Dr. Tariq Jagnarine
Fam Med, Endocrinology/ Diabetes
There is no universally accepted definition of the term “suicidal ideation.” For some, it means a person is actively planning suicide, while for others, it also includes suicidal thoughts. People with suicidal thoughts do not necessarily plan to act on them, which is why some people distinguish between only thinking about suicide and coming up with ideas or plans. For others, “suicidal ideation” includes both.
Suicidal ideation is when a person thinks about dying by suicide or creates a plan to do so. It is a term that can include a spectrum of thoughts and behaviors, such as passive thinking, active planning, suicidal behavior, such as self-harm or suicide attempts
However, some only use the term “suicidal ideation” to refer to the active planning stage.
Not everyone who thinks of suicide moves on to planning suicide. In 2022, 13.2 million people in the United States reported thinking about suicide, the CDC reports. Of those individuals, 3.8 million planned suicides, and 1.6 million attempted suicides. However, with support and treatment, suicide is preventable.
CAUSES OF SUICIDAL IDEATION
Suicidal ideation often does not have a single cause but occurs due to a combination of different life events, thoughts, and feelings. That said, 90% of people who die by suicide also have mental health condition, often a mood disorder. This includes conditions such as depression or bipolar disorder. Other risk factors include:
• Exposure to violence, including sexual or physical abuse
• Leaving a substance use disorder
• Family history of suicide, substance use, or mental disorders
• Personal history of suicide attempts
• Chronic pain
• Recent release from prison
• Direct or indirect exposure to others’ suicidal behavior
SYMPTOMS OF SUICIDAL IDEATION
A person who is thinking about or planning suicide may show changes in their speech, feelings, and behavior. They may talk about:
• Wanting to die
• Feeling empty, hopeless, or trapped
• Being a burden to others
• The person may feel:
o Unbearable emotional pain
o Extremely anxious or sad
o Full of rage or agitated
o Guilty or ashamed
o That there is no reason to live
o Severe fluctuations in mood or changes in mood
Their behavior may also change. A person contemplating suicide may:
• Withdraw from friends or family
• Use alcohol or drugs more frequently
• Sleep or eat more or less
• Take dangerous risks
• Research ways to die
• Stockpile medications
• Plan for their suicide
• Purchase a gun
• Make a will
• Give away important possessions or money
• Say goodbye
Not everyone who is thinking about suicide shows these warning signs. Sometimes the signs may be subtle.
DIAGNOSING SUICIDAL IDEATION
The process of diagnosing suicidal thoughts or ideation can happen in several ways. If a person is having suicidal thoughts and makes an appointment to speak with a doctor or therapist, the professional will have a conversation to determine how severe the person’s symptoms are and whether they have an intent to attempt suicide. This refers to whether a person has an active plan to die.
An array of suicide screenings and risk assessment tools are also available to doctors. However, these tools cannot always accurately predict an imminent risk of suicide. For this reason, a face-to-face interview is vital.
A doctor or therapist may also spot signs of suicidal thoughts in other situations, such as in a routine appointment for chronic pain or depression. If a person is seriously unwell or displays signs that they may be a danger to themselves, diagnosis may take place in a mental health facility.
TREATMENT FOR SUICIDAL IDEATION
Treating suicidal thoughts and actions involves addressing the underlying causes.
• Safety planning
Safety planning is a short-term intervention that can help reduce the likelihood that a person will attempt suicide. This approach limits a person’s access to lethal means of suicide by removing weapons, drugs, and poisonous substances from the home. Safety planning also provides people with contacts and support resources they can use if they are in a crisis.
• Psychotherapy
Psychotherapy, or talk therapy, helps people understand how their thoughts, feelings, and experiences affect their mental health. It then helps people work through their emotions and find ways to move forward. There are many types of psychotherapy. Some of the most used options include cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT).
• Medication
Many people who think about suicide may have mental health condition, such as anxiety, depression, or a substance use disorder. Medications may help treat the symptoms of these conditions and regulate a person’s mood. However, some of these drugs can also cause suicidal ideation as a side effect, particularly in adults under 25 years old. Experts advise people of the importance of discussing any medications they already take with a doctor or another healthcare professional to determine whether adding another drug, or changing the dose, is likely to benefit them.
• Ongoing support
People are less likely to die by suicide if they receive ongoing support. This may involve easy access to effective mental healthcare, should a person need it again, as well as frequent follow-up calls from healthcare professionals.
A person’s family, friends, and community also play an important role in ensuring they stay connected with people. It can be helpful for people to focus on the things that give their life meaning and purpose, such as:
• Looking after a pet, as they provide unconditional love
• Leaning into their faith, as many religions promote the sanctity of life
• Having things to look forward to, such as a wedding, graduation, or vacation
• Making long-term plans or goals
SUICIDE PREVENTION
Sometimes family members or friends may notice a person shows signs of suicidal ideation. When this happens, the American Foundation for Suicide Prevention advises:
• Talking with them in private
• Calmly listening to their story without judgment
• Telling them you care about them
• Taking what they say seriously
• asking directly if they are thinking of suicide
• Try to avoid minimizing their problems or giving advice. If the person does have suicidal thoughts or plans:
• Remove dangerous objects, such as guns and drugs, from their reach if it’s safe to do so
• Call for help via 911 or the 915 Suicide and Crisis Lifeline
• Stay with them until help arrives or escort them to the emergency room
• Follow up with them to see how they are doing later
• Alternatively, if the person is exhibiting signs of suicidal ideation on social media, people can contact that company’s safety team for help.
• Do not assume that someone else will reach out. Many people who experience suicidal thoughts believe there is nothing anyone can do to help them. So, they may not ask for help.
