Information presented in this article may be triggering to some people. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) to speak with a trained counselor.
Suicide is the act of taking one’s own life. Suicidal ideation refers to planning or thinking about suicide. These thoughts often are disruptive and scary, but are common. Many people will experience these kinds of harmful thoughts at least once in their lives. Suicidal ideation can include a wish to die or no longer be alive without actually planning or wishing to die by suicide. According to a 2017 study conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), 4.3% of American adults had thoughts of suicide.
There are two main types of suicidal ideation: passive suicidal ideation and active suicidal ideation. With passive suicidal ideation, you may feel like you want to die, but you have no concrete plans to commit suicide. In active suicidal ideation, a person begins the planning process, thinking of ways they may be able to take their own life.
Passive and active suicidal ideation should both be taken extremely seriously. Even if someone is experiencing passive suicidal ideation and says something like “I just wish I was dead,” this should be taken just as seriously as active suicidal ideation. There’s no telling when circumstances or feelings may shift from passive thoughts to active plans. Therapists and other mental health professionals treat all suicidal ideation as a serious issue.
Suicide is an issue of increasing importance, as the suicide rate has risen by more than 30% in half of the states in the U.S. since 1999. Suicide is the 10th leading cause of death in the U.S., and the second leading cause among young people from the ages of 10 to 34. In 2017, the number of suicides was double the number of homicides.
What Are the Warning Signs of Suicidal Ideation?
Knowing how to spot suicidal ideation can help save your own life, or someone else’s. Here is a list of symptoms to watch for in someone experiencing suicidal ideation:
- Withdrawing from loved ones
- Feeling trapped
- Talking often about death or suicide
- Increased substance abuse
- Giving away possessions
- Engaging in risky behaviors like unprotected sex or drug use
- Procuring items such as guns or drugs that will facilitate suicide
- Saying goodbye to people
- Acting overly nervous or anxious
- Extreme mood swings
- Expressing regret and saying things like, “I wish I’d never been born” or “The world would be so much better without me.”
What Are the Causes of Suicidal Ideation?
While suicidal ideation impacts individuals with a major depressive disorder at higher rates, it can happen to anyone. There are countless things that can cause a person to struggle with suicidal thoughts: chronic pain, divorce or a breakup, depression, financial problems, loss of a job, loneliness, grief, or any other type of trauma or loss. These issues can cause those feelings of hopelessness that can trigger suicidal ideation.
There are a number of risk factors associated with suicidal ideation, including:
- A past suicide attempt
- Mental health issues
- Feeling isolated or lonely
- Being single
- Being part of the LGBTQ community
- Serving in the military
- Being a victim of racism or other kinds of prejudice
- Having chronic pain or a chronic illness such as cancer or diabetes
- Having a family history of suicide
- Struggling with substance abuse issues
- Being a victim of bullying or harassment
- Legal trouble or struggling with debt
- Not having access to mental health care
- Having a traumatic brain injury
- Having access to firearms or lethal doses of medication or drugs
- Being a survivor of childhood trauma or abuse
- Living in a rural area
What Treatment Options Are Available for Suicidal Ideation
If you’re experiencing suicidal thoughts but are not in an active crisis, your doctor may suggest several paths toward treatment, including therapy and medication. Talk therapy can be immensely helpful in determining why you might be experiencing suicidal thoughts and how you can develop healthy coping mechanisms. Family therapy may also be helpful, as it engages your support network into your treatment plan. Medications can also help address underlying mental health issues, such as depression and anxiety.
Some medications, particularly antidepressants, have been linked to an increase in suicidal thoughts, especially in the first few weeks of use. Younger people are more at risk. However, antidepressants are more effective in preventing suicide long term by helping manage the symptoms of stress and depression. If you’re experiencing suicidal thoughts as a side effect of medication, contact your prescriber immediately to adjust your dosage, prescription, or treatment plan.
Some lifestyle changes, such as making sure to get enough sleep and exercise, as well as maintaining a healthy diet and managing stress, may also be critical in mitigating suicidal ideation.
If you are at a high risk of suicide, you may enter an inpatient treatment facility, where you will be closely watched for your safety until the immediate crisis has passed. You will receive therapy and other treatment during your stay at this facility.
How to Avoid Suicidal Ideation Triggers
There are effective ways of coping after experiencing suicidal ideation. It’s important to identify triggers that bring up suicidal ideation, such as substances or triggering situations. Try to eliminate as many of those triggers as you can, for instance by attending substance abuse programs or ending a toxic relationship.
It’s also crucial to remember that our feelings aren’t reality. Like most feelings, suicidal feelings are most often temporary and pass like other feelings do. Therapy can help you develop strategies to move past destructive thoughts and feelings.
Since suicidal ideation can cause you to withdraw from loved ones and is also triggered by feelings of isolation, cultivating a sense of community is extremely important. Make sure to check in with those who make you feel loved and supported. You may also find it valuable to engage in volunteer opportunities or become involved in community groups.
Similarly, suicidal ideation can cause you to cease the activities you find most fulfilling. If you can, try to get back into the habit in participating in those hobbies and habits. Also, make sure you take time to relax and unplug. Prioritize your well-being above all else, especially in the short term.
What If a Loved One Is Experiencing Suicidal Ideation?
First, if you think someone you care about may be thinking about suicide, ask them if they’re considering taking their own life. It’s not prying — asking this extremely sensitive question shows that you care about this person. It also illustrates that you’re willing to have an open and supportive conversation, without judgment. However, it’s important never to promise that you’ll keep their pain a secret — you may need to involve others, including but not limited to this person’s doctors or family members.
It’s also important to listen to the person’s response. While it’s good to focus on reasons why they may want to keep living, you should also be mindful not to project your own reasons or things you think they may want to live for. Saying things like, “But your mother will miss you so much,” or generic phrases like “You have so much to live for,” may only put more pressure on someone who’s struggling.
Be there for them
If a person confesses they are thinking about suicide, do everything you can to make sure this person is safe. Offer to be there for them in whatever ways you think you can be. If you’re not able to physically be present, call them on the phone or have a FaceTime call. Ask them if there’s anyone who can be physically with them that they’d like for you to reach out to. According to Klonsky & May’s “Three-Step Theory,” connectedness acts as a key protective factor in helping those struggling with suicidal ideation.
Keep them safe
Once you’ve established that your loved one is considering the possibility of suicide, try to get more information from them. Ask whether they’ve already tried to harm themselves or if they have access to a gun, medication, or other drugs. Do they have a plan in place? The more information you know, the more able you are to determine the severity and likelihood of suicide. If you can, try to keep this person safe by keeping them away from lethal methods — studies have shown that restricted access to a person’s chosen suicide method can help dissuade a person from following through with suicide. You may need to drive this person to an emergency facility or immediately take them to another safe place. If you’re unsure what to do, you can always call the National Suicide Prevention Lifeline, and a counselor can help guide you.
Help them connect
Connection is also vital going forward. You can help your loved one by connecting them with local resources or support groups so they have others to turn to in times of crisis, often folks who have been through similar experiences or dealt with the same kinds of feelings. If your friend or loved one is not already seeing a mental health professional or licensed therapist, help them find someone. Another tactic is helping to set up a crisis plan, with trusted people to call and steps to take if they find themself having suicidal thoughts. There’s an app called My3 that can help a person define their support network and quickly put a plan in place for a moment of crisis.
After the initial conversation, make sure to follow up. Call, text, or FaceTime with your loved one so they know you’re thinking of them and they aren’t alone. Ask how they’re feeling and whether they need anything. Follow up has been found to help prevent suicides in the critical period after a person is released from a hospital or care facility.
Where to Get Help for Suicidal Ideation
National Suicide Prevention Lifeline
The National Suicide Prevention Lifeline (1-800-273-8255 or TALK) is a 24/7 hotline that provides on-the-spot guidance and counseling for those in crisis. The resources provided are free and confidential. To access online support, you can go to Lifeline Chat.
The Lifeline is a network of 180 local crisis centers, which provides local resources and national standards of best practice. The Lifeline was launched on January 1, 2005 by Vibrant Emotional Health and the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). Legislation has just passed in the U.S. that will allow individuals to dial 988 and be connected to the Lifeline. This number is scheduled to go into effect in 2022.
Crisis Text Line
You can also text HOME to 741741 to speak with a crisis counselor at the Crisis Text Line. The Crisis Text Line is also free, confidential, and staffed 24/7 by trained counselors. It defines a crisis not only as thinking of ending one’s own life, but as any emotional crisis. You can text any keyword to start a text conversation with a counselor who can help guide you out of the crisis.You can also message the Crisis Text line on Facebook.
Veterans Crisis Line
The Veterans Crisis Line is specifically for military veterans, active service members, and those who are concerned about a vet or service member. Counselors from the VA can be reached via the hotline 24 hours a day, 7 days a week. To reach a counselor, you can call 800-273-8255 and press 1, or send a text to 838255.
The Trevor Project
The Trevor Project offers resources in crisis intervention and suicide prevention for LGBTQ+ youth (under 25 years old). The Trevor Lifeline is available 24/7 at 866-488-7386 for LGBTQ+ youth experiencing suicidal ideation. Text support is also available via TrevorText by texting START to 678-678.
One of the reasons suicide is so tragic is because it’s preventable. Remember, you are never alone, and there are always resources available to you. If you or anyone you know are in a crisis or may be in danger, please use these resources to get immediate help.