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HomeMental HealthWhat Is Suicidal Ideation
Suicidial Thoughts scaled

11 Minutes

Edited & medically reviewed by THE BALANCE Team
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A person with suicidal thoughts will think about taking their own life. In the medical world, there is no generally recognized definition of the term “suicidal ideation.” So what does suicidal ideation mean? Some individuals believe that suicidal ideation entails actively planning suicide, although suicidal ideation would not always imply that a person intends to take his or her own life.

Others, however, see planning a suicide as a distinct entity and claim that suicidal ideation and thoughts are the same. Suicidal ideation is prevalent. In the year 2020, 12.2 million Americans reported having serious suicidal thoughts. Approximately 10 percent had attempted suicide. With assistance and treatment, however, suicide can be prevented.

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.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes it as thoughts about self-harm, including purposeful consideration or preparation of possible means for causing one’s death.

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.

On measures of suicide risk, the spectrum of suicidal ideation ranges from momentary ideas to extensive planning. Passive suicidal ideation involves not wanting to live or envisioning death. Active suicidal ideation is contemplating various methods of suicide or formulating a suicide plan.

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.

The following are suicidal ideation signs that indicate that you or a loved one is thinking about or considering suicide:

  • 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.

Be available if and when they require your assistance. If the situation is grave, you may need to consult your loved one’s physician or mental health expert or call a suicide prevention hotline for information or assistance. Maintain a close eye on them till you are convinced that they are once again in a safe mental state.

There are three categories of reasons for suicidal ideation: psychiatric conditions, life experiences, adverse drug 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.

Several psychiatric conditions appear to be co-occurring with suicidal thoughts or significantly increasing the likelihood of suicidal ideation. Many people with borderline personality disorder, for instance, demonstrate recurrent suicidal conduct and suicidal ideation. Seventy-three percent of individuals with borderline personality disorder have tried suicide, with an average of 3.4 attempts per patient, according to one study.

Adverse effects of drugs

Some research suggests a link between the use of antidepressants and suicidal thoughts and tendencies, hence raising the risk of suicidal thoughts in some individuals. Antidepressants are routinely prescribed to patients who have moderate to severe depression to alleviate their symptoms.

Certain drugs, like selective serotonin reuptake inhibitors (SSRIs), might cause suicidal thoughts as a side effect. In addition, the intended benefits of these medications may have the unintended effect of increasing the individual risk and collective rate of suicide conduct. A subgroup of individuals taking the drug feel awful enough to want to try suicide (or to prefer the imagined consequences of suicide) but are prevented from doing so by depression-induced symptoms, like a lack of motivation and energy.

Due to their link with suicidal thoughts and acts, the U.S. Food and Drug Administration (FDA) issued its highest warning for makers of all antidepressants (particularly monoamine oxidase inhibitors and tricyclic antidepressants [TCAs]) in 2003. Recent research contradicts the warning, particularly when provided to adults, indicating that the link between medicines and suicide ideation is ambiguous.

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:

  1. 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.
  1. Minority gender expression or sexual orientation
  2. Joblessness
  3. Chronic pain or disease
  4. Death of relatives or acquaintances
  5. Relationship termination or rejection by a love interest
  6. A significant shift in life standards (e.g. Relocation abroad)
  7. Some studies have revealed a correlation between tobacco use and depression and suicidal ideation.
  8. Unintended pregnancy
  9. Bullying includes cyberbullying and bullying in the workplace
  10. Prior suicide attempts
  11. Military experience
  • Suicidal ideation is more prevalent among military personnel with symptoms of PTSD, alcohol use disorder, major depressive illness, and generalized anxiety disorder.
  1. Community conflicts
  2. Unwanted variations in body weight
  3. Exposure and focus on pictures or phrases relating to suicide

Family history 

  1. 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.
  1. Abuse
  • This includes emotional, physical, and sexual abuse in childhood and adolescent years
  1. Family or domestic violence
  2. 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. 
  • Estimates of the lifetime prevalence rate of suicidal thoughts in nonclinical teenage populations range between 60 percent and 75 percent, and in many instances, its intensity increases the chance of suicide.

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 towards 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. Depression is the main cause of suicide, and shunning interactions and social activities can be indicators of depression. This involves the loss of interest or enjoyment in previously cherished activities.

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.

Dangerous or self-destructive conduct. Potentially harmful behaviors, like driving recklessly, engaging in risky sexual behavior, and increasing drug or alcohol usage, may suggest that the individual no longer respects 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.

The highest suicide rates are among adolescents, young adults, and the elderly. White men older than 65 have the greatest suicide rate. Suicide risk is also increased when:

  • 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
  • Individuals who are unmarried, illiterate, or unemployed.
  • 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 of suicidal ideation aims to fully understand an individual by incorporating data from various sources, including clinical interviews, medical examinations, physiological measurements, questionnaires, standardized psychometric tests, review of medical records, structured diagnostic interviews, and collateral interviews.

Clinical interviews are conducted by psychiatrists, psychologists, and other mental health experts to determine the extent of a patient’s or client’s troubles, including any symptoms or signs of illness. Clinical interviews are unorganized in the sense that each therapist creates a unique method of questioning, without always adhering to a predetermined structure. Structured (or semi-structured) interviews dictate the questions, their presentation sequence, “probes” (questions) if a patient’s answer is not specific, and a mechanism for rating the frequency and severity of symptoms.

Standardized psychological or psychometric tests include:

  • Beck Suicide Ideation Scale
  • Suicidal Affect–Behavior–Cognition Scale (SABCS)
  • Nurses’ Global Assessment of Suicide Risk
  • Columbia Suicide Severity Rating Scale

Resource References:

  1. What is suicidal ideation? Verywell Mind. Available at: https://www.verywellmind.com/suicidal-ideation-380609.
  2. 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.
  3. Suicide ideation: Symptoms, causes, prevention, and resources. Medical News Today. MediLexicon International. Available at: https://www.medicalnewstoday.com/articles/193026#getting-help.
  4. What are suicidal feelings? Mind. Available at: https://www.mind.org.uk/information-support/types-of-mental-health-problems/suicidal-feelings/about-suicidal-feelings.
  5. Suicidal ideation (2022) Wikipedia. Wikimedia Foundation. Available at: https://en.wikipedia.org/wiki/Suicidal_ideation.

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