Knowing the warning signs to be on the lookout for is key.

The coronavirus pandemic has, of course, had a detrimental effect on the physical health of the world—but according to data from the Centers for Disease Control and Prevention (CDC) the mental health of citizens in the US took a hit too.

In a Morbidity and Mortality Weekly Report published by the CDC last August, data show that 40% of US adults—namely younger adults, racial and ethnic minorities, essential workers, and unpaid caregivers—"reported considerably elevated adverse mental health conditions associated with COVID-19" during late June 2020. Those mental health conditions include anxiety and depression, substance abuse, trauma or stressor-related disorder, and suicidal ideation.

For suicidal ideation in particular, twice as many people (10.7%) reported suicidal consideration in the past 30 days than did those in 2018 for the past 12 months (4.3%). Some groups of people—like employed essential workers and unpaid caregivers—also reported higher rates of the suicidal thoughts than others. Researchers believe increased suicidal ideation, along with the other adverse mental health conditions, were due to attempts to mitigate COVID-19, like physical distancing and stay-at-home orders, though more research still needs to be done on the exact causes. Thankfully, new research shows that overall psychological distress have since dropped back to pre-pandemic levels.

But still, there's certainly been increased talk about suicidal ideation over the past year and a half—and the term may be a new one to many people. Here's what you need to know about the dangerous thought pattern, including signs to look out for and potential ways to ease symptoms.

What is suicidal ideation, exactly?

Suicidal ideation is simply the technical term for thoughts of suicide or thinking about taking one's own life. “A person can have fleeting, intermittent, or ongoing thoughts about suicide,” David A. Merrill, MD, PhD, psychiatrist and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center at Providence Saint John’s Health Center in Santa Monica, California, tells Health.

There are different types of suicidal ideation: passive and active. Passive thoughts may include thinking you’d be better off dead, or that death would be a relief from current circumstances. Active thoughts have an intent to die by suicide, and perhaps including planning how it will happen. “Active suicidal ideation represents an escalation in risk of self-harm,” Dr. Merrill explains. “The most intense level of suicidal ideation involves having a plan."

Who is at risk for suicidal ideation? 

Mental illness, such as anxiety, clinical depression, bipolar disorder, and personality disorder, put someone at a greater risk for suicide. 

“There is a clear connection between major depressive disorder (MDD) and suicidal ideation,” board-certified psychiatrist Jason Mensah, DO, tells Health. “Often, the person experiencing depression is not wishing to die to end their life, but instead to end the hopelessness that comes with MDD.”

However, it’s important to be aware that suicide may occur in people with no history of mental illness, and the COVID-19 pandemic was an example of this. Despite the recent CDC study results on an increased prevalence in mental health issues, including suicidal ideation, it’s still too early to say for sure how the pandemic will affect actual suicide rates, but the measures put in place to mitigate the pandemic may be a trigger for these thoughts. “Stay at home orders, change of routines and fear of the virus have exacerbated symptoms in those who currently have a mental illness, but also those who have never experienced symptoms before,” Dr. Mensah says. 

Another risk factor for suicidal ideation is substance dependence—another adverse mental health condition triggered recently by the pandemic. “Even if you don’t actually have an addiction to a substance, alcohol intoxication is frequently involved when someone attempts to take their own life,” board-certified psychiatrist Margaret Seide, MD, tells Health. “This is likely due to how alcohol lowers your inhibition.”

What are the warning signs to look out for? 

It’s important to understand the warning signs of suicidal ideation, but also to keep in mind that these vary from person to person. “While some people are more vocal about their intentions, others may instead hide their feelings and thoughts,” Dr. Mensah says. 

Common signs include consuming large and frequent amounts of drugs and/or alcohol, actively planning their own death, expressing feelings of hopelessness, having constant thoughts of death or violence, experiencing severe mood swings or personality changes, and making suicidal statements, e.g. “I don’t want to live” or “I wish I hadn’t been born.” 

“Planning can look like someone who has actually purchased [a method] in which to end their lives,” Dr. Seide says. “They may have even given away belongings or written goodbye letters to loved ones.”

Dr. Seide points out that searching online for suicide methods is another cause for great concern. (Luckily, when someone does a Google search on anything related to suicide, the suicide hotline number is the first thing you’ll see.)

It can be difficult to spot suicidal ideation because the signs often overlap with the signs of depression and anxiety. “Anyone struggling with depression can attempt to harm themselves at any time,” Dr. Seide says. “Overlapping signs include an inability to sleep or sleeping all day, a change in appetite, becoming socially withdrawn, difficulty performing at school or work, or not caring about or being interested in anything.” But if you have any concerns at all, you should immediately reach out to a health professional. 

How can suicidal ideation be treated? 

Experts agree that suicidal ideation can only be successfully treated by getting to the root cause. “We would not necessarily aim to cure suicidal ideation,” Dr. Seide says. “We aim to use treatment in an attempt to treat the source of those thoughts. So if that is depression or bipolar disorder, we would treat that and usually, that would resolve the issue. Treatment would typically include talk therapy but in some cases, inpatient hospital care or medication.

Studies have shown that in patients with bipolar disorder, the oral medication lithium can significantly reduce suicide risk. In a review published in the British Medical Journal in 2013, researchers concluded that “lithium is an effective treatment for reducing the risk of suicide in people with mood disorders.” 

Scientists also continue to search for new ways to prevent death by suicide. In August 2020, the Food and Drug Administration (FDA) approved the nasal spray Spravato, which has been proven to ease depressive symptoms within 24 hours. It was approved in March 2019 to treat patients with depression who were resistant to other therapies, but doctors now have the green light to give it to patients with acute suicidal ideation. However, Spravato hasn’t been proven to prevent suicides, and there’s no research to show that it rapidly reduced the severity of patients' suicidal thoughts significantly more than a placebo. 

In addition to any prescribed medication or professional therapy, having a social network and/or a list of go-to people who can support you is crucial, Dr. Seide adds.

Remember: How we talk about suicidal ideation is important

Not everyone who is having thoughts of ending their own life will go to do so, or attempt to do so. But their experience shouldn’t be minimized, Dr. Seide says, and this is where care should be taken around the language used.

“In the past, the term ‘suicidal gesture’ was used to describe someone who attempted to harm themselves, but it wasn’t a ‘serious’ attempt, or seemed as if it was for attention,” Dr. Seide reveals. “In medicine, saying that something is a ‘lower-level attempt’ is also incorrect. Anyone who attempts to harm themselves in any way is of great concern and should not be dismissed, but evaluated immediately by a medical professional—ideally by a mental healthcare worker.” 

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter