Background: Studies suggest there may be perceived secondary advantages to engaging in suicidal behavior that impact the help-seeking behavior of at-risk individuals. Aims: The aim of this study was to assess the views of patients with depression regarding the advantages and disadvantages of engaging in suicidal behavior using a decisional balance worksheet (DBW) to inform prevention and intervention efforts. Method: Participants were adults with depression between the ages of 18 and 75 presenting to the emergency department with suicidal ideation (N = 42) who participated in a larger pilot study of a brief intervention aimed focused on treatment engagement. Using a content analysis approach, common themes were extracted. Results: Escaping from problems and negative thoughts, ending pain and suffering, and eliciting support and help were the most commonly cited advantages of engaging in suicidal behavior. Negatively impacting family, violating one’s values, and missing out on the future were the most commonly reported disadvantages of suicidal behavior. Limitations: Results may not be generalizable to patients without depression who are experiencing suicidality. Conclusion: Results suggest intervention efforts focused on addressing decision-making and problem-solving skills and reinforcing the important role patients play in the lives of their significant others may help patients to resist the urge to act on suicidal thoughts.