What is Suicide Ideation: How to Recognize a Problem
If you or someone you love is experiencing thoughts of suicide and suicide ideation, call the National Suicide Prevention Lifeline, available 24/7 at 1-800-273-8255, or text HOME to the Crisis Text Line at 741-741 to chat with a trained crisis counselor.
Suicidality is a controversial subject — and for good reason. The suicide rate in the United States is now at its highest since World War II. Between 1999 and 2017 alone, the U.S. suicide rate increased by one third.
Young people are at some of the highest risks of suicide. Among youth ages 15 to 19, the rate is at a 20-year high — a problem compounded by cultural issues like cyberbullying and pop culture references like the television show 13 Reasons Why.
Among people of all ages, a history of suicide ideation is an important risk factor for death by suicide. Addressing suicide ideation, then, before it becomes a larger problem could help prevent a person in need from attempting suicide. In fact, if more and more people become aware of how to intervene in a crisis, it may even help lower overall suicide rates in the United States.
This blog post answers the question, “What is suicide ideation?” and provides guidance for helping yourself or someone you love to address their suicide ideation. Dealing with thoughts of suicide is always tough, but it’s important to remember that you are never alone.
What is Suicide Ideation?
Studies of suicide attempt survivors have shown that when a person is in a suicidal state, they think differently than they might otherwise. Their pain and desperation prevent them from making positive decisions.
In this state, a person may believe that suicide is the only option to end their suffering. They may wish they were not alive, or that they had never been born. In a clinical setting, these persistent thoughts of death or suicide are referred to as suicide ideation.
Suicide ideation alone does not guarantee a person will kill themselves. Oftentimes, people experiencing suicide ideation fear to talk about these thoughts for that very reason: they do not want their intentions misunderstood, especially if they think it will result in unwanted hospitalization.
However, suicide ideation can be concerning, and often indicates a deeper problem. For example, persistent thoughts of death or suicide are an important symptom of major depressive disorder, which can precede a suicide attempt.
Suicide Ideation vs. Being Suicidal
A person can have suicidal thoughts without wanting to take their life. They may fantasize about suicide as a solution to their problems, but not show any signs of plotting to end their own life.
People who have another mental disorder, such as depression, bipolar disorder or obsessive-compulsive disorder, may also suffer from unwanted thoughts of suicide known as intrusions. Such unwanted thoughts do not mean the person actually wants to kill themself — they simply mean the person needs help.
A person who is actively suicidal may also experience suicide ideation, but they will also exhibit other signs that they want to take their own life. They will likely have a well-thought-out plan regarding how, when and where they will commit suicide. They may begin to give away their earthly possessions, write notes or say “goodbye” to people they love in preparation to commit suicide.
Suicide Risk Factors and Warning Signs
While suicide ideation does not guarantee someone will attempt suicide, a history of suicidal thoughts contributes to a person’s suicide risk. Everyone should know how to spot a person who is at high risk of suicide so they can help a friend in need. Here are some risk factors and warning signs you should know about for suicide, sourced from the American Foundation for Suicide Prevention (AFSP):
Risk Factors
Risk factors make a person more likely to commit suicide, but do not guarantee that they will or will not go on to do so. Some risk factors predisposing a person to suicide include:
- Mental health conditions such as depression, anxiety and substance use disorders make a person more likely to commit suicide
- Serious physical health conditions, especially chronic pain and trauma to the brain, can affect a person’s mood and predispose them to suicide
- Access to lethal means, including firearms and drugs, puts someone at higher risk of suicide
- Prolonged stress — harassment, bullying, relationship problems, divorce, financial crisis, loss or any other stressful life event — can drive a person to suicide
- Exposure to graphic and sensationalized accounts of another person’s suicide, whether through television, newspaper or social media, might increase a person’s suicide risk, making it important for the media to consider how they portray and talk about suicide
- Previous suicide attempts and/or family history of suicide both increase a person’s risk of suicide, as does childhood trauma, abuse or neglect
Warning Signs
Warning signs are especially important to pay attention to since they indicate a person may be facing an immediate crisis. Some warning signs to watch out for include:
- If a person talks about killing themselves, feeling hopeless or trapped, having no reason to live, unbearable pain or being a burden to others, they may be planning a suicide attempt
- If a person engages in behaviors such as increased use of alcohol or drugs, searching online for ways to end their life, withdrawing from people or activities, calling or visiting people to say goodbye, giving away their prized possessions or sleeping too much or too little, this could signal a plan to attempt suicide
- If a person displays depression, anxiety, loss of interest, irritability, shame, aggression or sudden relief, they may be at immediate risk of a suicide attempt
When Does Suicide Ideation Become a Problem?
When a person is suffering, they may not be themselves or able to think clearly. They see suicide as an escape from their pain — and because they are not thinking flexibly, they cannot come up with alternative solutions to their life’s problems. They truly believe suicide is their only option.
However, suicide ideation does not indicate that a person does not want to keep living their life. Beneath the pain and suffering, the same person you know and love is in there, feeling motivated to live and be productive. In fact, of suicide attempt survivors, more than 90 percent continue to live and engage with life.
So, when does suicide ideation become problematic? Suicide ideation may not present an immediate threat in every circumstance, but that does not mean it is not dangerous or that you should not take it seriously. Suicide ideation can be a symptom of an underlying mental health condition, such as depression, and requires action regardless of a person’s intent to attempt suicide.
Depression and Suicide Ideation
Major depression is the diagnosis most commonly associated with suicide. Of the people who complete suicide, ⅔ are depressed at the time of their deaths. If a person does not yet have a diagnosis of major depression, suicide ideation can be an important warning sign that they are suffering from this disorder.
The risk of suicide in a person who is depressed is about 20 times greater than the general population’s risk. If a person has had multiple episodes of depression or has a dependence on alcohol or drugs in addition to depression, they are at an especially high risk of completing suicide.
Suicide ideation is one symptom of depression that should always attract concern. Other symptoms and signs that you or a loved one may be suffering from depression, according to the Anxiety and Depression Association of America:
- Persistent sad, anxious or “empty” mood
- Feelings of guilt, hopelessness or worthlessness
- Fatigue; moving and/or speaking so slowly that others could notice
- Loss of interest or pleasure in activities typically enjoyed (including sex)
- Difficulty concentrating, remembering and/or making decisions
- Insomnia, early-morning awakening or oversleeping
- Weight loss or weight gain; significant increase or decrease in appetite
- Restlessness, anxiety and/or irritability
- Persistent physical symptoms that do not respond to treatment, such as headaches or muscle aches and digestive disorders
Active vs. Passive Suicide Ideation
Active vs. passive suicide ideation is analogous to being suicidal vs. experiencing suicide ideation: the question at hand is whether the person is at immediate risk of suicide, or is experiencing suicidal thoughts that may or may not be unwanted.
Determining the urgency of a person’s suicide risk is important because it also determines your next steps in helping them. For example, a person with passive suicide ideation may be able to wait and seek advice from a doctor or therapist. However, a person at immediate risk of attempting suicide, who has access to lethal means, is considered to have active suicide ideation and needs urgent medical care from a mental health service or emergency room.
That does not mean that a person with passive suicide ideation is not in danger. Many laypeople and even medical professionals possess the false belief that passive suicide ideation poses less of a risk to the person’s health and safety. However, as a case study by Dr. Robert I. Simon notes, a person’s suicide ideation can quickly change from passive to active, meaning health professionals must be no less vigilant in cases where a patient expresses passive suicide ideation.
How to Help Someone with Suicide Ideation
The ASFP recommends reaching out and asking a person directly if they are considering suicide. Contrary to popular belief, asking someone whether they plan to attempt suicide will not “put the idea into their head” if it was not there already, nor will it drive someone to kill themselves if they are already thinking about it.
When speaking with someone about their suicidal thoughts, avoid offering advice or debating the value of their life. Instead, listen to them non-judgmentally, take them seriously and tell them you care about them. When they are done sharing, you should encourage them to talk to their doctor or therapist about their thoughts.
If a person is at immediate risk of suicide, stay with them and help them remove any lethal means, such as firearms or drugs. Then, escort them to mental health services or an emergency room to make sure they receive the treatment they need.
Creating a Suicide Safety Plan
Do you know someone who suffers from suicide ideation, or suffer from suicide ideation yourself? If so, you may benefit from creating (or helping your loved one create) a suicide safety plan alongside a trained therapist, doctor or other health professional.
A suicide safety plan is designed to help a person recognize suicide ideation and intervene before they can become actively suicidal. Patients who are at risk of suicide can work with loved ones and medical professionals to write a list of coping strategies and support systems they can utilize when they begin to experience suicide ideation.
The ideal suicide safety plan will include six elements, written down on a piece of paper that the patient can easily access in a crisis, according to the Suicide Prevention Resource Center:
- Warning signs: What thoughts or feelings do they experience when they start to get depressed or think about suicide?
- Internal coping strategies: What can they do, on their own, to soothe themselves if they begin to feel suicidal?
- Social contacts who may distract from the crisis: Who can they call or what social settings can they visit when they are feeling suicidal?
- Family members or friends who may offer help: Who can they contact in confidence to talk about their suicidal thoughts or feelings?
- Professionals and agencies to contact for help: Where can they go to seek help in a crisis — i.e. mental health professionals and resources; the nearest hospital?
- Making the environment safe: What can they do to limit their access to lethal means in a crisis?
A printable worksheet such as the Brown-Stanley Safety Plan Template may help the person better organize their thoughts regarding their safety plan.
Seeking Treatment for Suicide Ideation
Experiencing thoughts of suicide is understandably distressing and, frankly, frightening for many people — especially if it is the first time such thoughts have emerged. The person may want to seek the advice of a trained medical professional or seek treatment in a facility where they can be safe away from any lethal means.
Alternatively, some people may be resistant to treatment when it is suggested to them. A person experiencing depression or anxiety may not be their kindest self and may not respond positively to the idea of treatment. The AFSP advises keeping persisting in your efforts to reach out and encourage them to seek treatment anyways. Oftentimes, when a person in pain is pushing you away, what they really need is for you to run toward them with open arms.
Many people think to go to the emergency room first in a crisis. While this is an important and valid option, especially when other mental health services may not be available, emergency rooms are often overburdened with patients seeking help of all kinds. A person in crisis who visits the emergency room may need to wait hours before receiving medical attention, only to wind up referred to an inpatient treatment center outside the hospital.
Mental health services, such as inpatient treatment centers, are one of your best options for seeking treatment for suicide ideation, whether active or passive. Inpatient treatment centers like The Meadowglade offer around-the-clock care to help control the risk factors of suicide.
In a residential treatment center, medical professionals — including doctors, nurses and psychotherapists — will work together to create a treatment plan customized to yours or your loved one’s needs. At intake, these professionals will assess your current suicide risk and symptoms of depression to provide the best treatment possible for your needs.
Residential treatment for suicide ideation combines multiple types of treatment to meet your unique needs. This can include treatments ranging from medication to individual therapy to group therapy sessions. All the while, staff will monitor you or your loved one to ensure there is no access to lethal means that can be used to harm or kill oneself, protecting the patient from suicide while they learn how to better cope with their feelings of distress.