Thorough risk assessment may reveal active suicide ideation
The commonly held belief that passive suicidal ideation poses less risk for suicide than active suicidal ideation is steeped in the lore of psychiatric practice. "Passive suicidal ideation" appears countless times in psychiatric records, articles, texts, guidelines, and clinical discourse. When a patient reports passive suicide ideation, the clinician may seize upon it as an indicator of low risk of suicide. The clinician may feel relieved and not perform a thorough suicide risk assessment.
Whether suicide ideation is active or passive, the goal is the same--terminating one's life. Suicidal ideation, such as the wish to die during sleep, to be killed in an accident, or to develop terminal cancer, may seem relatively innocuous, but it can be just as ominous as thoughts of hanging oneself. Although passive suicidal ideation may allow time for interventions, passive ideation can suddenly turn active.
"I love my family too much to hurt myself"
Mr. F, a 52-year-old business executive, is brought to the hospital emergency room by his wife. His business is heading to bankruptcy and he is unable to go to the office and face his employees. Mr. F cannot sleep or eat, spending most of the day on the couch crying. His wife has threatened her husband with separation if he does not seek psychiatric treatment.
Robert I. Simon, MD is Clinical Professor of Psychiatry, Georgetown University School of Medicine, Washington, DC, and Chairman, Department of Psychiatry, Suburban Hospital, a member of Johns Hopkins Medicine, Bethesda, Maryland.
Dr. Simon reports no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.
Adapted with permission from: Simon Rl: Preventing patient suicide: Clinical assessment and management. Arlington, VA: American Psychiatric Publishing, Inc.; 2011.
Passive suicidal ideation
When a patient reports passive suicidal ideation, active suicidal ideation invariably is present
Mr. F tells the emergency room psychiatrist, "I am stressed but have no intention of hurting myself. I love my wife and kids too much...