6 Differences Between Passive and Active Suicidal Ideation

Writer’s note: Hey, Psych2Goers! This article isn’t meant for diagnosis or treatment. Please note that it is a very important topic to be highlighted since both passive and active suicidal ideation should not be taken lightly and intervention from mental health professionals are required so that it does not escalate into suicidal attempt and ultimately suicide.

Trigger warning: Information presented in this article discusses on suicide which may be triggering to some people. If you notice you or your loved ones exhibit such behaviour, please know there are helpful resources to support you.

Whenever someone is discussing on “suicide”, it surely makes our ears all prick up. Mostly this happens for a good reason, the prospect of someone whom we dearly love having such dark thoughts to end their life inevitably raises concern, or the very least, disconcertment.

What is suicidal ideation?

Suicidal ideation or suicidal thoughts, is defined as thoughts about killing oneself; these thoughts may include a plan (Schreiber & Culpepper, 2021)

According to the Centre for Disease Control (2017), 17% of adolescents in the USA reported having suicidal ideation. Suicide attempt often follows suicidal ideation, whereby more than a third of teenage ideators proceed to make an attempt to end their life (Nock et al., 2013).

However, we should realize that suicidal ideation, like most of any other mental health terminology, exists on a spectrum, from passive suicidal ideation to active suicidal ideation.

What are the differences between these two types of suicidal ideation?

Below are the criteria that you can use to differentiate the two categories:

A wish to die VS An existing wish to die accompanied by a plan to carry out the death

According to revised nomenclature for the study of suicide and suicidal behaviours by Silverman et al. (2007), “passive suicidal ideation (also referred to as death ideation) is defined as a wish to die, thinking about one’s own death or that one would be better off dead, in comparison with active suicidal ideation, which refers to thoughts of killing oneself.”

Ziba Redif shared a personal story for Refinery29, where she described her passive suicidal ideation as “I’ve never actively wanted to die, but every now and then, when things were particularly difficult, I wanted to close my eyes and disappear.” When she was overwhelmed with bad feelings, she would be imagining relief in going to sleep and never waking up again, however, she never truly wanted to die.

2. Would leave life or death to chance VS Actively seeking out for ways to end life (with their own hands)

I just hope for the pain to stop. I wish to die during sleep, or perhaps be killed in a tragic accident. And…it would be great to actually develop terminal cancer.

Above can be a monologue that a person with passive suicidal ideation may have. They secretly desire that an accident or disease takes the choice out of their hands. They are not afraid or making reckless or self-sabotaging decisions. On the other hand, a person with active suicidal ideation will be actively searching for methods to kill themselves, such as ways to overdose themselves, how to buy a gun, or how to drown themselves in the water.

3. Looking forward to a good future but occasionally wanting to disappear VS Feeling hopeless of a good future

“Currently, I don’t have a plan to kill myself. I feel like I am in a grey area between fleeting thought and attempt,” your friend confessed to you one day.

“Do you know about the warning signs of suicide?” you asked your friend.

“Yes, I know about that, but I don’t check the majority of the boxes on that list of warning signs,” she said with a soft, melancholic tone of voice. “I still enjoy my life and I am definitely curious about the future, however on particularly bad days, I truly wish to die and disappear.”

Now, imagine you have the above conversation with your friend. This will be a typical conversation with a person who is having passive suicidal ideation.

On the contrary, a person with active suicidal ideation may portray hopelessness about the future and they feel indifference about life in general.

4. No preparation VS Start to prepare for taking their lives

You visit your sister one day, since you are concerned about her well-being after she lost her husband a few months ago due to a motor vehicle accident. Her apartment looks spick and span, unlike what it looks like when she has just lost her husband. Before, it had been untidy and in a mess. You thought perhaps she has already recovered from her grief of losing her loving husband, however you notice she is still gloomy and does not appear to be her regular cheerful self.

Oftentimes, an individual who is contemplating to take their own lives will start to put their personal business in order. This might include giving away personal belongings, visiting friends and family members, making a will, and cleaning up their room and home. One can also write a note before committing suicide. This behaviour is portrayed by those with active suicidal ideation. In contrast, those with passive suicidal thoughts do not make such preparations (Casarella, 2020).

5. Would not attempt suicide because of a deterrent VS Minimal or no concern about deterrents

I feel so miserable. I can’t see past the pain. It is a different reality for me. I want the anguish to go away. But…what would happen after I die? My family will be more miserable and devastated.

According to a report published in the Journal of Consulting and Clinical Psychology by Beck and Weissman (1979), the Scale for Suicidal Ideation or SSI is a 19-item clinical questionnaire, which quantifies and assesses suicidal intention. One item measured the effect of deterrents in a person’s life, such as family or religion, which become a preventative factor from committing suicide. An individual who displays indifference towards the deterrents is one who may be having active suicidal intention compared to those who are still concerned about the deterrents.

6. No courage and unsure VS Sure of competence to carry out the suicidal attempt

“Have you ever planned to kill yourself?”

“Yes…” said the man who was sitting across from a therapist.

“And…are you confident you will succeed in your attempt?”

“Yes…” the man nodded.

SSI scale also evaluated the “sense of capability to carry out a suicidal attempt”. People who are confident that they will succeed in their suicidal attempt are considered to be having active suicidal thoughts, whilst those who are unsure that their attempt will be successful are those who are passively having suicidal ideation.

Final thoughts

Suicide.

The word is inevitably heavy in its own way. Utter “suicide” and people may never imagine one’s lack of attachment to life and one’s passive fantasies.

Suicidality exists on a continuum and people with suicidal ideation are on that continuum somewhere. Some of them are just closer to an actual suicidal attempt than others.

People with passive suicidal ideation may feel doubtful to seek help since most of them tend to downplay its severity, or worry about the stigma their seeking for help could face. However, it is crucial to note that passive suicidal ideation can escalate into active suicidal ideation quickly without warning, due to triggering circumstances or exacerbated mental issues.

Imagine this! You are swimming in the ocean, treading to stay afloat. You still think that the ocean is nice, the sun comes out and you ride the tranquil currents, finding solace in the drifting. However, on one bad weather day, the storm is raging, and you have some sort of a hunch that unfortunately, there will be nothing left for you to do but to stop trying to swim and sink down into the deepest part of the ocean.

But…it is important for you to actually learn to live in the water. Remember, don’t be too hard on yourself. Don’t struggle alone, instead try to search for “life preservers”, by reaching out for mental health professionals. They can evaluate suicidal intentions and risk; and help you to navigate the ocean currents better. Passive and active suicidal thoughts should be discussed openly with a professional to ensure they are not trivialized or normalized; but processed in a way that is conducive to well-being. Suicidal ideation in any form shouldn’t be taken lightly.

Suicide Hotlines:

America: 1-800-273-TALK (8255)

Canada: 1-866-531-2600

Australia: 13 11 14

United Kingdom: +44 (0) 8457 90 90 90

Malaysia: 03-76272929

Beijing: 0800-810-1117

Hong Kong: +852 28 960 000

Japan/Tokyo: 81 (0) 3 5286 9090

Brazil: 55 11 31514109 or (91) 3223-0074

Mexico: 9453777

Germany: 0800 111 0 111

Russia: (495) 625 3101

India: 91-22-27546669

Iran: 1480

South Africa: 0800 12 13 14

REFERENCES

Beck, A., Kovács, M., & Weissman, A. (1979, January 1). [PDF] Assessment of suicidal intention: the Scale for Suicide Ideation.: Semantic Scholar. undefined. https://www.semanticscholar.org/paper/Assessment-of-suicidal-intention%3A-the-Scale-for-Beck-Kov%C3%A1cs/924d9dbaa1d3da50a40e78104a960a590aae2089?p2df.

Casarella, J. (2020, March 11). How to Recognize Symptoms of Suicidal Behavior. WebMD. https://www.webmd.com/mental-health/recognizing-suicidal-behavior.

Centers for Disease Control and Prevention. (2017). Leading causes of death reports, national and regional. pp. 1999-2015

Retrieved from http://webappa.cdc.gov/sasweb/ncipc/leadcaus10_us.html

Nock, M. K., Green, J.G., Hwang, I., McLaughlin, K. L., Sampson, N. A., Zaslavsky, A. M., et al. (2013).

Prevalence, correlates, and treatment of lifetime suicidal behaviour among adolescents. Results from the National Comorbidity Survey Replication Adolescent Supplement

JAMA Psychiatry, 70, pp. 300-310

Redif, Z. (2020, September 10). I Had Passive Suicidal Ideation. Here’s What Everyone Should Know. What Is Passive Suicidal Ideation? Symptoms & Treatment. https://www.refinery29.com/en-us/what-is-passive-suicidal-ideation.

Schreiber, J. & Culpepper, L. (2021, May 24). UpToDate. https://www.uptodate.com/contents/suicidal-ideation-and-behavior-in-adults#H1.

Silverman,M. M., Berman, A. L., Sanddal, N. D., O’carroll, P. W., Joiner, T. E. (2007). Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 2: Suicide-related ideations, communications, and behaviors. Suicide Life Threat Behav. 37(3):264-77.