Suicidal Ideation

What is Suicidal Ideation?

Suicide is a serious problem in the U.S., as the suicide rate in 2021 was around 14.1 per 100,000 people. There are growing concerns that deaths labeled as unintentional falls or poisonings, which have also increased, could actually be misrecorded suicides. From 2000 to 2018, the suicide rate surged by 36.7%. Among 10 to 24-year-olds, suicide is the second most common cause of death. And even though the suicide rate for this age group was stable from 2001 to 2007, it has been increasing since then.

Furthermore, the suicide rate varies greatly depending on demographic factors. The Centers for Disease Control and Prevention (CDC) reported that in 2021, men were 4 times more likely to commit suicide than women. Also, people over 85 had the highest suicide rates. For men aged 55 and older, the suicide rate increased with age, but for women, the rate decreased with age. There are also significant differences in suicide rates among different racial groups. The suicide rate is highest among American Indian and Alaska Native populations and lowest among Asians. In 2021, the CDC found that 12.3 million adults had thoughts of suicide, 3.5 million adults made plans for suicide, 1.7 million adults attempted suicide, and 48,183 people died by suicide.

Suicidal thoughts or planning suicide, known as suicidal ideation, varies in intensity, starting from a general wish to die, without any specific plan or intent to act, to active suicidal ideation, which includes a detailed plan and a strong intent to act on the thoughts. Such ideation is strongly linked to suicide attempts and deaths, and is a considerable risk factor for future suicide attempts. Suicidal thoughts and actions are often grouped together, but there is a spectrum ranging from passive thinking and active planning to actual behavior. Some people may attempt suicide without having suicidal thoughts beforehand, but there’s a debate about this because such attempts might not be reported due to stigma. An analogy often used is viewing suicidal ideation as the larger, unseen part of an iceberg, with the act of suicide as the visible tip. This highlights the need to identify and help those with suicidal thoughts early, to prevent them from taking their lives.

Identifying people with suicidal thoughts not only serves as an early warning of possible suicide attempts but also provides insight into the person’s distress and specific needs. Only a small portion of these individuals will go on to commit suicide, yet if the ideation is accompanied by intent and a clear plan, it is considered a psychiatric emergency requiring urgent intervention.

Around 90% of people who commit suicide have a mental health condition, with mood disorders being the most common. Recognizing suicidal thoughts in patients opens an opportunity to conduct a detailed evaluation to understand their struggles, needs, and risk levels. Studies indicate that the majority, 80%, of suicide victims had seen primary care doctors within a year of their death, compared to only 25% to 30% who had seen psychiatric doctors during that period. Therefore, primary care doctors play a vital role in managing patients with suicidal thoughts, assessing suicide risk, and implementing suitable interventions.

What Causes Suicidal Ideation?

Suicide can stem from numerous risk factors that accumulate over a lifetime. The most impactful of these are individual mental health disorders. Conditions like depression, bipolar disorder, schizophrenia, substance use disorders, epilepsy and traumatic brain injury greatly increase suicide risk, raising the odds by over three times. While we understand the risk factors for suicide pretty well, the same can’t be said for suicidal thoughts. Despite this, it’s been found that suicidal thoughts are the third biggest predictor of future suicide cases, following previous psychiatric hospital stays and suicide attempts. Prior suicidal thoughts are a major risk factor for future episodes.

According to the CDC, in the U.S. in 2021, there were about 35 reported suicide attempts for each suicide. Also, for each suicide attempt, two adults had suicidal thoughts and had plans, and seven adults were thinking about suicide. But the real figures could be even higher because suicides are sometimes wrongly classified as accidental deaths, and people often don’t report suicidal thoughts due to stigma around mental health. This highlights the desperate need to identify those with suicidal thoughts and understand how they progress towards suicide attempts.

Suicidal thoughts can result from complex combinations of psychological, biological, environmental, and cultural factors. There are several theories to help understand how people progress from suicidal thoughts to suicide attempts.

Psychological Theories:

– Stress-diathesis models: These propose that people have an inherent tendency towards suicidal actions due to factors like their genetic makeup, biological traits, or mental health history, including prior trauma. When such people face stressors in life that are beyond their coping abilities, they express their feelings via suicidal thoughts and are more likely to act on suicidal impulses.

– Ideation-to-action framework: This theory tries to understand how individuals move from thinking about suicide to attempting it, recognising that these are related but separate behaviours. The key factor in this transition is an individual’s capability for suicide, involving various elements that allow a person to make a suicide attempt.

Biological Theories:

– Hypothalamic-pituitary-adrenal (HPA) axis dysfunction: This hormonal loop, which is crucial to our stress response, has been linked to mental health issues and suicide. Disruptions to this perhaps caused by gene variations or early life trauma can lead to an imbalance in cortisol release, a stress hormone.

– Neuroinflammation and immune system dysfunction: Research has found links between inflammation of the brain’s nerve cells and suicidal thoughts.

– Genetic factors: Research has found certain gene variants, like those in the FKBP5 gene, can be linked to depression and suicidal thoughts, suggesting that some people might be genetically predisposed.

The different theories put forward and the connections found between biological elements and suicide highlight the complexity of suicidal ideation. It’s important to keep researching to better manage the problem.

Risk Factors and Frequency for Suicidal Ideation

Suicide is a significant worldwide health concern. The World Health Organization (WHO) reports that every year, over 800,000 people globally lose their lives to suicide. It ranks as the 18th leading cause of death worldwide and comes in second among individuals between the ages of 15 and 29. A worrying statistic is that one suicide death happens every 40 seconds.

Many countries report high rates of suicide deaths. Between 1950 and 1995, the global rates of suicide deaths rose by about 35% in men and 10% in women, impacting all age groups. It should be noted, however, that the real number of suicides might be higher than reported. Deaths from suicide are often misinterpreted as “unnatural” or “unknown,” which could lead to under-reporting. The actual rates could be 10% to 50% higher than what is documented.

The number of attempted suicides (which are nonfatal) is believed to be 10 to 20 times higher than the number of suicide deaths. This phenomenon is more prevalent among adolescents. Thoughts of suicide without following up with action is more common than actual suicidal behavior.

The situation of suicide in the United States also demands attention. A report by the CDC showed an increase in the adjusted suicide rate by 33% from 10.5 per 100,000 individuals in 1999 to 14.0 per 100,000 individuals in 2017. However, there was a small reduction in 2019, decreasing to 13.9 per 100,000 people, compared to 2018’s figure of 14.2 per 100,000. But, in 2021, it climbed back to 14.1 per 100,000 individuals. It’s important to consider that many suicide deaths might be misinterpreted, raising the possibility that the real suicide rates in the United States may be higher than reported.

Signs and Symptoms of Suicidal Ideation

Assessing patients with suicidal thoughts involves a complete psychiatric evaluation. This evaluation helps identify potential contributing factors and evaluate immediate danger. Ultimately, the goal is to guide the appropriate treatment.

Identifying patients who might be at risk of suicide is crucial in mental health and primary care. Even though there’s no definitive tool to pinpoint the level of risk, the evaluation typically includes clinical interviews and self-report measures. Existing tools for suicide risk screening have limits, and there’s no strong evidence to show that routine screenings significantly reduce suicide attempts or deaths. This indicates the need for a thorough, multifaceted evaluation of each patient.

Certain risk factors are linked to higher suicide rates. These include belonging to older demographics, men, and members of the LGBTQ community. Risk factors can be divided into two categories:

Predisposing factors such as neuropsychiatric disorders, family history of suicide, previous suicide attempts, adverse childhood experiences, and socioeconomic challenges
Precipitating factors like substance abuse, access to lethal means, stressful life events, and recent diagnoses of terminal or chronic illness

Each of these factors can trigger feelings of isolation, hopelessness, and perceived burdensomeness. There’s also a link between media influence and suicide, although the association with actual deaths by suicide is quite weak. During the patient’s clinical history, there should be a complete exploration of these suicide risk factors.

Complete psychiatric evaluations for assessing suicide risk factor in current suicidal thoughts, any history of suicide attempts, mental health conditions, symptoms of psychiatric issues, and previous psychiatric hospitalizations. Other factors considered include recent biopsychosocial stressors, access to firearms, and protective factors, particularly reasons to keep on living.

It’s proven that substance abuse, especially alcohol, increases the risk of suicide. This risk may rise even further if the individual also has conditions like bipolar disorder or depression. Mental health evaluations for suicide risk should also consider the patient’s psychiatric history, previous treatments, family history of psychiatric disorders, and coping mechanisms. The assessment should include information gathered from friends, family, and treatment records.

Risk stratification can help in suicide risk assessment, but the current evidence isn’t enough to confirm its effectiveness. This is in part due to inconsistencies in study findings and limitations of the methodologies used. A comprehensive approach is recommended, including using multiple evaluation methods along with information from other sources.

When evaluating a patient with suicidal thoughts, the assessment should encompass several key areas:

Details about the suicidal thoughts, including triggers, frequency, severity, and whether they are passive or active
Differentiating between passive and active suicidal ideation to identify immediate risk
Inquiring about specific plans for suicide, as the presence of a detailed plan indicates a higher risk
Assessing access to lethal means
Determining the patient’s intent to die
Evaluating the lethality of the method from both the patient’s and clinician’s perspective
Identifying reasons the patient has for living
Inquiring about previous suicide attempts

Each of these elements provides insights and helps identify potential areas of intervention.

Testing for Suicidal Ideation

Suicide risk assessment scales are tools that help doctors systematically evaluate the seriousness of suicidal thoughts. Using these tools can help guide doctors in what steps to take next, and can help improve their suicide prevention efforts.

There are a handful of scales that help understand how severe the suicidal ideas are and calculate the risk of suicide. Here are a few that are often used:

The Columbia-Suicide Severity Rating Scale (C-SSRS) is widely used for measuring suicidal thoughts and behaviours. It looks at the seriousness and urgency of self-destructive thoughts, suicide attempt behaviours, and how lethal these attempts are. The C-SSRS can identify those needing immediate intervention, and it is frequently utilized in both clinical and research settings.

The Beck Scale for Suicide Ideation (BSI) was developed by Dr. Aaron T. Beck. It measures the strength of suicidal thoughts by asking about 21 different aspects of these thoughts. It can be used to identify individuals at risk and to track changes in these thoughts, with higher scores indicating a greater severity of suicidal ideas.

The Suicidal Ideation Attributes Scale (SIDAS) is used to assess the presence and seriousness of suicidal thoughts, particularly in community populations. The scale includes 5 factors that evaluate the frequency of these thoughts, control over them, distress level, and their impact. Higher scores on the 10-point scale indicate greater severity.

The Patient Health Questionnaire-9 (PHQ-9) is a short, self-reported scale used in medical records. The ninth question focuses on thoughts of death or self-harm. Doctors closely monitor the responses to this item to identify patients at an increased risk of suicide, making the PHQ-9 an essential tool in a variety of settings.

Treatment Options for Suicidal Ideation

Treatments without medication

Cognitive behavioral therapy (CBT), a type of treatment that helps modify patterns of thinking or behavior, is highly recommended for individuals with a history of self-harming behavior. It aims to reduce future episodes of such behaviors. Research suggests CBT focused on suicide prevention is generally well received by patients. Despite this, the quality of evidence supporting the effectiveness of CBT is moderate.

Dialectical behavior therapy (DBT) is recommended for individuals diagnosed with borderline personality disorder who have recently engaged in self-harming behaviors. DBT blends components of CBT with mindfulness techniques and training in managing emotions and improving interpersonal relationships. Research indicates DBT can reduce self-harming behaviors, including suicidal ones, in those with borderline personality disorder, but the overall quality of supporting evidence is low.

Crisis response plans, customized plans detailing steps for individuals to take during a mental health crisis, are recommended for individuals with suicidal thoughts or a history of suicide attempts. While studies show that these plans can reduce suicide attempts in groups like military personnel, the quality of the evaluations supporting crisis response plans is low due to certain study limitations.

Problem-solving-based therapies, which improve handling of stressful life experiences, are suggested for individuals with a history of self-harming behaviors or feelings of hopelessness, particularly those suffering from traumatic brain injuries. While such therapies have shown to be effective in reducing recurring self-harm and suicidal thoughts, the quality of evidence supporting these findings is low due to small sample sizes and other study limitations.

Treatments with medication

Antidepressants have been shown in several studies to reduce suicidal thoughts. Notably, research conducted by the FDA demonstrated that antidepressants decrease suicide risk in older adults. Nevertheless, these medications carry an FDA warning for increased suicide risks in children and adolescents, so they need to be used with caution and close monitoring in these age groups.

Ketamine, a medication often used for anesthesia, rapidly reduces suicidal thoughts. Nonetheless, most trials of ketamine have involved small patient groups, so its use to treat suicidal tendencies is considered off-label (not specifically approved for this use by regulatory authorities).

Lithium, often prescribed for mood disorders like bipolar disorder, decreases suicide risk. Despite its effectiveness in reducing suicidal behaviors, long-term use of lithium may lead to kidney problems, so careful consideration should be given when prescribing this medication.

Clozapine, a medication typically prescribed for individuals with schizophrenia, reduces suicidal behaviors but should be used with caution due to potential side effects and required monitoring.

Brain Stimulation Methods

Methods that stimulate the brain, like repetitive transcranial magnetic stimulation and electroconvulsive therapy, appear promising in decreasing suicidal thoughts. However, current studies don’t have enough participants to measure their effect on actual suicide attempts accurately.

Methods to make lethal means less accessible

Measures to limit access to lethal means, such as restrictions on firearms, reducing access to toxic substances and medications, and barriers at lethal heights, have resulted in fewer suicides. Restricting access to certain medications and reducing their pack sizes, for example, had positive impacts on suicide and accidental poisoning rates. Installing barriers at deadly heights has decreased suicide rates by jumping, though this could lead to an increase in such incidents elsewhere without barriers.

Public Health and Suicide Prevention

Public health strategies often focus on community-based suicide prevention interventions, but their effectiveness remains uncertain due to the limited evidence in this area.

If someone is experiencing suicidal thoughts, it’s important that a range of psychological, psychiatric, and medical conditions are taken into consideration. These conditions can often contribute to the presence of such thoughts, or be associated with them. A comprehensive assessment and appropriate treatment depend on considering these possible diagnoses:

Mood disorders: These include major depressive disorder, bipolar disorder (and its manic and depressive phases), and dysthymia, all of which have strong links to suicidal thoughts.
Anxiety disorders: Conditions like generalized anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD) can also include suicidal ideations.
Personality disorders: Particularly borderline personality disorder and antisocial personality disorder are often linked with impulsivity and self-harm behaviors.
Psychotic disorders: Disorders such as schizophrenia or schizoaffective disorder, can influence suicidal thoughts through their associated delusions and hallucinations.
Substance use disorders: Alcohol and drug abuse can either make underlying psychiatric conditions worse or directly contribute to suicidal thoughts by affecting mood, cognition, and impulse control.
Adjustment disorders: Difficulty in dealing with major life changes or stressful events can lead to suicidal thoughts.
Neurocognitive disorders: Cognitive impairments and dementias can sometimes include depressive symptoms and suicidal thoughts.
Chronic medical conditions: Long-term physical health conditions, especially those associated with chronic pain, disability, or a terminal illness, can lead to suicidal thoughts.
Eating disorders: Severe psychological distress often accompanies anorexia nervosa and bulimia nervosa, and can include suicidal thoughts.
Childhood trauma and abuse: Trauma, abuse, or neglect in one’s past can lead to long-term psychological effects, including suicidal ideations.
Situational factors: Acute stressors like relationship problems, financial difficulties, or legal issues can trigger suicidal thoughts if the individual lacks adequate coping mechanisms or support.

What to expect with Suicidal Ideation

The outlook for individuals with suicidal thoughts can greatly differ. It’s influenced by several factors including the reasons behind these thoughts, any mental health issues they have, how well treatments work, and the support they receive from others.

If the suicidal thoughts are tied to situations that can be solved such as severe stress or a specific problem, then the outlook is generally better. But, if they are part of a long-term mental health problem like major depressive disorder (MDD) or bipolar disorder, the outlook depends on how severe the issue is and how the individual responds to treatment.

Those who get timely and appropriate mental health care, like talk therapy, medication, or a mix of both, generally have a better outlook. Supportive people around the individual including family, friends, and healthcare professionals, as well as resources in their community, can improve the outlook greatly.

There are certain risk factors that can make the outlook worse. These include past suicide attempts, substance abuse, not having a supportive network of people, long-term physical illness, and having more than one mental health issue at the same time.

Constant assessment and management of suicide risks, which includes looking out for warning signs of suicidal behavior and making changes in treatment when needed, can better the outlook considerably.

The individual’s ability to bounce back from hardship and cope with stress can also play a role. Those who are more resilient and have better coping strategies may have a more positive outlook.

Suicidal thoughts are extremely serious and can be life-threatening, requiring immediate attention from healthcare professionals. With the right care and support, many individuals struggling with suicidal thoughts can see a great improvement in their symptoms and quality of life.

Possible Complications When Diagnosed with Suicidal Ideation

Suicidal thoughts, if not correctly handled, can result in numerous complications affecting not just the person experiencing them, but also their wider social circle. These problems can be emotional, physical, societal, or a mix of the three. Below are some examples:

Higher chances of suicide attempts and completion: The most serious issue resulting from suicidal thoughts is the possibility of suicide attempts or actual suicide.
Deterioration of mental health: Constant suicidal thoughts can worsen existing mental health problems like depression, anxiety, or PTSD, leading to further mental health decline.
Impaired daily functioning: Individuals with suicidal thoughts might have trouble doing daily tasks, keeping jobs, or participating in educational activities due to the overpowering nature of these thoughts.
Social withdrawal and isolation: Suicidal thoughts could lead to withdrawal from social situations and isolation, which might worsen feelings of solitude and despair.
Substance abuse: To deal with their distressing thoughts and emotions, some people might resort to substance abuse, which could result in addiction and worsen mental health conditions.
Physical health problems: Chronic stress linked to suicidal ideation can lead to various physical health issues like heart problems, a weakened immune response, and stomach problems.
Relationship strain: Suicidal thoughts can put stress on relationships with family, friends, and partners, resulting in interpersonal conflicts, communication breakdowns, and in some cases, loss of essential support networks.
Stigma and discrimination: Individuals with suicidal thoughts may face stigma and discrimination, which could prevent them from seeking help and worsen their feelings of isolation and hopelessness.
Legal and financial issues: In some cases, suicidal behaviours might result in legal issues or financial issues, particularly if they lead to injury or necessitate prolonged medical treatment.
Emotional trauma to loved ones: The emotional impact on the family and friends of people with suicidal thoughts is significant, leading to their own mental health challenges.

Preventing Suicidal Ideation

It is important to advise people and their families to limit access to potentially harmful materials such as locked-away medications or firearms, especially when the person is having thoughts about ending their own life. However, studies have shown that often this advice isn’t given. Training health professionals, particularly in hospital emergency rooms, can help improve how often this advice is provided.

Occasionally, if there isn’t an assigned person to give this advice, it may be skipped as some nurses may feel uncomfortable discussing the subject. More studies are needed to figure out the best way to provide such education and advice to patients.

School programs aimed at education might lower the number of kids thinking about suicide, but recent reviews show that the existing evidence supporting this is not very solid. Currently, there’s not enough proof to back ‘gatekeeper’ training programs, which are designed to teach people to recognize and react to signs of suicide risks in others.

A project in rural India has shown some promise – ordinary people were trained to identify and deal with mental health problems within their communities. This kind of education also helped decrease the stigma or negative connotations surrounding mental illness in these areas.

Similar approaches could be helpful for groups that are at high risk. For example, people grieving the suicide of a loved one have a very high likelihood of experiencing suicidal thoughts themselves. Education that aims to lower the fear and stigma of appearing weak may influence these groups’ willingness to report their suicidal intentions, especially groups known to struggle with these thoughts but generally refrain from talking about them.

The best method of action would be helping the individual create a safety plan containing suitable support, resources, and distractions, and taking steps to keep potentially harmful materials out of reach.

Frequently asked questions

The prognosis for suicidal ideation can vary depending on several factors, including the underlying reasons for the thoughts, any coexisting mental health conditions, the effectiveness of treatment, and the support received from others. Generally, if the thoughts are tied to solvable situations or temporary stressors, the outlook is better. Timely and appropriate mental health care, along with a supportive network and community resources, can greatly improve the prognosis. However, certain risk factors, such as past suicide attempts, substance abuse, and lack of support, can make the outlook worse. Constant assessment and management of suicide risks, along with effective coping strategies, can also play a role in improving the prognosis.

Suicidal ideation can result from complex combinations of psychological, biological, environmental, and cultural factors. Some psychological theories propose that individuals with inherent tendencies towards suicidal actions may express their feelings through suicidal thoughts when faced with stressors that exceed their coping abilities. The ideation-to-action framework recognizes that thinking about suicide and attempting it are related but separate behaviors, with an individual's capability for suicide being a key factor in the transition. Biological factors such as disruptions to the hypothalamic-pituitary-adrenal (HPA) axis, neuroinflammation and immune system dysfunction, and certain gene variants have also been linked to suicidal thoughts.

Signs and symptoms of suicidal ideation include: - Thoughts of death or dying - Expressing a desire to die or a wish to not wake up - Feeling hopeless or trapped - Having feelings of worthlessness or guilt - Withdrawing from friends, family, or activities - Changes in sleep patterns (insomnia or excessive sleeping) - Changes in appetite or weight (significant weight loss or gain) - Loss of interest in previously enjoyed activities - Increased irritability or agitation - Expressing feelings of being a burden to others - Talking about feeling trapped or having no reason to live - Engaging in reckless or risky behaviors - Giving away possessions or making final arrangements - Increased use of drugs or alcohol - Self-harming behaviors - Sudden improvement in mood after a period of depression (may indicate a decision to attempt suicide) - Social withdrawal or isolation - Expressing feelings of hopelessness or helplessness - Talking about feeling trapped or having no reason to live - Expressing feelings of being a burden to others - Talking about feeling hopeless or having no purpose in life It's important to note that these signs and symptoms can vary from person to person, and not everyone who experiences suicidal ideation will exhibit all of these signs. If you or someone you know is experiencing these symptoms, it is crucial to seek help from a mental health professional or a helpline immediately.

The types of tests that are needed for Suicidal Ideation include: - Columbia-Suicide Severity Rating Scale (C-SSRS) - Beck Scale for Suicide Ideation (BSI) - Suicidal Ideation Attributes Scale (SIDAS) - Patient Health Questionnaire-9 (PHQ-9)

The doctor needs to rule out the following conditions when diagnosing Suicidal Ideation: 1. Mood disorders: major depressive disorder, bipolar disorder, and dysthymia. 2. Anxiety disorders: generalized anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). 3. Personality disorders: borderline personality disorder and antisocial personality disorder. 4. Psychotic disorders: schizophrenia or schizoaffective disorder. 5. Substance use disorders: alcohol and drug abuse. 6. Adjustment disorders: difficulty in dealing with major life changes or stressful events. 7. Neurocognitive disorders: cognitive impairments and dementias. 8. Chronic medical conditions: long-term physical health conditions. 9. Eating disorders: anorexia nervosa and bulimia nervosa. 10. Childhood trauma and abuse. 11. Situational factors: acute stressors like relationship problems, financial difficulties, or legal issues.

When treating suicidal ideation, there can be several side effects and complications that may arise. These include: - Higher chances of suicide attempts and completion: Suicidal thoughts can lead to actual suicide attempts or completion, which is the most serious consequence. - Deterioration of mental health: Constant suicidal thoughts can worsen existing mental health problems like depression, anxiety, or PTSD, leading to further decline in mental health. - Impaired daily functioning: Individuals with suicidal thoughts may struggle with daily tasks, maintaining employment, or participating in educational activities due to the overwhelming nature of these thoughts. - Social withdrawal and isolation: Suicidal thoughts can result in withdrawal from social situations and isolation, exacerbating feelings of loneliness and despair. - Substance abuse: Some individuals may turn to substance abuse as a way to cope with distressing thoughts and emotions, which can lead to addiction and worsen mental health conditions. - Physical health problems: Chronic stress associated with suicidal ideation can contribute to various physical health issues such as heart problems, weakened immune response, and gastrointestinal problems. - Relationship strain: Suicidal thoughts can strain relationships with family, friends, and partners, causing interpersonal conflicts, breakdowns in communication, and in some cases, loss of crucial support networks. - Stigma and discrimination: Individuals with suicidal thoughts may face stigma and discrimination, which can hinder their ability to seek help and worsen feelings of isolation and hopelessness. - Legal and financial issues: Suicidal behaviors may result in legal or financial problems, particularly if they lead to injury or require extensive medical treatment. - Emotional trauma to loved ones: The emotional impact on the family and friends of individuals with suicidal thoughts is significant and can lead to their own mental health challenges.

Primary care doctor

Suicidal ideation is more common than actual suicidal behavior.

Suicidal ideation can be treated through various methods. Non-medication treatments include cognitive behavioral therapy (CBT), which helps modify patterns of thinking or behavior, and dialectical behavior therapy (DBT), which combines CBT with mindfulness techniques and training in managing emotions and improving interpersonal relationships. Crisis response plans, customized plans detailing steps for individuals to take during a mental health crisis, are also recommended. Problem-solving-based therapies are suggested for individuals with a history of self-harming behaviors or feelings of hopelessness. Medication treatments include the use of antidepressants, ketamine, lithium, and clozapine, which have shown effectiveness in reducing suicidal thoughts and behaviors. Brain stimulation methods, such as repetitive transcranial magnetic stimulation and electroconvulsive therapy, are also promising. Additionally, measures to make lethal means less accessible, such as restrictions on firearms and reducing access to toxic substances, have resulted in fewer suicides. Public health strategies for suicide prevention are also being explored, although their effectiveness remains uncertain.

Suicidal ideation refers to thoughts or planning of suicide, ranging from a general wish to die to active planning with a strong intent to act on those thoughts. It is strongly linked to suicide attempts and deaths, and is a significant risk factor for future suicide attempts.