Suicidal ideation, also known as suicidal thoughts, are feelings about, or considering, or planning suicide.

According to the World Health Organization-WHO, close to 800,000 people die due to suicide every year, which is one person every 40 seconds. Suicide is a global phenomenon and occurs throughout the lifespan. 

The WHO states that suicide is a global phenomenon and 79 per cent of suicides occurred in low- and middle-income countries in 2016. Suicide accounted for 1.4 per cent of all deaths worldwide, making it the eighteenth leading cause of death in 2016.

Dr Janvier Yubahwe, a psychiatrist at Huye Isange Rehabilitation Center, says that suicidal ideation is thought content which is more about killing oneself. It is most common in some mental health conditions such as, depression, schizophrenia, schizoaffective disorder and psychoactive substance misuse. 

For him, suicidal ideation is a symptom itself and can be found in the conditions described above. To a certain extent, suicidal ideas can be intrusive and stick in one’s mind

Yubahwe says that treating people with suicidal ideation requires a thorough treatment plan. Sometimes, the management of the underlying mental health condition may be enough. However, when the risk to commit suicide is judged highly, the placement and surveillance (under medication or not) of the patient in a safe room will be the first thing to do.

"Some medications such as sedatives or tranquilizers can be given for the individual to be stable and cooperate for psychotherapy or other medications that are required. When suicidal thoughts are not severe and the risk to commit suicide judged low, psychotherapy and the management of the underlying condition such as depression, are enough,” he says.

 Yvonne Uwamahoro, a counselor at Mental Health Hub, Kicukiro says that suicidal thoughts have many causes. Most often suicidal thoughts are a result of feeling like you can’t cope in an overwhelming life situation, such as a loss of friends, finances and so forth.

According to her, if you don’t have hope for the future, you may mistakenly think suicide is a solution. Uwamahoro states that they may be also a genetic link to suicide. People who have suicidal thoughts or behavior are more likely to have a family history of suicide.

She says that warning signs of feeling suicidal changes can include, anxiety, being more irritable, more confrontational, becoming quiet, having mood swings, acting recklessly, sleeping too much or too little, not wanting to be around other people, and avoiding contact with friends and family.

"You could also have different problems with work or studies, or hear negative things about yourself, all these trigger suicidal thoughts,” Uwamahoro notes.

She points out that it is mandatory to consult a mental health professional when you have the following behaviors, such as, threatening to hurt or kill yourself, talking or writing about death, dying or suicide, preparing to end your life, like storing up medication, or putting affairs in order such as, giving away belongings or making a will.

The mental health therapist adds that when you are feeling suicidal, but you aren’t immediately thinking of hurting yourself, make an appointment with your doctor, or other mental health professionals.

How to help people with suicidal thoughts

She notes that you should break the isolation, for example, if you’re worried that someone may be thinking about suicide, talk to them, ask them about how they are feeling.

"Talking to someone about their suicidal thoughts does not make them more likely to end their life. You can help someone who is feeling suicidal by listening, without judging them. You can support someone to think about other options to deal with their feelings. Such as accessing support from mental health professionals,” Uwamahoro explains.

She carries on that small gestures such as saying ‘hello’ or asking, ‘how are you today?’ can sometimes make a big difference to how someone is feeling.

‘If someone is in crisis you may need to get help from mental health services or the emergency services.’

Risk factors

"Biological and genetic factors like genetic illnesses, birth weight, physical abnormalities, neurotransmitter abnormalities, and others, also, mental health disorders in childhood or adolescence and adulthood, bullying, conduct disorders, coping difficulties, academic and social difficulties, are a risk factor,” Uwamahoro adds.

 The mental health therapist highlights that socio-demographic factors like age, sex, occupation, level of education, and others, plus family factors and early adversity like conflicts, loss of one or both parents, parental care, abuse, other types of family dysfunction, lack of help-seeking, ability to form attachments with significant people, early adversity, parental abuse, are all risk factors.

 She also points out that psychological factors, for instance, personality traits, and cognitive styles that promote the development of protective factors or risk factors depending on the internal resources available.

In addition, environmental factors like life events, social and cultural context, and others but also mental health vulnerability factors, for example, mental health problems, previous suicide attempts, and psychiatric care, are risk issues according to Uwamahoro.