Suicidal ideation is a deeply distressing and complex mental health issue that affects millions of people worldwide. It could be a symptom of severe depression and could occur in both people with mental health issues and those without. Addressing the topic needs empathy, sensitivity, and a commitment to providing support to those who may be struggling with their emotions. 

What is Suicidal Ideation?

Suicidal ideation means what it is: the thought and planning process related to ending one’s own life. Such thoughts can vary in intensity and range from just thinking about suicide to planning. It is vital to understand the differences between the two thought processes involving suicide being passive and active suicide ideation.

Passive Suicidal Ideation: Involves thoughts of death or a desire to die without a specific plan or intent to act on these thoughts. For example, someone might say, “I wish I were dead,” without actively planning to make it happen.

Active Suicidal Ideation: This level of ideation involves specific plans or intentions to carry out self-harm or suicide. Someone might express their intent to take their own life and may have even formulated a plan to do so.

Suicide Prevalence Worldwide

According to the WHO, suicide is increasing every year, with almost 1 million people ending their own lives annually; the attempts at suicide are 20 times more than that. It is a global phenomenon affecting every part of the world across communities, lifespans, and income groups. In fact, suicide was the fourth leading cause of death among 15–29-year-olds globally in 2019. Moreover, 77% of global suicides occurred in low- and middle-income countries in 2019. According to one study, the lifetime prevalence of suicidal ideation for the general world population was 14.0% over 12 months.

Suicide Prevalence in India

Suicide in India is a growing concern, and the number of suicidal deaths released by the National Crime Records Bureau in August 2022 is literally shocking. The number of suicides in 2021 had increased from the previous year by 7.2%, which means 1,64,033 people ended their lives in 2021. In terms of rates of suicide, India reported a rate of 12 (per lakh population), and this rate reflects a 6.2% increase during 2021 over 2020. The number said is the highest ever recorded in the country since the inception of reporting of suicides by the NCRB in 1967. What is deeply concerning is how the age group of 18-30 years accounted for 34.5% of suicides in the country, and the majority of these were students. The five states that showed the highest rates of suicide were the Andaman and Nicobar Islands, Sikkim, Puducherry, Telangana, and Kerala.

India launched its first National Suicide Prevention Strategy (NSPS) on Nov 21, 2022, to make suicide prevention a public health priority. The strategy aims to reduce suicide mortality by 10% by 2030 by establishing effective surveillance mechanisms (by 2025).

Symptoms of Suicidal Ideation

Suicide is a tragedy and a serious public health problem. However, it can be prevented by timely intervention and better multisectoral suicide prevention strategies that can create awareness and understanding of the problem. Recognizing the signs of suicidal ideation is crucial for providing support to those in need. These symptoms can vary widely among individuals, and not everyone will exhibit the same warning signs. Here are some common indicators to look out for:

Behavioral Symptoms:

• Changes in temperament
• Mood swings
• Risky behaviors
• Repeated bouts of self-harm
• Threats of self-injury
• Drug/alcohol abuse
• Talking about death and dying
• Writing about death
• Self-isolation
• Lack of interest in once enjoyable activities

Physical symptoms:

• Unable to experience pleasure
• Lack of interest in intimacy
• Panic attacks
• Insomnia or hypersomnia
• Weight loss or weight gain
• Poor hygiene
• Lack of self-care
• Lack of appetite

Cognitive Symptoms:

• Memory loss
• Inability to focus and concentrate
• Intrusive thoughts about death
• Inability to fulfill responsibilities
• Psychosocial symptoms:
• Feelings of hopelessness
• Depression and Anxiety
• Irritability and agitation
• Mood shifts

Causes of Suicidal Ideation

The psychology of suicide is a complex one, with studies and research providing a variety of scientific data on why such thoughts occur. Several different factors could be the cause of suicide ideation that contribute to studies of hopelessness and a sense of no purpose in life. Some of the common reasons that trigger feelings of suicide are physical health, relationship problems, trauma, substance abuse, financial problems, unemployment, exam performance, PTSD (post-traumatic stress disorder), bipolar disorder, severe anxiety, and depression. New age trends in suicide have found a growing connection between suicide and overuse of social media, with cyberbullying, irrational challenges, and failure to gain desired responses being the main reasons for suicide. Suicide ideation can also be caused by the following.

Genetics: People with a genetic predisposition to mental illnesses like anxiety, depression, and bipolar disorder are more at risk of suicide ideation.

Physical: When neurotransmitters in the brain are unable to regulate mood and emotions, an imbalance may occur, often resulting in mental illness, especially when suicidal tendencies become apparent.

Environmental: Some people find it hard to cope with stressors such as extreme amounts of chaos, trauma, abuse, and neglect. Lacking coping skills in such an environment could cause a person to respond to stress poorly and develop ideations of suicide. Other stressors of environmental issues leading to suicide are academic failure, bullying, domestic abuse, financial ruin, loss of loved ones, and relationship failures. Other risk factors include:

• Family history of mental illness
• Personal history of mental illness
• Undiagnosed mental illness
• Substance abuse
• Lack of a support network
• Loss of friends or a loved one
• Academic failure
• Unemployment
• Homelessness  and poverty
• A victim of bullying or crime
• Experiencing childhood trauma and neglect
• Being gay, lesbian, bisexual, or transgender
• Access to firearms
• Drug or alcohol abuse
• Chronic pain, chronic illness, and brain injury
• Feeling hopeless, isolated, and lonely

Medication and Suicide ideation

In some cases, medication misuse can also cause suicide ideation. A 2019 study published in the Harvard Data Science Review reviewed 922 prescription medications. It found that ten were associated with an increased rate of suicide attempts. Drugs, mainly of the anti-depressant kind, have several dangerous side effects, which can increase the risk of suicide ideation and behavior. Psychiatric medications like Alprazolam, clonazepam, lorazepam, fluoxetine, and levetiracetam are some examples with links to suicidal thoughts or behavior. Ironically, several anti-anxiety medications can cause adverse reactions, increasing the likelihood of users developing worsening mental health symptoms.

This is a medical mystery, with several doctors, drugmakers, and patients confused as to how drugs intended to help people are putting them at risk of suicidal behavior instead. The experts are still researching the answer, but some feel that it could be directly the fault of the drug, an underlying condition increasing the risk of depression, or combined factors. Perhaps the most common reason is the long-term use of such medication. Long-term usage creates a tolerance for the drug, increasing dosage. This only increases adverse side effects, which can end up negatively impacting both physiological and mental health.

Diagnosing Suicidal Ideation

Diagnosing suicidal ideation involves a thorough evaluation by a mental health professional. It’s essential to consult a licensed therapist, psychologist, or psychiatrist to assess the severity and underlying causes of these thoughts where a diagnosis will be based on the following:

Clinical Interviews: The mental health professional will conduct interviews to understand the individual’s thoughts, feelings, and behaviors. Honest and open communication is vital during this assessment.

Assessment Tools: Various standardized assessment tools, such as the Columbia-Suicide Severity Rating Scale (C-SSRS), may be used to gauge the severity of suicidal ideation. C-SSRS is now a standardized suicide risk screening tool validated for children, adolescents, and adults. It assesses suicidal ideation, method, plan, intent to act on the plan, and suicidal behavior. Other scales for suicide ideation include:

• Suicide Probability Scale: Measures well-being and coping behavior using a four-point scale
• Beck Scale for Suicide Ideation (BSS): A set of 19 questions for adults
• Ask-Suicide Screening (ASQ) Questions: A set of four questions for children and adults designed to detect early signs of suicide
• P4 Screener: Assesses suicide risk by asking about the “4 P’s”: past suicide attempts, a plan, probability of completing suicide, and preventive factors.

Medical Evaluation: In some cases, a medical evaluation may be necessary to rule out any underlying physical health issues that could contribute to psychological distress.

Psychiatric Evaluation: A psychiatrist can diagnose and treat any co-occurring mental health conditions, such as depression, anxiety, or bipolar disorder, which may be contributing to suicidal ideation.

Treatment for Suicide Ideation

Suicide ideation is usually treated by psychotherapy, medications, and lifestyle changes that can help reduce the risk of suicidal behavior. Speaking with a therapist who will help you explore why you feel the way you do is the first step in coping with the condition. Therapy sessions can also include counseling and education for families to help them understand what a person is going through and identify warning signs for timely intervention. Therapy and counseling can also help manage substance abuse, manage stress, make lifestyle changes, and improve diet and sleep.

How to Help Someone with Suicide Ideation

For those helping a loved one or friend struggling with suicide ideation, it’s essential to take it seriously and seek help immediately. Here are some humane and supportive ways to deal with this challenging situation:

• Communication and Trust: Create a safe and non-judgmental space for the individuals to express their thoughts and feelings. Let them know you are there to listen without offering immediate solutions or judgment. The idea is to gain and maintain the trust of the individual whose primary need is compassion and support.
• Encourage Professional Help: Encourage the individual to seek help from a mental health expert, therapist, or counselor.

• Stay Connected: Loneliness and isolation only increase the negativity that comes with suicide ideation. Maintain regular contact with the person experiencing suicidal ideation. Show your support through texts, calls, or in-person visits, if possible. Building a support network of care can provide additional resources and emotional support.

• Remove Access to Means: If you know someone has an active plan for self-harm or suicide, remove their access to any potentially dangerous items or substances.

• Stay Calm: It can be emotionally challenging to support someone with suicidal ideation, but it’s crucial to remain calm and composed. Panic or anger may escalate the situation.

• Help Create a Safety Plan: Work with the individual to develop a safety plan. This plan should outline coping strategies, emergency contacts, and steps to take when suicidal thoughts intensify.

• Educate Yourself: Educate yourself about suicidal ideation and mental health. Understanding the challenges involved can make you a more effective source of support.

• Monitor their Well-Being: Regularly check in with the person to see how they’re doing. Be observant of any worsening symptoms or signs of distress.

• Seek Immediate Help in Crisis: If the person’s condition deteriorates or they express an immediate intent to harm themselves, do not hesitate to call emergency services or take them to the nearest emergency room.

How to Cope if You are Experiencing Suicidal Ideation

Coping with suicide ideation just takes a little moment of your time to stop and think. It isn’t necessary to act on your thoughts or even think about the future. Just be mindful of the present moment and how you can get through it. If you stop and introspect, you’ll find maybe today, the negativity has increased, but wait a few days. Thought processes change, feelings come and go, and nothing is ever permanent. Even though you may feel life is hopeless, you can learn to cope better with treatment. You’ll realize how a different mindset helps you manage stress, reset your mood, and stop the suicidal thoughts. Here are some more ways to cope with suicidal thoughts.

Identify Triggers

Keep an eye out for events or triggers that cause emotions of despair, such as a funeral or other loss, drinking, or relationship tension. Eliminate what you can, then discuss the remaining issues with a friend or counselor. Being aware of your triggers can do much to prevent suicidal thoughts arising from emotions and feelings that make you feel bad. Understanding your motivations puts you more in control of your feelings or stress levels.

Talk to people

Talking to someone you can trust, a loved one, family member, or friend can help. If you do not wish to do so, there is always a helpline you can talk to among the numbers given below. Join support groups, use an emotional support app, or even get professional help. It will be worth it.

Self-care

Self-care is important to mental well-being. A healthy diet without skipping meals, adequate rest, and sleep can go a long way in rectifying suicide ideation. What you need to know is perhaps things aren’t as hopeless as they seem; maybe it could be an unhealthy lifestyle that is causing some physiological issues in your body, which could be the culprit of depressive behavior, which could be rectified.

Be Active

Indulge yourself in hobbies, travel, or give yourself a vacation occasionally. Exercise is one way to improve emotional well-being. Physical and outdoor activities do much to reduce stress and anxiety.

Learn Coping Mechanisms

Find your coping mechanisms for stress. In addition to physical activity, you can utilize relaxation techniques such as sensory deprivation, breathing exercises, mindfulness, and meditation to assist you in overcoming suicidal thoughts. Mindfulness is a type of meditation that helps you be mindful of the present. Being mindful enables you to become more conscious of your thoughts and feelings to help you cope better with them.

Make A Crisis Plan.

You can make a crisis plan with the help of a professional or create your own. Write down in a crisis diary all the things that you will find helpful. Make a list of contacts whom you could call when you need to talk to someone. Fill your crisis book with things that make you feel happier about life.

Go To Your Happy Place.

A safe place or a happy place is an ideal exercise to place yourself in an environment that induces positive feelings within you. These could be your bedroom, a friend’s house, a crisis center, outdoors like a park, or a religious center.

Try A Grounding Exercise.

Grounding exercises using all your senses can help calm your nervous system. These can be:

• Vision. Focus on something beautiful, a happy photograph, greenery, art, or a feel-good movie.
• Hearing. Listen to your favorite music or sit in nature and listen to the sounds.
• Smell. Notice smells around you and try to keep something near you that makes you feel good. Some of these could be scented oils, food, scented soaps, candles, or even herbs like holy basil, which has a lovely soothing fragrance.
• Taste. Find something good to eat and eat it mindfully, savoring every moment of the meal, focusing on the sensations and flavors on your tongue.
• Touch. Stroke something comforting. It could be a comfortable blanket, a dressing gown, a pillow, or even your pet.

Grounding can also be part of distraction exercises where you could distract yourself by playing with your pet, indulging in a hobby, watching movies, or talking to friends.

Reframe Your Mind

Suicidal ideation does not make you feel positive, but if you help yourself and try to rethink through various reframing exercises, you could change your mind set for a more positive one. Keep a diary and write down the things you feel grateful for. Mention the good people in your life, the happy incidents, and the times you felt gratitude for being who you are.

Suicidal ideation can be resolved. Feeling suicidal can overwhelm you into thinking there is just no way out. You might feel as if you’ve run out of options, but act on that one feeling, and nothing you do will make it go away. But how about you give yourself one brain freeze and think? What if there are things you can do that might make you feel different? Yes, of course, your pain is real; you’re hurting inside, but live in this moment and forget about the future. You’ll see that even feelings like these can pass.