Suicidal ideation is the clinical term for thinking of or imagining suicide.
Suicidal ideation can take many forms. Sometimes, it might be a vague thought of wishing to die. Other times, it can be very specific, such as forming a clear plan for suicide.
Although there are many warning signs of suicide, suicidal ideation is one of the clearest warning signs that a person may be in immediate danger of attempting suicide.
How common is suicidal ideation?
An international survey from the World Health Organization found that worldwide, about 2% of people surveyed had thought about suicide at least once in the past year.
The National Institute of Mental Health reports that in 2017, about 4.3% of adults in the United States had thoughts of suicide.
Another study found that suicidal behaviors are generally more common among women, younger people, people with lower levels of education, and people who had been diagnosed with a mental health condition.
Who might experience suicidal ideation?
Suicidal ideation can happen in a very wide variety of circumstances.
It’s important to remember that suicidal ideation does not have one clear cause. Rather, it usually comes about as the result of a combination of different stresses and risk factors.
Some of the most common risk factors for suicidal ideation include:
- Family history of suicide
- Drug or alcohol abuse
- Past suicide attempts
- Childhood experience of abuse
- Feeling lonely or isolated
- Chronic pain, or a chronic or terminal illness
- Access to weapons or other means of self-harm
- Prolonged stress, such as bullying, harassment, or financial issues
- Stressful life events, such as divorce or the death of a loved one
- Serving in the military
- LGBTQ+ identity, especially when living in families or communities that are hostile to one’s identity
- Traumatic brain injury
Additionally, people with the following mental health conditions (among others) are at a greater risk of suicidal ideation:
- Post-traumatic stress disorder (PTSD)
- Bipolar disorder
- Schizophrenia, schizophreniform disorder, or schizoaffective disorder
- Borderline personality disorder
- Anxiety disorder
What are other warning signs of suicide?
In addition to suicidal ideation, there are several other warning signs of suicide. Some of the most common include:
- Talking about suicide or death
- Giving away possessions
- Extreme anxiety, depression, or agitation
- Mood swings
- Sudden improvement in mood
- Talking about feeling isolated or lonely
- Seeming disconnected from loved ones
- Making a suicide plan
- Looking for a means of suicide (such as acquiring a firearm or drugs)
- Increased drug or alcohol use
What should I do if I’m experiencing suicidal ideation?
If you (or a loved one) are experiencing suicidal ideation, the most important thing to do is seek help.
If you are in a life threatening situation, call the 24h National Suicide Prevention Lifeline at 1 (800) 273-8255 or use these resources. If your issue is an emergency, call 911 or go to your nearest emergency room.
If you have thoughts of suicide that are passive and that you do not plan to act upon, it is still important to seek help. Try drawing on the following resources:
- Talk to a doctor or therapist: You can always start by talking to a doctor or therapist.
- Call a hotline: The National Suicide Prevention Lifeline is available 24/7 at 1-800-273-8255. You can also find additional hotlines and resources for immediate help.
- Reach out to friends and family: Relying on loved ones for support can be an important step in seeking help for suicidal ideation.
- Make a safety plan: Whether alone or with help from a loved one, you can make a plan to keep yourself safe. This will involve identifying stressful triggers, listing coping strategies, and making note of people you can reach out to in a crisis. Try using a safety plan template to guide you.
- Prioritize self-care: Daily habits like exercise, healthy eating, and getting enough sleep can be powerful ways to reduce suicidal ideation. You might try making a plan with a friend or family member to work on building these habits together.
- Learn mindfulness and relaxation strategies: Meditation and other mindfulness practices can help you relax and manage your emotions. Studies have shown that these practices can help reduce the symptoms of stress and anxiety that can contribute to suicidal ideation.
What should I look for in a therapist for suicidal ideation?
The most important thing is to seek treatment immediately from a medical or psychiatric professional. Suicidal ideation can be dangerous in the short term, so it’s important to get the support you need.
In the long term, you may also want to work with a therapist to support your mental health needs going forward. In this case, you’ll want to make sure that your therapist is qualified to treat people who have experienced suicidal ideation. This will usually involve:
- Advanced education in a field related to mental health, such as psychiatry, psychology, or social work;
- Licensure to practice in the state where you live;
- Additional training and/or experience in treating suicidal ideation specifically, as well as any related mental health conditions. For example, if you have been diagnosed with bipolar disorder, you’ll want to find a therapist who has extensive experience treating bipolar disorder.
The particular kind of psychotherapy you choose will depend on your mental health overall, since different treatments are more effective for different disorders. For example, dialectical behavior therapy (DBT) would be a good choice for someone with borderline personality disorder, but it would be less likely to work for someone with schizophrenia.
Finally, as with any therapy, it’s important to make sure that your therapist is a good fit for your unique needs. Be sure to evaluate the following in your initial calls with therapists:
- How will you pay for therapy? Does the therapist take your insurance or otherwise offer rates that will work with your budget?
- When and where will you attend sessions? Does the therapist offer treatment at a location that is convenient for you and at times that work with your schedule?
- Most importantly, do you feel comfortable talking to this therapist and sense that you have the potential to develop a therapeutic alliance?