Suicidal Ideation: Symptoms, Causes, Effects, & Prevention

What Is Suicidal Ideation?

Suicidal ideation encompasses a spectrum of thoughts about death or taking one’s life. Individuals may experience intrusive thoughts ranging from fleeting and “passive” to persistent and “active.” Sadly, suicide is the 10th leading cause of death in the United States.

Teens, young adults, and college students are at the highest risk for suicide. The risk for suicide significantly decreases after age 25 and continues to lower throughout mid and later life.⁹ Females attempt suicide more often than men, but men are three times as likely to die from an attempt.¹

* Contact someone who can come and stay with you, the National Suicide Prevention Lifeline (1-800-273-8255), 911, your nearest emergency room, or inpatient psychiatric hospital for help if you need immediate help for suicidal ideation.

Passive Vs. Active Suicidal Ideation

Passive suicidal ideation describes more generalized thoughts about wanting or wishing to die, such as “I don’t want to live anymore.” Active suicidal ideation is more serious because individuals have an urge, intention, or plan to commit suicide. Active suicidality places people at higher risk, with research suggesting that 56% of those with plans make suicide attempts versus 15.4% without plans.⁸

Acute Vs. Chronic Suicidal Risk

Sometimes, circumstances seem dire at the moment. A personal crisis or significant stressors can lead to acute suicidal risk or temporary suicidal ideation. Others experience chronic suicidal risk without an immediate cause or known stressors, with ongoing distressful suicidal thoughts. For example, individuals with multiple suicide attempts face chronic suicidal risk.

Signs of Suicidal Ideation

Warning signs of suicidal ideation differ depending on the individual and the cause of their distress. Stressful and traumatic events and untreated or unmanaged mental health conditions can trigger thoughts of suicide, but not for everyone.

Regardless of the source, suicidal ideation can manifest as increased sadness, hopelessness, and anxiety. Some individuals may begin isolating themselves from loved ones or withdraw from previously enjoyed activities. Many signs of suicidality can mimic symptoms of depression, so being mindful of behavioral and emotional changes is imperative.

Possible signs of suicidality include:¹

• Appearing more sad, tired, and disconnected
• Social isolation and withdrawal
• Not engaging in previously enjoyed activities
• Having a flat affect or not showing emotions
• Changes in eating or sleeping patterns
• Talking about being a burden
• Talking about feeling trapped
• Talking about death, suicide, or about life being pointless
• Substance use
• Giving away possessions
• Saying goodbye to loved ones
• Searching online for suicide methods
• Posting on social media about death or suicide
• Drastic changes in appearance/dress/music/media preferences
• Conflict with friends or having few close friends
• Talking about feeling misunderstood
• Abnormal behavioral outbursts
• Risky Behaviors

Symptoms of Suicidal Ideation

Recognizing characteristic signs can aid in better understanding suicidal ideation and can be instrumental in getting the help needed to save a life. Look for significant changes in overall mood, self-talk, and anxiety. These early warning signs can signal the need for professional intervention.

Below are common symptoms of suicidal ideation:¹

• Feelings of hopelessness
• Guilt or shame
• Moodiness, irritability, or sensitivity
• Increased anxiety
• Depression
• Self-loathing
• Low self-esteem

What Causes Suicidal Thoughts?

What causes suicidal ideation cannot be definitively determined because each person experiences life differently. However, extensive research indicates specific factors can increase the risk of suicidal thoughts and behaviors.

Substance use disorders, bipolar disorder, and major depressive disorder frequently correlate with suicidal tendencies, with those experiencing more severe symptoms being at the highest risk.^2,3

Research indicates a common theme of stress and psychological suffering in those struggling with suicidality. Many feel trapped, helpless, and hopeless. Some may simply seek an escape or end to suffering rather than a desire to die.¹

Common suicide risk factors and causes include:^1,2,4,5

• Post-traumatic stress disorder (especially veterans)
• Eating disorders (especially anorexia)
• Traumatic brain injuries
• Schizophrenia
• Anxiety disorders
• Mood disorders
• Personality disorders
• Adverse Childhood Experiences (abuse or neglect)
• Insomnia or persistent sleep problems
• Heightened levels of stress or trauma exposure
• Chronic health issues or chronic pain
• Having attempted suicide in the past
• Having a history of self-harming behavior (i.e., cutting)
• Recent inpatient psychiatric hospitalization
• Experiencing discrimination (i.e., racism, gender bias, etc.)
• Having a substance use disorder

Long-Term Effects of Suicidal Thoughts & Ideation

The long-term effects of suicidal ideation can be life-altering. While reasons for suicide vary and are sometimes unknown, the impacts of attempting suicide can be severe. Attempts can leave individuals with long-lasting mental and physical challenges, including damaged organs and overall emotional well-being.

Below are possible impacts on suicidal ideation:⁶

• Recurring self-harm
• Paralysis
• Coma
• Organ failure
• Scars
• Brain damage
• Death

How Is Suicidal Ideation Diagnosed?

Assessment of current symptoms and circumstances is crucial in diagnosing suicidal ideation. A suicide risk assessment is warranted when someone experiences an acute and significant increase in depression or anxiety symptoms. Those with combined depressive and manic features, like agitation or impulsivity, are at increased risk.

Professionals may look for immediate stressors contributing to suicidal ideation, such as the recent loss of a loved one, divorce, legal issues, financial loss, or medical diagnosis.¹³ Then, treatment teams can establish appropriate and life-saving interventions to address the underlying causes.

A screen for suicide risk may include questions, such as:⁷

• How long have you had these thoughts?
• How often do you have these thoughts?
• Do the thoughts come in response to certain upsetting situations?
• Have you ever acted on thoughts like these?
• Do you intend or want to act on these thoughts?
• Have you ever made a plan of how you would end your life?
• Do you have any weapons in your home?
• Do you have symptoms of depression or another condition?
• Do you use alcohol or drugs?

Treatment for Suicidal Ideation

Treatment of suicidal ideation and behavior depends on the individual situation, risk level, and underlying issues. Psychotherapy, medication, family support, and substance abuse treatment (when applicable) can be beneficial in non-emergencies.⁸ Other times, immediate intervention may be necessary to prevent suicide attempts or completion.

Therapy

Mental health professionals can provide outpatient counseling for those with suicidal ideation. Individuals can opt for individual, couple, or group sessions depending on their needs and wants for treatment.

Therapists can help you identify and work through the underlying causes of your constant thoughts of suicide. Learning healthier coping mechanisms can aid in managing stress, mental health symptoms, and other stressors that influence urges about taking your own life.

Dialectical behavioral therapy (DBT) and cognitive behavioral therapy (CBT) are evidence-based approaches to assist you in overcoming anxious, depressed, and suicidal thoughts.¹

Psychiatric Medication

Alongside therapy, medication can help stabilize or reduce symptoms of an underlying condition, like depression or anxiety. Choosing a psychiatrist can decrease immediate distress so long-lasting therapeutic work and improvement can begin.

Inpatient Hospitalization

In severe cases, inpatient treatment may be necessary for overcoming suicidal ideation. Inpatient treatment offers a hospital-like setting where you receive short-term stabilization through medication adjustment, group and individual counseling, therapeutic programs, and case management.

Prevention Strategies for Suicidal Ideation

Suicidal ideation often indicates unmanaged mental illness, addiction, or systemic life problems. Consider seeking treatment, leaning on loved ones, and revisiting enjoyable activities when experiencing suicidal ideation.^1,9

Below are eight healthy ways to cope with suicidal ideation:

1. Seek Professional Treatment

Although it is scary, it is important to talk to a therapist about your suicidal thoughts because this allows them to understand the severity of what is happening and help you to heal. Counseling or medication can help you address underlying mental health or dependency issues. Finding the right therapist specializing in specific stressors, problems, and conflicts (like divorce, grief, or unemployment) unique to your situation is beneficial.

2. Use Your Support System

Maintain and utilize your support system of friends, family, and other loved ones. Contact old friends, deepen your relationship with coworkers, or start a new activity if you do not have a supportive network. These relationships provide guidance, comfort, and advice to improve physical and mental well-being.

3. Enjoy Your Free Time

Engage in hobbies or activities you enjoy, attend religious services, volunteer for a cause, or learn a new skill. Find a meaningful and fulfilling activity that aligns with your values to boost hopes for the future. Setting and working toward goals can increase positive and hopeful thoughts, allowing you to feel more in control of your life.

4. Stay Positive

Don’t “participate” in negative, upsetting, or suicidal thoughts. You cannot necessarily stop intrusive thoughts, but you can choose how much you participate in repeating or finding evidence to support them. Even trying to disprove or replace your thoughts is active participation, sometimes leaving you further stuck in your head. Mindfulness and meditation can help you learn to distance and reduce suicidal ideation.

5. Don’t Avoid Your Feelings

Feelings can be difficult and uncomfortable, but avoid letting them prevent you from making good decisions. Often, how people respond to their emotions is more problematic than the emotion itself (i.e., using drugs when sad, lashing out when mad, or skipping work when anxious).

Work on responding differently to emotions instead of investing time in trying to fix, stop, control, or avoid them. Focus on making good decisions to feel more in control of your actions and choices, even when upset.

6. Practice & Maintain Positive Self-Care

Practice self-compassion and improve self-care. Self-criticism, shame, and self-hatred often contribute to and exacerbate suicidal thoughts. Change your self-talk to mimic how a loved one would speak to you. Actions speak louder than words, so treat yourself more kindly by prioritizing your physical and mental health. Be consistent with these self-care routines (including proper sleep, nutrition, and exercise).

7. Stay Connected With the Part of You That Wants to Live

Thoughts of suicide overshadow the part of you that wants to live. Tap into your reasons for living, including those you care about, fulfilling activities, and exciting plans and goals for the future. Being attuned to these reasons allows you to resist suicidal ideation as it occurs.

8. Remember That Your Feelings Are Temporary

Though your current situation may feel overwhelming, remember that suicidal thoughts and feelings are temporary. Therapy and other treatment options can help when you feel hopeless by showing you life from a different perspective. Life and your emotions change over time, especially with the right support. Seek help, and take your recovery one small step at a time.

How to Help a Loved One Considering Suicide

Helping a suicidal friend, family member, or other is critical. Remain empathetic and listen to their emotions and experiences. Begin with the least extreme option and only consider more serious interventions when warranted.^1,9

Below are ways to support a loved one experiencing suicidal ideation:

Ask Directly

Initiating a conversation about suicide can be awkward and uncomfortable. However, doing so is often the best way to identify whether a person is considering suicide. If they deny thoughts of suicide, let them know you are there to talk with or support them. Leaving the door open may encourage them to reach out to you later.

Listen Empathetically

Try not to panic or react negatively to them if a loved one admits to suicidal thoughts. People considering suicide often feel alone, so simply listening and being compassionate can make a big difference.

Ask How You Can Help

Ask how your loved one wants to receive help. Offer to stay with them to listen or talk until they feel better if they are unsure. You could also help them locate a counselor or drive them to a hospital. However, you may need to take additional action if you are still worried they might act on their thoughts of suicide.

Express Concern & Encourage Treatment

Sometimes, a loved one will resist your help. Express your concern openly if you worry about them acting on suicidal thoughts. Let them know you do not want to leave them alone until you ensure they are okay. Encourage them to take steps to get treatment or at least set up an appointment with a counselor or other professional.

Involve Authorities

In most cases, involving authorities is unnecessary. However, severe cases may warrant a welfare or wellness check from the police. Filing an involuntary commitment order may be necessary in extreme situations, resulting in the person being taken (even against their will) for a mandatory psychiatric evaluation. They can be committed to inpatient treatment without their consent if deemed at risk of hurting themselves or others.

Follow-Up

Follow up with the individual experiencing suicidal ideation. Consider a phone call or visit to let them know you have been thinking about them, still care, and are there for support.

Finding Immediate Help for Suicidal Ideation

Below are available resources if you are struggling with suicidal ideation and in need of support or immediate help:

• American Foundation for Suicide Prevention 24/7 hotline: 1-800-273-8255
• Substance Abuse and Mental Health Association 24/7 hotline: 1-800-662-4357
• Helpline for resources and services in your community: 211
• Emergency first responders (police, fire dept., or ambulance): 911
• Poison control (for intentional or accidental overdose or ingestion of dangerous substance): 1-800-222-1222
• Go to the nearest emergency room for immediate medical emergencies

Final Thoughts

Suicidal ideation can be frightening and overwhelming. But, with insight into the signs of suicidal ideation and a roadmap for available treatment possibilities, hope for a brighter future is possible. If you are struggling with suicidal ideation, don’t keep it to yourself. Reach out for help early and surround yourself with support. If you are concerned about someone you love, let them know. Together, we can stay and find new ways to thrive.