Scale of Suicidal Ideation: How to Use These Suicide Prevention Tools

Suicidal thoughts exist on a specturm, and there are many ways to experience suicidal ideation. Suicide ideations scales help healthcare providers understand the risk and protective factors that may influence someone’s suicidal thoughts. 

There are different types of suicidal ideation scales. But they are all designed to help determine what kind of intervention is needed. For example, understanding the severity of a person’s suicide risk factors can help determine if emergency support is needed or if monitoring is more appropriate. 

How does a scale of suicidal ideation work? 

Suicidal ideation scales include a series of questions to measure a person’s suicidal thoughts, risk factors, and sometimes protective factors. They are typically used by healthcare professionals and are based on questions about:

• A person’s desire to die or escape intolerable emotional or physical pain

• How long a person has been experiencing suicidal ideation 

• How often a person experiences suicidal ideation 

• A person’s attitudes about their own death or dying 

• Whether or not a person has a suicide plan 

• Whether or not a person has the capability to follow through with a suicide plan 

• Whether or not a person has a timeframe for when they might attempt suicide

The answers to these questions help determine what types of suicidal thoughts someone has. They may be actively suicidal, meaning they currently have a suicide plan in place and intend to kill themselves. Or they may be passively suicidal. This means they’re experiencing suicidal thoughts but don’t necessarily have a plan or intention to follow through. 

Typically, people with active suicidal ideation require more urgent care, especially if they have a specific suicide plan. Those with passive suicidal ideation need support and monitoring over time. Ultimately, healthcare providers use their best judgment to determine what interventions are needed. And it’s important to ensure safety no matter what type of suicidal ideation someone has. 

What are the different types of suicidal ideation scales?

Healthcare providers use different types of suicidal ideation scales to help determine if someone is experiencing suicidal thoughts. 

The following are common scales used in clinical settings:

• Columbia-Suicide Severity Rating Scale (C-SSRS)

• Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) 

• Modified Scale for Suicidal Ideation (MSSI)

• Beck Scale for Suicide Ideation (BSSI) 

All of these scales involve a set of questions your provider will ask you to answer about the intensity of your suicidal ideation. Depending on the scale, you’ll be asked about suicidal thoughts with the last:

• 1 week

• 2 weeks

• 30 days

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When are suicidal ideation scales used?

There are many settings healthcare providers use suicide ideation scales in. In most mental health settings, a mental health provider will screen for suicide risk during an intake assessment. And they may check in about suicidal thoughts throughout mental health treatment as well. 

Suicide ideation scales can also be used in other healthcare settings, including: 

• Primary care 

• Hospitals 

• Emergency rooms 

It’s important that all healthcare providers, not just mental health professionals, ask about suicide risk. An estimated 45% of people who die by suicide visited their primary care provider within a month before their death. 

Are suicidal ideation scales reliable?

In general, commonly used suicide ideation scales are reliable for capturing someone’s current suicidal ideation. But using that information to predict someone’s risk of attempting suicide is more complicated. 

The intensity of someone’s suicidal thoughts can fluctuate from day to day and even hour to hour. This makes it difficult to capture someone’s suicide risk after one assessment.

Additionally, suicide ideation scales rely on people to be honest about their suicidal ideation. But there are many reasons someone may not want to share their feelings. They may have had a bad experience sharing suicidal thoughts in the past. Or they might be afraid of losing their freedom.

In the findings of one study, 75% of people who died by suicide denied experiencing suicidal ideation the last time they were asked by a healthcare professional. This also makes deciding who needs emergency intervention and who doesn’t difficult based on suicidal ideation scales alone.

How do you manage suicidal thoughts?

So what can you do if you or someone you love has suicidal thoughts? The following actions can help. But if you’re in immediate danger, call the 988 suicide prevention hotline now for assistance.

Reach out for emergency support

If you’re experiencing suicidal thoughts and are unsafe, you can access the following resources immediately: 

• Call 988 to reach the National Suicide Prevention Lifeline. 

• Text HOME to 741-741 to reach the Crisis Text Line.

• Visit Find a Helpline for crisis resources around the world.

The bottom line

Suicidal ideation scales can help you and your healthcare providers understand the severity of your suicidal thoughts. These scales ask about a person’s desire to die, how long they’ve been experiencing suicidal ideation, and whether or not they have a suicide plan in place. Based on the answers, providers determine what kind of intervention may be needed. 

If you’re experiencing suicidal thoughts, no matter where they fall on the scale, it’s OK to ask for help. 

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Written by:

Sarah Schuster

Sarah Schuster is a master of social work (MSW) student at California State University, Los Angeles. She earned her journalism degree at Syracuse University and spent 6 years helping people tell their health and disability stories at The Mighty.

Edited by:

Renée Fabian, MA

Renée Fabian is the senior pet health editor at GoodRx. She’s worked for nearly 10 years as a journalist and editor across a wide range of health and well-being topics.

Reviewed by:

India B. Gomez, PhD

India B. Gomez, PhD, is a licensed clinical psychologist with a certificate in Latin American Family Therapy. She completed her doctoral education at the California School of Professional Psychology/Alliant International University.

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References

Centers for Disease Control and Prevention. (2022). Risk and protective factors. 

Ghasemi, P., et al. (2015). Measurement scales of suicidal ideation and attitudes: A systematic review article. Health Promotion Perspectives. 

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GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

Centers for Disease Control and Prevention. (2022). Risk and protective factors. 

Ghasemi, P., et al. (2015). Measurement scales of suicidal ideation and attitudes: A systematic review article. Health Promotion Perspectives. 

Harmer, B., et al. (2023). Suicidal ideation. StatPearls. 

King, C. A., et al. (2018). Suicide risk screening in healthcare settings: Identifying males and females at risk. Journal of Clinical Psychology in Medical Settings. 

Kleiman, E. M., et al. (2017). Examination of real-time fluctuations in suicidal ideation and its risk factors: Results from two ecological momentary assessment studies. Journal of Abnormal Psychology.

Luoma, J. B., et al. (2016). Contact with mental health and primary care providers before suicide: A review of the evidence. The American Journal of Psychiatry. 

Miller, I. W., et al. (1991). The modified scale for suicide ideation. Department of Psychiatry and Human Behavior Brown University and Butler Hospital. 

Richards, J. E., et al. (2018). Understanding why patients may not report suicidal ideation at a health care visit prior to a suicide attempt: A qualitative study. Psychiatric Services. 

Sweeney, J. A., et al. (1993). Factor composition of the Suicide Intent Scale. Suicide and Life-Threatening Behavior. 

The Columbia Lighthouse Project. (n.d.). About the protocol. 

U.S. Department of Health and Human Services. (2009). SAFE-T. 

For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.