Table of Contents
What Are Suicidal Thoughts?
Suicidal thoughts, also called suicidal ideation, happen when someone thinks about ending their life. These thoughts are more common than many people realise. About 4% of adults in the United States have serious thoughts of suicide each year, and about 12% of adults have had suicidal thoughts at some point in their lives.
Suicidal thoughts are a symptom of emotional distress, not a character flaw. They're often a sign that someone is experiencing more pain than they can cope with using their current resources.
Important: If you're having thoughts of suicide, you're not alone and help is available. Suicidal thoughts can be treated, and people can recover from them.
Key points:
- Suicidal thoughts are symptoms of treatable conditions
- They don't mean you're weak or broken
- Professional help is available and effective
- Recovery is possible
- You deserve support and care
Types of Suicidal Thoughts
Passive Suicidal Thoughts
Wishing you were dead without planning to act:
- "I wish I could just disappear"
- "I wish I wouldn't wake up tomorrow"
- "Everyone would be better off without me"
- "I don't want to be alive anymore"
- Feeling like life isn't worth living
Characteristics:
- No specific plan to end your life
- May feel like giving up on life
- Often accompanied by hopelessness
- May involve fantasies about dying
- Still concerning and need attention
Active Suicidal Thoughts
Thinking about specific ways to end your life:
- Considering specific methods
- Thinking about when and where
- Making plans or preparations
- Researching methods online
- Writing notes or giving away possessions
More serious signs:
- Having a specific plan
- Access to means (weapons, pills, etc.)
- Setting a timeline
- Taking steps toward the plan
- Feeling calm after making the decision
Suicidal Urges
Strong impulses to act on suicidal thoughts:
- Sudden, intense urges to hurt yourself
- Feeling like you might act without planning
- Difficulty controlling the impulse
- May come and go quickly
- Very dangerous and require immediate help
Warning Signs of Suicide Risk
Emotional Warning Signs
Changes in mood and emotions:
- Severe depression or sadness
- Overwhelming hopelessness
- Intense emotional pain
- Feeling trapped with no way out
- Extreme mood swings
- Sudden calmness after depression
- Feeling like a burden to others
- Loss of interest in everything
Behavioural Warning Signs
Changes in actions and behaviour:
- Talking about wanting to die
- Looking for ways to kill themselves
- Giving away prized possessions
- Saying goodbye to people
- Withdrawing from friends and family
- Increased use of alcohol or drugs
- Taking dangerous risks
- Dramatic changes in routine
Physical Warning Signs
Changes in appearance and self-care:
- Neglecting personal hygiene
- Significant weight loss or gain
- Sleep problems (too much or too little)
- Fatigue and low energy
- Unexplained aches and pains
- Looking dishevelled or unkempt
Social Warning Signs
Changes in relationships and social behaviour:
- Isolating from friends and family
- Avoiding social activities
- Conflict in relationships
- Feeling disconnected from others
- Loss of support systems
- Feeling rejected or abandoned
Risk Factors for Suicide
Mental Health Conditions
Conditions that increase suicide risk:
- Depression (especially severe depression)
- Bipolar disorder
- Anxiety disorders
- PTSD and trauma
- Substance use disorders
- Eating disorders
- Personality disorders
- Psychotic disorders
Life Circumstances
Situations that increase risk:
- Recent loss (death, divorce, job loss)
- Financial problems
- Legal troubles
- Chronic illness or pain
- Relationship problems
- Academic or work stress
- Bullying or harassment
- Social isolation
Personal History
Past experiences that increase risk:
- Previous suicide attempts
- Family history of suicide
- History of trauma or abuse
- Childhood adversity
- Previous psychiatric hospitalisation
- History of self-harm
Demographic Factors
Groups with higher risk:
- Men (complete suicide more often)
- Women (attempt suicide more often)
- LGBTQ+ individuals
- Veterans and military personnel
- Indigenous populations
- Older adults
- People in rural areas
Access to Means
Having access to lethal methods:
- Firearms in the home
- Large quantities of medication
- Other lethal means
- Knowledge of lethal methods
- Previous experience with methods
Protective Factors
Personal Strengths
Individual factors that reduce risk:
- Strong problem-solving skills
- Effective coping strategies
- Sense of purpose and meaning
- Religious or spiritual beliefs
- Hope for the future
- Reasons for living
- Fear of death or dying
Social Support
Relationships that provide protection:
- Strong family connections
- Close friendships
- Supportive romantic relationships
- Connection to community
- Positive relationships with healthcare providers
- Mentors or role models
Professional Support
Mental health care that reduces risk:
- Regular therapy or counseling
- Appropriate medication
- Crisis planning
- Strong therapeutic relationships
- Coordinated care team
- Regular follow-up
Environmental Factors
Circumstances that provide safety:
- Restricted access to lethal means
- Safe living environment
- Stable housing
- Financial security
- Meaningful work or activities
- Cultural or religious prohibitions against suicide
Immediate Safety Planning
If You're Having Suicidal Thoughts
Steps to take right now:
- Reach out for help immediately
- Remove access to lethal means
- Stay with someone you trust
- Call a crisis hotline
- Go to an emergency room if needed
Crisis resources:
- National Suicide Prevention Lifeline: 988
- Crisis Text Line: Text HOME to 741741
- Emergency services: 911
Safety Planning
Create a written plan that includes:
- Warning signs that crisis is developing
- Coping strategies you can use alone
- People and places that provide distraction
- People you can ask for help
- Professional contacts
- Ways to make your environment safer
Sample safety plan elements:
- Remove firearms, medications, or other means
- List of people to call for support
- Coping activities (exercise, music, pets)
- Reasons for living
- Emergency contacts
- Safe places to go
Helping Someone in Crisis
If someone tells you they're suicidal:
- Take it seriously
- Listen without judgment
- Ask directly about suicide
- Don't leave them alone
- Help them get professional help
- Remove access to lethal means
What to say:
- "I'm glad you told me"
- "You're not alone in this"
- "We can get through this together"
- "Let's call someone who can help"
- "Your life matters to me"
What not to say:
- "You have so much to live for"
- "Suicide is selfish"
- "Things could be worse"
- "Just think positive"
- "You don't really want to die"
Treatment for Suicidal Thoughts
Immediate Treatment
Crisis intervention:
- Emergency room evaluation
- Crisis counseling
- Safety planning
- Medication adjustments
- Hospitalization if needed
- Intensive outpatient programs
Therapy Approaches
Cognitive Behavioural Therapy (CBT):
- Identify and change negative thought patterns
- Develop coping skills
- Problem-solving training
- Relapse prevention
- Usually 12-20 sessions
Dialectical Behaviour Therapy (DBT):
- Learn distress tolerance skills
- Emotion regulation techniques
- Mindfulness practices
- Interpersonal effectiveness
- Particularly effective for repeated suicide attempts
Cognitive Behavioural Therapy for Suicide Prevention (CBT-SP):
- Specifically designed for suicide prevention
- Focuses on suicide-specific thoughts and behaviours
- Develops alternative coping strategies
- Addresses hopelessness and problem-solving
Medications
Medications that may help:
- Antidepressants for depression
- Mood stabilisers for bipolar disorder
- Anti-anxiety medications for anxiety
- Antipsychotics for psychotic symptoms
- Medications for substance use disorders
Important considerations:
- Some medications may initially increase suicide risk
- Close monitoring is essential
- May take weeks to see full effects
- Combination with therapy is most effective
Hospitalization
When hospitalisation may be needed:
- Immediate danger to yourself
- Unable to keep yourself safe
- Severe mental health symptoms
- Need for medication adjustments
- Lack of support system
- Previous serious suicide attempts
Types of hospital care:
- Emergency room evaluation
- Inpatient psychiatric hospitalisation
- Partial hospitalisation programs
- Crisis residential programs
Recovery and Healing
The Recovery Process
Recovery from suicidal thoughts:
- Is possible for everyone
- Takes time and patience
- May involve setbacks
- Requires ongoing support
- Looks different for each person
Signs of recovery:
- Decreased frequency of suicidal thoughts
- Improved coping skills
- Better problem-solving abilities
- Stronger support relationships
- Increased hope for the future
- Better management of mental health conditions
Building Resilience
Developing protective factors:
- Learn healthy coping strategies
- Build strong relationships
- Find meaning and purpose
- Develop problem-solving skills
- Practice self-care
- Connect with community
Ongoing Support
Long-term recovery support:
- Regular therapy sessions
- Medication management
- Support groups
- Peer support
- Family involvement
- Crisis planning
Prevention of Suicide
Individual Prevention
Personal strategies:
- Learn warning signs
- Develop coping skills
- Build support networks
- Get treatment for mental health conditions
- Limit access to lethal means
- Create safety plans
Family and Friends
How loved ones can help:
- Learn warning signs
- Ask directly about suicide
- Listen without judgment
- Encourage professional help
- Remove access to lethal means
- Stay connected and supportive
Community Prevention
Broader prevention efforts:
- Mental health education
- Reducing stigma
- Training for healthcare providers
- Crisis intervention programs
- Means restriction policies
- Media guidelines for reporting suicide
Healthcare System
System-level prevention:
- Screening for suicide risk
- Evidence-based treatments
- Follow-up after discharge
- Coordination of care
- Training for providers
- Quality improvement initiatives
Special Populations
Adolescents and Young Adults
Unique considerations:
- Second leading cause of death in ages 10-24
- Often impulsive decisions
- Social media and cyberbullying factors
- Academic and social pressures
- Identity development challenges
Warning signs in youth:
- Dramatic mood changes
- Withdrawal from friends and activities
- Decline in academic performance
- Risky behaviors
- Talking about death or suicide
Older Adults
Higher risk factors:
- Social isolation
- Health problems
- Loss of independence
- Grief and loss
- Depression often unrecognized
Prevention strategies:
- Regular social contact
- Treatment for depression
- Pain management
- Meaningful activities
- Support for caregivers
LGBTQ+ Individuals
Increased risk due to:
- Discrimination and stigma
- Family rejection
- Bullying and harassment
- Minority stress
- Lack of affirming support
Protective factors:
- Family acceptance
- LGBTQ+ community support
- Affirming healthcare
- Anti-discrimination policies
- Inclusive environments
Veterans and Military
Unique risk factors:
- Combat exposure
- PTSD and trauma
- Transition challenges
- Access to lethal means
- Military culture around help-seeking
Specialised resources:
- VA mental health services
- Veterans Crisis Line: 1-800-273-8255, Press 1
- Military-informed therapy
- Peer support programs
Myths and Facts About Suicide
Common Myths
Myth: Talking about suicide will give someone the idea Fact: Talking about suicide does not increase risk and often provides relief
Myth: People who talk about suicide don't actually do it Fact: Most people who die by suicide have talked about it beforehand
- Myth: Suicide happens without warning
- Fact: Most suicides are preceded by warning signs
- Myth: People who attempt suicide are just seeking attention
- Fact: Suicide attempts are serious cries for help that should always be taken seriously
- Myth: Once someone is suicidal, they're always suicidal
- Fact: Suicidal thoughts can be temporary and treatable
- Myth: Suicide only affects people with mental illness
- Fact: While mental illness increases risk, suicide can affect anyone
Crisis Resources
Immediate Help
If you're in immediate danger:
- Call 911
- Go to nearest emergency room
- Call National Suicide Prevention Lifeline: 988
Crisis Hotlines
- National Suicide Prevention Lifeline: 988 (24/7)
- Crisis Text Line: Text HOME to 741741
- Veterans Crisis Line: 1-800-273-8255, Press 1
- LGBTQ National Hotline: 1-888-843-4564
- Trans Lifeline: 877-565-8860
Online Resources
- National Suicide Prevention Lifeline: www.suicidepreventionlifeline.org
- Crisis Text Line: www.crisistextline.org
- American Foundation for Suicide Prevention: www.afsp.org
- Suicide Prevention Resource Centre: www.sprc.org
Apps for Support
- MY3: Safety planning app
- Stay Alive: Crisis support app
- notOK: Quick help request app
- PTSD Coach: For trauma-related symptoms
Related Terms
Sources:
Centres for Disease Control and Prevention. (2023). Suicide Prevention: Facts at a Glance.
National Institute of Mental Health. (2023). Suicide Prevention.
American Foundation for Suicide Prevention. (2023). Suicide Statistics.
Substance Abuse and Mental Health Services Administration. (2023). Preventing Suicide: A Toolkit for High Schools.
World Health Organisation. (2023). Suicide Prevention.
Remember: If you're having thoughts of suicide, please reach out for help immediately. Call 988 (National Suicide Prevention Lifeline) or go to your nearest emergency room. You are not alone, and help is available.
This information is for educational purposes only and is not a substitute for professional medical advice. If you or someone you know is having suicidal thoughts, please seek immediate professional help.
