Passive suicidal ideation: Still a high-risk clinical scenario

When treating a suicidal patient, clinicians often experience complex, distressing feelings. Maltzberger and Buie⁷ describe anger, frustration, despair, and even hate toward the suicidal patient. In addition to the devastating loss of one’s patient, fears of a lawsuits and damage to one’s professional competence and reputation may arise if the patient attempts or completes suicide. These can all lead a clinician to prematurely accept a patient’s statement regarding passive suicidal ideation rather than conduct a thorough suicide risk assessment. Consultation should be considered.

The necessity of action

Suicidal ideation must be carefully assessed—not labeled. Passive suicidal ideation should not deter a clinician from performing a thorough suicide risk assessment. A patient’s report of passive suicidal ideation is not an end but a beginning of thorough suicide risk assessment.⁸

Bottom Line

Passive suicidal ideation, such as a wish to die during sleep or being killed in an accident, does not indicate that a patient is at a low risk of suicide. A thorough suicide risk assessment may reveal active suicidal ideation that informs treatment and management interventions.

Related Resources
• Simon RI. Suicide rehearsals: A high risk psychiatric emer­gency. Current Psychiatry. 2012;11(7):28-32.

• Baca-Garcia E, Perez-Rodriguez MM, Oquendo MA, et al. Estimating risk for suicide attempt: are we asking the right questions? Passive suicidal ideation as a marker for suicidal behavior. J Affect Disord. 2011;134(1-3):327-332.