Talk:Suicidal ideation

Suicidality redirects here but this link says it is not about suicidal ideation alone

..this link http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-m-mhaust2-toc~mental-pubs-m-mhaust2-hig~mental-pubs-m-mhaust2-hig-sui

maybe it's wrong — Preceding unsigned comment added by 2a00:23c4:7155:6d00:f513:b931:66eb:f79f (talk) 11:41, 26 April 2018‎ (UTC)

Short description

The current short description for this article, which was pulled from Wikidata, is: "Having an unusual preoccupation with suicide". We should change the short description because the current version is inaccurate and pejorative. It is inaccurate because "preoccupation with suicide" describes one type of suicidal ideation. Missing from the description are other manifestations of suicidal ideation, such as "thinking about", "considering", or "planning for" suicide.

I seriously doubt anyone intended the current short description to come across as disparaging. The word "unusual" has two meanings in this context. It can mean "uncommon", which I assume is the intended meaning in the current short description. However, "unusual" can also mean "deviating from the normal; peculiar, strange." Many people reading the current short description will read it as "having a strange preoccupation with suicide."

People suffering from major depressive disorder, schizophrenia-spectrum disorders, bipolar disorder, and substance use disorders, for example, often feel stigmatized. We do not want to pour salt on that wound.

The most common definition for suicidal ideation is: "thinking about, considering, or planning for suicide", as stated and cited in the first sentence of the article. Our short description should be something like "ruminating about suicide". Mark D Worthen PsyD (talk) [he/his/him] 05:33, 5 October 2020 (UTC)

Thanks for pointing this out. I agree it needs to be changed. How about "thinking about, considering, or planning for suicide"? "Ruminating", while accurate, may not be easily understood by the average Wikipedia reader. Sundayclose (talk) 16:57, 5 October 2020 (UTC)

I second the motion! Good point about "ruminating". :0) Thank you. Mark D Worthen PsyD (talk) [he/his/him] 19:29, 5 October 2020 (UTC)

I'd state that "thinking about, considering, or planning for suicide" is "having an unusual preoccupation with suicide." That is, if the "thinking about it" is prolonged or was persistent at some point in a person's life. I don't think of the "unusual" wording as pejorative, and I state that as someone who experiences suicidal ideation. I don't consider it the same as saying that someone with bipolar disorder, for example, isn't normal. The disorder (bipolar disorder) is atypical, but that doesn't mean that the person isn't normal. We wouldn't want to state that a person isn't normal. But as for the condition or disorder? We do use the word atypical in some cases. Experts on suicidal ideation are clear that suicidal ideation is an atypical way of thinking/behaving. It's normal for me and others who deal with suicidal ideation, but it's not typical for the general population to experience suicidal ideation. Despite the lead currently stating "thinking about", suicidal ideation is not a passing thought about suicide. It's persistent thoughts about suicide, or a pronounced enough thought about it that it is distressing or leads to suicide. Now I understand why the IP I reverted wanted to lead with the DSM-5 definition of "thoughts about self-harm, with deliberate consideration or planning of possible techniques of causing one's own death."

All that stated, I understand that your intention is good, Markworthen, and I can be okay with the current short description since it's the same as the lead. The short description usually isn't the same exact wording as the lead, though. Flyer22 Frozen (talk) 02:05, 6 October 2020 (UTC)

And, yes, I know that the article also states "varies from fleeting thoughts to detailed planning." But the fleeting thoughts are persistent...at least for a time in the person's life. That's why they are considered a risk factor for suicide. I've yet to see an expert on this topic who feels that someone having thought about suicide once and with no serious consideration toward committing suicide as someone who has experienced actual suicidal ideation. Flyer22 Frozen (talk) 02:18, 6 October 2020 (UTC)

Do not breake the definition please. Long or short, in any way it should include the remark about deliberate consideration or planning, because it is the most simple way to indicate that just "thinking about suicide" is nothing more than thinking activity and is not a suicidal ideation. There was a reason for putting exactly such definition it DSM-5. — Preceding unsigned comment added by 37.78.189.116 (talk • contribs)

IP, as you can see, I stated similarly above.

This version of your text has been reinstated. Flyer22 Frozen (talk) 02:59, 31 October 2020 (UTC)

• I made some edits to begin the process of improving this disjointed, often inaccurate article (diff). Please read the references I cited for the first sentence before you conclude that DSM-5 has the last word on this topic. Thank you. Mark D Worthen PsyD (talk) [he/his/him] 20:10, 22 November 2020 (UTC)

See the #Definition and Teminology section below. Flyer22 Frozen (talk) 05:30, 24 November 2020 (UTC)

___

References

Definition and Teminology section

This is a continuation from the #Short description section above.

I reverted Markworthen here and here. And this is why: Having the lead sentence state "usually means thoughts of engaging in suicide-related behavior" is not a good WP:Lead sentence. The wording "engaging in suicide-related behavior" is vague while the wording "is thinking about suicide with deliberate consideration or planning" is clear and tells us exactly what it is. This is not only the DSM-5 definition. That is why the lower part of the lead tells us that passive suicidal ideation is "not wanting to be alive or imagining being dead", while active suicidal ideation "is thinking about different ways to die or forming a plan to die." The "is thinking about suicide with deliberate consideration or planning" covers those two aspects. There is no need to state anything in the lead about a definition not being universal. It is beneficial to have a Terminology section, or a "Definitions" section that can also be about terminology. If anything in the section needs cutting, then let's discuss that.

If Markworthen feels that the issue is with the IP having added "deliberate", we can discuss that. But, like I noted above, suicidal ideation is not a passing thought about suicide. It's persistent thoughts of suicide, or a pronounced enough thought about it that it is distressing or leads to suicide. I also noted above that "I know that the article states 'varies from fleeting thoughts to detailed planning.' But the fleeting thoughts are persistent...at least for a time in the person's life. That's why they are considered a risk factor for suicide. I've yet to see an expert on this topic who feels that someone having thought about suicide once and with no serious consideration toward committing suicide as someone who has experienced actual suicidal ideation."

We can list sources for our arguments here. But let's leave the WP:Status quo in place while we discuss. I'm fine with reverting the IP's change to the lead while we discuss. Flyer22 Frozen (talk) 05:30, 24 November 2020 (UTC)

You will not be surprised to learn that I disagree with your analysis. Here is why your reasoning is faulty:

• You (Flyer22 Frozen) wrote, "The wording 'engaging in suicide-related behavior' is vague ...." The full sentence was, "Suicidal ideation usually means thoughts of engaging in suicide-related behavior, although this definition is not universal." You might consider part of the sentence to be vague, but, as the four (since deleted) references showed, this definition was developed 20 years ago, and has continued as the recommended definition by the U.S. Surgeon General, the National Action Alliance for Suicide Prevention, and the Centers for Disease Control and Prevention. The definition is broad, not vague. It is broad because suicidal ideation covers a lot of territory. In particular, contrary to the DSM-5's ill-conceived definition, it does not refer to deliberate consideration or planning alone.
• You wrote, "while the wording 'is thinking about suicide with deliberate consideration or planning' is clear and tells us exactly what it is." Simply because you (Flyer22 Frozen) assert that your preferred definition is accurate does not make it so.
• And, with regard to your statement that the current wording "is clear": While we all prefer clarity and conciseness in Wikipedia prose, clarity and conciseness are not truth.
• You assert that "thinking about suicide with deliberate consideration or planning" covers passive suicidal ideation, which the article describes as "not wanting to be alive or imagining being dead". How do you reconcile "deliberate" with "passive"? If you "passively" think about going for a walk, is your thinking "deliberate"? passive means "not acting but acted upon : subject to or produced by an external agency; lacking in energy or will; not active or operating : not moving : inert, quiescent". And deliberate means "characterized by or resulting from slow careful thorough calculation and consideration of effects and consequences : not hasty, rash, or thoughtless; characterized by presumed or real awareness of the implications or consequences of one's actions or sayings or by fully conscious often willful intent"; and "deliberate always indicates full awareness of what one is doing and, used precisely, implies careful and unhurried consideration of procedures or consequences". Mark D Worthen PsyD (talk) [he/his/him] 15:23, 28 November 2020 (UTC)

I'm not getting into all of that, especially since I'd be repeating myself, I would have to list no telling how many sources, and you have now started a RfC. I'll just state that I stand by what I've argued and that the table in the #Comment section below speaks to my point. Those sources show what I mean about how we should begin the lead sentence. There is no "Simply because [I] (Flyer22 Frozen) assert that [my] preferred definition is accurate makes it so." Everyone knows that I don't argue that way and that I instead adhere to the literature and our policies and guidelines...such as what is a better lead sentence for readers. Flyer22 Frozen (talk) 02:19, 29 November 2020 (UTC)

And as for the "deliberate" wording, which I did not indicate being tied to, what I stated is that the "is thinking about suicide with deliberate consideration or planning" wording is covered by the lower part of the lead because passive suicidal ideation is "not wanting to be alive or imagining being dead", while active suicidal ideation "is thinking about different ways to die or forming a plan to die." Saying that not wanting to be alive or imagining being dead is not deliberate consideration is something that one can consider questionable. There is overlap on this topic. If one is arguing that the passive matter is an intrusive thought matter, that person should provide sources for that. And we should not be relying on dictionary definitions for the topic or for words of the definition(s). My main point has been that I've yet to see an expert on this topic who feels that someone having thought about suicide once and with no serious consideration toward committing suicide is someone who has experienced actual suicidal ideation. My main point has been that the thoughts are recurring. And the literature backs me up on that. Flyer22 Frozen (talk) 05:47, 29 November 2020 (UTC)

Passive suicidal ideation is thoughts of wanting to not be alive, not necessarily wanting to not be alive. The DSM below lists recurrent suicidal ideation as a sympton of Major Depressive Disorder, etc.; suicidal ideation itself isn't necessarily defined by recurring thoughts, because that would be redundant to say that a sympton of Major Depression is recurrent recurring thoughts of suicide. Kolya Butternut (talk) 07:23, 30 November 2020 (UTC)

Kolya Butternut, you appear to have followed me here. And I wondered if you would while I was away, but I hoped that you would not since medical topics are out of your field of expertise. Follow to an article again, and I will be reporting you. You've been warned on your talk page before about WP:Hounding me in any way. As for commentary on this matter, I pay it no mind since you do not know what you are talking about. I do. Flyer22 Frozen (talk) 00:21, 1 December 2020 (UTC)

Markworthen, as a fan of your advice, I noticed many "you" statements in your above comments which may not be ideal. I hope you're giving yourself breaks to watch funny pet videos :-). Kolya Butternut (talk) 04:00, 30 November 2020 (UTC)

References

RfC on how to define "suicidal ideation" and compose the lead paragraph

I propose changing the first paragraph from: Suicidal ideation (or suicidal thoughts) is thinking about suicide with deliberate consideration or planning. Suicidal ideation is not a diagnosis, but is rather a symptom of many mental disorders.

to: Suicidal ideation means thoughts of engaging in suicide-related behavior, although this definition is not universal. For example, the American Psychiatric Association defines suicidal ideation as "thinking about suicide with deliberate consideration or planning." Suicidal ideation is not a diagnosis, but is rather a symptom of many mental disorders. // Submitted for your consideration by Mark D Worthen PsyD (talk) [he/his/him] 15:51, 28 November 2020 (UTC)

Explanatory notes

Note_1: A kind editor suggested that a survey (support or oppose) is not necessary and potentially counter-productive when discussing the wording of a lead paragraph. It is usually better to simply discuss and try to reach a consensus. I very much appreciate this appropriate and helpful suggestion. I changed "Survey" to "Discussion" (immediately below). I changed my own entry by striking through "Support" and editing the first sentence, but I left the other two editors' text intact, since it is theirs to edit or not. Thank you for your patience and understanding. - Mark D Worthen PsyD (talk) [he/his/him] 23:45, 29 November 2020 (UTC)

Note_2: See the table below for sourced descriptions and definitions of suicidal ideation. Kolya Butternut (talk) 11:40, 30 November 2020 (UTC)

Survey Discussion

* Support - Please see discussion above for context. (Talk:Suicidal ideation#Definition and Teminology section and Talk:Suicidal ideation#Short description). Briefly, the proposed change consistently comports with more reliable sources than the current version, and the proposed change is consistent with the article's short description ("thinking about, considering, or planning for suicide"), whereas the current lead paragraph contradicts the short description. Mark D Worthen PsyD (talk) [he/his/him] 15:51, 28 November 2020 (UTC)

• Opppose per my arguments in the #Definition and Teminology section above. To repeat, having the lead sentence state "usually means thoughts of engaging in suicide-related behavior" is not a good WP:Lead sentence. The wording "engaging in suicide-related behavior" is vague while the wording "is thinking about suicide with deliberate consideration or planning" is clear and tells us exactly what it is. This is not only the DSM-5 definition. That is why the lower part of the lead tells us that passive suicidal ideation is "not wanting to be alive or imagining being dead", while active suicidal ideation "is thinking about different ways to die or forming a plan to die." The "is thinking about suicide with deliberate consideration or planning" covers those two aspects. There is no need to state anything in the lead about a definition not being universal. The table in the #Comment section below speaks to my point. Those sources, which are authoritative medical sources, show what I mean about how we should begin the lead sentence. Flyer22 Frozen (talk) 02:19, 29 November 2020 (UTC)
  • "Suicide-related behavior" or "suicidal behavior" appears to be the current jargon for trying to kill yourself. I agree with you that this will not be obvious to most people. If you thought that was plain English, you'd probably think that suicidal ideation includes anything that a person might do that's related in any way to suicide, such as sleeping too much (as a symptom of depression).
    On the other hand, I can't support the existing definition, because requiring "with deliberate consideration or planning" means that passive suicidal ideation doesn't count as suicidal ideation, which is wrong. WhatamIdoing (talk) 21:37, 29 November 2020 (UTC)
• oppose per Flyer22 rationale--Ozzie10aaaa (talk) 13:04, 29 November 2020 (UTC)

===Comment=== This paragraph, in the Monitoring and Evaluation section of Preventing Suicide: A Technical Package of Policy, Programs, and Practices (2017) is apropos:

Gathering ongoing and systematic data is important for prevention efforts. However, it is also important to gather data that are uniform and consistent across systems. Consistent data allow public health and other entities to better gauge the scope of the problem, identify high-risk groups, and monitor the effects of prevention programs and policies. Currently, it is common for different sectors, agencies, and organizations to employ varying definitions of suicidal ideation, behavior, and death that can make it difficult to consistently monitor specific outcomes across sectors and over time. For example, the manner in which deaths are classified can change from one jurisdiction to another, and can change based on local medical and/or medico-legal standards. CDC’s uniform definitions and recommended data elements for self-directed violence provide a useful framework to help ensure that data are collected in a consistent manner across surveillance systems. (emphasis added)

- Mark D Worthen PsyD (talk) [he/his/him] 16:23, 28 November 2020 (UTC)

I'm going to have a read of the sources (and perhaps create some sort of table). The "suicide-related behaviour" term reminds me of terms like "reasonable" in law, a kind of "indirection" where what is suicide related is decided on a case-by-case basis (preferably with reference to other cases); a kind of "too hard to define". Adding a case to consider, suppose someone thinks about ways of killing themselves wherever they go, e.g. they see a knife they think about cutting their throat, they see a car they think of jumping in front of it, this might be considered *persistent* but still *passive* (in the sense that the thought is not directed). In another case, someone might careful plan how they would kill themselves with no actual intent to carry out the plan, this would be *active thought* but have no intent attached to. Talpedia (talk) 17:32, 28 November 2020 (UTC)

I appreciate the table provided below. It speaks to my point. And the following is the WP:MEDRS guidance about following authoritative sources, which the DSM ad CDC are: Wikipedia:Identifying reliable sources (medicine)#Medical and scientific organizations. Flyer22 Frozen (talk) 02:19, 29 November 2020 (UTC)

• Oppose this proposal. It's too much emphasis on just vague solely the vague term "thoughts" and this can be misleading regarding what sources actually say it means. And saying "although this definition is not universal. For example..." seems less than ideal, and has a risk of WP:Editorializing. I don't see that those sources, which all are connected to U.S. government agency definitions, necessarily outweigh the DSM-5 (and the review article also currently being used). Crossroads ^-talk- 04:44, 30 November 2020 (UTC) Clarified. Crossroads ^-talk- 21:58, 30 November 2020 (UTC)

  Crossroads, but aren't "just vague thoughts" considered suicidal ideation? The sources below (especially the last few in the table) seem to indicate that it is. WhatamIdoing (talk) 05:45, 30 November 2020 (UTC)

  I clarified my comment. When I said "vague" I meant the text, not the thoughts themselves. Crossroads ^-talk- 21:58, 30 November 2020 (UTC)

Alternate suggestions

Here are two suggestions around which we might build consensus.

(a) Change the lead sentence to: Experts differ on a precise definition for suicidal ideation. The most common definitions are "thinking about suicide with deliberate consideration or planning"; "thoughts of engaging in suicide-related behavior"; and "thinking about, considering, or planning suicide". [with appropriate citations]

(b)(1) Change the lead sentence to: Suicidal ideation is thinking about, considering, or planning suicide.

(b)(2) Change the short description to: "thoughts ranging from a wish to die to developing specific plans to kill oneself" (or something similar).

Thank you - Mark D Worthen PsyD (talk) [he/his/him] 00:16, 30 November 2020 (UTC)

Support (b)(1) which is the version which was apparently stable from March 2019 to October 2020; it covers the broad variety of definitions, and perhaps most importantly it clearly and concisely desribes to the reader the types of ideation by juxtaposing them in a list: "thinking about", "considering", and "planning".

This is supported by the Klonsky source in the lead[1] which itself cites the CDC: "The use of vague or inconsistent terms and definitions has hindered progress in suicide research and theory...The scope of this review precludes a comprehensive discussion of issues of terminology and definition, but we emphasize a few key points. We utilize the definitions provided by the US Centers for Disease Control and Prevention...suicidal ideation is defined as thinking about, considering, or planning suicide." Kolya Butternut (talk) 07:59, 30 November 2020 (UTC)

Table

Caption

Contributor	Source	Source Type	Feature	Link + Quote
Talpedia	DSM	guidelines, usage	does not require plan	'Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation with­out a specific plan, or a suicide attempt or a specific plan for committing suicide'
Talpedia	DSM	guidelines, glossary, definition	deliberate consideration	'suicidal ideas (suicidal ideation) Thoughts about self-harm, with deliberate consider­ation or planning of possible techniques of causing one's own death.'
Talpedia	New Oxford Textbook of Psychiatry	textbook	thoughts in OCD not suicidal ideation,usage	"Nevertheless, it is important to note that suicidal thoughts may sometimes be a symptom of OCD (for example, ‘I might commit suicide’, ‘what is the prefer-able way to commit suicide’), and not a genuine suicidal ideation."
WhatamIdoing	Merk Manual	clinical textbook	all thoughts or plans, whether or not serious or deliberate	"Thinking about, considering, or planning suicide is referred to as suicide ideation."
Kolya Butternut	National Institute of Mental Health	general information	definition	"Suicidal ideation refers to thinking about, considering, or planning suicide."[2]
Markworthen	CDC (Crosby, et al., 2011)	uniform definitions and data elements for self-directed violence surveillance	thoughts do not necessarily involve "deliberate consideration or planning"	"...suicidal ideation (i.e., thinking about, considering, or planning for suicide)" "Suicidal thoughts can be a risk factor for subsequent fatal and nonfatal suicidal behavior and are sometimes associated with other disorders. In general suicidal thoughts do not focus upon the actual suicide process. Suicidal planning involves a much higher complex cognitive process."
Markworthen	U.S. Surgeon General and National Action Alliance for Suicide Prevention	National strategy	thoughts, not necessarily "with deliberate consideration"	"Suicidal ideation—Thoughts of engaging in suicide-related behavior."
Markworthen	National Action Alliance for Suicide Prevention: Youth in Contact with the Juvenile Justice System Task Force	Literature review	thoughts about ending life	"'Suicidal ideation' is defined as thoughts of engaging in behavior intended to end one’s life."
Markworthen	O'Carroll, et al. (1996)	seminal article	definition	"Suicidal Ideation: Any self-reported thoughts of engaging in suicide-related behavior."
Markworthen	Columbia University, University of Pennsylvania, & University of Pittsburgh with National Institute of Mental Health support	Columbia–Suicide Severity Rating Scale (C-SSRS)	Empirically-grounded suicide assessment protocol	One of the most reliable and valid suicide measures, the Columbia–Suicide Severity Rating Scale (C-SSRS), assesses several risk factors including suicidal ideation, a category that includes two suicidal ideation items (interview questions) that assess ideation without "deliberate consideration or planning".
Talpedia	CDC	Research	serious consideration	'Suicidal ideation was measured with the question, “During the past 12 months, did you ever seriously consider attempting suicide?” Making a suicide plan was measured with the question, “During the past 12 months, did you make a plan about how you would attempt suicide?”'
Markworthen	See cited references	scholarly literature	passive suicidal ideation is a suicide risk factor	"Taken together, these findings suggest that suicidal ideation is not the only starting point on the trajectory to making a suicide attempt, and thus assessing desire for death in people who deny suicidal thoughts would be clinically useful. Querying individuals on desire for death has the same value as assessing suicidal ideation to examine the risk for suicide attempts ...."

Here's the Merck Manual: ideation "Thinking about, considering, or planning suicide is referred to as suicide ideation." I'm not quite sure how to fill in all the columns for that in User:Talpedia's table. WhatamIdoing (talk) 18:42, 28 November 2020 (UTC)

:) Not sure what I'm doing! I added your source, if you want to add a couple of words that you think distinguishes this sources from others you could add it in the "feature" column. The idea is that people can see a summary of the issue at a glance. I'm aware that different groups law, researchers, psychologists, psychiatrists, "general doctors" are likely to have different perspectives, and that different types of sources will have different types of definitions, so I think including this information might help one understand the argument (at the risk of imposing a way of thinking about the problem). I'm also suspicious that "usage" might be the best of way of understanding the definition (i.e. how do you use the word versus how you define it), but am also aware that this sort of thinking is a little "original researchy" Talpedia (talk) 14:26, 29 November 2020 (UTC)

Hey Kolya Butternet, I moved your definition in the table so that it's next to another one that's very similar. Feel free to revert me if you like :) Talpedia (talk) 10:16, 30 November 2020 (UTC)

I did the same with one of Markworthens's.[3] Kolya Butternut (talk) 11:05, 30 November 2020 (UTC)

Notes

References