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Passive Suicidal Ideations: When to Be Concerned?

Suicidal ideations occur in the planning phase of when someone is thinking about committing suicide. Passive suicidal ideations refer to passive thoughts of what it might be like to die. With the rise of suicidal rates in the United States, it is important to understand the difference between passive ideation, active ideation, and imminent threat of suicide.

According to the American Association of Suicidology, suicide was the tenth leading cause of death in the United States in 2016. Just under 45,000 individuals died from suicide at a rate of 1 person every 11.7 minutes. Additionally, suicide rates are by far the highest among white males. While some demographics have higher suicide rates, suicide is universal and does not discriminate. The symptoms and factors leading to suicide may similarly apply to all individuals.

Factors Associated with Suicide

The American Foundation for Suicide Prevention reports that depression is highly associated with suicide, especially when it goes untreated. The mental health aspect reaches beyond depression and into the realms of a variety of other disorders. The nature of depression can vary from mild to severe. One particular diagnostic criterion looks at “thoughts of death.” Not everyone, who experiences depression thinks about death or suicide. With that said, having depression is still considered a risk factor. Depression can be so severe that psychosis can occur. Psychosis is hearing or seeing things that are not there.

Another risk factor is Bipolar Disorder. Like depression, it is in the mood disorder family. One often thinks of Bipolar Disorder as being up, down, and all around. In fact, one can experience mostly depression and only have a history of one manic episode to meet diagnostic criteria for Bipolar Disorder. It can also be characterized as severe and be associated with psychotic symptoms.

Another area of mental health related to a higher incidence of suicide is Post-traumatic Stress Disorder. This is considered an anxiety disorder. Once again, not everyone with PTSD has suicidal ideations or thoughts. Substance abuse and dependency is also another possible trigger that may lead to suicidality.

Suicidal Ideation Assessment

Mental health and psychiatric professionals usually perform suicidal ideation assessments. These professionals are well versed in knowing the signs and determining lethality. People do not always seek help when they are considering suicide. This is why it is critical for peers or loved ones to reach out. In order to do this, one must increase his or her understanding of risk factors and signs.

With the increased rates, suicide has become a tremendous public health concern. What does the general public need to know? The fact that someone has a history of mental health concerns is a red flag. It is easy to miss the flags, so it is essential to educate yourself. Specific behaviors act as red flags, such as isolation, increased substance use, withdrawing from things he or she once enjoyed, changes in sleep habits, giving away essential possessions, saying goodbye, increased irritability, and increased references about dying. There is sometimes a significant change in mood. The person once appeared very depressed and suddenly seems happy and at peace with the world.

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Therapists take these risks into consideration when assessing for lethality. Additional risk factors include a history of suicide attempts, family history of suicide, history of abuse or neglect, access to firearms or drugs, chronic physical conditions, and continuous stress associated with bullying, relational difficulties, or life transitions.

Summarizing Signs Of Suicidal Behaviour

  • Regularly taking about wanting to die, even if it seems casual or joking.
  • Researching ways to kill oneself. This might show up in internet browser history, phone history or a journal.
  • Talking about feelings of hopelessness or purposelessness in life (what’s the point?)
  • Talking about feeling trapped or being unable to escape the pain. Suggesting they are a burden to others.
  • Substance abuse or increased use of alcohol and/or drugs.
  • Acting reckless and/or impulsive.
  • Changes in sleeping patterns (too much or too little.)
  • Withdrawing from loved ones and friends.
  • Showing anger, rage, and revenge-seeking behavior and thoughts.
  • Displaying extreme mood swings and changes.

Personality and Other Factors that Raise Concern

Another proponent in assessing for lethality is imminence. This reflects the differences between active suicidal ideations and passive suicidal ideations. Is the individual talking specifics about wanting to die or in a very generic way? Does he or she want to die today or in the near future? It is important to take concerns about suicide seriously every time regardless if it is active or passive. This might mean getting someone else involved or calling the hotline. Some might believe that the individual is only seeking attention.

While some individuals talk about suicide often, they never follow through with it. This leads to confusion for those around the individual. If someone is genuinely trying to get attention, he or she might accidentally die trying. Therapists tend to err on the side of caution in these instances. Another concern is associated with self-mutilation practices, such as cutting. Those who cut are often seeking relief from significant life stressors and to gain control over certain life circumstances. While the individual might not intend on killing his or herself, he or she is at risk of harm due to possible infection and other health concerns.

What to Do When Someone You Know Is at Risk for Suicide

When someone talks about dying, take them seriously. If you are concerned, you may ask the individual if he or she is contemplating suicide. This will not put the idea into someone’s head. It simply helps you understand the situation better. If someone identifies as having suicidal thoughts, DO NOT leave the person alone. Seek help immediately. How do you approach the subject of suicide when you are concerned about someone you care about? Every individual and situation is different. Here are some options to consider:

If you are uncomfortable in broaching the subject with an at-risk individual, you can call the National Suicide Prevention Lifeline at 1-800-799-TALK (8255) or text “HOME” to 741741. They can assist you in finding ways to help. When in doubt, ask for help. The local mental health agency is another resource. They are often available 24/7 and on an emergency basis. The National Institute for Mental Health is a great resource and provides information on how to help those considering suicide.  You may also visit https://suicidepreventionlifeline.org/ for more information.

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Christina Wilson, PhD Candidate Psychology
Christina Wilson, PhD Candidate Psychology

Christina is a PhD Candidate with an emphasis on positive psychology at Capella University. She has practiced in the area of psychology and addictions for over 20 years as a Master's Level Clinician and currently teaches psychology at Capella University. She lives in Indianapolis with her husband and son.

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