Suicidal Ideation

Contributing Factors

Contributing factors are substances, contexts or conditions that have roles in promoting increased risk of suicidal ideation and suicide.

Food and diet

Eating an unhealthy diet is known to lead to nutrient deficiencies, which, in turn, can negatively affect brain function.

Foods that promote good brain health:

  • whole, fresh foods
  • eat sufficient good quality protein (w/fish 3x week) animal + plant-based
  • good-quality fats
  • minimal amounts of starches
  • antioxidant-rich vegetables and fruit

Substances that are bad for brain health:

  • sugar-containing foods and snacks
  • high glycemic foods (sugars and starches)
  • processed fats (processed plant oils, hydrogenated fats)
  • artificial ingredients (colours and preservatives)
  • fast food meals

Diet and suicide risk

A study with 6803 adults comparing food consumption of suicide attempters and non-attempters reported that fruits, vegetables and meat were significantly underconsumed in adults who had attempted suicide (Li et al., 2009).

Healthy diets for supporting addiction recovery

Mediterranean diet

  • ​​The mediterranean diet is considered a good model for a healthy diet. It includes foods that are beneficial, and also reduces or eliminates foods that promote mental health issues.
  • General components of the mediterranean diet include:
    • plenty of vegetables and fruit
    • healthy fats including olive oil
    • regular consumption of seafood
    • poultry, beans, and small amounts of red meat
    • small amounts of dairy as yogurt and cheeses
    • whole grains instead of refined grains

More information and menu plans:
(Mediterranean Diet 101, 2021)

Paleo diet

Foods to eat:

  • meat, fish, eggs
  • vegetables, fruits
  • nuts, seeds
  • healthy fats and oils
  • herbs, spices

Foods to avoid:

  • sugar, high-fructose corn syrup
  • grains
  • legumes and beans
  • dairy products
  • vegetable oils, and transfats
  • artificial sweeteners
  • processed foods


Inflammation is a normal part of the body’s defense to injury or infection. However, inflammation is damaging when it occurs in healthy tissues or lasts too long (months or years).

Causes of chronic inflammation include (Inflammation, n.d.):

  • Environmental chemicals
  • Poor nutrition and nutritional deficiencies
  • Imbalanced microbiome (dysbiosis)
  • Sleep issues
  • Stress
  • Personal environment

Additional sources of Inflammation (Berk et al., 2013):

• consuming the Standard American diet
• environmental toxins
• low grade infections
• sedentary lifestyle
• allergies

Inflammation and Depression

Inflammation plays a mediating role in both the risk and progression of depression (Berk et al., 2013).

Depression is a symptom of inflammation. Symptoms include (Greenblatt, 2018):

  • lethargy/malaise/fatigue
  • decreased concentration
  • decreased appetite
  • decreased interest in pleasurable things
  • weakness

Cytokines and Depression

Depressed patients have been found to have (Huang & Lee, 2007):

  • Higher levels of pro-inflammatory cytokines (TNF- α & CRP) than healthy patients
  • Lower levels of anti-inflammatory cytokines than healthy patients

Pro-inflammatory cytokines are responsible for activating indoleamine 2,3-dioxygenase (IDO), a tryptophan and serotonin-degrading enzyme (Müller & Schwarz, 2007). Increased levels of IDO, and increased consumption of tryptophan and serotonin, results in a reduction in serotonergic neurotransmission (Müller & Schwarz, 2007) (Greenblatt, 2018).

Inflammation and suicide

    • In psychiatric patients increased inflammation is associated with increased suicidal ideation (Greenblatt, 2018)
    • Patients with depression and high suicidal ideation have been shown to have significantly higher markers of inflammation including TNF-α, IL-6, and C-reactive protein (O’Donovan et al., 2013).
    • Pro-inflammatory marker levels in suicide attempters (Lindqvist et al., 2009):
      • IL-6 was higher in suicide attempters than controls
      • IL-6 was highest in violent suicide attempts
      • the higher the IL-6 the higher the depression severity
    • In a study assessing inflammation, people with the highest inflammation were 4.2 times more likely to die by suicide than those with the lowest inflammation (Batty et al., 2016).

Sleep loss and inflammation

  • In a 12-day study a moderate reduction in sleep duration is associated with a significantly increased amount of inflammatory compounds (Vgontzas et al., 2004)

Trauma and inflammation (Danese et al., 2009):

  • immune function is affected in a pro-inflammatory way by childhood maltreatment, abuse, social isolation, and economic hardship
  • people who had strsss in childhood are twice as likely to suffer chronic inflammation

IDO, cytokines (inflammation mediators), and neurotransmission

  • The activity of Indoleamine 2,3-dioxygenase (IDO) – an important enzyme in tryptophan metabolism – is increased by pro-inflammatory cytokines (cell-signalling molecules)
  • IDO decreases levels of serotonin, and in turn, melatonin (important for mood and sleep)
  • IDO increases the production of quinolinic acid, which increases excitatory glutamate neurotransmission

Lifestyle factors

Some modifiable lifestyle behaviors implicated in suicide risk (Berardelli et al., 2018):

• internet addiction

• nutrition, dietary patterns

• stressful occupation or work

• sedentary, lack of exercise

• substance and alcohol abuse

• tobacco smoking

• obesity, or being underweight

Sedentary activities and suicide

More than two hours a day playing video games or using a computer has been shown to significantly increase the likelihood of sadness, hopelessness and serious consideration of suicide. (Michael et al., 2020)

Suicidal thoughts and behaviours can be increased by feelings of isolation and loneliness that come from long periods of sedentary activities. (Michael et al., 2020)

Sleep disturbances and suicide

A meta analysis that included 10 studies with over 100,000 participants showed that people with psychiatric diagnoses and sleeping disturbances were more likely to report suicidal behaviours (Malik et al., 2014).

A study of college students with a history of attempted suicide showed that (Bernert et al., 2017):

  • 78% experienced frequent insomnia
  • 36% had recurrent nightmares
  • sleep disturbances predicted suicide


Standard treatments for suicide prevention include antidepressants, antipsychotics, and anti-anxiety medications. These medications typically only partially reduce symptoms and some can increase the risk of suicide.

Medications and Suicidality

  • Glucocorticoid medication increases risk of suicidal behaviour and neuropsychiatric disorders (Fardet et al., 2012).
  • Side effects of antidepressant and anti-anxiety medications include insomnia and increased risk of suicide (Huang et al., 2019; Eby et al., 2011)

The use of orthomolecular nutrients in conjunction with medications can reduce medication need, reduce side effects, and increase the potential for a full recovery.

Batty, G. D., Kivimäki, M., Bell, S., Gale, C. R., Shipley, M., Whitley, E., & Gunnell, D. (2018). Psychosocial characteristics as potential predictors of suicide in adults: An overview of the evidence with new results from prospective cohort studies. Translational Psychiatry, 8(1), 1–15. 

Berardelli, I., Corigliano, V., Hawkins, M., Comparelli, A., Erbuto, D., & Pompili, M. (2018). Lifestyle Interventions and Prevention of Suicide. Frontiers in Psychiatry, 9, 567. 

Berk, M., Williams, L. J., Jacka, F. N., O’Neil, A., Pasco, J. A., Moylan, S., Allen, N. B., Stuart, A. L., Hayley, A. C., Byrne, M. L., & Maes, M. (2013). So depression is an inflammatory disease, but where does the inflammation come from? BMC Medicine, 11(1), 200. 

Bernert, R. A., Hom, M. A., Iwata, N. G., & Joiner, T. E. (2017). Objectively Assessed Sleep Variability as an Acute Warning Sign of Suicidal Ideation in a Longitudinal Evaluation of Young Adults at High Suicide Risk. The Journal of Clinical Psychiatry, 78(6), e678–e687. 

Danese, A., Moffitt, T. E., Harrington, H., Milne, B. J., Polanczyk, G., Pariante, C. M., Poulton, R., & Caspi, A. (2009). Adverse childhood experiences and adult risk factors for age-related disease: Depression, inflammation, and clustering of metabolic risk markers. Archives of Pediatrics & Adolescent Medicine, 163(12), 1135–1143. 

Eby, G. A., Eby, K. L., & Murk, H. (2011). Magnesium and major depression. In R. Vink & M. Nechifor (Eds.), Magnesium in the Central Nervous System. University of Adelaide Press. 

Fardet, L., Petersen, I., & Nazareth, I. (2012). Suicidal behavior and severe neuropsychiatric disorders following glucocorticoid therapy in primary care. The American Journal of Psychiatry, 169(5), 491–497. 

Greenblatt, J. (2018, May 24). Integrative therapies for schizophrenia and psychosis. 

Huang, Q., Liu, H., Suzuki, K., Ma, S., & Liu, C. (2019). Linking What We Eat to Our Mood: A Review of Diet, Dietary Antioxidants, and Depression. Antioxidants, 8(9), 376. 

Huang, T.-L., & Lee, C.-T. (2007). T-helper 1/T-helper 2 cytokine imbalance and clinical phenotypes of acute-phase major depression. Psychiatry and Clinical Neurosciences, 61(4), 415–420. 

Inflammation. (n.d.). National Institute of Environmental Health Sciences. Retrieved August 16, 2021, from 

Li, Y., Zhang, J., & McKeown, R. E. (2009). Cross-sectional assessment of diet quality in individuals with a lifetime history of attempted suicide. Psychiatry Research, 165(1–2), 111–119. 

Lindqvist, D., Janelidze, S., Hagell, P., Erhardt, S., Samuelsson, M., Minthon, L., Hansson, O., Björkqvist, M., Träskman-Bendz, L., & Brundin, L. (2009). Interleukin-6 is elevated in the cerebrospinal fluid of suicide attempters and related to symptom severity. Biological Psychiatry, 66(3), 287–292. 

Malik, S., Kanwar, A., Sim, L. A., Prokop, L. J., Wang, Z., Benkhadra, K., & Murad, M. H. (2014). The association between sleep disturbances and suicidal behaviors in patients with psychiatric diagnoses: A systematic review and meta-analysis. Systematic Reviews, 3, 18. 

Mediterranean Diet 101: Meal Plan, Foods List, and Tips. (2021, October 25). Healthline. 

Michael, S. L., Lowry, R., Merlo, C., Cooper, A. C., Hyde, E. T., & McKeon, R. (2020). Physical activity, sedentary, and dietary behaviors associated with indicators of mental health and suicide risk. Preventive Medicine Reports, 19, 101153. 

Müller, N., & Schwarz, M. (2007). The immune-mediated alteration of serotonin and glutamate: Towards an integrated view of depression. Molecular Psychiatry, 12(11). 

O’Donovan, A., Rush, G., Hoatam, G., Hughes, B. M., McCrohan, A., Kelleher, C., O’Farrelly, C., & Malone, K. M. (2013). Suicidal ideation is associated with elevated inflammation in patients with major depressive disorder. Depression and Anxiety, 30(4), 307–314. 

The Paleo Diet—A Beginner’s Guide + Meal Plan. (2018, August 1). Healthline. 

Vgontzas, A. N., Zoumakis, E., Bixler, E. O., Lin, H.-M., Follett, H., Kales, A., & Chrousos, G. P. (2004). Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines. The Journal of Clinical Endocrinology and Metabolism, 89(5), 2119–2126.