Mental Images Of Suicide: Theoretical Framework And Preliminary Findings In Youth

Suicide is the second leading cause of death in young people between 10 and 24 years old.There is a clear need to identify novel treatment targets in order to develop more effectivestrategies to reduce the massive impact of youth suicide. This paper discusses ‘suicidalflashforwards’ as a potential novel target. Suicidal flashforwards are vivid mental images offuture death or suicide - a form of suicidal cognition that has received very little attention in bothresearch and clinical practice to date. Here we present a brief review of relevant literature andpropose potential clinical and cognitive factors associated with suicidal flashforwards, and theprogression from suicidal flashforwards to suicidal behaviours (e.g., suicide attempt). Inaddition, we present data from our pilot study on suicidal flashforwards, which is the first studyto examine this phenomenon in young people. Thirty-three young people (aged 16-25) withcurrent or recent (in past 4 weeks) suicidal ideation, who received treatment at a local youthmental health clinic for a mood disorder participated in the study. Our findings suggest thatsuicidal flashforwards are very common in this population (reported by 97% of the sample), andare experienced as vivid, real, distressing and intrusive. Importantly, we found an associationbetween higher ratings of distressing effects of suicidal flashforwards and the number ofprevious suicide attempts, while no associations with attempts were found for characteristics ofverbal suicidal thoughts. These findings highlight the importance of suicidal flashforwards as apotential target for risk management and treatment strategies for suicide. Future larger studiesthat aim to understand the clinical, cognitive and biological mechanisms underlying suicidalflashforwards are needed to identify targets for appropriate preventions and interventions.