Passive Suicidal Ideation: What It Means and How to Get Support

Not all thoughts of suicide look like a crisis. Some people might find themselves wishing they weren’t here, while also knowing that they don’t want to die. This experience can be an example of passive suicidal ideation. Passive suicidal ideation refers to thoughts about death or dying, or a wish to be dead, without a current intent to act on those thoughts or a specific plan to end one’s life. These thoughts can range from wishing you could go to sleep and not wake up to feeling that life is no longer worth living.

It can be difficult to admit that you're having suicidal thoughts, but it’s important to remember you’re not alone. A 2020 meta-analysis in Psychological Medicine found that 10.6% of people have passive suicidal thoughts at some point in their lives.

Although passive suicidal ideation means there’s no active plan, your experience still matters. Passive suicidal ideation can affect your mental health daily and can progress into active suicidal ideation. Treatment can help reduce the intensity of difficult thoughts and help you create a plan so that you feel safe and supported.

In this article, we’ll go over what passive suicidal ideation is, what causes it, and available treatment options.

What is passive suicidal ideation?

Passive suicidal ideation means that someone may wish they weren’t alive but isn’t actively making plans to end ‌their life. This can show up in different thoughts, feelings, and behaviors. Thoughts may come or go or be persistent. Some examples of common passive suicidal ideation thoughts include:

• “I wish I’d never been born.”
• “I wish the world would just end.”
• “I wish I wasn’t here.”
• “I think everyone would be better off without me.”

People experiencing suicidal thoughts may sometimes feel less concerned about their own safety or may engage in behaviors that put them at greater risk. 

Passive vs. active suicidal ideation

Suicidal ideation can include thoughts about death or wishing to not be alive. It may also involve planning or preparing to end your life.

With passive suicidal ideation, a person may wish they were dead or think about death without the current intent to act on those thoughts or a specific plan for ending their life.

Active suicidal ideation can involve thoughts of ending one’s life, particularly when they are accompanied by intent, a plan, access to a method, or preparation to act. The level of risk can vary, so any thoughts of suicide deserve to be taken seriously. If you or someone you know is in immediate danger or has a plan to end their life, please call 911, go to the nearest emergency room, or call or text 988 to reach the Suicide & Crisis Lifeline. 

What causes passive suicidal ideation?

Mental health conditions, physical health conditions, and ongoing stress can all contribute to a person experiencing passive suicidal ideation.

Depression and other mental health conditions

Certain mental health conditions, such as major depressive disorder (MDD), bipolar disorder, schizophrenia, and substance use disorder, can contribute to passive suicidal ideation. For example, MDD can make it difficult to enjoy things in your life and can also cause feelings of worthlessness and hopelessness. These symptoms can lead to passive suicidal thoughts. 

Chronic pain, illness, and exhaustion

Living with chronic pain, illness, or ongoing exhaustion can sometimes contribute to passive suicidal thoughts. These thoughts may arise during periods of prolonged physical or emotional distress, such as after receiving a diagnosis of a serious medical condition or while caring for a loved one with a serious illness.

Grief, isolation, and major life stress

Ongoing stress, grief, isolation, and a lack of social support can contribute to passive suicidal ideation. Examples include:

• Financial difficulties
• Difficult or stressful legal situations
• The death of a loved one
• The end of a relationship
• Experiencing a traumatic event
• Facing discrimination, rejection, bullying, or stigma

Research supports some of these links. A 2025 study in the Journal of Psychiatric Research found an association between passive suicidal ideation and a history of childhood trauma, including physical and emotional abuse, among people with depression. A 2022 study in the American Journal of Preventive Medicine found that suicidal thoughts were more common among lesbian, gay, and bisexual adults than among heterosexual adults.   

Can passive suicidal ideation become active?

Passive suicidal ideation can become more frequent or intense, and for some people, it can develop into thoughts involving suicidal intent or planning. However, this does not happen to everyone. If you notice changes in how often or intensely you have suicidal thoughts, it's important to get extra support.

What to do if you’re having passive suicidal thoughts

If you’re having passive suicidal thoughts, focus on reaching out for support and creating or using a safety plan.

Telling someone

Reaching out can feel hard, especially when you're not sure how to explain what you're feeling. However, simply being around others or doing things you've enjoyed before can help. Consider reaching out to a trusted friend or family member. You can also contact the Suicide & Crisis Lifeline at 988 for 24/7 support. 

What to expect when you reach out for support

When you reach out for support, whether that’s by calling 988 or connecting with a mental health professional, you can expect to feel heard. A trained counselor will listen to what you wish to share about what’s been going on and how you’re feeling. They may ask a few follow-up questions to better understand what you’re experiencing. From there, they’ll help you develop a coping plan for the next steps or make a safety plan.

Making a safety plan

A safety plan is a personalized plan to keep you safe in moments of overwhelming emotions. While you can create a safety plan on your own, you’ll often create it in collaboration with a trained mental health professional. Your safety plan will include your personal warning signs, what tells you to use it, along with coping skills and contacts you can reach out to for further support. 

How to support someone with passive suicidal ideation

If someone you love shows signs of passive suicidal thoughts, you might hesitate to talk about it. Many people worry that mentioning suicide could make things worse. However, research has shown that asking someone if they're having thoughts of suicide doesn't increase these thoughts. A 2012 study published in Suicide and Life-Threatening Behavior found that asking people directly about suicidal thoughts did not increase them. By asking, you’ve given your loved one an opportunity to share how they’re feeling so they don’t feel alone or unseen. 

When a loved one shares how they are feeling, thank them for trusting you and listen without shame or judgment. You can do this by listening actively, nodding at appropriate moments, or paraphrasing what they’ve said to check that you understand. You can also offer practical support, such as getting them water or a snack, or helping them reach out to a professional.

Treatment options for suicidal ideation

Effective treatment for suicidal thoughts is personalized. It may include therapy, crisis stabilization, intensive outpatient care, and medication. A mental health professional will help you decide on the best treatment plan by asking questions about how you’re feeling and your situation. They may also ask you to complete a questionnaire, such as the Columbia-Suicide Severity Rating Scale (C-SSRS), to help determine how severe your symptoms are. 

Therapy approaches

Therapy approaches commonly used to treat suicidal ideation include:

• Cognitive-behavioral therapy (CBT): Focuses on the relationship between thoughts, feelings, and behaviors. Helps individuals learn to identify and challenge unhelpful thoughts and learn coping skills and strategies to help reduce suicide risk.
• Dialectical behavior therapy (DBT): Teaches skills to manage intense emotions, tolerate distress, practice mindfulness, and improve relationships. DBT can also address suicidal and self-harming behaviors and urges. 
• Interpersonal therapy (IPT): Focuses on how relationships and major life changes impact your mood. IPT helps you work through challenges like grief, conflict with loved ones, role changes, and isolation, while building stronger connections and support.
• Collaborative assessment and management of suicidality (CAMS): Identifies and addresses the drivers, or root causes, of suicidal ideation. 

Crisis stabilization and intensive outpatient care

In some cases, crisis stabilization and intensive outpatient care may be recommended. Crisis stabilization focuses on stabilizing intense symptoms and keeping you safe so you can meaningfully engage in treatment. Some programs offer crisis stabilization in person, whereas others offer it virtually.

Intensive outpatient care means that you receive structured, intensive treatment while still returning home each night. These include intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs). Both programs offer a combination of group therapy and individual therapy, and some programs offer medication management. They differ in their intensity and time commitment. IOPs usually meet 9-15 hours per week, whereas PHPs meet 20-30 hours per week.

Medication as part of a treatment plan

Depending on a person's diagnosis, symptoms, and history, a psychiatrist or other prescribing clinician may recommend medication alongside therapy. Common options include antidepressants, which are used for depression and many anxiety disorders; mood stabilizers, often used for bipolar disorder; antipsychotics, used for psychotic symptoms and sometimes as add-on treatment for mood disorders; and anti-anxiety medications, typically prescribed for short-term use. Finding the right medication and dose can take time, so ongoing check-ins with your prescriber help track how well it's working and manage side effects.   

How Willow Health can support your mental health journey

If you’re experiencing passive suicidal ideation, Willow Health can help. Willow Health’s crisis program provides urgent mental health care online, with intake appointments available within 48 hours. A licensed mental health professional will help you make a personalized care plan. This plan may include 24/7 crisis support, therapy, medication, and coaching. We’ll also support your transition to long-term care for continued recovery. 

Sources

Liu, R. T., Bettis, A. H., & Burke, T. A. (2020). Characterizing the phenomenology of passive suicidal ideation: A systematic review and meta-analysis of its prevalence, psychiatric comorbidity, correlates, and comparisons with active suicidal ideation. Psychological Medicine, 50(3), 367–383. https://doi.org/10.1017/S003329171900391X 

Mathias, C. W., Furr, R. M., Sheftall, A. H., Hill-Kapturczak, N., Crum, P., & Dougherty, D. M. (2012). What's the harm in asking about suicidal ideation? Suicide and Life-Threatening Behavior, 42(3), 341–351. https://doi.org/10.1111/j.1943-278X.2012.0095.x 

Olgiati, P., Luca, M., Luca, A., Ferri, R., & Serretti, A. (2025). Passive suicide ideation in major depressive disorder: Prognostic role and effect of antidepressant treatment. Journal of Psychiatric Research, 189, 445–454. https://doi.org/10.1016/j.jpsychires.2025.06.012 

Ramchand, R., Schuler, M. S., Schoenbaum, M., Colpe, L., & Ayer, L. (2022). Suicidality among sexual minority adults: Gender, age, and race/ethnicity differences. American Journal of Preventive Medicine, 62(2), 193–202. https://doi.org/10.1016/j.amepre.2021.07.012 

Rizvi, A., Harmer, B., & Saadabadi, A. (2024). Suicidal ideation. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK565877/