Suicidal Ideation (Suicidal Thoughts)

What is suicidal ideation?

Suicidal ideation, or suicidal thoughts, is when you think about, consider or feel preoccupied with the idea of death and suicide. These thoughts may come and go or be extremely distracting. You might dwell on thoughts of suicide to the point where you make a plan to take your own life.

It’s difficult to simply define what suicidal ideation looks like because it’s different for each person. For example, you might fall asleep to the thought of not waking up in the morning. Or you might see a fast-moving vehicle and think about jumping out in front of it. As such, these thoughts can range in severity and intensity.

While having a thought isn’t the same as physically attempting suicide, it can still impact your mental health and lead to suicidal behaviors or self-harm. If you’re thinking about suicide or have suicidal thoughts, it’s important to talk to someone about it. This may help or prevent it from getting worse. You can call or text the Suicide & Crisis Lifeline by dialing 988. However, you don’t need to be in a “crisis” to call the Lifeline. Someone is available to talk to you 24/7.

How common is suicidal ideation?

Suicidal ideation is common. One study reported that 10.6 million adults (people over age 18) in the United States, or 4.3% of the U.S. adult population, experienced suicidal thoughts. Among children (before age 18) in the United States, 18% thought about attempting suicide.

What’s the difference between passive and active suicidal ideation?

There are two forms of suicidal ideation. These can look and feel different for each person who experiences it.

• Passive suicidal ideation: Suicidal thoughts occur without any desire to make a plan of action to harm yourself.
• Active suicidal ideation: Suicidal thoughts motivate you to create an action plan of self-harm. When a plan is in place, you may feel at ease or withdrawn. Warning signs of suicide, like giving away valued belongings and writing a note, may occur. This usually requires emergency treatment.

How is suicidal ideation diagnosed?

A healthcare provider or mental health professional will diagnose suicidal ideation after asking you a series of questions to learn more about your thoughts of suicide.

While there are several types of suicidal ideation assessments and questionnaires, there isn’t a specific suicidal ideation test to predict whether you’re going to harm yourself. The goal of a diagnosis is to help your provider learn more about what’s going on, including the cause of the suicidal ideation, so they can help you treat it.

Suicidal ideation scale

There are several types of suicidal ideation scales available to help a healthcare provider learn more about how suicidal ideation affects you and its severity. To do this, your provider will ask you several “yes” or “no” questions. For example, questions on the Columbia-Suicide Severity Rating Scale (C-SSRS) could include:

• Have you wished you were dead or wanted to go to sleep and not wake up?
• Have you had any thoughts about killing yourself?
• Do you have a plan in place to kill yourself?
• Have you harmed yourself or done anything to fulfill the plan you created (like purchasing a weapon, giving away valuables, writing a note, etc.)?

If a provider asks you questions, it’s important that you answer honestly. They’re looking out for your health and safety, so your truthfulness can open doors to treatment.

What are the most common causes of suicidal ideation?

There are many possible causes of suicidal ideation. Sometimes, there isn’t a single identifiable cause or there could be several things that contribute to suicidal thoughts. Common risk factors may include:

• Biological factors (genetics, brain development).
• Demographics (like age, education, employment and socioeconomic status).
• Interpersonal relationships.
• Negative life events.
• Sexual orientation and/or gender identity.
• Stress.
• Substance use disorder.
• An underlying mental health condition, such as depression, anxiety or psychosis.

How is suicidal ideation treated?

Treatment for suicidal ideation varies based on the severity and likely cause. One goal of treatment is to keep you safe. Your healthcare provider might recommend one or a combination of the following as treatment for suicidal ideation:

• A safety plan that includes coping skills and people to reach out to if suicidal ideation occurs.
• Cognitive behavioral therapy or other therapies to strengthen coping skills.
• Medications.
• Inpatient or outpatient mental health programs in a hospital or clinic.

If you’re a caretaker for someone who has active suicidal ideation, make sure to remove any items or objects from their living space that could cause harm, including weapons or unprescribed medications. If you’re on the receiving end of treatment, know that your caretakers aren’t taking away your property — they’re relocating items until you’re safe enough to have them in your possession.

How do I deal with suicidal ideation?

If you’re experiencing suicidal thoughts right now, here are some tips to help you cope:

• Reach out for help by calling (or texting) emergency services or a crisis line like 988 if you’re in danger of acting on your suicidal thoughts.
• Reach out to someone you trust. Meet with them or have a conversation. You don’t have to talk about suicide — it helps to be around others who care and listen.
• Participate in an activity you enjoy (or used to enjoy). You may not feel up to participating fully, but activities, even taking a short walk or petting a dog, can offer a positive distraction.
• Focus on the moment and getting through the day rather than the future. Thinking too far ahead can be overwhelming and stressful.
• Avoid using substances like alcohol or unprescribed drugs.

What are the possible complications or risks of not treating suicidal ideation?

Death by suicide is the most serious complication of untreated suicidal ideation. You’re also at risk of self-harm. Help is available — you don’t need to have a severe diagnosis to get the help you need.

Can suicidal ideation be prevented?

You can’t prevent your brain from thinking thoughts. So, there isn’t a way to prevent suicidal ideation. But there are ways to make the thoughts less severe and prevent suicide. Education and learning the warning signs are helpful. Engaging in a mental health treatment plan if you do experience suicidal ideation can reduce your risk of life-threatening outcomes.

How do I get help for suicidal ideation?

You might feel like you’re on an island when you experience suicidal thoughts, but you’re never alone.

It can be difficult to ask for help. But there are several resources available so you can get the care you need. You might start by calling or texting 988 to reach the Suicide & Crisis Lifeline (U.S.). They’re available to listen and offer assistance.

Your healthcare provider (a primary care physician) and/or a mental health professional (a therapist, psychologist or psychiatrist) can treat suicidal ideation and its causes. Support from your friends, family and community can help in the long term.

With your approval, your care team can offer guidance to your family and friends to be there for you on a daily basis. This could include providing education and skills for crisis planning and helping you cope.

If you’re unsure how to take the first step, have a conversation with someone you trust. You may feel more comfortable getting started when you know you have support.