Passive Suicidal Ideation: How To Identify It and Help Teens

When your teen feels overwhelmed with life’s many demands and stressors or is struggling with depression, they may experience passive suicidal ideation.* This is a serious issue that requires action. To learn more about it, we talked to Cindy Song, a licensed master social worker and therapist at Embark Behavioral Health in Alpharetta, Georgia. 

Song emphasized that while it may be an uncomfortable or scary topic, as a parent, you need to understand what passive suicidal ideation is — including the difference between passive suicidal ideation versus active suicidal ideation. By understanding this issue, she said, you can navigate it and best help your teen.

What Is Passive Suicidal Ideation?

“Passive suicidal ideation refers to thoughts about dying or not wanting to exist anymore, or general ideas about suicide that occur randomly or infrequently,” Song said. 

These thoughts and ideas are not uncommon for teens, as shown in a recent study published in Pediatrics where researchers asked if participants had ever thought about suicide. According to the study, 22.2% of teens ages 13-17 had experienced passive suicidal thoughts. Females were most likely to struggle with this issue, with 28.4% experiencing passive suicidal ideation, compared to 15.4% of males.   

Are Passive Suicidal Thoughts Normal for Teens?

Regarding whether passive thoughts of suicide are normal for teenagers, Song said, “I hate to use the term ‘normal,’ because any mental health issue is not necessarily normal.”  

However, she said that the growing destigmatization of mental health, and more teens talking about their mental well-being, highlights how passive thoughts of suicide may be more common than previously thought. 

In fact, according to a U.S. Centers for Disease Control and Prevention analysis of mental health data for high school students, almost every indicator of suicidal thoughts and behaviors increased from 2011 to 2021.  

Active vs. Passive Suicidal Thoughts

“Intention is the big keyword that differentiates passive suicidal ideation versus active suicidal ideation,” Song said while describing the difference between these types of suicidal thoughts. 

Examples of active suicidal ideation

Active suicidal ideation involves concrete thoughts, plans, or intentions to end one’s life.  

“Your teen might be thinking, ‘I’m going to kill myself,’ or ‘I want to die by suicide,’” Song said.  

When talking to teens about how they’re feeling, Song digs into whether they have intent and are thinking about methods and means of suicide, along with having an actual plan.  

“If it’s a ‘yes’ to any of those, I define it as active ideation, and we want to take more precautions and get them into treatment immediately,” she said. 

Examples of passive suicidal ideation

Passive suicidal ideation revolves around thoughts of death or a desire to not exist, but without any specific plans or intent to act on those thoughts.  

Song said, “Your teen may say things like, ‘I’m so tired. I’m so done. I don’t have the energy anymore. I want to go to sleep until everything blows over.’”  

Other passive suicidal ideation examples include: 

• Wishing to disappear. 
• Feeling like a burden. 
• Fleeting fantasies of death, but without a specific plan to act them out. 

These thoughts can vary in intensity and frequency, but Song said they usually involve a desire for relief from emotional pain or stress rather than actually wanting to end one’s life.  

Symptoms and Warning Signs of Passive Suicidal Ideation

Song said there are many subtle symptoms your teen is struggling with passive thoughts of suicide: 

• Expressions of hopelessness or helplessness, such as making comments about feeling trapped or that things will never get better. 
• Avoiding social interactions or being disinterested in the usual activities that bring them joy. 
• Excessive self-blame, feelings of worthlessness, or persistent negative self-talk. 
• Talking about feeling numb or empty. 

Causes of and Risk Factors for Passive Suicidal Ideation

Every teen is different, but Song identified six common causes and risk factors that may increase the odds that your teen is experiencing suicidal ideation.  

A history of mental health challenges

“Genetics and generational or intergenerational trauma in a family can be a big risk factor,” Song said. “A history of mental illness or vicarious trauma in a family often affects things like brain chemistry, making children more susceptible to these thoughts.” 

Attention-deficit/hyperactivity disorder (ADHD)

ADHD has been associated with an increased risk of suicidal ideation and behavior, according to research in the Frontiers in Psychiatry journal. ADHD-related impulsivity may make teens more prone to acting on impulsive thoughts, and those with ADHD also often struggle with managing their emotions. 

Depression

“One of the most trending causes that I see for passive suicidal ideation is depression,” Song said.  

According to Mental Health America, over 1 in 10 youths are experiencing depression that severely impairs their ability to function at school, work, or home, with family, or in their social life.  These teens may feel like they can’t handle life anymore, causing them to have passive thoughts of suicide. 

Anxiety

Song noted that anxiety is right up there with depression as a risk factor.  

“I think a lot of it is due to the pandemic, where teens were stuck at home, socially isolated, and feeling like they were being a burden,” she said. “Then they had to suddenly transition back to school without some of the core skills to engage with others, and I’m seeing increased levels of anxiety because of that.” 

Traumatic events

Trauma can have profound effects on mental health and well-being.  

“I like to look at trauma more deeply because definitions change a lot,” Song said. “In the past, we talked about physical, emotional, or sexual trauma. But what we’re recognizing as we’re researching trauma and suicidal ideation is that other traumas exist too.” 

For instance, Song said public embarrassment in high school, such as tripping in the classroom in front of peers, can be incredibly embarrassing and traumatic.  

“Those traumas add up and overwhelm teens,” Song said. 

Discrimination

Discrimination can be a source of stress and depression for teens in certain racial and ethnic groups and the LGBTQ+ community, leading to passive thoughts of suicide. LGBTQ+ teens are especially at risk. In the previously mentioned CDC report, researchers noted that those students were more likely than their peers to experience suicidal thoughts.  

Bullying

Persistent bullying causes emotional pain, erodes a teen’s sense of self-worth, and often triggers social isolation. All three of these factors are well-established risk factors for passive thoughts of suicide, according to Song.  

Substance use

There’s a complex relationship between substance use and suicidal ideation. For instance, substance use may exacerbate underlying mental health issues, such as depression or trauma. Alcohol and other substances may also make it harder for a teen to emotionally regulate themselves when they’re stressed or overwhelmed. 

Past suicide attempts

Teens who’ve attempted suicide in the past can struggle with passive suicidal ideation later. They may have a heightened vulnerability to experiencing severe emotional distress or reaching a point of crisis where suicidal thoughts become overwhelming. There are also situations where unresolved psychological pain that led to the previous attempt may resurface. 

How To Help a Teen Deal With Passive Suicidal Ideation

“When you hear your child express thoughts about dying, you might begin stressing out and spiraling, wanting to rush in and ‘fix’ everything,” Song said.  

She said one of the first things you should do is practice your own emotional regulation and self-care. Once you’re centered, she recommended four ways you can help your teen. 

1. Create a safe space for open communication about suicidal thoughts

“Practice empathy and actually listen to your teen,” Song said. “Give them an open space to talk about whatever they want without you talking over them, interrupting them, or asking a million questions.”  

When discussing suicidal ideation with your teen, Song recommended: 

• Simply asking how they’re feeling and what they’re thinking. 
• Practicing a level of validation. You could say, “I don’t agree with your thoughts about not wanting to exist anymore, but I understand the hardship you’re experiencing.” 
• Co-regulating with them by giving them eye contact, physical proximity, and safe touch, such as a hug. Song said taking these steps “will help your teen feel more secure so they can be more communicative and honest.” 

2. Encourage your teen to practice coping and DBT skills

“After you and your teen talk,” Song said, “there are various coping skills and strategies they can try.” 

She highly recommended your teen try dialectical behavior therapy (DBT). This evidence-based talk therapy can help your teenager take control of their thoughts and emotions and teaches skills such as distress tolerance.  

When treating teens, Song encourages them to work through the SOP acronym: 

• S: “When they’re distressed, I tell them to stop in the moment and take a step back before reacting,” Song said. 
• O: “Your teen observes and ask questions like, ‘What am I feeling? What’s going on in my environment? What’s in my control?’,” Song said. “Teens often feel their thoughts are out of control, and they can feel more in control if they just observe what’s happening inside and outside of them.” 
• P: “Proceed when they’re ready,” Song said. “Teens don’t have to be ‘on’ and go-go-go all the time. They can take a breath. Practice emotion regulation skills. Tell themself, ‘I’m changing my thoughts. I’m creating reassurance within myself. I’m going forward when I’m ready.’”  

3. Have your teen use a safety plan

A safety plan is a proactive way to prepare for challenging moments and empower your teen to better manage their emotions and thoughts. Song said a basic plan typically includes: 

• Defining the specific situations or feelings that trigger or exacerbate passive thoughts of suicide. 
• Developing a list of self-soothing or distracting activities to turn to when they recognize they’re overwhelmed, such as mindfulness exercises or brain puzzles. 
• Creating a list of trusted friends, family members, or support groups to contact in a time of emotional turmoil.  
• Addressing the intention and planning side of suicidal ideation, such as removing or limiting access to specific items or substances your teen associates with self-harm or suicide, and having a list of emergency contacts should a crisis occur. 

4. Get mental health treatment for passive suicidal ideation

“A great place to start is your teen’s primary doctor or physician,” Song said. “But don’t assume getting a prescription for medication is the solution. There are certain diagnoses where your teen might need medication long term, but I tell teens that medication is like training wheels. Talk to a mental health professional, and get your teen into talk therapy to actively develop the skills they need to be more in control of their thoughts and emotions.”  

Song suggested that your teenager lead the discussion on what they’re struggling with and the kind of support they’d like to receive.  

“Teens are exposed to so many mental health concepts on social media these days that can be misleading,” she said. “However, if you’re willing to listen to what they relate to, that could help guide mental health professionals to provide them the support they need.”  

Passive Suicidal Ideation: Wrapup

If your teen experiences passive suicidal thoughts, Song said you should take comfort in all the ways you can support them. 

“You’re on the right track,” she said. “Reading articles like this one about passive suicidal ideation tells me that you care and that you’re committed to helping your teen get the help they need. Don’t fall into a pit of hopelessness. You’re doing the best you can, your teen is doing the best they can, and there are so many opportunities to help them overcome suicidal ideation.” 

*This article is for informational purposes only and not to be considered medical advice. If your child is having a mental health emergency, contact the 988 Suicide & Crisis Lifeline for immediate support by calling or texting 988. You can also text HOME to 741741 ─ the Crisis Text Line ─ from anywhere in the country to talk with a trained crisis counselor.     

Embark is the most trusted name in teen and young adult mental health treatment. We’re driven to find the help your family needs. If you’re looking for support, contact us today.