What Is Suicidal Ideation?

Suicidal Ideation Symptoms to Watch For

Some people with suicidal ideation say they feel:

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

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

• Use more alcohol or drugs
• Act aggressively
• Retreat from family and friends
• Have severe mood swings
• Behave recklessly or impulsively

Someone with severe suicidal ideation may also:

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

Types of Suicidal Ideation

There are two types:

Active suicidal thoughts. This is when you’re not only having suicidal thoughts but also have the intention to complete 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 intention to harm yourself or plans to complete suicide.

Acute and Chronic Suicidal Risk

Doctors also like to pay attention to how likely you are to complete or make plans to complete suicide at a given time. They may base it on how often, how long, and how intense your suicidal thoughts are.

Acute suicide risk. This refers to mild to moderate to severe risk of completing suicide in the future. It will depend on many things, such as significant stressors, plans, intensity, specific plans, and duration of your suicidal thoughts. Your doctor will address your symptoms at your current risk level.

Chronic suicide risk. This refers to ongoing long-term risk of completing suicide in the near future. Usually, a person who’s a considered a chronic suicide risk has a specific plan to self-harm, signs of lack of self-control, and intent to complete suicide. They may also have access to weapons to carry the plan out.

This classification is based on your previous history of attempts to complete suicide, depression, mental and physical health background, and current risk factors for suicide.

How Is Suicidal Ideation Diagnosed?

If you think you might be having suicidal thoughts, talk to your doctor as soon as possible. During your appointment, they will:

• Do a physical exam
• Ask you for a detailed medical and family history
• Carry out physical and mental health tests to rule out possible causes
• Check your medication list to rule out possible causes
• Ask about your history with drug and alcohol use

What Is The Suicidal Ideation Scale?

Your doctor will also ask in-depth questions to figure out why you might be having suicidal thoughts. They will use the questions to screen your risk of suicide. The standard questions may differ and might depend on the doctor’s office or the hospital you’re visiting.

The questions are often called suicidal ideation scale. 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 options such as, yes, no, maybe, and always, among other options. 

They may ask questions like:

• Have you ever wished you were dead or wished you didn’t wake up?
• 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?

Based on your answers, your doctor will assign a risk and come up with a treatment plan that suits you best. They may also refer you to specialists like psychologists or psychiatrists to give you the help and support you need.

How Is Suicidal Ideation Treated?

Doctors and mental health professionals have a number of ways to help you feel better. The right treatment plan for you depends on things like:

• 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:

A safety plan. 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, like certain images, situations, or moods
• Come up with healthy ways to de-stress, like 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

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.

What if You’re Worried About a Loved One?

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 you can, get rid of any items from their home that the person close to you could use to make suicidal actions. And keep your loved one away from places that could pose a danger to them, too.

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, like:

• 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.