Talking About Passive Suicidal Ideation: Communication Strategies for Caregivers

Few things are more alarming than hearing your loved one express a desire to die. Yet, according to the CDC, over 12 million adults experienced suicidal thoughts in 2021. Consequently, it’s important to be able to talk openly about suicide with your loved ones, especially if you are a caregiver of someone living with a depressive disorder and passive suicidal ideation. 

The CDC doesn’t differentiate between individuals with passive versus active suicidal ideation. The symptoms of passive suicidal ideation are often more subtle, making them harder to detect. This article will help you identify the signs of passive suicidal ideation and provide you with strategies for creating a safe and supportive space for your loved one to open up about their experience.

What is passive suicidal ideation?

Passive suicidal ideation is non-specific thoughts and/or feelings of wanting to die. It differs from active suicidal ideation in that there is no plan or intent to die by suicide. However, this does not make passive suicidal ideation less real or debilitating. Left unaddressed, passive suicidal ideation can progress to active suicidal ideation, so it’s important to take your loved one’s symptoms seriously. What are the signs of passive suicidal ideation?

For a variety of reasons (e.g., stigma, shame), your loved one may not openly express their passive suicidal thoughts. Moreover, passive suicidal ideation looks different from person to person. However, there are certain signs to look out for, including:

• Apathy or indifference– Your loved one no longer cares about things they once showed a preference or passion for. They exhibit a “why bother” attitude about a variety of things.
• Uncharacteristically risky behavior– Your loved one takes unnecessary risks or neglects to use caution in situations where they otherwise would.
• Withdrawal/social isolation– Your loved one communicates less with family and friends and prefers to be alone rather than in the company of others.
• Wishing for external factors to intervene– Your loved one fantasizes about getting in a fatal car crash or contracting an incurable disease.
• Non-specific thoughts about death– Your loved one expresses a wish to disappear or says that people would be better off without them. Other passive suicidal thoughts include “I want to go to bed and never wake up” and “I wish I was never born.”

How do I talk about passive suicidal ideation with my loved one?

Any conversation that includes the topic of suicide is bound to elicit some strong emotions. However, if you want to create a safe and supportive space for your loved one to talk, it’s crucial that you keep your emotions in check. If your loved one senses that you are anxious or alarmed, they may shut down out of a desire to avoid upsetting you further. Here are some other tips for talking to your loved one about passive suicidal ideation.

Approach the conversation with curiosity.

Ask clarifying questions— for example, “How would people  be better off without you?” Use tone of voice and body language to communicate compassion and concern while you do this. Otherwise, your questions may come across as accusatory or argumentative.

Offer some form of validation. 

Show your loved one that you understand and appreciate their perspective even if you don’t agree with everything they say. For example, “I disagree that people would be better off without you, but I understand that depression makes it feel that way.” Alternatives include, “It sounds like life is so painful for you right now; it’s natural that you would think about an end to that pain.”

Brainstorm ways to help manage passive suicidal thoughts.

While you can’t “fix” your loved one’s depression, there are things that you can do to ease their suffering. Unfortunately, your loved one might be in a place where they feel like nothing will help, or they might not have the mental energy to think of possible interventions. You can help by making a list of things you and your loved one can control– for example, making appointments with care providers, arranging for accommodations at school or work, and reaching out to friends and family members for additional support.

Make a safety plan.

Because passive suicidal ideation can progress to active suicidal ideation, it’s important to talk to your loved one about what to do if their symptoms get worse. Talk about possible “red flags,” and identify people your loved one can talk to if they are feeling suicidal. Make a list of resources such as the 988 Suicide and Crisis Lifeline or the Helpline at the National Alliance on Mental Illness (NAMI).

Check in regularly.

Let your loved one know that you will continue to check in with them about how they are feeling. Invite them to choose the time, place, and method of communication.

By recognizing the signs of passive suicidal ideation and approaching the topic with curiosity and compassion, you can help your loved one feel safe and supported and pave the way for future dialogue.

---