. Mayo Foundation for Medical Education and Research. Available at: https://www.mayoclinic.org/diseases-conditions/suicide/symptoms-causes/syc-20378048.
- Suicide ideation: Symptoms, causes, prevention, and resources. Medical News Today. MediLexicon International. Available at: https://www.medicalnewstoday.com/articles/193026#getting-help.
- What are suicidal feelings? Mind. Available at: https://www.mind.org.uk/information-support/types-of-mental-health-problems/suicidal-feelings/about-suicidal-feelings.
- Suicidal ideation (2022) Wikipedia. Wikimedia Foundation. Available at: https://en.wikipedia.org/wiki/Suicidal_ideation
