Learning More About Suicidal Ideation

By Jill Harkavy-Friedman, Ph.D. | Sep. 26, 2017


Someone once asked me, “Doesn’t everyone who has a mental illness want to die at some point?” With a puzzled look on my face, I answered, “Life and the brain don’t work that way.”

Mental illnesses, such as depression, bipolar disorder and substance use disorders are certainly among the risk factors for suicide. But there are other biological, psychological, social and environmental factors that can increase a person’s risk for suicide. For example: a history of physical or sexual abuse, traumatic brain injury, chronic pain and chronic health conditions. Other contributors closer to the time of suicidal behavior may include stress, adverse life events and intoxication.

Suicide is never the result of one cause, rather a combination of risk factors coming together often in the context of stress and with access to lethal means. And while most people who die by suicide have a potentially diagnosable and treatable mental health condition, most people with a mental health condition do not die by suicide.

We have learned through research that people who have made suicide attempts think differently when in a suicidal state. Their pain and desperation affect their ability to make decisions. Their brain isn’t working flexibly, and they can’t generate alternate solutions. They are hurting—they truly believe they are a burden and their pain will never end.

This doesn’t mean they aren’t motivated to live and be productive. In fact, among people who have made a suicide attempt, more than 90% go on living and engaging with life. That’s why it’s okay—even necessary—to reach out for support when suicidal thoughts occur. And if someone reaches out to you for help, it’s essential to give the support a person experiencing suicidal ideation needs.

What Can We Do to Help?

We can all help prevent suicide by learning the risk factors and warning signs, and by being alert to changes in our family, friends and co-workers.

Trust your instincts if you notice differences in someone’s behavior. If they seem depressed, disinterested or irritable, tell them you’ve noticed, and let them know what raises your concern. If someone isn’t sleeping or they seem agitated, are drinking more alcohol than usual, try to connect and be persistent.

We know from research that asking someone directly if they’re thinking about suicide will not put the idea in their head. It will simply let them know that someone cares enough to have an uncomfortable conversation. It will let them know that help is available.

If someone mentions suicide to you, talks about how you “would be better off without them,” says you “won’t have to worry about them anymore” or believes they are a burden—take notice. These are red flags.

If a loved one is experiencing a suicidal crisis, the immediate steps you should take are removing access to lethal means and helping them get to mental health care. There are medications and therapies that have been proven to reduce suicidal ideation and change brain function in the area that controls decision-making and impulsivity. This helps to remove the tunnel vision of the suicidal moment. Finding the right health team can be a tough task, but there are people out there who will work with them to make sure they get back to feeling well.

Keep in mind that in suicidal moments people are often not at their kindest and won’t necessarily accept your efforts to connect. They are hurting, don’t feel well and don’t believe things will get better. Also know that supporting them with patience and encouragement can have a huge impact. Rather than running away, run toward them and try to be there. Recovery is a process and takes time. No one chooses to have a mental health condition, but everyone fares better with respect and compassion.


A pioneer in suicide research, Dr. Jill Harkavy-Friedman was the first researcher to ask high school students about suicidal ideation and behavior. As the Vice President of Research, she leads the American Foundation for Suicide Prevention’s growing research grant program, working with over 150 scientific advisors to evaluate progress in the field and chart the next areas of inquiry to yield impactful insights and strategies for suicide prevention. She has published over 100 articles, and has appeared as an expert in the Washington Post, USA Today, Newsweek, and other publications.

Doug.. that elation you mentioned is often the result of having made a decision and a plan. The stress is gone, the worry is over. All that remains is to tidy up the few things they think that needs to be taken care of before they complete the process.
12/19/2017 5:34:14 PM

Doug Hyman, you bring up a really good point Doug. Many people who have decided to take their own lives will seemingly change their moods to an upbeat one. Simply because they feel at peace with their decision to end their lives. They believe they're paying will end shortly and so they are actually relieved. Sudden changes in behavior is a definite red flag!!!!
12/18/2017 9:27:23 PM

Tari Gregory
Yes, there definately needs to be meetings like A.A., N.A, Codependents Anonymous,etc. for people struggling with suicidal thoughts. Support groups for those experiencing the symptoms of suicide. Having a sponsor who have overcome suicidal thoughts and understand. People need connection with other people who understand and they can support one another. It is a very lonely place with lots of disturbing thoughts, a roller coaster of mental stress, the prison of having to keep turning the thoughts over and over are exhausting.
10/29/2017 2:34:38 PM

I just wish it was more meetings or any meetings (like Aa) where a person could go and be with others that share depression, suicide. I set in my apt. And try to find things in the internet but that makes it worse. I think about suicide often.
10/12/2017 1:57:47 PM

<a href="http://www.good.com">Good</a> Post.
10/12/2017 8:31:04 AM

Donna Judalet
10/5/2017 4:27:39 PM

Please subscribe
9/28/2017 7:25:32 PM

Seth Caldwell
This is so true. And it's so frustrating that no matter how you raise awareness about this issue, and how many people virtue signal that they are aware of it, they still will treat people that are sad terribly differently and even blame them for bringing them down, making them feel extra worse simply for feeling bad.
9/28/2017 1:29:44 PM

These articles are great and all but the REAL problem is our health care for mental illness. Want to see one? Most of the time you need a referral. A lot of places don't accept Medicaid. More times than not, the wait list to be seen is 6 months or greater. What's a depressed person to do? We need changes!
9/28/2017 12:39:38 PM

Doug Hayman
I'd add to the warning sign list "sudden change of behavior from depressed to elation" or something like that as it can preclude carrying out suicide. This was the case with my brother and one other person I know's sibling. The previously depressed person appeared to be doing really well the day before killing himself. So bypassing the expected ups/downs of bi-polar symptoms...someone who was usually depressed and flat acting like life had finally turned for the better could easily throw loved ones off to where they'd think "I was worried for so long but now he is in a better state of mind. What a relief." Only to be informed hours or days later that the person was dead.
9/27/2017 2:05:37 PM

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