Skip to content

If you may be in danger, call or text 988. Call 911 for emergencies.

More crisis resources
DepressionResource.org

Suicide and crisis terms

Suicidal ideation

Shariq Refai, MD, MBA, board-certified psychiatrist and the reviewer of this article.

Reviewed by Shariq Refai, MD, MBA·Updated March 15, 2026·About 3 minutes

About this term

Quick definition
Thoughts about ending one's own life. May be passive, with wishes for death, or active, with intent or plan.
Crisis note
If you are having thoughts of suicide with intent or a plan, call or text 988 in the United States, or call 911. The Suicide and Crisis page on this site lists more options.
Full clinical definition
Suicidal ideation is a category of thought, not a single symptom. Clinicians divide it along several lines. Passive ideation includes wishes to die without active steps or intent. Active ideation includes intent or a plan. Specificity of the plan (means, time, place), access to means, and any rehearsal or preparatory behavior all change the level of clinical concern.
Epidemiology
About 12.3 million U.S. adults reported serious thoughts of suicide in the past year (SAMHSA, 2022). Most never act on those thoughts, especially when they reach a clinician or call 988. Suicide is one of the top causes of death among people ages 10 to 34 in the United States (CDC, 2023). Depression is one of the strongest risk factors. Other risk factors include prior attempts, substance use, recent loss, untreated psychiatric illness, access to lethal means, and a family history of suicide.
What it can feel like
A wish to disappear. A wish to fall asleep and not wake up. A specific plan with a date in mind. Sudden calm after a long period of distress, sometimes a sign that a decision has been made. Sorting through possessions. Saying goodbye in small ways.
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). Item 9 of the PHQ-9 also screens for suicidal ideation. Any positive screen leads to a more detailed clinical assessment.
What helps
A safety plan made with a clinician is one of the most useful tools we have. Means restriction (especially firearms and stockpiles of medication) is one of the strongest protective steps. Treatment of the underlying psychiatric condition matters. 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.
Related terms
Passive suicidal thoughts. Active 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.
  • Stanley B, Brown GK. Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk. Cognitive and Behavioral Practice. 2012.

Frequently asked questions

What is 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.
When is suicidal ideation 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 are with someone in immediate danger, do not leave them alone and reduce access to lethal means.
How common is suicidal ideation?
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 does not plant the idea; research consistently shows that asking is safe and is the first step in a safety plan.
How do clinicians assess suicidal ideation?
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.
What helps reduce suicidal ideation?
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).

Last reviewed March 15, 2026.

Every clinical page on DepressionResource.org is written in plain language, dated, and reviewed by a board-certified psychiatrist against current clinical guidelines. See our editorial standards and medical review process.