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What Is Suicide Ideation?

Know the warning signs and how to get help for yourself or a loved one

Oprah Winfrey interviews Prince Harry and Meghan Markle on A CBS Primetime Special premiering on CBS on March 7, 2021. (Photo by Harpo Productions/Joe Pugliese via Getty Images)

Photo by Harpo Productions/Joe Pugliese via Getty Images

Prince Harry and Meghan Markle talk to Oprah about her thoughts of suicide.

En español | When former-actress-turned-royalty Meghan Markle, wife of Britain's Prince Harry, confessed to having had suicidal thoughts this month in an Oprah Winfrey primetime special, she put a spotlight on a public health crisis that is anything but glamorous. “I was really ashamed to say it at the time and ashamed to have to admit it to Harry. ... But I knew that if I didn't say it, then I would do it,” she said. “I just didn't want to be alive anymore."

Markle's thoughts about ending her life are what's known as “suicidal ideation,” says Patricia Kaine, M.D., a retired family physician who's now a suicide prevention speaker in Cleveland and has experienced such thoughts herself. “Suicidal ideation is where you have gone beyond the fleeting thought of suicide to ‘I'm thinking of ways to commit suicide. I'm thinking how suicide will make life better, for either me or the people around me,’ “ Kaine says. “Meghan Markle's story is more common than people realize."

Kim Ruocco, who lost her husband to suicide in 2005, can relate. “Meghan said a lot of similar things that you hear from people who are struggling,” says Ruocco, vice president of Suicide Prevention & Postvention for the Tragedy Assistance Program for Survivors (TAPS). “And you think about if she could get to that place, anybody could."

Suicide prevention lifeline sign

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Finding help

If you or someone you care about is considering suicide, call the free 24-hour National Suicide Prevention Lifeline, 800-273-TALK (8255), or text the word ‘home’ to the Crisis Text Line at 741741 to speak with someone who can offer confidential support and resources. The National Suicide Prevention Lifeline also runs the Veterans Crisis Line at the same number (800-273-8255, Press 1, or text 838255), and offers options for the deaf and hard of hearing. Find more information at suicidepreventionlifeline.org.

The Substance Abuse and Mental Health Services Administration also has a helpline (the Treatment Referral Routing Service) offering information on support groups, treatment options and other assistance: 800-662-HELP (4357).

Beyond fleeting thoughts

The data varies, but somewhere around 25 to 35 percent of adults in the U.S. have had suicidal thoughts at some point in their lives, says Christine Moutier, M.D., chief medical officer at the American Foundation for Suicide Prevention.

Suicidal thoughts are so widespread, according to the Centers for Disease Control and Prevention (CDC), that in 2019, 12 million American adults admitted to seriously thinking about suicide, 3.5 million planned a suicide attempt, and 1.4 million attempted suicide. It was responsible for 47,500 deaths that year.

"It does not necessarily indicate anything other than the fact that life is challenging for all human beings,” says Moutier. “Challenges and struggles are kind of universal to the human condition.”

The pandemic has exacerbated these challenges, spurring a rise in mental health issues. The number of people in the U.S. reporting symptoms of depression in April through June 2020 increased fourfold over the same period in 2019, according to the CDC. Three times as many people reported symptoms of anxiety disorder in that same time period. And 10.7 percent of 5,470 adults surveyed at the end of June 2020 reported having seriously considered suicide in the 30 days before completing the survey.

"We do know, based on these CDC surveys, that Americans are feeling more distressed during the pandemic,” Moutier says. “But it's also important to know that suicide is preventable."

Warning signs

Signs of suicide ideation include changing patterns in eating or sleeping; engaging in risky or dangerous behaviors; drug or alcohol use; and other symptoms associated with depression (see box for more signs).

"[They might do] things like withdrawing or starting to give their things away,” Kaine says. “Or say, ‘When I'm gone, will you take care of my pet?’ “

Among older adults, warning signs might include a change in their engagement with activities they've always enjoyed, low energy, or flat speech, Moutier says. They may have depression, which, because the symptoms are similar, can sometimes be mistaken for dementia in older people.

The most common signs of suicidal ideation include:  

  • Talking about being a burden or wanting to end their life
  • Unusual, risky or dangerous behavior
  • A dramatic change in eating or sleeping routines
  • Withdrawing from activities they once loved
  • Giving things away, even if they have no terminal diagnosis
  • Asking people to take care of their pets when they're gone
  • Physical changes, lack of energy, slow speech
  • Recent trauma, such as a breakup or job loss

Reaching out

If you're concerned that someone in your life is at risk for suicide, talk to them about how they're feeling, says Moutier. “You can't assume that the people in your life, even the ones that you see all the time, aren't suffering in some way inside, unless you open up that dialogue,” she says. “Even if it isn't in your normal repertoire of ways that you've been interacting in your life ... you can still take that risk and reach out to people in your life and have these deeper conversations. It actually expresses a level of caring that most people really appreciate."

If you don't know what to do, or if things escalate and someone might be on the verge of killing themselves, you should immediately reach out to a crisis hotline, she says.

For guidance and resources, contact the National Suicide Prevention Lifeline (see box). There are effective treatments for depression and other mental health issues associated with suicide, including medication and talk therapy. It's important to know that you're not alone, and there are people who can help.

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