What is Suicidal Ideation?
Suicidal ideation refers to “thinking about, considering, or planning suicide.”
If you have ever had a psychiatric assessment or received psychotherapy, chances are you were asked about suicidal ideation or previous suicide attempts. In this article, I discuss what it is about is and why it needs to be assessed.
According to a major national survey, in 2019 alone, nearly 5% of American adults reported experiencing serious thoughts of committing suicide. Suicidal ideation was more common in younger people—nearly 12% of those between the ages of 18 and 25 years reported suicidal thoughts in 2019.
We need to remember that these percentages concern the prevalence of suicidal ideation during one year only. The lifetime prevalence of it is likely much higher, which means there is a good chance that the majority of people have experienced (or will experience) thoughts of suicide at some point in their lives.
Sometimes suicidal ideation consists of fleeting thoughts of suicide occurring during times of distress (e.g., after receiving terrible health news or while grieving the death of a loved one). Other times, it consists of much more intense, frequent, and enduring thoughts of killing oneself.
Some individuals with suicidal ideation not only experience suicidal thoughts but also have the conscious intention of committing suicide. And some report actively planning their suicide—deciding the time, place, and method of suicide, and making the necessary preparations (e.g., putting their affairs in order, purchasing a weapon).
From Suicidal ideation to attempt
So, why do clinicians ask about it? The primary reason is that research suggests suicidal ideation and planning increase the likelihood of suicide attempts.
A suicide attempt refers to “non-fatal, self-directed, potentially injurious behavior with intent to die as a result of the behavior.” In 2019, nearly 12 million American adults had serious thoughts of committing suicide; of these, 1.4 million attempted suicide. In other words, roughly one in eight people who reported suicidal thoughts attempted suicide.
As these numbers show, only in some cases do thoughts related to suicide indicate that suicide is imminent. The question is when?
The answer may depend on the characteristics of the suicidal ideation (e.g., frequency, intensity) and the time frame. For instance, new-onset and intense suicidal ideation could be quite predictive of suicidal behavior in a short time-frame (e.g., a few weeks). Fleeting suicidal thoughts, in contrast, especially in relation to a considerably longer time-frame (e.g., a couple of years), maybe much less predictive.
To ask or not to ask?
According to one review study, despite disagreements regarding the exact percentages of people with suicidal thoughts who later attempt suicide, there is a consensus among mental health researchers that knowledge of this disorder can help predict suicidal behavior.
However, a well-known concern is that suicide-related questions might encourage depressed patients to begin considering suicide.
While that is a possibility, in general, the benefits of asking to outweigh the potential for inducing suicidal thoughts. This is true especially given that many suicidal patients do not spontaneously report their thoughts or plans of killing themselves.
It is important to remember clinicians are trained to ask suicide-related questions in a sensitive manner and to create a safe place where patients can discuss their most unpleasant or disturbing thoughts.
The information the patients provide, on the frequency or intensity of their suicidal ideation, can help therapists prevent suicide attempts and save lives. In addition, this information allows them to form a diagnosis, assess the progress of a patient’s condition, and evaluate the effectiveness and side effects of the treatment.