Suicidal ideation

Suicidal ideation is thinking about, considering, or planning suicide. Clinicians distinguish passive ideation (a wish to be dead without a plan or intent) from active ideation (intent or a plan). Both deserve clinical attention; active ideation with intent or a plan is an emergency.

Active intent, a plan, access to means, or a recent attempt is a reason to call or text 988, call 911, or go to the nearest emergency department now. If you're with someone in immediate danger, don't leave them alone and reduce access to lethal means.

About 12.3 million U.S. adults reported serious thoughts of suicide in the past year (SAMHSA, 2022). Lifetime prevalence in major depressive disorder is substantially higher. Asking about suicide doesn't plant the idea; research consistently shows that asking is safe and is the first step in a safety plan.

A clinical assessment covers the frequency, intensity, and duration of thoughts, presence of intent or a plan, access to means (especially firearms and stockpiled medication), prior attempts, protective factors, and reasons for living. The Columbia Suicide Severity Rating Scale (C-SSRS) is one common tool.

Treating the underlying depression, a written safety plan made with a clinician, means restriction (especially firearms), follow-up contact after an emergency visit, and certain medications including lithium and clozapine in selected patients have evidence. The Stanley-Brown Safety Planning Intervention reduces suicide attempts after a crisis (JAMA Psychiatry, 2018).