Identifying differences between those with suicidal ideation-with-action, compared to ideation alone, using a community representative sample

Background: Few studies examine suicidal ideation in the general population and who might act on suicidal thoughts. It is important to understand ideators, the largest group on the suicidality continuum. Objectives: This study examines factors associated with suicidal ideation among community-dwelling individuals, and sociodemographic, health and help-seeking factors associated with ideation accompanied by planning or suicide attempt (‘ideation-with-action’) compared to ideation alone. Methods: Using the 2002 and 2012 Canadian Community Health Surveys – Mental Health cycles (CCHS-MH), this cross-sectional cohort study examined 14,708 Ontarians 15 years and older who answered questions about suicidal ideation, and compared characteristics between non-ideators, ideators with a plan or previous attempt, and ideators alone, with chi-square tests and logistic regression. Results: 2.1% of CCHS respondents reported past-year ideation alone (n = 302) and another 0.5% reported ideation with plan or past-year suicide attempt (n = 76). The risk profile of ideators compared to non-ideators was similar to that of ideators-with-action compared to ideators-without-action: male, younger, unpartnered, less educated, have lower income, no job, have a mood and anxiety disorder, a substance use disorder and seek help for mental health problems. Most ideators (65%) do not seek help, and those with a plan or previous suicide attempt are more likely to do so. Conclusion: Ideators differ in profile in terms of whether they have ideation only, have made a plan or had previous attempts. Risk factors differentiating ideators from non-ideators are the same factors that further differentiate ideators-with-action compared to those with only ideation, suggesting the existence of a suicidality continuum and opening up the opportunity for targeting common risk factors in prevention efforts.