Passive suicidal ideation is when people are having thoughts about death or a desire for death, but they are not making plans to harm themselves. While passive, these thoughts can be a risk and coping can be difficult. If you are having passive or active suicidal thoughts and are concerned you may hurt yourself, call the Suicide Prevention Lifeline (1-800-273-8255) or text the Crisis Text Line (HOME to 741741).
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What Is Passive Suicidal Ideation?
Passive suicidal ideation is when people desire death but do not make active plans to harm themselves. These thoughts may sound like, “I wish I could go to sleep and not wake up,” or “I wish I could die in a car accident.” Although these are not active plans and tend to be situations in which people do not die by their own hand, people may still engage in riskier behaviors as a result of these thoughts.1
Passive Suicidal Ideation vs. Active Suicidal Ideation
It is important to understand the difference between passive suicidal ideation and active suicidal ideation, especially if there is a risk of self-harm.
Passive suicidal ideation presents with:2
- A desire for death
- Thoughts that are more geared towards external events
Active suicidal ideation presents with:2
- Direct thoughts of wanting to kill oneself
- Making active plans on how, when, and where one might complete suicide
- Active plans include collecting prescription medications or lethal drugs, buying a gun, or actively researching ways online to commit suicide
- Engaging in certain behaviors like saying goodbye and giving away important items
- Sudden periods of elevated mood and happiness after periods of low moods
Is It Less Dangerous to Be Passively Suicidal?
Although passive suicidal ideation is perceived as less of a risk compared to active suicidal ideations, these thoughts can still be dangerous. There have been indications that intent and motivation can vary quickly, making it important for those with passive suicidal ideations to consider pursuing treatment.2
Observed with high levels of depression and suicidality, passive suicidal ideation has shown no significant difference from active suicidal ideation.1 Studies indicate that significant markers of suicide attempts in someone’s lifetime are most influenced by both a desire to die and thoughts of self-harm. The presence of both of these thoughts made a significant difference in measurements for lifetime suicide attempts.3
Does Passive Suicidality Often Become Active?
Although some people don’t consider passive suicidal ideations to be as much of a risk as active suicidal ideations, the research indicates that these thoughts have the ability to quickly change into something more dangerous.1 While there is no specific data on how quickly or how often passive suicidal ideations become active, it is important to know that these thoughts can change.
Passive suicidal ideations that become active can be influenced by:4
- An unpredictable or triggering event like a fight, bad day, or mental health trigger
- Physical illness
- Decline in mental health (for example, a full-fledged depressive episode)
Some suggest the importance of a full assessment regardless of passive or active status.5
How Is the Risk of Suicide Measured?
Suicide risk is generally assessed through a variety of tested and reliable measurements as well as clinical interviews. Some of the most common assessments include the Scale for Suicidal Ideation (SSI), Columbia Suicide Severity-Rating Scale (CSSRS), and the Beck Depression Inventory-II (BDI).4,5,6,7 They share common themes for assessment, but each measures their own unique factors.
Measured factors that determine suicide risk include:7
- Protective factors: Things that keep people safe or stable in their environment, such as supportive family/friends, hobbies, successes and achievements, work, etc.
- Risk factors: Things that challenge people’s stability or wellness, such as illness, trauma, substance abuse history, mental health and mental health hospitalization history, family history of mental health, etc.
- Warning signs: Certain indicators of potential self-harm, such as talking about suicide, hopelessness about the future, presenting with increased emotional distress or a decline in mental health symptoms, ensuring responsibility is covered for dependents, etc.
- Suicidal thoughts and planning: Past and current thoughts or plans and access to a means
Although the measurements sound straightforward, those who are struggling with passive suicidal ideations may not be properly assessed or able to access the help they need.
Do Passive Suicidal Thoughts Still Require Treatment?
People who are experiencing passive suicidal ideations should seek mental health treatment. Even though they are not actively planning their death, they are still experiencing a desire for death and may be more likely to engage in risky behaviors.
Passive suicidal ideation is dangerous because of the potential fluctuation from a passive desire to an active urge to harm themselves and end their lives. Further, even if people have no history of active suicidal ideation, passive suicidal thoughts indicate a level of unhappiness and an impact on quality of life.
Passive Suicidal Ideation Treatment
Those who experience passive suicidal ideations would benefit greatly from receiving mental health treatment, although it may be difficult or uncomfortable for them to obtain due to multiple barriers such as cost, stigma or inaccessibility. Treatment options include therapy, psychotropic medications, and, at most severe risk, hospitalization.
Therapy
If you are not currently in crisis or experiencing active suicidal ideations, therapy is highly beneficial. A number of suicide prevention foundations suggest that the most common types of therapy for those experiencing passive suicidal ideations are cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), cognitive therapy for suicide prevention (CT-SP), and motivational interviewing (MI) for suicidal ideation (MI-SI).8,9
While each style of therapy works differently, they all address central themes of reducing depression, stabilizing mood dysregulation, reducing suicidal ideations (passive or active), and increasing the ability to cope. Motivational interviewing specifically helps to reduce ambivalence and increase the motivation to live.8,9 If you’re struggling to find a therapist, you may want to try an online directory.
Medication
If you think medication is necessary to improve your mood and reduce your symptoms, schedule an appointment with a local psychiatrist who can help assess your symptoms and find the appropriate medication and dosage. You can also go to your primary care provider (PCP) to receive psychotropic medications; however, many primary care doctors do not have the same amount of extensive training as psychiatrists.
The most common type of medications prescribed for passive suicidal thoughts include antidepressants, anti-anxiety, and antipsychotic medications. The American Foundation for Suicide Prevention (AFSP) suggests that there are 22 current antidepressants that are approved by the FDA to treat depression and, in turn, suicidal ideation.
Discuss potential side effects of medication with your doctor.2,9 While it may be a difficult step, medication can help you improve your quality of life while managing your symptoms.
Hospitalization
When passive suicidal ideation occurs, hospitalization is not necessarily required depending on your safety plan with your therapist and your history of risk. However, this may change if you are placing yourself in increasingly dangerous situations. Also, if you begin to have thoughts of harming yourself or are showing other signs of active suicidal ideations, you can go to the hospital or reach out to a crisis line to be assessed. Generally, an admission to the hospital will give you time to reduce mental health symptoms and suicidal thoughts and increase your stability and ability to cope.2
How to Get Help for Passive Suicidal Ideation
If you are hesitant to seek professional help, the first step is to talk to a trusted individual such as a friend or family member. From there, the next person you should reach out to is a therapist or primary care physician. They can help you process what is going on with your thoughts and help you obtain medication, therapy, or both.
If you are in crisis and are thinking about engaging in dangerous behaviors or entering active suicidal ideation, reach out to a crisis hotline, a local hospital, or your therapist’s emergency hotline to ensure you get the help you need.
How to Help a Loved One Who Is Experiencing Passive Suicidal Ideations
If your loved one has expressed passive suicidal ideations, listen to them, ask questions, and be supportive. Many people are afraid to talk about suicide directly, which can stigmatize the experience for those who are struggling. Empathy and support show that you care.10
Next, encourage them to reach out to a mental health professional (counselor, psychiatrist, psychologist, etc.) or support group. Follow-up is also helpful to ensure that your loved one is assessing their needs and paying attention to any warning signs.
If your loved one begins to have thoughts of harming or killing themselves, plans to do so, or the access to do so, contact 911, call the Suicide Prevention Lifeline at (1-800) 273-8255, or find a local crisis center. You may want to get rid of or hide items they could use to harm themselves, such as prescription medications, guns and sharp objects. Also, do not promise to keep their reported suicidal ideations a secret, especially since you are trying to help.10
How to Deal With Passive Suicidal Thoughts
Passive suicidal ideations can be difficult and scary to experience, but there are ways to deal with these thoughts including going to therapy, attending a support group, and just spending time with people who make you happy.
Here are five ways to cope with passive suicidal ideations:11
- Identify, and engage with your support system
- Identify any underlying triggers that contributed to these suicidal ideations
- Engage in self-care including a structured sleep schedule, regular nutritious meals, hygiene, exercise, and relaxation
- Explore hobbies, activities, and ways to relax that increase your self-esteem, make you feel proud of yourself, and reduce anxiety levels
- Challenge your schedule, thought process, and cognitive flexibility to increase self-awareness12
Preventing Suicide & Suicidal Ideations
Although suicide and suicidal ideations are scary topics to approach, awareness can reduce rates. Two reliable sites that are frequented for suicide topics are the American Foundation for Suicide Prevention and the Suicide Prevention Lifeline. Refer to them for more information about advocacy and education.
Know the Risk Factors
Part of suicide prevention is knowing the risk factors that may indicate an increased risk of ideations, attempts, or completion of suicide.
Risk factors for suicidal ideations include:10
- Personal history of mental health illnesses (especially mood-based disorders like depression and bipolar disorders)
- Family history of mental health, suicide, suicide attempts or ideations, depressive emotions (hopelessness, worthlessness, guilt, or loneliness)
- Substance use disorders
- Impulsive behaviors
- Increased aggression
- History of abuse or significant traumas
- Physical illness
- Major losses
- Limited access to a support network
- Lack of access to healthcare services
- Access to a means of suicide
Warning Signs to Look For
Knowing and looking for the warning signs of suicidal ideation can help prevent or reduce rates. It is important to note that the existence of any warning signs are a concern and may be reason to follow up with a therapist or the suicide lifeline.10
Warning signs for suicidal ideation include:
- Expressing a desire to die or kill themselves
- Identifying ways they may do this (i.e. searching for poison or pills online, buying a gun, etc.)
- Expressing feelings of hopelessness, purposelessness, feeling trapped or in pain, and feeling like they are a burden to others
- Increased substance use
- Increased recklessness in behaviors
- Anxious or agitated behaviors
- Significantly increased or decreased sleep
- Self-isolation
- Anger or talking about revenge against others
- Significant mood swings
Use the Resources
A final part of suicide prevention is being aware of the available resources in your community and being willing to reach out and share more. Prevention is important, especially if you know people with mental illness who face significant stigmas or who have a history of trauma surrounding reporting their issues.
Final Thoughts On Passive Suicidal Ideation
Passive suicidal ideations can be scary and difficult to understand. Just know that if you or a loved one are experiencing this, you are not alone. There are support networks who can help you get through it. Seek out support, learn more about yourself and your thoughts, and learn ways to manage these thoughts so you can start to feel better.
Additional Resources
- 17 Best Books on Suicide
- Mental Health America
- National Alliance on Mental Health
- MentalHealth.gov
- Online Therapist Directory: Sort therapists by specialty, cost, availability and more. Watch intro videos and see articles written by the therapists you’re considering working with. When you’ve found a good match, book an online therapy appointment with them directly.
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