Suicidal thoughts: everything you need to know

Contents:

• What are suicidal thoughts and feelings?
• How common is attempted suicide?
• Causes and risk factors
• How does one get from ideation to action?
• How do we know if someone is suicidal?
• Where can I get help?
• How can I help myself?
• Guide for loved ones: What can I do if I notice signs in a loved one?

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What are suicidal thoughts and feelings?

Suicidal thoughts (also called suicidal ideation) are thoughts about ending one’s own life. They can occur when a person feels overwhelmed by persistent negative emotions and thoughts, such as the idea that others would be better off without them. Suicidal thoughts can be associated with mental disorders, but can also occur in response to life difficulties. These thoughts may evolve into concrete planning and/or self-harm and sometimes into a suicide attempt, which may or may not be fatal. [1] It is important to note that not all suicide attempts necessarily reflect a genuine wish to die. Some studies suggest that suicidal people are often ambivalent about whether they want to live or die and are in fact seeking relief from their suffering. [2], [3] At times, someone may act impulsively and lose their life, even though, deep down, they would have wished to continue living. Access to emotional support at the right time can prevent suicide.

How common is attempted suicide?

Each year, approximately 720,000 people die by suicide globally. ^[4] Suicide is the leading cause of death in many European countries for young people aged 15-24, accounting for 17.6% of reported deaths in this age group in high-income countries. ^[5] In addition to these deaths, many more people experience suicidal thoughts or suicide attempts. It is estimated that for every person who dies by suicide, another 20 people have at least one attempt. ^[4] The prevalence of suicidal thoughts is even higher, since not all suicidal thoughts lead to attempts.

In Europe, the average suicide rate is 14.1 per 100,000 inhabitants, above the global average of 10.7 per 100,000. ^[7] The highest rates are in Eastern and Central Europe, followed by Western and Northern Europe, and the lowest in the Mediterranean area. In Romania, the suicide rate is close to the European average.

In addition, it is estimated that about 135 people in someone’s lifetime are affected by suicide, bringing the total number of people affected by suicide each year to around 100 million. ^[8]

Causes and risk factors

Suicide is a complex phenomenon, influenced by a combination of genetic, psychological, social and cultural factors. These factors can interact with each other and increase the risk of suicide ^[8]:

• Presence of mental disorders (depression, anxiety, schizophrenia, schizophrenia, ADHD, autism, bipolar disorder, personality disorders, PTSD, etc.);
• Suicidal ideation;
• Previous suicide attempt: this is a major red flag as it significantly increases the risk of a future lethal attempt;
• History of self-harm: a UK study shows that women with a history of self-harm are 15 times more likely to die by suicide than those without such a history ^[6];
• History of physical and/or sexual abuse;
• Substance abuse;
• Family history of suicide;
• Living alone;
• Age: adolescence or over 60;
• Gender: although women have more attempts, the rate of completed suicide is 3 times higher among men in high-income countries and 4 times higher in low- and middle-income countries ^[5];
• Stress related to belonging to a minority group (ethnicity, sexual orientation, migration status, etc.) ^[4];
• Major life events: bereavement, serious illness, significant changes (retirement, redundancy, family enlargement, relocation), financial or housing difficulties;
• Feelings of inadequacy, loneliness or isolation;
• Cultural pressure (e.g. forced marriage);
• Side effects of some psychiatric drugs;
• Trauma of various kinds.

The strongest predictors of fatal suicide attempts are:

• old age,
• suicidal ideation,
• a previous suicide attempt.

How does one get from ideation to action?

There are two types of suicidal ideation:

• Passive suicidal ideation: the person is experiencing thoughts of wanting to die, but the thoughts do not take the form of a concrete plan to act on them.
• Active suicidal ideation: thoughts turn into actual intentions and the person plans ways in which they could end their life.

However, passive suicidal ideation does not eliminate the risk of a suicide attempt. When thoughts of this nature are present, the transition from thought to action may occur either slowly or abruptly. A significant number of people make the decision to take their own life impulsively, without much premeditation. It is therefore important not to ignore the signs when they appear.

Why do some people end up committing or attempting suicide and others do not? One of the prevailing theories, called the Interpersonal Theory of Suicide ^[9], argues that suicidal thoughts occur when two elements are present simultaneously, lack of social belonging and the perception of the burdensomeness of the people around, which may be accentuated by the lack of hope for improvement. Although suicidal thoughts are a necessary condition, they are not sufficient to attempt suicide. According to the theory, the capability to attempt suicide emerges gradually through habituation to physical pain and frightening experiences, which can lead to a decrease in the fear of death by normalizing it. The presence of the three elements (lack of belonging, feeling of burden, and capability) is the condition by which ideation becomes a suicide attempt.

How do we know if someone is suicidal?

It is difficult to tell if someone is facing such thoughts, but there are some signs that may indicate that a person is contemplating suicide. Many of these signs can only be seen through direct conversation, as they are related to that person’s perspective and experience. From the outside, some situations may seem minor or not so painful, but for the person experiencing them, the impact can be profound. That’s why, if we want to be there for someone, it’s important to remain open and talk about how he or she sees and feels things. Some examples of signs include:

• The person avoids social interactions and isolates him/herself from close people;
• The person acts in a risky, life-threatening manner, such as driving the car at speed;
• The person experiences extreme changes in behavior (may be very anxious or agitated);
• In the discussion, the person mentions:
  • a pain that seems overwhelming and unbearable;
  • constant negative thoughts;
  • loneliness;
  • feelings of worthlessness or hopelessness;
  • the feeling that they are a burden to others and that everyone would be better off without them;
  • difficulty understanding why they think or feel the way they do;
  • difficulty imagining another way of coping (other than suicide);
  • death.

Sometimes the signs are more subtle. Even if they don’t mention it directly, a person contemplating suicide may leave certain clues:

• No longer cares about their own appearance, home, work/school responsibilities;
• No longer enjoys things they used to enjoy (their own hobbies, passions);
• Frequently jokes or makes ironic comments about their own death;
• Frequently shares memes about depression or the meaninglessness of life;
• Hints about upcoming events (e.g. an exam, going out with friends) that they will miss;
• Shares songs with a theme of grief or suicide or listens to artists who are mainly associated with these themes.

Taken in isolation, these manifestations are not enough to signal a problem. For some people, dark humor and sad music are ways of coping with hardship, in some cases helping to alleviate some symptoms of mental disorders, including suicidal ideation. If they end up making up the majority of someone’s online presence, or appear in combination with other items in the lists above, it’s important to make sure that person has the support they need.

Where can I get help?

Suicidal thoughts or feelings can be really overwhelming and can make you feel that no one can understand or help you. But there are options to help you cope in such situations.

1. Talk to a mental health specialist

We know that in Romania a large number of people are afraid of going to a psychologist or psychiatrist. We encounter a lot of prejudices that discourage people and make them feel ashamed of their emotions or avoid them. Although seeking specialised help can be a difficult step at first, in the long run it can help you improve your quality of life considerably. If you are experiencing suicidal thoughts, there are two routes to mental health services: public and private. Through the public pathway, you can access services covered by the National Health Insurance House, in the following order: your family doctor can give you a referral to a psychiatrist, who can assess you, offer you medication, and refer you to a psychotherapist for therapy. On the private route, you can go directly to a specialist (e.g. clinical psychologist, psychotherapist or psychiatrist) who can guide you towards the right treatment. You can start your search on the MHR Map of Professionals, where you can find over 300 mental health professionals, more than half of whom offer free or reduced services for different vulnerable groups.

How can therapy help?

Therapy can help you find the resources to get through difficult times in your life. A psychotherapist can offer you acceptance, validation and understanding in a safe space, as well as understand the reasons behind suicidal emotions, thoughts or behaviors.

The psychotherapeutic process is different for each individual, and the goals will be set together with the professional and tailored to your needs. These goals may include:

• developing a safety plan so you know what to do in case of relapse;
• learning strategies to cope more easily with the problems you face;
• increasing hope and the ability to find reasons to live.

2. Call a hotline

There are helplines you can call if you need psychological support. Many are available 24/7, are free and offer a confidential, non-judgmental service where the caller is open to listening and helping you. In Romania you can call:

1. The Romanian Alliance for Suicide Prevention
→ Provides counseling in situations of suicidal crisis
☎️ 0800.801.200
📧 sos@antisuicid.com
🗓️ daily between 19:00-07:00

2. depreHUB
→ Provides counseling, emotional support, information about depression and anxiety and referral to professionals who can help
☎️ ☎️ 0374.456.420 (number can also be accessed from the diaspora)
🗓️ 🗓️ non-stop

3. depreHUB teens
→ Provides counseling and support for teenagers
☎️ ☎️ 0374.461.461.461
📧 teens.deprehub.ro
🗓️ non-stop

4. Child’s Helpline
→ Provides support to children and adolescents in Romania for abuse, bullying, depression, anxiety or suicide
☎️ ☎️ 116.111
🗓️ M-F: 08:00-20:00

5. HELPLINE for victims of domestic violence
→ Provides primary legal and psychological counseling, i.e. directing the victim to the appropriate institutions nearby, where he/she can receive support and referral to other services
☎️ 0800.500.333
🗓️ non-stop

6. depreHUB corporate
→ Provides counseling and support for those facing psychological difficulties caused by the work environment
☎️ ☎️ 0374.475.475 or 0374.456.424
🗓️ non-stop

3. Join a support group

Support groups can provide additional support for people with mental disorders and their loved ones. They may or may not be moderated by a mental health professional.

For example, support groups can be useful for those who need support more or more frequently than counseling/psychotherapy sessions provide, can include useful information and advice, and last but not least, can help by simply offering reassurance that you are not alone in this struggle and that there are others going through similar difficulties. In such a space, it may be easier for you to share your thoughts and emotions with people who understand what you are going through.

In the online space, you can try the Friends of Mental Health for Romania Discord Server or one of the Facebook groups verified by our volunteers.

How can I help myself?

If you find yourself in a time of crisis, it’s important to keep in mind that you have several options. As well as choosing whether or not to stay alive, there is a third option: stay safe for the moment and you can think about the ‘final decision’ later. You can follow these steps to stay safe:

1. Call someone now. You can call someone close to you or a hotline to talk openly about your situation. Try not to be alone to prevent impulsive decisions.
2. Remove the danger around you. This can be anything you could hurt yourself with. Or, if you’re in a dangerous place, try to move away and go somewhere safe. In everyday life, try to build a safe space around you with as few ‘accessible’ dangers as possible.
3. Try making a list, however short, of things you wouldn’t want to lose. They can be material (a cherished plant that would die if you didn’t water it), events (a friend’s wedding you would miss), sensations (the smell of your favorite food). Anything, however small, whose loss may cause a trace of regret.
4. Avoid alcohol, drugs or medication in larger than prescribed amounts. They can intensify your feelings and make you act impulsively.

Below are a few other methods you can try if you feel a critical moment approaching:

5. Focus on your senses – try the 5, 4, 3, 2, 1 technique.
6. Try a simple breathing exercise like this one.
7. Allow emotions to surface and cry if you feel the need. If you’re angry or frustrated, take a run or do some exercise, tear something to pieces or punch some pillows. If you feel disconnected, stimulate your senses: hold ice cubes in your hands until they melt or take a cold shower.

The Stay Alive app can guide you through the steps mentioned above, offering strategies for staying grounded in the present when you feel overwhelmed, breathing exercises, and a customisable plan to help you rediscover reasons to stay alive. The app can also be helpful to those close to someone facing suicidal thoughts, providing information and resources.

In the long term, there are many methods that have been shown to prevent, relieve or even stop suicidal thoughts.

• Create a safety plan on your own, with someone close to you or with a professional. The plan could include: calming exercises and activities, a list of reasons for living, the names and contact details of people who might be able to help you or helplines.
• Be kind to yourself. Imagine a friend that you appreciate and accept as they are – then try to think the same about yourself. Give yourself a warm bath, or wrap yourself in a blanket and watch your favorite movie. Don’t talk to yourself in a way that you wouldn’t talk to a friend.
• Make a hope kit / happy box. Fill a box with mementos and different things that can comfort and cheer you up when you feel hopeless. The box can contain anything that is meaningful and useful to you, such as: your favorite book, favorite quotes, photos from trips or with loved ones, letters or messages, notes, your favorite chocolate, a gift received from a loved one.
• Seel social support from family, friends, therapeutic or social groups on certain interests etc.

Guide for loved ones: What can I do if I notice signs in a loved one?

Worrying that someone close to you could commit suicide at any moment can be painful and truly overwhelming. Whether the person has spoken openly to you about wanting to take their own life or there are signs that they are thinking about it, it’s normal to be concerned and want to find a way to support them.

Often, you can’t be sure of the best way to help, but there are things you can do:

• encourage the person to seek professional help as soon as possible to ensure the best chance of recovery and to avoid the risk of harming themselves;
• encourage them to talk about their feelings;
• offer emotional support;
• offer practical support;
• help them make a safety plan;
• remove objects they could use to harm themselves, especially if they have mentioned specific things.

Also, if you suspect that someone close to you has suicidal thoughts, it is useful to ask them about it. Such a direct question in no way encourages the act, but on the contrary – according to studies ^[10], it is a way of prevention by giving the person a chance to open up, and minimising the stigma surrounding the subject.

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Bibliography:

1. A. Z. Ivey-Stephenson, “Suicidal Ideation and Behaviors Among High School Students – Youth Risk Behavior Survey, United States, 2019,” MMWR Suppl, vol. 69, 2020, doi: 10.15585/mmwr.su6901a6.

2. G. K. Brown, R. A. Steer, G. R. Henriques, and A. T. Beck, “The internal struggle between the wish to die and the wish to live: a risk factor for suicide,” Am J Psychiatry, vol. 162, no. 10, pp. 1977-1979, Oct. 2005, doi: 10.1176/appi.ajp.162.10.1977.

3. M. Kovacs and A. T. Beck, “The wish to die and the wish to live in attempted suicides,” J Clin Psychol, vol. 33, no. 2, pp. 361-365, Apr. 1977, doi: 10.1002/1097-4679(197704)33:2<361::aid-jclp2270330207>3.0.co;2-h.

4. “Suicide.” Accessed: Oct. 06, 2025. https://www.who.int/news-room/fact-sheets/detail/suicide

5. “World Suicide Prevention Day – facts and statistics.” Accessed: Oct. 06, 2025. https://www.antisuicid.ro/wp-content/uploads/2019/09/WSPD-2019-date-si-statistici.jpg

6. E. D. Klonsky, A. M. May, and B. Y. Saffer, “Suicide, Suicide Attempts, and Suicidal Ideation,” Annu Rev Clin Psychol, vol. 12, pp. 307-330, 2016, doi: 10.1146/annurev-clinpsy-021815-093204.

7. “Understanding suicidal thoughts and feelings | Mind.” Accessed: Oct. 06, 2025. https://www.mind.org.uk/information-support/suicidal-thoughts-and-suicide-prevention/understanding-your-experiences/

8. M. Beghi, J. F. Rosenbaum, C. Cerri, and C. M. Cornaggia, “Risk factors for fatal and nonfatal repetition of suicide attempts: a literature review,” Neuropsychiatr Dis Treat, vol. 9, pp. 1725-1736, 2013, doi: 10.2147/NDT.S40213.

9. K. A. Van Orden, T. K. Witte, K. C. Cukrowicz, S. R. Braithwaite, E. A. Selby, and T. E. Joiner, “The interpersonal theory of suicide,” Psychol Rev, vol. 117, no. 2, pp. 575-600, Apr. 2010, doi: 10.1037/a0018697.

10. L. Sheehan et al, “Benefits and risks of suicide disclosure,” Soc Sci Med, vol. 223, pp. 16-23, Feb. 2019, doi: 10.1016/j.socscimed.2019.01.023.