Suicidal ideation


Suicidal ideation, or suicidal thoughts, is the thought process of having ideas or ruminations about the possibility of dying by suicide. It is not a diagnosis but is a symptom of some mental disorders, use of certain psychoactive drugs, and can also occur in response to adverse life circumstances without the presence of a mental disorder.
On suicide risk scales, the range of suicidal ideation varies from fleeting thoughts to detailed planning. Passive suicidal ideation is thinking about not wanting to live or imagining being dead. Active suicidal ideation involves preparation to kill oneself or forming a plan to do so.
Most people who have suicidal thoughts do not go on to make suicide attempts, but suicidal thoughts are considered a risk factor. During 2008–09, an estimated 8.3 million adults aged 18 and over in the United States, or 3.7% of the adult U.S. population, reported having suicidal thoughts in the previous year, while an estimated 2.2 million reported having made suicide plans in the previous year. In 2019, 12 million U.S. adults seriously thought about suicide, 3.5 million planned a suicide attempt, 1.4 million attempted suicide, and more than 47,500 died by suicide. Suicidal thoughts are also common among teenagers.
Suicidal ideation is associated with depression and other mood disorders; however, many other mental disorders, life events and family events can increase the risk of suicidal ideation. Mental health researchers indicate that healthcare systems should provide treatment for individuals with suicidal ideation, regardless of diagnosis, because of the risk for suicidal acts and repeated problems associated with suicidal thoughts. There are a number of treatment options for people who experience suicidal ideation.

Definitions

The ICD-11 describes suicidal ideation as "thoughts, ideas, or ruminations about the possibility of ending one's life, ranging from thinking that one would be better off dead to formulation of elaborate plans".
The DSM-5 defines it as "thoughts about self-harm, with deliberate consideration or planning of possible techniques of causing one's own death".
The U.S. Centers for Disease Control and Prevention defines suicidal ideation "as thinking about, considering, or planning suicide".

Terminology

Another term for suicidal ideation is suicidal thoughts.
When someone who has not shown a history of suicidal ideation experiences a sudden and pronounced thought of performing an act which would necessarily lead to their own death, psychologists call this an intrusive thought. A commonly experienced example of this is the high place phenomenon, also referred to as the call of the void, which is a sudden urge to jump when in a high place.
A euphemism for suicidal ideation is internal struggle, while voluntary death and eating one's gun are a synonym and a euphemism, respectively, for suicide itself.

Risk factors

The risk factors for suicidal ideation can be divided into three categories: psychiatric disorders, life events, and family history.

Mental disorders

Suicidal ideation is a symptom of many mental disorders but can also occur in response to adverse life events without the presence of a mental disorder.
There are several psychiatric disorders that appear to be comorbid with suicidal ideation or considerably increase the risk of suicidal ideation. For example, many individuals with borderline personality disorder exhibit recurrent suicidal behavior and suicidal thoughts. One study found that 73% of patients with borderline personality disorder have attempted suicide, with the average patient having 3.4 attempts. The following list includes the disorders that have been shown to be the strongest predictors of suicidal ideation. These are not the only disorders that can increase the risk of suicidal ideation. The disorders where the risk is increased the greatest, in arbitrary order, include:
Antidepressant medications are commonly used to decrease the symptoms in patients with moderate to severe clinical depression, and some studies indicate a connection between suicidal thoughts and tendencies and taking antidepressants, increasing the risk of suicidal thoughts in some patients.
Some medications, such as selective serotonin reuptake inhibitors, can have suicidal ideation as a side effect but can also be effective as antidepressants. Monitoring is advised for those who take SSRIs.
In 2003, the U.S. Food and Drug Administration issued the agency's strictest warning for manufacturers of all antidepressants due to their association with suicidal thoughts and behaviors. Further studies disagree with the warning, especially when prescribed for adults, claiming more recent studies are inconclusive in the connection between the drugs and suicidal ideation.
Individuals with anxiety disorders who self-medicate with drugs or alcohol may also have an increased likelihood of suicidal ideation.
Most people are under the influence of sedative-hypnotic drugs when they die by suicide, with alcoholism present in between 15 and 61% of cases. Use of prescribed benzodiazepines is associated with an increased rate of suicide and attempted suicide. The pro-suicidal effects of benzodiazepines are suspected to be due to a psychiatric disturbance caused by side effects, such as disinhibition, or withdrawal symptoms.

Life events

Life events are strong predictors of increased risk for suicidal ideation. Furthermore, life events can also lead to or be comorbid with the previously listed psychiatric disorders and predict suicidal ideation through those means. Life events that adults and children face can be dissimilar, and for this reason, the list of events that increase risk can vary in adults and children. The life events that have been shown to increase risk most significantly are:
  • Alcohol use disorder
  • * Studies have shown that individuals who binge drink, rather than drink socially, tend to have higher rates of suicidal ideation
  • * Certain studies associate those who experience suicidal ideation with higher alcohol consumption
  • * Not only do some studies show that solitary binge drinking can increase suicidal ideation, but there is also a positive feedback relationship causing those who have more suicidal ideation to have more drinks per day in a solitary environment
  • Minoritized gender expression and/or sexuality or being a minority group of any kind
  • Unemployment
  • Chronic illness or pain
  • Death of family members or friends
  • End of a relationship or being rejected by a romantic interest
  • Major change in life standard
  • Other studies have found that tobacco use is correlated with depression and suicidal ideation
  • Social isolation
  • Unplanned pregnancy
  • Bullying
  • * Cyberbullying
  • * Workplace bullying
  • Previous suicide attempts
  • * Having previously attempted suicide is one of the strongest indicators of future suicidal ideation or suicide attempts
  • Military experience
  • * Military personnel who show symptoms of PTSD, major depressive disorder, alcohol use disorder, and generalized anxiety disorder show higher levels of suicidal ideation
  • Community violence
  • Undesired changes in body weight
  • * Women: increased BMI increases the chance of suicidal ideation
  • * Men: severe decrease in BMI increases the chance of suicidal ideation
  • ** In general, the obese population has increased odds of suicidal ideation in relation to individuals that are of average-weight
  • Exposure and attention to suicide related images or words

    Family history

  • Parents with a history of depression
  • * Valenstein et al. studied 340 adults whose parents had experienced depression. They found that 7% of the offspring had suicidal ideation in the previous month alone
  • Abuse
  • * Childhood: physical, emotional, and sexual abuse
  • * Adolescence: physical, emotional, and sexual abuse
  • Family violence
  • Childhood residential instability
  • *Certain studies associate those who experience suicidal ideation with family disruption

    Relationships with parents

According to a study conducted by Ruth X. Liu of San Diego State University, a significant connection was found between the parent–child relationships of adolescents in early, middle, and late adolescence and their likelihood of suicidal ideation. The study consisted of measuring relationships between mothers and daughters, fathers and sons, mothers and sons, and fathers and daughters. The relationships between fathers and sons during early and middle adolescence show an inverse relationship to suicidal ideation. Closeness with the father in late adolescence is "significantly related to suicidal ideation". Liu goes on to explain the relationship found between closeness with the opposite sex parent and the child's risk of suicidal thoughts. It was found that boys are better protected from suicidal ideation if they are close to their mothers through early and late adolescence; whereas girls are better protected by having a close relationship with their fathers during middle adolescence.
An article published in 2010 by Zappulla and Pace found that suicidal ideation in adolescent boys is exacerbated by detachment from the parents when depression is already present in the child. Lifetime prevalence estimates of suicidal ideation among nonclinical populations of adolescents generally range from 60 to 75% and in many cases its severity increases the risk of suicide.
Parents who are unaccepting of their child's expressed LGBT sexuality create a hotbed for suicidal ideation.