Understanding Suicidal Ideation: A Guide to Recognition and Response

Suicide is a significant public health concern, particularly among Australians aged 15 to 49, where it is the leading cause of death. Approximately one in eight Australians have seriously considered suicide, underscoring the importance of understanding how suicidal thoughts, or suicidal ideation, manifest.

Approximately one in eight Australians have seriously considered suicide.

Types of Suicidal Ideation

Suicidal thoughts can be categorized as passive or active, though the distinction is not always clear-cut. Thoughts often co-occur and can independently predict suicide attempts.

Passive Suicidal Ideation

Passive suicidal ideation involves thinking about death or not wanting to live, without a current intention to act. Examples include statements like “I wish I could fall asleep and never wake up” or “My life is not worth living.” These thoughts indicate significant distress but lack concrete plans for self-harm.

Active Suicidal Ideation

Active suicidal ideation includes thoughts about ending one's life with some degree of intent or planning. Examples include statements like “I’m having thoughts about how I would end my life” or “I’m going to kill myself.”

Recognizing Warning Signs

Recognizing suicidal thoughts in oneself or others can be challenging as individuals may not express them openly. Regardless of whether thoughts are passive or active, patterns indicating increased risk include:

• Increased frequency or intrusiveness of thoughts.
• Heightened hopelessness or despair.
• Developing plans to end one’s life or preparing to act.
• Engaging in risky behaviors.

Behavioral changes to observe include shifts in sleep/eating habits, social withdrawal, loss of interest in hobbies, irritability, decreased performance in academics or work, or organizing personal affairs.

Over two-thirds of individuals who die by suicide do not engage with mental health professionals in the year prior, highlighting the vital role of friends, family, and peers.

How to Respond to Suicidal Thoughts

When someone discusses suicidal thoughts, a supportive response is critical. The Black Dog Institute provides a four-step guide:

1. Ask Directly: Inquire directly if they are having thoughts of suicide. Asking does not implant the idea but can open a dialogue.
2. Listen and Assess Safety: Listen seriously to what they are saying and ensure there is nothing they can use to harm themselves. Ask about the frequency, intensity, and controllability of their thoughts, and whether they are doing anything to prepare to act on them.
3. Get Help: If life is in immediate danger, call emergency services (e.g., 000 in Australia), a crisis helpline (e.g., Lifeline 13 11 14), or take them to an emergency department. If not in immediate danger, assist them in making an appointment with a GP or psychologist, or call a helpline.
4. Follow Up: Check in with the person to show continued care and support, determining an appropriate frequency for contact.

All suicidal thoughts, whether passive or active, are indicators of deep distress. Responding with calm curiosity, compassion, and practical support can be life-saving.

If you have lost someone to suicide, understand that you are not responsible for their death; their decision was shaped by many factors beyond any single person’s control.

If this article has raised issues for you or if you are concerned about someone, contact Lifeline on 13 11 14.