Suicidal ideations (SI), often called suicidal thoughts or ideas, is a broad term used to describe a range of contemplations, wishes, and preoccupations with death and suicide.
There is no universally accepted consistent definition of SI, which leads to ongoing challenges for clinicians, researchers, and educators.
For example, in research studies, SI is frequently given different operational definitions. This interferes with the ability to compare findings across studies and is frequently mentioned as a limitation in meta-analyses associated with suicidality. Some SI definitions include suicide planning deliberations, while others consider planning to be a discrete stage. In this article, we shall discuss suicidal ideation: an overview.
Beyond the lack of clear nomenclature, there are other concerns. A systematic review of the numerous interprofessional clinical guidelines for suicide yielded no consensus on a clinical gold standard for assessing and managing SI or people at risk of suicide. Although scales to measure depression, SI, and risk for suicide exist, none produce a score that is sufficiently reliable or clinically useful in predicting the very small subgroup of suicide ideators whose death by suicide is imminent.
During extreme stress or when facing mental health challenges, some people might feel there’s only one way to find relief: self-harm or suicide.
You might regularly think about suicide or contemplate what life would be like without you around. You might even reach the point where you plan in your mind how you’d do it.
Understanding these feelings and thoughts can help you ease them if you or someone you know is experiencing them.
Table of Contents
What is suicidal ideation?
Suicidal ideation is the broad term trusted Source that describes a preoccupation with death, suicide, or self-harm.
There are two types of suicidal ideation:
- passive: a person has specific thoughts of suicide, of “not wanting to be alive,” or “not wanting to wake up in the morning” but doesn’t intend or plan to commit the action
- active: a person not only thinks about suicide but intends to commit the action and plans how to do it
Not everyone with suicidal ideation acts on it, making it impossible to predict who will or won’t act on these thoughts or ideas.
Whether you regularly think about it or have taken steps and made a plan to carry the action out, help is available.
Suicide is one of the leading causes of death.
In a cross-national survey of more than 84,000 adults across 17 countries, about 9% report having suicidal ideation at some point, 3% report they’ve made a plan, and 3% report attempts.
In the United States, suicide is on the rise in some states:
- Suicide rates increased by more than 30%Trusted Source in half the states since 1999.
- Suicide was the 10th trusted Source leading cause of death in the United States in 2019, the 2nd leading cause of death among people ages 10 to 34 years old, and the 4th leading cause of death among people ages 35 to 44 years old.
- In 2019, the suicide rate was 3.7 times higherTrusted Source among males than females.
- The most common method used in suicide deaths in 2019 was firearmsTrusted Source.
- In 2019, 4.8%Trusted Source of adults aged 18 and older reported having serious thoughts of suicide, with the highest numbers (11.8%) seen in adults ages 18 to 25 years old.
- In 2019, the number of adults age 18 and older who reported attempts of suicide in the past year was 0.6%Trusted Source. Among this number, the highest (1.5%) was from individuals who report having multiple (two or more) races.
- During the early part of the 2020 COVID-19 pandemic, suicidal ideation rates increased with twice as many trusted Source U.S. adults (10.7%) reporting that they seriously considered suicide in the previous 30 days compared to those in 2018 (4.3%).
The symptoms of suicidal ideation can vary from person to person. There are common ones that might be helpful to look out for:
- talks about feeling hopeless or having no reason to live, including telling friends and family they would be better off without you
- gives away personal possessions
- exhibits reckless behaviors, such as using drugs or alcohol often
- avoids social interactions
- increased rage or anger
- appears anxious or overly agitated
- feels trapped
- extreme mood swings
- talks or posts on social media about wanting to die
- makes plans for suicide, such as buying a weapon or researching methods of suicide
Not everyone will show the same symptoms.
Some people might not show symptoms at all. They might keep their thoughts and feelings about suicide from family and friends.
There’s no exact or known cause of suicidal ideation. Many factorsTrusted Source may contribute:
- a family history of violence or suicide
- a history of mental health issues
- feelings of hopelessness
- identifying as LGBTQIA+ with no family or home support
- a sudden loss of work, friends, finances, or a loved one
- having financial or legal problems
- having a physical illness or health condition
- a history of suicide attempts
- experiencing bullying
- exposure to suicidal behavior in others
- relationship issues, such as a breakup or violence
- a history of abuse or neglect
- experiencing sexual violence or trauma
- stress due to racism or discrimination
- a lack of access to quality care for mental health issues
While mental health is often believed to be the cause of suicide, more than half (54%Trusted Source) of U.S. suicide deaths were not by people with a diagnosed mental health condition.
However, some common conditions have been linked to an increased chance of suicidal ideation:
- major depression
- bipolar disorder
- substance use disorder
- borderline personality disorder
- post-traumatic stress disorder (PTSD)
- serious medical conditions with pain
- traumatic brain injury
If you or someone you know ever experiences thoughts of suicide, seek medical help immediately.
If you decide to reach out to your family doctor or visit a clinic near you, you’ll likely be asked questions to determine the seriousness of your situation and evaluate your thoughts.
Some questions you may be asked include:
- Do you have a history of mental health issues?
- How long have you been having thoughts of suicide? Do you have a plan?
- Are you taking any medications? If so, what kind do you take?
- How often do you use alcohol or drugs?
You might also be asked to fill out a questionnaire. These questions will help the doctor determine if you might benefit from an evaluation by a mental health professional or if treatment is needed.
Suicidal ideation can be a symptom of an underlying issue.
Your doctor might refer you to a mental health professional for further evaluation. If it’s determined that you might have a mental health condition — such as depression — your doctor might recommend therapy to discuss any issues in a safe space that might be causing you stress or anxiety.
Your doctor might also recommend medications to help manage your symptoms.
Self-care strategies, in combination with therapy or medication, might also help ease your symptoms.
If you need additional help or resources, an online or in-person support group can connect you with others with similar issues and provide support.
When is suicidal ideation a medical emergency?
If there’s an immediate threat of suicide or an attempt, call 911. Depending on the seriousness of the situation, the person may be transported to an emergency room.
If it’s determined that you’re in danger of harming yourself, you might be admitted to the hospital for further evaluation. This may be followed by a recommendation to a mental health professional once you’re discharged.
If the threat is low, they might refer you to a mental health professional near you.
If the emergency room is not an option, there are other ways to seek help immediately.
- Crisis hotlines. There are several suicide hotlines and resources that can provide support and guidance right away.
- Mobile crisis teams. These teams can assist with finding resources or programs near you that can provide support as well as perform prescreening evaluations.
- Walk-in services. Clinics and urgent care centers offer counseling and help in less emergent situations. However, if necessary, they may refer you to the emergency room.
If you have thoughts of suicide or self-harm, understanding when these thoughts occur can help you manage them.
- Try to identify the situations that might prompt these feelings and jot down in a journal or tracker when they happen and how you handle them.
- Consider keeping a journal to help keep track of any distressing thoughts or emotions.
- Try some self-care strategies — such as deep breathing, mindfulness meditation, or physical activity — to ease feelings of depression or anxiety.
- Consider reaching out to someone you trust or a family doctor when you first begin to experience these thoughts or feelings.
How to help someone in need
If you suspect someone you know is having thoughts of suicide or self-harm, there are 5 steps you can take to help them.
- Ask the question: “Are you thinking about suicide?”
- Be there to show support, whether that’s in person or on the phone.
- Find out if they’re safe from firearms and any other lethal means (objects such as medications or sharp instruments), and take steps to remove them from this danger or harm.
- Connect them with people who can help right away. You can call 911 or reach out to a suicide hotline.
- After you’ve connected them with someone who can help, follow up to see how they’re doing and how else you can offer support.
Additional ways we can help
Suicide can be prevented. There are some things we can all do to help. We can:
- provide support to those in need
- create safe and supportive environments
- strengthen access to quality healthcare
- offer programs in our communities that bring people together
- provide services that teach coping and problem-solving skills to help people manage stressful situations
- promote employee health and well-being
- learn the symptoms of suicidal ideation, how to respond, and where to seek help