Suicidal Ideation

What Is Suicidal Ideation?

Suicidal ideations are thoughts about committing suicide. Suicidal ideation exists on a spectrum from a general desire to die and thoughts about taking one’s life to creating a plan of action or attempting to commit suicide. Suicidal ideations can look different for everyone, and these thoughts can come and go at certain times or become worse in specific scenarios. Having suicidal ideations does not always mean a person will attempt suicide, but it is a warning sign and should be handled with serious care.

If you are contemplating suicide, please stop reading and call 1-800-273-8255. The National Suicide Prevention Hotline is open 24/7 and allows anyone to speak openly and anonymously.

Suicidal ideations should always be taken seriously. Suicide is the 11th leading cause of death in the U.S, and in 2023, there were over 49,000 deaths by suicide in the United States, meaning one death occurred every 11 minutes. Males have a higher risk compared to females for committing suicide, and older adult males (80-85 years of age) have the highest risk of suicide in the United States.

Committing suicide starts with suicidal ideation. Suicidal ideations range from fantasizing about what it would be like to not be on this earth anymore, to others having realistic means and methods to end their life. Some people believe that suicide is a plausible way out, whereas others have no intention of acting on their thoughts. Some people obsess over suicidal thoughts, whereas others may obsess over trying to hide and cover up these thoughts. Regardless, suicidal ideations are a sign that something deep underneath the surface is not okay in someone’s life. Maybe they are struggling with their self-esteem, are unhappy, have a mental health condition, or are not able to cope with a stressful life event or past trauma.

Signs and symptoms of suicidal ideation include:

Saying goodbye to people
Giving away belongings
Feelings of worthlessness
Social isolation
Engaging in risk-taking behaviors
Lack of motivation (not showing up to work or school)
Decrease in personal hygiene
Talking about death or suicide
Mood swings
Increase in alcohol and/or drug use
Talking about feeling “trapped” or being in unbearable pain
Anger fits
Depression
Anxiety
PTSD
Accessing means to commit suicide (purchasing a gun, medications, etc.)
Writing a suicide note
Feeling hopeless
Talking about being a burden, worthless, etc.

Passive Vs. Active Suicidal Ideation

Passive suicidal ideation is when a person wishes they were dead or thinks about suicide, but they do not have a plan to take their own life.

Examples of passive ideations include the following:

“I don’t want to live anymore.”
“I feel like such a burden to everyone.”
“I have no other options.”
“I want to escape my suffering.”
“My loved ones would be better off without me.”
Hoping you do not wake up in the morning
Think about throwing yourself in front of a fast-moving vehicle

Active suicidal ideation goes beyond thinking or talking about suicide to forming a plan to die by suicide. This could mean purchasing a gun, writing a suicide note, researching information about strangulation or poisoning, etc. The risk of committing suicide is highest when three factors are involved:

Passive suicidal ideations
The means to commit suicide
The opportunity to commit suicide

Causes and Risk Factors of Suicidal Ideation

Research has yet to uncover all the answers to why someone has suicidal ideations and what exactly causes these thoughts. Still, there are some established risk factors, such as depression and anxiety, that can lead people to have suicidal ideations.

Suicide ideations most commonly occur when major life stressors and health issues merge, and the person feels as if they have no support or way out, and experiences feelings of hopelessness and despair.

Other risk factors associated with suicidal ideation include:

Previous suicide attempts (this is the strongest risk factor for a future suicide attempt)
Family history of suicide or suicide attempts
Underlying mental health disorders
Underlying substance use disorder
Experiencing a major stressful life event such as a financial crisis, divorce, conflict with family members, death in the family, etc.
Living in a rural area
Having access to firearms
Having a history of being bullied or harassed
A history of childhood trauma
History of brain injury or head trauma
Chronic pain or illness

Protective Factors for Suicide Ideation

Many protective factors can help people from experiencing suicidal ideations, and many of these factors are based on community and support structures. Protective factors against suicidal ideation include the following:

Having affordable access to medical and mental health care
Having the support of family and friends
Having healthy problem-solving and coping skills
Feeling connected to people in the community
Not having access or having minimal access to firearms and other lethal means.
Having cultural and religious beliefs that bring a sense of purpose and self-esteem
Feeling as though you have a purpose in life or having reasons to live (family, friends, career, pets, etc.)

How Common Is Suicidal Ideation?

It is difficult to determine the commonality of suicidal ideations, as many people do not verbalize these to others. Hence, the documented numbers are likely to be significantly lower than the actual reality. It’s reported that 10.6 million adults in the U.S., or 4.3% of the U.S. adult population, experienced suicidal ideations, and 18% of children (people under the age of 18) in the U.S. experienced suicidal ideations.

According to a 2024 study from PEW, “the overall rate of suicide increased 30% from 2000-2020 and climbed to more than 49,000 deaths in 2022, the highest number ever recorded in the United States. For every death by suicide in 2022, about 32 people attempted suicide, and more than 250 people seriously considered it”.

How Is Suicidal Ideation Diagnosed?

Suicidal ideations are not a diagnosable mental health condition but rather a symptom of an underlying problem. There are multiple suicide risk screening tools and assessments to guide health professionals and loved ones to determine whether or not an individual is at risk for suicide.

The first screening tool commonly used by clinicians is a 4-question assessment that takes approximately 20 seconds to complete. The Ask-Suicide Screening ASQ tool asks the following four questions to determine if the person needs a more in-depth evaluation:

In the past few weeks, have you wished you were dead?
In the past few weeks, have you felt that you or your family would be better off if you were dead?
In the past few weeks, have you thought about killing yourself?
Have you ever tried to kill yourself?

Suppose the person answers “yes” to any of these questions. In that case, the clinician will determine if the person is suicidal right now and will then further asses the individual with a more thorough evaluation using the Beck Scale for Suicide Ideation (BSS). The BSS is a suicidal ideation evaluation tool that includes a set of 19 questions that takes five to 10 minutes to administer and helps determine whether a more comprehensive mental health evaluation is needed.

Other suicidal ideation scales that are commonly used to assess the severity of suicidal ideation include:

Columbia Suicide Severity Rating Scale (C-SSRS): A short questionnaire that anyone, such as a family member or loved one, can administer.
Suicide Probability Scale: Measures well-being and coping behavior using a four-point scale; takes five to 10 minutes to complete

How Is Suicidal Ideation Treated?

Treatment for suicidal ideation depends on the severity of the risk of committing suicide.

According to clinical guidelines, if a person is deemed low risk, they will receive resources and a mental health referral. If a patient is at imminent risk, they require emergency mental health evaluation and treatment. Mental health treatment may include outpatient care or a higher level of care, such as inpatient care or an emergency psychiatric hold to stabilize the patient.

Therapy

Mental health treatment can consist of multiple types of therapy, including:

Cognitive Behavioral Therapy (CBT): CBT is highly effective for people with suicidal ideation because it helps people understand and challenge negative views and harmful thought patterns and how they relate to dangerous behaviors.
Dialectical Behavior Therapy (DBT): DBT teaches individuals new techniques to help regulate emotions and tolerate distress. DBT teaches people mindfulness techniques to manage overwhelming emotions in the present and to accept the present without experiencing distress. The goal is for the person to be able to take the reality of dealing with suicidal thoughts without suffering emotionally or acting on these thoughts.
Interpersonal Therapy (IPT): IPT helps people work on problematic relationships that could be triggering their suicidal ideations in hopes of reducing stress. The goal is to utilize hope and support to navigate life changes and cultivate a new, healthy relationship with oneself and with others.
Psychodynamic therapy: In psychodynamic therapy, the therapist and the patient dive into the patient’s subconscious motives and unresolved conflicts to improve their understanding of their past and any current trauma or harmful behaviors. The goal is to uncover triggers and address them to heal and reduce instances of suicidal thoughts.

Treatment Medications

Although there is limited evidence that psychiatric medications reduce suicidal thoughts and behaviors, there is some evidence that medications can decrease the long-term suicide rate for people with mood disorders. Lithium and clozapine are the only two proven medications that have been shown to lower suicidal ideations.

Safety Planning For Suicidal Ideation

Having a safety plan is an evidence-based and very effective technique to help reduce the risk of suicide. A safety plan consists of steps or measures to take when you are experiencing suicidal ideations and is often created between the individual, their loved ones, and a healthcare professional. Safety planning can help the person think about what they will do in case they have suicidal thoughts, and the goal is to stay safe and delay any suicide attempt by at least 48 hours.

A safety plan can include:

Individual triggers or warning signs for suicidal thoughts
Healthy coping strategies (reading through a list of positive things about yourself, reading through a list of people and things you love in life, healthy distractions such as reading a book, journaling, going for a walk, listening to music, going to sleep)
List of social contacts to call for support
List of emergency contacts (therapist, suicidal hotlines, support groups, or a loved one who can be with you)
Reducing access to firearms and other lethal means
A safe place you can go, such as a community center, shelter, or a friend’s house
A plan to go to the emergency room (having someone drive you, calling an Uber, or taking an ambulance)

How To Cope If You’re Experiencing Suicidal Thoughts

If you are experiencing suicidal thoughts or ideations, there are healthy coping strategies you can practice to keep yourself safe.

First and foremost, refer to your personalized safety plan, which you created with your loved ones or therapist.
Remember that these feelings are temporary and will subside with time.
Avoid alcohol or drugs, as these can cloud your judgement
Go to sleep. Sleep is a beneficial way to escape suicidal thoughts, and a long nap or a good night’s rest can help re-focus your mind
Avoid being alone. Call a friend, a neighbor, or someone in your community with whom you can spend time. Stay at a friend’s or family member’s home and spend the night if possible. If you cannot get in touch with loved ones, consider visiting a public place such as a community center or the library, which can help distract you from being alone with your feelings.
Practice breathing exercises such as box breathing
Engage in physical exercise
Practice mindfulness techniques
Engage in healthy distractions, such as watching your favorite movie, reading a book, or writing in a journal.
Call a suicide hotline.

Being aware of national and local resources can help combat suicidal ideations. Some resources include:

Find Help Today For Suicidal Ideation

If you are experiencing suicidal ideations, don’t wait to get help. Reach out to a mental health professional who can help you work through your struggles, develop healthy coping techniques, and recommend further treatment.

If you are contemplating a suicide attempt, call the National Suicide Prevention Hotline at 1-800-273-8255 immediately. This hotline is available for you to speak openly and anonymously to someone who can help.

Last Updated: July 15, 2025

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