Understanding Suicidal Ideation and Ways to Cope

Strictly speaking, suicidal ideation refers to thoughts (ideating) of suicide or taking your own life. However, there are two kinds of suicidal ideation: passive and active.

Passive suicidal ideation occurs when you wish you were dead or that you could die, but you do not formulate a plan to die by suicide.

Active suicidal ideation, on the other hand, is not only thinking about it but having the intent to die by suicide, including planning how to do it.

"There’s an urgent need to address suicide from young to old populations. According to the CDC, in 2021, at least 20% of high school students seriously considered attempting suicide,” says Hilary Blumberg, MD, the John and Hope Furth Professor of Psychiatric Neuroscience and Professor of Psychiatry at Yale School of Medicine.

How Common Is It?

The lifetime prevalence of suicidal ideation for the general world population is about 9% and about 2% within a 12-month period.

According to the 2017 National Survey on Drug Use and Health (NSDUH) by the Substance Abuse and Mental Health Services Administration (SAMHSA), 4.3% of U.S. adults ages 18 and older had thoughts about suicide, with the highest prevalence among adults ages 18 to 25.

Suicide is on the rise, with half of the states in the United States reporting more than a 30% increase since 1999 and nearly all the rest reporting increased rates since then, according to the Centers for Disease Control and Prevention (CDC).

Suicide is the 10th leading cause of death in the United States and the second leading cause of death among 10- to 34-year-olds. Women attempt suicide more often than men, but men are successful about three to four times more often than women.

Signs and Symptoms of Suicidal Ideation

Warning signs that you or a loved one are thinking about or contemplating suicide include:

• Isolating yourself from your loved ones
• Feeling hopeless or trapped
• Talking about death or suicide
• Giving away possessions
• An increase in substance use or misuse
• Increased mood swings, anger, rage, and/or irritability
• Engaging in risk-taking behavior like using drugs or having unprotected sex
• Accessing the means to kill yourself, such as medication, drugs, or a firearm
• Acting as if you're saying goodbye to people
• Feeling extremely anxious

If you think a loved one is thinking about or planning suicide, ask. It's a myth that you'll give another person the idea to kill themselves. Asking shows that you're concerned and that you care about the person.

Be aware that passive suicidal ideation, wishing that you could die in your sleep or in an accident rather than by your own hand, is not necessarily any less serious than active suicidal ideation. It can quickly turn active and it most certainly has a blend of active and passive components.

It's also important to note that suicidal thoughts fluctuate. They are known to "wax and wane," which means that thoughts may be specific, intense, and persistent one day, and the next, they may be more vague and occur less frequently.

However, it's always important to take thoughts about suicide seriously and seek help—even if they seem like they've improved.

Be there for them if and when they need you. If the situation is serious, you may need to involve your loved one's doctor or mental health professional or perhaps call a suicide hotline for advice or help. Keep checking on them until you feel certain that they're in a safe state of mind again.

What Causes It?

Many different factors can contribute to suicidal ideation. Often these thoughts strike when you're feeling hopeless and out of control in your life and/or like it has no meaning or purpose.

These feelings may be due to circumstances like relationship problems, trauma, substance use, a crisis of some sort, pressure at work, a physical health issue, or financial difficulties. Having any mental health disorder such as depression, bipolar disorder, post-traumatic stress disorder (PTSD), or anxiety can also contribute.

There are a variety of risk factors for suicidal ideation and suicide, including

• Having attempted suicide in the past
• Having a mental health disorder
• Feeling hopeless, isolated, and/or lonely
• Not being married
• Being gay, lesbian, bisexual, or transgender
• Having served in the military
• Having a chronic physical illness like cancer, diabetes, or a terminal disease
• Having chronic pain
• Having a traumatic brain injury
• Having a family history of suicide
• Having a drug or alcohol use disorder
• Having experienced childhood abuse or trauma
• Living in a rural area
• Having access to firearms

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Diagnosis

If you’re experiencing symptoms of depression and are having suicidal thoughts, your doctor will likely give you a medical exam and ask you to respond to a questionnaire that may include the following questions:

• Do you have a history of depression or mental illness?
• How long have you been having thoughts of suicide?
• Have you created a suicide plan?
• Are you taking any medication—and, if so, what kind?
• How often do you use alcohol or drugs?

You may have also heard of a suicidal ideation scale (also called a suicidal ideation assessment). These are also questionnaires developed by health professionals to determine someone's risk of suicide.

They often assess factors such as how a person views themselves, and whether they have feelings of helplessness or a negative outlook on life.

Examples of a suicidal ideation scale include:

• Ask-Suicide Screening (ASQ) Questions: A set of four questions for children and adults designed to detect early signs of suicide; it takes only 20 seconds to administer
• Beck Scale for Suicide Ideation (BSS): A set of 19 questions for adults that takes five to 10 minutes to administer
• Columbia Suicide Severity Rating Scale (C-SSRS): A short questionnaire that is designed so that you don't need formal mental healthcare training to administer it
• Suicide Probability Scale: Measures well-being and coping behavior using a four-point scale; takes five to 10 minutes to complete
  

How to Cope If You're Experiencing Suicidal Thoughts

Here are some ways to help reduce suicidal thoughts and get the help you need to get back on track, whether you or a loved one are experiencing suicidal ideation:

Identify Triggers

Look for triggers or circumstances that lead to feelings of despair such as a death or a loss, alcohol use, or stress from relationships. Eliminate what you can and talk to someone, such as a counselor or close friend, about the others.

Remember Feelings Are Temporary

Feelings come and go and are not permanent. Even when life seems hopeless, you can get on the road to feeling better with treatment. You'll learn how to cope with life stresses, as well as to get a new perspective.

Sometimes even just taking a nap or going to bed when you're feeling especially low can reset your mood, at least enough to stop the suicidal thoughts.

Take Care of Yourself

In addition to eating healthy meals regularly and never skipping meals, get plenty of rest and relaxation to stave off stress and help your body recuperate from days past. Exercise is also important for relieving stress and improving your emotional well-being.

Build a Community of Support

Make the time to be around people with positive influences on your life and those who make you feel good about yourself. Also, don't forget to give back to your community either through money or your time. Helping others and giving back can be a great way to get out of your own head and find meaning.

Get Active

Just as old habits have to die to let go of suicidal ideation, new ideas must take their place to stick. Develop your personal and professional interests. Find fun things to do, volunteer activities, or work that gives you a sense of purpose.

When you’re doing things you find fulfilling, you’ll feel better about yourself and those feelings of despair are less likely to return.

Relax

Find personal ways to relieve stress levels. In addition to exercising, you can meditate, use sensory strategies to relax, practice simple breathing exercises, and challenge self-defeating thoughts to help you overcome suicidal thoughts.

Additional Treatment Options

If you have suicidal thoughts but there is no crisis, your doctor or therapist may recommend psychotherapy, medications, and lifestyle changes that can help reduce the risk of suicide.

Psychotherapy, or talk therapy, during which you work with a therapist to explore why you’re feeling suicidal and how to cope.

Family therapy and education. Involving loved ones in treatment can help them better understand what you're going through, learn the warning signs, and improve family dynamics.

Substance use disorder treatment: if you are also experiencing an increase in alcohol or drug use.

Lifestyle changes: Including managing stress, improving sleep, eating, and exercise habits, building a solid support network, and making time for hobbies and interests.

Medications to treat any underlying depression causing your suicidal ideation. This may include antidepressants, antipsychotic medications, or anti-anxiety medications.

“The future is hopeful. Recent research has identified biological differences, such as brain differences, that may underlie suicide risk so that better methods for detection and treatments that can reduce risk are being generated and tested. Psychosocial factors, such as stressors, also have very important roles and are also critical to address,” says Blumberg.

Keep in Mind

Though it may be difficult, studies show that if you're able to talk to someone regularly, particularly in a face-to-face situation like to a close friend or counselor, you're less likely to attempt suicide.

You can also talk to your doctor or go directly to the emergency room if you are having suicidal thoughts. Doctors will evaluate your immediate risk and may recommend hospitalization if the risk is severe or refer you to a mental health professional for treatment.