Suicidal ideation: What it is and when to seek help
Case study by Chimezirim Ozonyiri
Trigger warning: this article discusses suicide and suicidal ideation which may be triggering for some. Please navigate away from this page if you are affected by this topic.
Chimezirim Ozonyiri discusses the different forms of suicidal ideation, warning signs, when to seek help, and how to cope with or help a loved one who may be experiencing it.
Almost 1 in 10 people worldwide will experience suicidal thoughts at some point in their lives, making them just as common as experiencing any form of mental health issue.
Even so, suicide is a taboo subject in the world today. We avoid talking about it, but not talking about it does not make it go away. If anything, it means that the pressure keeps weighing on those of us who experience suicidal thoughts when things get tough, which may cause some of us to cave and fall through the cracks.
Talking about suicide helps raise awareness and educate people on ways to seek help when they feel the dark cloud of suicidal thoughts looming. If you or someone you know is ever in this situation, please remember that you and they are not alone, and support is out there.
What is suicidal ideation?
When discussing suicidal ideation, it is easy to be drawn into the idea that someone is looking to end their own life. But this is not always the case. Suicidal ideation is when a person fantasises or thinks about ways to end their life, which can be in the form of fleeting thoughts or detailed planning – but an actual attempt to take one’s own life is far less common.
The type of suicidal ideation someone is experiencing is based on intent. In passive suicidal ideation, the individual thinks about death, ways they could die, or wish they could die from an illness, all with no plans to end their life. This intrusive thought could be because they believe suicide is the only option to get through whatever speed bump they face, even though they desperately desire to live. Passive suicidal ideation is characterised by thoughts like, “I wish I am dead right now,” “I hope I do not wake up tomorrow,” and “I could be able to get out of this situation if I were dead.”
Active suicidal ideation requires a person to research, plan, and execute harm to themself. It is characterised by self-harm and suicide threats such as talking about their intent to commit suicide, or seeking the resources they need to end their life.
How many lives are lost to suicide?
Although suicidal ideation does not always lead to a suicide attempt, lives are still lost to it.
Based on data from the World Health Organization, 9% of people worldwide will experience suicidal thoughts, and 3% will attempt to take their own life. The number of people successful with their attempts totals an estimated 703,000 each year. In 2019, suicide accounted for more than 1 in 100 deaths, 58% of which occurred before age 50.
In England and Wales, 5,583 lives were lost to suicide in 2021, accounting for 10.7 deaths per 100,000 people. Although not a gender-specific issue, suicide is more common among males than females: 74% the suicides reported in England and Wales in 2021 occurred in men, equivalent to 16 deaths per 100,000, compared with 5.5 deaths per 100,000 women.
What can increase the risk of suicidal ideation?
The risk of suicidal ideation is higher in people who have experienced one or more of the following:
Mental health problems: Mental health issues like depression, bipolar disorder, and schizophrenia put you at a high risk of suicidal ideation.
History of abuse or trauma: People who have experienced trauma or abuse can start thinking about suicide. Ideation can be seen in veterans, people who have had life-changing experiences like losing a loved one, and people who have been sexually, physically, or psychologically abused.
Discrimination or bullying: Being bullied or discriminated against due to financial or societal status, race, religion, sexual orientation, or marital status can cause suicidal ideation.
Family history: If you have a history of suicide in your family, you are more likely to experience suicidal thoughts.
Marital status: Studies show that single people are most likely to commit suicide than married people. A married person would consider their children or partner before thinking about taking their life.
Relationship or family issues: When your safe place, your family or partner is not there for you, you may start feeling neglected, lonely, and worthless.
Work issues: A toxic work environment or lack of career growth when you do not have any hope for a new job for fear of joblessness might trigger suicidal ideation.
Financial issues: Lack of finances to solve a pressing need can cause a feeling of hopelessness, leading to suicidal ideation.
Critical illness or long-term physical pain: A person who has been sick and in pain for a long time may romanticise dying.
Doaa Morsy Abdel Kader shares their insights into suicidal ideation and why some may see it as the only possible solution to their problems.
What are the signs of suicidal ideation?
Some people try to mask signs of suicidal thoughts, but the signs listed below are some more apparent indicators:
Withdrawal: Withdrawal from social activities, family, friends, and any interaction involving meeting or talking to people. Passive suicidal ideation could happen because the person does not want to talk about what is happening to them, perhaps because they feel no one could understand. In active suicidal ideation, they do this because they do not want anyone to discourage them or make them feel guilty or ashamed of their thoughts or intended actions.
Giving away belongings: In active suicidal ideation, the individual starts giving out their belongings and properties because they hold no value to them anymore and do not need them.
Reckless behaviour: As experienced in passive suicidal ideation, a person idealising their demise stops being careful, especially if they are very cautious. They find themselves living on the edge, hoping one of their actions will cause their death. They may start doing things they usually would not do, like having unprotected sex, speeding while driving, facing phobias, or even eating something that causes allergies.
Severe hopelessness: They lose hope that all will ever be well. They are easily fatigued, slow to do tasks, and have a change in sleeping or feeding habits.
Alcohol or substance abuse: Some turn to alcohol or drugs to help them escape their reality and, in the long run, become dependent on them to function because they like the high and illusion it offers them.
Suicide threat: They may use phrases like “I could end it all by…” and “Just in case I do not see you again, know that I love you.”
Frequent or drastic mood swings: An individual idealising suicide will have a period of extreme highs or extreme lows. They could be happy this moment and back to being sad, teary, or angry in a split second.
Paranoia: Not trusting situations or people and second-guessing everything around them. They have an exaggerated sense of reality.
Anxiety and irritability: Panic attacks, breathlessness, and excessive worry become a new normal, which causes them to get easily frustrated over the little things.
Can suicidal ideation be treated?
In order to first determine what treatment may be necessary for someone experiencing suicidal ideation, the Beck Scale for Suicide Ideation (BSI), which consists of 21 questions, is used to evaluate patients' levels of hopelessness, vulnerability, and risk of suicide. The result places a person either on the passive suicidal ideation spectrum or the active suicidal ideation spectrum.
To treat passive suicidal ideation, a person should seek professional help through therapy, medication, or lifestyle change. Treatment for active suicidal ideation includes hospitalisation for proper monitoring and therapy, medication, teaching of coping skills to deal with a crisis, group therapy, and actively keeping a person away from any substance they can use to cause harm to themselves.
How can I help myself or someone else get out of passive suicidal ideation?
We tend to pay more attention to people in the active suicidal ideation phase, paying little mind to those experiencing passive suicidal ideation. Still, they also need support because it takes a lot of willpower to get up daily with these thoughts and choose to see a brighter future. The risk is still there, just not imminent. Without the right support system or treatment, someone on the passive suicidal ideation spectrum can be pushed into active suicidal ideation.
If you are experiencing suicidal thoughts, try to practice self-care, stay active, take up a hobby, be honest with your therapist or anyone around you about your feelings, and only stay around people who bring out that glimmer of hope in you. Identifying your triggers and trying as much as you can to avoid them also goes a mile to help. This is by no means an easy process and can take time, so seeking professional help is always recommended.
If a loved one is experiencing suicidal thoughts, creating a safe space for them to talk freely gives them reassurance and may help break them out of any unhealthy thought patterns. Seeking professional help should always be encouraged.
If you are based in the UK and you or someone you know needs help right now, or if you or they ever start feeling overwhelmed for any reason and need to speak to someone who can help, here are some numbers you can call: Samaritans UK & ROI Hotline: 116123 (free call from mobile and landline) Hotline: +44 (0) 8457 90 90 90 (UK - local rate) Hotline: +44 (0) 8457 90 91 92 (UK minicom) Hotline: 1850 60 90 90 (ROI - local rate) Hotline: 1850 60 90 91 (ROI minicom) The Hope Project Hotline: 0117 428 8930 Email: firstname.lastname@example.org (Target - men 30 to 64 yrs) Breathing Space (Scotland) Hotline: 0800 83 85 87 The Mix Hotline (under 25yrs): 0808 808 4994 HOPELineUK (for under 35 yrs) Hotline: 0800 068 41 41 SMS: 07786 209697 Childline Hotline: 0800 1111 CALM Hotline (National): 0800 58 58 58 Hotline (London): 0808 802 58 58 Get Connected (for under 25 yrs) Hotline: 0808 808 4994 SMS: 80849 SANEline Hotline: 0300 304 7000 Maytree Hotline: 020 7263 7070 Rehab 4 Addiction (Addiction Helpline - open 24/7) Hotline: 0800 140 4690 Mobile: 0345 222 3508 International: +44 345 222 3508 Alternatively, you can call the corresponding number for your country in this directory.