What Is Suicidal Ideation?

Medically Reviewed by Jabeen Begum, MD on January 18, 2024
8 min read

Suicidal ideation is when you think about killing yourself. The thoughts might or might not include a plan to die by suicide.

You may have heard suicidal ideation referred to as suicidal thoughts.” Not everyone with suicidal ideation acts on it. But if you or a loved one has it, you should get help right away.

You could reach out to a:

  • A family member or friend
  • A crisis counselor
  • A doctor or therapist
  • A spiritual leader
  • Online support group

If you’ve attempted suicide and you’re injured, call 911. If you’re not alone, ask someone else to do it.

If you’re about to harm yourself, you should:

  • Call 911.
  • Call or text 988, the Suicide & Crisis Lifeline. (You can also chat online using 988lifeline.org/chat/). To speak to someone in Spanish, call 988 and press 2.
  • U.S. veterans or service members can call 988 and then press 1, or text 838255. (To chat, go to veteranscrisisline.net/get-help-now/chat/.)

The 988 Suicide & Crisis Lifeline is available 24/7, and it provides free and confidential support when you need it.

Call 877-565-8860 if you’re transgender and want to talk to someone who’s transgender or nonbinary (someone who doesn’t identify with any gender). Press 2 for Spanish. You can call this number even if you’re not sure you’re transgender.

You could also call the helpline of the National Alliance on Mental Illness at 800-950-NAMI (800-950-6264) or the National Suicide Prevention Lifeline at 800-273-8255.

While anyone can have thoughts of suicide, it's more common if you have:

Research shows women tend to have suicidal ideation more often than men, although men are more likely to die by suicide. It's also more common among:

  • Native Americans and Alaska Natives
  • People who are lesbian, gay, bisexual, or transgender
  • Military veterans
  • People with disabilities

There are many reasons people from different groups might be more likely to experience suicidal ideation. They may feel more psychological stress because of discrimination or even violence directed against them. They may feel disconnected from others. Or they may have higher poverty rates and limited access to health care, among other reasons.

Teenagers and children

Kids feel a lot of pressure, and they don't have the perspective that comes with age. A problem at school or with their friends that seems trivial to you may be a very big deal for them. Young people can experience suicidal ideation because of:

  • Conflict with friends or family members
  • Bullying
  • The death of someone they know by suicide
  • Depression or another mental health disorder
  • Trauma or abuse
  • Hostility or rejection (or the fear of it) because of their sexual orientation or gender identity
  • Feeling like they don't have anyone they can talk to about their problems

You may worry that you're planting ideas in your child's head if you ask them whether they've thought about suicide. But experts say it doesn't work that way. Talking is helpful and the best way to know if your child is at risk.

Many things can cause suicidal thoughts and ideas. You’re more likely to have them if you:

  • Feel you’re facing something that's difficult or impossible to get through
  • Lack hope for the future
  • Are unable to come up with a solution or a way out of your current situation
  • Have mental health problems including depression
  • Have a family history of suicide
  • Are taking certain prescription or over-the-counter medications, including antidepressants
  • Have had a traumatic brain injury

If you’re feeling this way, talk to someone close to you. Consider reaching out to a professional who can help you figure out how to move forward.

Some people with suicidal ideation say they feel:

  • Empty or hopeless
  • Guilty or shamed
  • Trapped or out of options
  • Severe mental or physical pain
  • Like a burden to loved ones

They might show outward signs of mental distress. For example, they could:

  • Talk about killing themselves, or seem preoccupied with death or violence
  • Use more alcohol or drugs
  • Act aggressively
  • Seem very anxious or agitated
  • Retreat from family and friends
  • Have severe mood swings
  • Behave recklessly or impulsively
  • Change their normal routines, such as eating or sleeping less

Someone with severe suicidal ideation may also:

  • Buy a weapon
  • Collect or save pills
  • Give away their valuables
  • Say goodbye to friends and family
  • Search online for ways to kill themselves
  • Take dangerous risks, such as driving far too fast
  • Make out a will or set other affairs in order

There are two types:

Active suicidal thoughts

This is when you’re not only having suicidal thoughts but also have the intention to die by suicide. This may include having plans or a method to carry it out. (For example, using a weapon.)

Passive suicidal thoughts 

This is when you have thoughts of suicide, like I wish I could go to sleep and not wake up,” but you have no real plans or intention to harm yourself.

If you think you might be having suicidal thoughts, talk to your doctor as soon as possible. During your appointment, they'll try to find out the cause of your suicidal thoughts and determine how likely it is that you'll actually try to kill yourself.

Suicidal ideation test

There isn't one specific test for suicidal ideation. Your doctor may:

  • Do a physical exam
  • Ask you for a detailed medical and family history
  • Carry out blood and other lab tests to see if there's a physical cause
  • Check your medication list to rule out possible causes
  • Ask about your history of drug and alcohol use
  • Assess you for mental health issues such as depression, anxiety, or a personality disorder

Most people who have suicidal ideation don't actually try to kill themselves. But it's important for your doctor to figure out how likely it is when you come to them, so they can give you the level of help and support you need.

Acute suicide risk. This refers to how likely you are to attempt suicide right now. It's based on things such as how often you have suicidal thoughts and how intense they are, whether you've made plans to kill yourself, and whether you're having stressful life events.

Chronic suicide risk. This refers to your ongoing long-term risk of dying by suicide in the future. It's based on your history of attempting suicide, your mental and physical health background, and your general level of life stress and coping skills.

How risk is assessed

Your doctor will ask about your feelings, your plans for suicide, and things going on in your life to determine your risk. There are several different scales, questionnaires, and screening tools, so the questions may differ and depend on the doctor’s office or the hospital you’re visiting.

They may ask questions such as:

  • Have you ever wished you were dead or wished you didn’t wake up?
  • Have you thought you or your family would be better off if you were dead?
  • Have you actually had any thoughts about killing yourself?
  • Have you thought about how you might do it?
  • Have you had any intention of acting on these thoughts of killing yourself?
  • Have you started to work out or worked out details of how to kill yourself?
  • Do you intend to carry out this plan?
  • Have you done anything, started to do anything, or prepared to do anything to end your life?
  • Do you feel like killing yourself right now?
  • Have you ever tried to kill yourself?

They may ask you to rank the intensity, type, and duration of your thoughts on a scale of 1-10 or ask questions with varying answer options such as yes, no, sometimes, or always. 

Based on your answers, your doctor will assign a risk level and come up with a treatment plan that suits you best. They may also refer you to specialists such as psychologists or psychiatrists.

Doctors and mental health professionals have several ways to help you feel better. The right treatment plan for you depends on things such as:

  • How severe your suicidal thoughts are
  • How often you have them and how long they last
  • How detailed or extensive they are

Your treatment plan could include:

Talk therapy. A mental health professional can teach you ways to take charge of negative or suicidal thoughts. They can also help you treat an underlying mental health condition or substance abuse problem that might trigger suicidal ideation.

Medication. If a doctor or therapist recommends this, it may take a few tries to find the right medicine and dose for you. Don’t stop taking any medication without talking to your doctor first.

Hospital care. Your team might recommend this if you're at a high risk of killing yourself right now -- for instance, you've made a plan you intend to carry out, or you're having a serious mental health crisis.

Safety plan for suicidal ideation

Research has found that having a personalized safety plan can keep people having suicidal thoughts from actually attempting suicide. Your doctor or therapist will help you come up with one specific to you. It could include lists to help you:

  • Spot things that trigger negative or suicidal thoughts, such as certain images, situations, or moods
  • Come up with healthy ways to de-stress, such as relaxation techniques or exercise
  • Identify loved ones and professionals you can reach out to for support
  • Make your home safer to make suicidal actions less likely

If you’re concerned that someone you care about might have suicidal ideation:

Have a candid talk. Ask them: Are you thinking about killing yourself?” As hard as it is to ask this, experts say doing so won’t make your loved one think about suicide more.

Show support. Research says talking about it and acknowledging it may help your friend think about suicide less often.

Help them stay safe. If someone close to you has any items in their home that they could use for self-harm or suicidal actions, get rid of those items if you can. Also, keep your loved one away from places that could pose a danger to them.

Find support. Add the National Suicide Prevention Lifeline -- 800-273-TALK (8255) -- and the Crisis Text Line’s number (741741) to your phone contacts. Share these numbers with your loved one, too. You could also connect them with someone else they trust, such as:

  • A mental health professional
  • Another family member or friend
  • A spiritual advisor

Stay in touch. Check in with them often after you talk. Let them know you’re there for them when they need you.

Suicidal ideation means thinking about killing yourself. You may or may not have an actual plan or intend to carry it out. While most people who experience suicidal ideation don't act on it, It's important to get help. You can reach out to family or friends, talk to your doctor, or contact a suicide prevention group, such as the 988 Suicide & Crisis Lifeline.

Are suicidal thoughts a sign of depression or anxiety?

Suicidal ideation is associated with many mental health conditions. It's a symptom of depression, and having either depression or anxiety makes you more likely to have suicidal thoughts. The risk is even higher if you have both conditions.

What causes suicidal thoughts?

Many things can cause suicidal ideation. It can come from having a mental health or substance abuse disorder, living with long-term trauma or chronic pain, or going through a stressful life event. Taking antidepressant medication or having a traumatic brain injury can cause suicidal thoughts. Suicidal ideation may also run in families.