What is the definition of Suicidal Ideation?

Question

Many resources on depression and suicide use the term "suicidal ideation" as an important sign/symptom. Some sources (e.g. Krahn, Miller, and Bergstrom, Rapid Resolution of Intense Suicidal Ideation after Treatment of Severe Obstructive Sleep Apnea, 2007) say that it alone (without anything else, like an actual suicide attempt) constitutes a medical emergency.

What is the definition of the medical term of art "suicidal ideation"? For example, does any fleeting thought or consideration of suicide as a possible option count, or is more required? Does it require a firm conclusion that suicide is the only reasonable option? Part of me suspects that the definition is "to think about suicide to the extent that such thinking rises to the level of a medical emergency", but that seems like a circular definition!

This is a definitions question. I do not need help with depression or suicide!

Answer 1

Thoughts about wanting to die or killing oneself do constitute suicidal ideation.

Ideation is defined as

the process of forming ideas or images.

So that applied to suicide or wanting to die = suicidal ideation.

That said, it doesn't mean that the individual is at immediate risk of completing suicide.

Depression is common; 1/3 of human beings alive will have at least a short episode of depression at some time in their lives. Having passing thoughts about wanting to die (or not be alive) is not uncommon.

Clinicians are now recommended to screen for depression/suicidality at all primary care visits due to how common and treatable it is. If someone replies "yes" to that question, additional questions are asked to characterize it.

Reassuring factors that a person isn't at immediate risk of self-harm:

• Passive suicidal ideation means the individual is thinking about it like "it'd be nice if I died" or "I'm ready for life to be over" but without a desire or plan to actually commit suicide to achieve that.
• No plan of how they'd go about doing it.
• Protective factors and reasons for living like family, spiritual beliefs, goals.

A person is more likely to follow through with suicide if they have a plan of how to do it. Or access to a gun. Or have tried before. So those are more red flags that this person may be at risk of harming themselves.

In the case there's risk of immediate harm, a person needs to seek help or be involuntarily given help - ideally by a counselor or medical professional.