About this term
- Quick definition
- Thoughts about ending one's own life that include intent, a plan, or steps taken toward acting.
- Crisis note
- Active suicidal thoughts are urgent. Call or text 988 in the United States, call a clinician the same day, or go to the nearest emergency department. The Suicide and Crisis page lists more options.
- Full clinical definition
- Active suicidal ideation, in the Columbia Suicide Severity Rating Scale, is suicidal thinking that includes one or more of: a method, a plan, intent without a specific plan, or intent with a plan. Each step up the ladder raises the level of clinical concern. Preparatory acts (acquiring means, writing a note, giving away possessions) and a recent attempt move the picture into the highest-risk category.
- Epidemiology
- Of the 12.3 million U.S. adults who reported any suicidal thoughts in the past year, 3.8 million made a suicide plan and 1.7 million made a suicide attempt (SAMHSA, 2022). Suicide is one of the top causes of death among people ages 10 to 34 in the United States, with about 49,000 deaths annually (CDC, 2023). Most people with active suicidal thoughts do not die by suicide, especially when they reach a clinician or call 988. Risk factors include prior attempts, untreated psychiatric illness, substance use, recent loss or transition, access to lethal means, and a family history of suicide.
- What others may notice
- Family members, friends, and clinicians sometimes notice these signs in someone at higher risk. None of these signs alone confirms intent. Together, they are a reason to act.
- Increasing certainty about a decision.
- Sudden calm after a long period of distress.
- Putting affairs in order in a way that feels final.
- Quiet goodbyes or unexplained gifts.
- Withdrawal from people who matter to the person.
- A worsening of depression after a stretch of improvement.
If any of these are present, calling or texting 988, contacting the person's clinician the same day, or going to an emergency department together is the right next step.
- Why it matters
- Active suicidal ideation, especially with a plan, intent, or recent preparatory behavior, is one of the strongest short-term predictors of suicide attempt. It is the point at which urgent steps (means restriction, higher level of care, around-the-clock support) become first priorities.
- How clinicians assess it
- A direct, structured conversation. Tools include the Columbia Suicide Severity Rating Scale (C-SSRS) and the Ask Suicide-Screening Questions (ASQ). A clinician asks about method, plan, intent, access, rehearsal, prior attempts, and protective factors. A positive screen leads to immediate planning around safety, level of care, and follow-up.
- Treatment implications
- Means restriction (especially firearms and stockpiles of medication) is one of the strongest protective steps and is a first action whenever active ideation is present. A safety plan, made before the patient leaves the visit, is standard of care after any positive screen (Stanley and Brown, 2012; JAMA Psychiatry, 2018). Hospitalization is considered when safety cannot be assured. Ketamine and esketamine have shown rapid anti-suicidal effects in research and are used in some severe cases under specialist care. Lithium has evidence for reducing suicide risk in bipolar disorder and recurrent depression. Treatment of the underlying psychiatric condition continues in parallel.
- Related terms
- Suicidal ideation. Passive suicidal thoughts. Safety plan. Major depressive disorder.
- Related articles
- Suicidal thoughts (Symptoms). Suicide and crisis.
Sources
- CDC. Suicide Data and Statistics. 2023.
- SAMHSA. Key Substance Use and Mental Health Indicators. 2022.
- Posner K, et al. The Columbia-Suicide Severity Rating Scale. Am J Psychiatry. 2011.
- Stanley B, et al. Comparison of the Safety Planning Intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA Psychiatry. 2018.