Understanding passive suicidal ideation is important to differentiate it from active suicidal ideation. Sometimes it’s as simple as feeling like a burden to everybody. While you don’t plan to end your life, you don’t feel like waking up the next day, so it can be a close tipping point into suicidal ideation. But it’s different for each person. Read on to learn more about these two forms of suicidal ideation and specifically its passive form.
What Is Suicidal Ideation?
Suicidal ideation, or having thoughts about suicide, is more common than you might think. One study reported that the U.S. suicide rate reached 14.1 per 100,000 population in 2021. And there is a strong belief that this figure understates the actual number due to other misclassified reports.
Between 2000 and 2018, the age-adjusted suicide rate increased by 36.7% with suicide being the second leading cause of death for the 10-24-year-old age group. According to the Centers for Disease Control and Prevention (CDC), in 2021, the rate of suicide among men was 4 times higher than that among women [1].
Passive suicidal ideation refers to wishing to be dead or not wanting to live. However, there is no specific intent, plan, or action to end one’s life. Active suicidal ideation goes beyond this to include specific plans or intentions to act on those thoughts.
Differences Between Passive and Active Suicidal Ideation
Examples of passive suicidal ideation include: “I wish I could disappear or not exist”, “I wish I were never born”, “My life is not worth living, and I wish I could go to sleep and never wake up again”.
Examples of active suicidal ideation include: “Maybe I should kill myself,” “I should kill myself”, and “I am going to kill myself”.
The currently held dominant theory about suicide, known as ideation-to-action, is that these two concepts are on a continuum in which passive ideation leads to active ideation. However, some recent research suggests that passive and active ideation are distinct concepts, but are highly related and likely to co-occur.
Therefore, they should not be viewed as a single underlying continuum. Thus, both passive and active ideation should be included in all suicide risk screenings and assessments. Recent studies show that passive and active ideation have similar risks for suicidal behaviors and that those with passive and active ideation are more similar than different [2].
Suicidal Ideation Scale: How Professional Assessments Work
Suicidal ideation assessments act as an early warning for later suicidal acts. They also provide valuable insights into an individual’s level of suffering and their specific needs. 90% of those who die by suicide have a psychiatric illness, usually a mood disorder. So recognizing suicidal ideation is a key opportunity for a thorough assessment to understand an individual’s needs and risk levels.
When assessing the suicide level, the risk factors need to be explored in a comprehensive manner. The most common assessment scales in use include [1]:
- Columbia-Suicide Severity Rating Scale (C-SSRS): Evaluates the severity and immediacy of self-destructive thoughts, suicide attempt behaviors, and the lethality of attempts.
- Beck Scale for Suicide Ideation (BSI): Measures the intensity of suicidal ideation through 21 items focusing on various aspects of suicidal thoughts.
- Suicidal Ideation Attributes Scale (SIDAS): Assesses the presence and intensity of suicidal thoughts, particularly in community populations.
- Patient Health Questionnaire-9 (PHQ-9): A quick reporting scale used in medical records, with the ninth item focusing on thoughts of death or self-harm.
As an illustration only, here are some examples from the Beck Scale. The actual questions are asked in a clinical interview format. The clinician chooses the response that best matches the patient’s statement.
Item 1: Wish to Live
Question Stem: The clinician assesses the patient’s attitude toward living.
Sample Response Choices:
- 0 – Moderate to strong wish to live.
- 1 – Weak wish to live.
- 2 – No wish to live.
Item 2: Wish to Die
Question Stem: The clinician assesses the patient’s attitude toward dying.
Sample Response Choices:
- 0 – No wish to die.
- 1 – Weak wish to die.
- 2 – Moderate to strong wish to die.
Risk Factors and Warning Signs of Suicidality
The greatest risk occurs among individuals who report both passive and active ideation. Each type of ideation increases risk, but their co-occurrence might be synergistic or additive. And it is believed that some thoughts straddle the line between passive and active ideation.
Some recent research also suggests that other suicide-related thoughts, such as hopelessness, entrapment, perceived burdensomeness, and unbearability, predict future suicidal behavior even though these thoughts do not involve explicit content about killing oneself and have not been well researched [2].
Common risk factors for passive ideation include:
Predisposing:
- Mental health conditions such as depression, bipolar disorder, schizophrenia, anxiety, or psychosis
- Family history of suicide
- Adverse childhood experiences
- Age, education, employment, and socioeconomic status
- Genetics and brain development or injury
Precipitating:
- Substance use disorder with co-occurring mental health conditions
- Access to lethal means
- Relationships with others
- Stressful life events
- Being transgender or non-binary
- Recent diagnoses of terminal or chronic illness
Suicidal ideation was found to be the third most robust predictor of future suicide deaths, following prior psychiatric hospitalizations and suicide attempts. And the most prominent risk factor for future suicidal ideation episodes was past suicidal ideation, showing how persistent it is.
All forms of suicidal ideation require the immediate attention of a family member, friend, mental health counselor, therapist, or psychiatrist. However, active suicidal ideation is an emergency, and a suicide help line should be contacted immediately.
Signs to watch for include [3]:
- Believing others would be better off without you.
- Withdrawing from loved ones.
- Sleep disturbances.
- Emotional numbness or emptiness.
- Increased substance use or self-harm.
- Researching suicide methods.
- Change in mood – either unexplained happiness or sadness.
Safety Plan for Suicidal Ideation
A suicide plan created by the individual is critical, as the presence and detail of a plan are strongly associated with suicide risk. More detailed plans often indicate a higher likelihood of serious attempts.
On the other hand, a safety plan should be created together with a mental health professional when the individual is feeling calm and clear-headed. The goal is to have a pre-written, step-by-step guide to follow when the individual starts to feel overwhelmed by suicidal thoughts. The main elements to be completed are:
- Recognizing the warning signs: List the specific thoughts, moods, behaviors, and situations that often precede or accompany suicidal thoughts.
- Internal coping strategies to distract myself: List activities you can do to cope without needing another person.
- Social supports and settings to distract myself: List people and places you can connect with and go to for distraction.
- Trusted contacts for support: People you can talk honestly with about your feelings.
- Professional and crisis supports: Who to contact when you can’t keep yourself safe.
- Making the environment safe: How to reduce access to means of suicide.
- Reasons for living: Positive things in your life, no matter how small.
If you know someone who has passive or active suicidal ideation, reach out immediately to:
- 988 Suicide & Crisis Lifeline: Call or text 988
- Crisis Text Line: Text HOME to 741741
- The Trevor Project (for LGBTQ+ youth): Call 1-866-488-7386 or text START to 67867
Evidence-Based Mental Health Treatment in Utah
At Maple Mountain Mental Health and Wellness, our compassionate team of clinical psychiatrists and experienced therapists is committed to providing compassionate treatment to address suicidal ideation. Through a holistic, blended approach, we address each aspect of your health and recovery needs to support long-term healing. Reach out for support today.
Sources
[1] Harmer B, Lee S, Rizvi A, et al. Suicidal Ideation. [Updated 2024 Apr 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.
[2] Wastler, H.M. et al. 2023. An empirical investigation of the distinction between passive and active ideation: Understanding the latent structure of suicidal thought content. Suicide and Life Threatening Behavior. Volume53, Issue2. April 2023. Pages 219-226
[3] What is passive suicidal ideation? Payrus-uk.org.
[4] ClevelandClinic.org.2024. Suicidal Ideation (Suicidal Thoughts).