Passive Suicidal Ideation: A Treatment Guide for Parents

In the United States, 18% of people under the age of 18 have thought about suicide. While parents may be aware of the rising rates of teen suicide, many have not heard of passive suicidal ideation. Learn about the condition, how it differs from active suicidal ideation, and how it presents in teens.

The key distinctions between these three types of thoughts are desire and intent toward dying.

Passive suicidal ideation is a desire to die without active planning or suicide attempts. Struggling teens may have thoughts about hopelessness or wish to die. They may express a desire to magically stop existing without specific thoughts on the realities or process of death.

• “I wish I was not here anymore.”
• “I don’t see the point in life.”
• “Things would be better if I could just disappear.”

Active suicidal ideation involves specific plans or intentions to end one’s life. Teens with active suicidal thoughts may think about when and how to end their life. They may research lethal means or obtain items to aid in suicide. They may plan pre-death rituals, like saying goodbye to loved ones. Passive suicidal thoughts can escalate into active suicidal thoughts if left untreated.

• “Everything would be better for my family if I were dead.”
• “I’ve made a plan for when I want to die.”
• “I’ve done research on the way I want to die.”

Intrusive thoughts are unwelcome involuntary thoughts, sometimes related to anxiety or obsessive thought patterns. Teens with intrusive thoughts about death or suicide typically do not want to engage in related behaviors. Examples of intrusive thoughts include unwanted, disturbing images of death; someone might imagine themselves dying even though they do not want to.

The sense of being trapped can magnify these feelings. Because teens are still developing coping skills for stressors at this age, suicide may feel like the only available option to escape an overwhelming situation. Suicidal thoughts may also be influenced by:

• History of suicide or suicide-related thoughts and behaviors in the teen or their family
• Mental health disorders such as depression, substance use disorders, and psychosis
• Trauma or other triggering events, such as abuse or a significant loss
• Medical health such as chronic pain or increasing symptoms of an ongoing condition
• Substance use, particularly new or altered use

Substance use can mask and enhance suicidal feelings, so sudden changes in consumption can open teens up to increased or amplified feelings of distress. However, a reduction in substance use can still put them at risk if it is not accompanied by overall mental wellness and access to healthy coping techniques.

Teens are also at risk because they lack access to care and resources. Learn more about risk factors for teen suicide.

Recognizing warning signs of suicidal ideation can help parents support a teen and direct them to appropriate treatment. When suicidal, teens may express pervasive sadness, exhaustion, or apathy. They may express thoughts of low self-esteem or being a burden.

If they do not talk directly about their feelings, teens may engage in behaviors that indicate their emotional state. Behavioral warning signs include:

• Dramatic changes in sleep or appetite patterns

• Increased substance use or other risky behaviors

• Mood changes, such as unprompted irritability or anger

• Withdrawal from social activities or previously loved hobbies

• Giving away possessions, particularly well-loved ones

• Researching or consuming media about death and suicide

• Talking about death or suicide

A safety plan is one common part of treatment for suicidal ideation. This tool guides a teen through moments of crisis, even in the early stages. It helps them understand their feelings and available support. Accessing information and resources in a crisis can be difficult, so having them pre-planned and recorded somewhere makes it easier for teens to remember the plan and take appropriate action.

A safety plan includes:

1. Personal warning signs: Teens should identify feelings, behaviors, or thoughts that indicate a crisis. This helps them recognize when a crisis is imminent or occurring.
2. Healthy coping strategies: These should involve things the teen can do even if they are alone. The teen should identify and problem-solve potential roadblocks to coping.
3. Family or friends that can help: Teens should identify and prioritize social contacts they can reach out to for support. Some may be to distract from suicidal thoughts, while others may be outlets for talking through stress. As part of this step, teens should identify and problem-solve potential roadblocks to accessing support.
4. Professional resources: A current clinical provider, if any, is typically at the top of this list. Local emergency rooms and crisis hotlines can also be professional resources. Teens should have names and numbers easily accessible.
5. Safe environments: Teens should identify their plans for lethal means and how to limit their access to those items. As part of this step, teens should plan how to remove themselves from an unsafe environment during a crisis.

While a parent or clinical professional often aids in making these plans, a teen should write them down in their own words. Writing the plan helps them process their feelings and ensures it truly resonates with their needs. The safety plan is designed to be used during crises until the teen alleviates distress.

Therapy, medication, and residential treatment programs are other intervention strategies used for teens experiencing suicidal ideation and, if necessary, co-occurring substance use.

If you notice signs of passive or active suicidal ideation in your teen, seek professional help immediately. Your intervention and support is a key lifeline for a struggling teen.

Muir Wood works with teens who are experiencing passive suicidal ideation. Our approach combines talk therapy, substance use treatment, and family support along with psychiatric assessments to identify any underlying diagnoses. Begin by filling out an assessment form, or reach our admissions team using the button below.