(PS13-7) Mental Imagery of Suicide and Capability for Suicidal Behavior

Suicidal thoughts and behaviors (STBs) are common among young adults. Historically, suicidal ideation (SI) has been assessed through measures primarily capturing verbal thoughts of suicide. However, previous work suggests that some individuals experience SI as mental images and that these thoughts tend to occur in more acutely suicidal people.

            Ideation-to-action models of suicidal thoughts and behaviors posit that capability for suicide develops via exposure to painful and provocative events. Mental imagery of suicide may be relevant to capability because the act of imagining one’s own suicide could serve as a rehearsal or habituate the individual to the fear and pain of suicide.

We used a single item to measure frequency of suicidal thoughts as images on a scale from “almost never” to “almost always”. To compare mental imagery with verbal suicidal thoughts, we used a single item to evaluate verbal suicidal thoughts on the same scale. We also evaluated the frequency of specific types of imagery (suicide method, one’s own funeral/memorial, etc.) on the same scale. We examined the relationship between the frequency of mental imagery of suicide, SI intensity, practical capability, fearlessness about death (FAD), and self-assessment of future suicide attempt risk in a sample of 176 young adults. We also examined the associations of the mental imagery scale item-by-item to determine which types of mental images were associated with our variables.

            As shown in previous work, frequency of thoughts of suicide as imagery was more strongly correlated (z = 2.19, p = .01) with SI intensity (r = .378, p = .01) than thoughts of suicide in words (r = .161, p = .292.  Thoughts of suicide as imagery was correlated with practical capability (r = .387, p = .008) but thoughts of suicide in words was not (r = -.018, p = .904).  Unexpectedly, neither thoughts of suicide as imagery (r = .078, p = .567) nor thoughts of suicide in words (r = -.001, p = .996) were correlated with FAD.  Similarly neither thoughts of suicide as imagery (r = .252, p = .091)  nor thoughts of suicide in words (r = .206, p = .175) were associated with self-assessed future suicide attempt risk.

            Examining the individual items of the imagery scale, SI was associated with images of a method (r = .445, p = .007) and with people finding the person’s body (r = .353, p = .040). Acquired capability was associated with all items (ps < .05) except for their own funeral/memorial (r = .314, p = .071).  FAD was associated with items of a person’s own dead body (r = .462, p = .006), people finding their body (r = .383, p = .025), and their own funeral/memorial (r = .345, p = .046). Self-assessed future suicide attempt risk was associated with imagining a method (r = .403, p = .016), their own dead body (r = .388, p = .023), people finding their body (r = .382, p = .026), and their own funeral/memorial (r = .441, p = .009).

            In summary, thinking about suicide in images may indicate more severe or intense SI. Future work will be needed to determine whether suicide imagery contributes to increased practical capability or is simply a marker of capability. Visual images of a suicide method are related to factors associated with risk for suicidal thoughts and behaviors.