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Suicidal Ideation

Suicidal ideation occurs when someone thinks about or plans to die by suicide. In the United States, suicide is an important public health issue. In the period between 2000 and 2018, the age-adjusted suicide rate increased by 36.7 percent. In the 10-24 age group, suicide is the second-leading cause of death.  

What is Suicidal Ideation?

Suicidal ideation exists on a scale of intensity. It includes someone who thinks about death and ending their life but who doesn’t have a specific plan for when and how they will act (passive suicidal ideation). The other end of the scale is someone who has made the decision that they want to die, has a plan for how they will do it, and has assembled what they need to take action (active suicidal ideation).  

Suicidal ideation is the unseen, unnoticed tip of the iceberg of a person who is in significant emotional pain and doesn’t feel they want to live. The act of taking one’s own life is the visible tip of the iceberg.  

When considered in this way, it’s easy to see that early evaluation and intervention for those experiencing suicidal ideation is crucial to prevent a progression in intensity to a suicide attempt (either unsuccessful or successful).  

Causes of Suicidal Ideation

There are many reasons why someone may have suicidal thoughts. In most cases, the person feels like they can’t cope with the stressors in their life anymore. If they have lost hope for the future, they may see suicide as the only solution. The person’s current circumstances may give them a type of tunnel vision where they can’t see any other options except suicide.  

Genetics may also play a role in who develops suicidal ideation. People who have suicidal thoughts or die by suicide are more likely to have a relative who died by suicide.  

Risk Factors for Suicide

Women are more likely to attempt suicide than men, but men are more likely to die by suicide. Men tend to choose more lethal methods to end their own lives, such as a gun. 

A person could be at risk of dying by suicide if they: 

  • Are gay, lesbian, bisexual, or transgender with an unsupportive family or are dealing with a hostile environment 
  • Feel worthless, hopeless, lonely, or socially isolated 
  • Have experienced a stressful life event, such as the loss of a loved one, a breakup, financial or legal trouble 
  • Have a medical condition linked to depression and suicidal thinking (chronic disease, chronic pain, or a terminal illness) 
  • Have a substance abuse problem 
  • Are living with a mental health issue, such as depression, post-traumatic stress disorder, or bipolar disorder 
  • Have attempted suicide previously 
  • Have suicidal thoughts and access to a firearm 

Signs and Symptoms of Suicidal Ideation

The warning signs of suicidal ideation include: 

  • Making statements like, “I wish I were dead,” “I wish I hadn’t been born,” or “I’m going to kill myself.” 
  • Withdrawing from social contact and wanting to be alone 
  • Feeling trapped or hopeless in a situation 
  • Having mood swings, such as being emotionally high one day and very low and discouraged the next 
  • Getting ready to commit suicide, such as stockpiling pills or buying a gun 
  • Being preoccupied with violence, death, or dying 
  • Behaving recklessly or self-destructively, such as using drugs or driving too fast 
  • Giving away belongings or getting affairs in order when there is no logical explanation for taking this step 
  • Saying goodbye to family and friends as if it’s the last time they will be seen 

How Suicidal Ideation is Treated

Someone who has suicidal thoughts but is not in a crisis can benefit from outpatient treatment. The treatment plan may include the following: 

  • Psychotherapy 

Talk therapy is used to discuss the types of issues that make someone feel suicidal. The person can learn skills to help manage their emotions in a more positive manner. With the help of their therapist, the client can develop a treatment plan and specific goals. 

  • Medications 

Since many people with suicidal ideations also have a mental illness, screening for mood disorders and other mental health concerns makes sense. Once a specific diagnosis has been determined, appropriate medication (anti-anxiety, antidepressant, antipsychotic, etc.) can be prescribed and monitored for the correct dose.  

Addiction treatment on an outpatient basis can include individual sessions with a counselor and group meetings. The goal is to provide support to newly sober clients and address any issues they are facing with family and in the community.   

 

How Suicidal Ideation Overlaps with Other Mental Illnesses

The vast majority (90 percent) of people who die by suicide have a mental illness. Most of them are living with a mood disorder (anxiety, depression, bipolar disorder, etc.). However, suicidal ideation can also be present in people who do not have a mental illness. 

Learn more about our Mental Health Program

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