Passive Suicidal Ideation: Definition, Treatments, & How To Get Help

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• What Is Passive Suicidal Ideation?What Is Passive Suicidal Ideation?
• Passive to ActivePassive to Active
• MeasurementMeasurement
• TreatmentTreatment
• ConclusionConclusion
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Depression Depression Treatments Types of Depression Online Therapy for Depression Passive Suicidal Ideation: Definition, Treatments, & How to Get Help

Author: Renee Skedel, LPC

Renee Skedel LPCC

Renee Skedel, LPCC, has extensive experience in crisis resolution, suicide risk assessment, and severe mental illness, utilizing CBT and DBT approaches. She’s worked in diverse settings, including hospitals and jails.

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Medical Reviewer: Kristen Fuller, MD

Kristen Fuller MD

Kristen Fuller, MD is a physician with experience in adult, adolescent, and OB/GYN medicine. She has a focus on mood disorders, eating disorders, substance use disorder, and reducing the stigma associated with mental health.

See My Bio Editorial Policy Published: January 18, 2022 Table of Contents

• What Is Passive Suicidal Ideation?What Is Passive Suicidal Ideation?
• Passive to ActivePassive to Active
• MeasurementMeasurement
• TreatmentTreatment
• ConclusionConclusion
• InfographicsInfographics
• Additional ResourcesAdditional Resources

Passive suicidal ideation describes when someone has thoughts about death or a desire for death, but they are not making plans to harm themselves. While passive, these thoughts are still dangerous and coping can be difficult. If you are having passive or active suicidal thoughts and are concerned you may hurt yourself, call the Suicide Prevention Lifeline (1-800-273-8255) or text the Crisis Text Line (HOME to 741741).

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What Is Passive Suicidal Ideation?

Passive suicidal ideation happens when people desire death but do not make active plans to harm themselves. These thoughts may sound like, “I wish I could go to sleep and not wake up,” or “I wish I could die in a car accident.” Although these are not active plans and tend to be situations in which people do not die by their own hand, people may still engage in riskier behaviors as a result of these thoughts.1

Passive Suicidal Ideation vs. Active Suicidal Ideation

It is important to understand the difference between passive suicidal ideation and active suicidal ideation, since there is a risk of harm either way. Passive suicidal ideation presents with a desire for death, but with thoughts that are more geared toward external events and circumstances.2

Active suicidal ideation presents with:2

• Direct thoughts of wanting to end one’s life
• Making active plans on how, when, and where one might complete suicide
• Active plans include collecting prescription medications or lethal drugs, buying a gun, or actively researching ways online to die by suicide
• Engaging in certain behaviors like saying goodbye and giving away important items
• Sudden periods of elevated mood and happiness after periods of low moods

Is It Less Dangerous to Be Passively Suicidal?

Although passive suicidal ideation is perceived as less of a risk compared to active suicidal ideations, these thoughts can still be dangerous. There have been indications that intent and motivation can change quickly, making it important for those with passive suicidal ideations to pursue treatment.2

Observed with high levels of depression and suicidality, passive suicidal ideation has shown no significant difference from active suicidal ideation.1 Studies indicate that significant markers of suicide attempts in someone’s lifetime are most influenced by both a desire to die and thoughts of self-harm. The presence of both of these thoughts heightened someone’s lifetime suicide attempts.3

Does Passive Suicidality Often Become Active?

Although some people don’t consider passive suicidal ideations to be as much of a risk as active suicidal ideations, the research indicates that these thoughts have the ability to quickly become more severe and dangerous.1 While there is no specific data on how quickly or how often passive suicidal ideations become active, it is important to know that these thoughts can change.

Passive suicidal ideations can be triggered to become active by:4

• An unpredictable event like a fight, bad day, or mental health trigger
• Physical illness
• Decline in mental health (like a full-fledged depressive episode)

Many professionals suggest the importance of a full assessment regardless of passive or active status.5

How Is the Risk of Suicide Measured?

Suicide risk is generally assessed through a variety of tested and reliable measurements as well as clinical interviews. Some of the most common assessments include the Scale for Suicidal Ideation (SSI), Columbia Suicide Severity-Rating Scale (CSSRS), and the Beck Depression Inventory-II (BDI).4,5,6,7 They share common themes for assessment, but each measures their own unique factors.

Factors that determine suicide risk include:7

• Protective factors: Things that keep people safe or stable in their environment, such as supportive family/friends, hobbies, successes and achievements, fulfillment at work, etc.
• Risk factors: Things that challenge people’s stability or wellness, such as illness, trauma, substance misuse history, mental health and mental health hospitalization history, family history of mental health, etc.
• Warning signs: Certain indicators of potential self-harm, such as talking about suicide, hopelessness about the future, presenting with increased emotional distress or a decline in mental health symptoms, ensuring responsibility is covered for dependents, etc.
• Suicidal thoughts and planning: Past and current thoughts or plans and access to a means

Although the measurements sound straightforward, those who are struggling with passive suicidal ideation may not be properly assessed or able to access the help they need.

Do Passive Suicidal Thoughts Still Require Treatment?

People who are experiencing passive suicidal ideations should seek mental health treatment. Even though they are not actively planning their death, they are still experiencing a desire for death and may be more likely to engage in risky behaviors. Passive suicidal ideation is dangerous because of the potential fluctuation from a passive desire to an active urge to harm themselves and end their lives. Further, even if people have no history of active suicidal ideation, passive suicidal thoughts indicate a level of unhappiness and an impact on quality of life.

Passive Suicidal Ideation Treatment

Those who experience passive suicidal ideation would benefit greatly from receiving mental health treatment. Treatment options include therapy, psychotropic medications, and, at most severe risk, hospitalization.

Find the Perfect Therapist for You

Therapy can be an effective approach to depression, anxiety, stress, burnout, trauma, and many other mental health and emotional challenges. Use the ChoosingTherapy.com Directory to find a licensed therapist near you. Many therapists accept insurance, offer in-person and online appointments, and have immediate availability.

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Know the Risk Factors

Part of suicide prevention is knowing the risk factors that may indicate an increased risk of ideations, attempts, or completion of suicide.

Risk factors for suicidal ideations include:10

• Personal history of mental health illnesses (especially mood-based disorders like depression and bipolar disorders)
• Family history of mental health, suicide, suicide attempts or ideations, depressive emotions (hopelessness, worthlessness, guilt, or loneliness)
• Substance use disorders
• Impulsive behaviors
• Increased aggression
• History of abuse or significant traumas
• Physical illness
• Major losses
• Limited access to a support network
• Lack of access to healthcare services
• Access to a means of suicide

Warning Signs to Look For

Knowing and looking for the warning signs of suicidal ideation can help prevent or reduce rates. It is important to note that the existence of any warning signs are a concern and may be reason to follow up with a therapist or the suicide lifeline.10

Warning signs for suicidal ideation include:

• Expressing a desire to die or end their life
• Identifying ways they may do this (i.e. searching for poison or pills online, buying a gun, etc.)
• Expressing feelings of hopelessness, purposelessness, feeling trapped or in pain, and feeling like they are a burden to others
• Increased substance use
• Increased recklessness in behaviors
• Anxious or agitated behaviors
• Significantly increased or decreased sleep
• Self-isolation
• Anger or talking about revenge against others
• Significant mood swings

Use the Resources

A final part of suicide prevention is being aware of the available resources in your community and being willing to reach out and share more. Two reliable resources are the American Foundation for Suicide Prevention and the Suicide Prevention Lifeline. Refer to them for more information about advocacy and education.

Prevention is important, especially if you know people with mental illness who face significant stigmas or who have a history of trauma surrounding reporting their issues.

Final Thoughts

Passive suicidal ideations can be scary and difficult to understand. Just know that if you or a loved one are experiencing these thoughts, you are not alone. There are support networks who can help you get through it. Seek out support, learn more about yourself and your thoughts, and learn ways to manage these thoughts so you can start to feel better.

Passive Suicidal Ideation Infographics

Additional Resources

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For Further Reading

• Best Books on Suicide
• Dreams About Suicide: Why They Happen & What to Do
• Helpful Books for Dealing With Self-Harm
• What Happens If You Tell Your Therapist You’re Suicidal

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Sources Update History

ChoosingTherapy.com strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.

• May, C. N., Overholser, J. C., Ridley, J., & Raymond, D. (2015). Passive Suicidal Ideation. Illness, Crisis & Loss, 23(3), 261–277. https://doi.org/10.1177/1054137315585422

• National Institute of Mental Health. Suicide in America: Frequently Asked Questions. https://www.nimh.nih.gov/health/publications/suicide-faq/

• Baca-Garcia, E., Perez-Rodriguez, M. M., Oquendo, M. A., Keyes, K. M., Hasin, D. S., Grant, B. F., & Blanco, C. (2011). Estimating risk for suicide attempt: Are we asking the right questions? Journal of Affective Disorders, 134(1–3), 327–332. https://doi.org/10.1016/j.jad.2011.06.026

• Rush AJ Jr, First MB, Blacker D. Suicide risk measures. In: Rush AJ Jr, First MB, Blacker D, eds. Handbook of psychiatric measures, 2nd ed. Arlington, VA: American Psychiatric Publishing; 2008:242-244.

• Simon, R. I. (2014). Passive suicidal ideation: Still a high-risk clinical scenario. Current Psychiatry, 13(3), 13–15. https://cdn.mdedge.com/files/s3fs-public/Document/September-2017/013_0314CP_Commentary_FINAL.pdf

• Brown, G. K. (2001). A review of suicide assessment measures for intervention research with adults and older adults. University of Pennsylvania. https://sprc.org/sites/default/files/migrate/library/BrownReviewAssessmentMeasuresAdultsOlderAdults.pdf

• Toolkit | Zero Suicide in Texas (ZEST). (2014). Zero Suicide in Texas. https://sites.utexas.edu/zest/toolkit/

• Jobes, D. A., Au, J. S., & Siegelman, A. (2015). Psychological Approaches to Suicide Treatment and Prevention. Current Treatment Options in Psychiatry, 2(4), 363–370. https://doi.org/10.1007/s40501-015-0064-3

• Treatment. (2020, June 23). American Foundation for Suicide Prevention. https://afsp.org/treatment/

• Help Someone Else. (2021, May 4). American Foundation for Suicide Prevention. https://afsp.org/

• Suicide Prevention Resource Center. Risk and Protective Factors. Retrieved from https://www.sprc.org/about-suicide/risk-protective-factors

• Lai, Y. (2018, June 21). Difference in Cognitive Flexibility between Passive and Active Suicidal Ideation in Patients with Depression. Neuropsychiatry. https://www.jneuropsychiatry.org/peer-review/difference-in-cognitive-flexibility-between-passive-and-active-suicidal-ideation-in-patients-with-depression-12644.html

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January 18, 2022 Author: No ChangeReviewer: No ChangePrimary Changes: Updated for Readability and Clarity. May 14, 2021 Author: Renee Skedel, LPCReviewer: Kristen Fuller, MD Show more

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