Clinical Summary
Clinical Summary: Suicidal Mental Imagery in Suicide Attempters: A Cross-Sectional Study
After a suicide attempt, clinicians need practical ways to identify who carries greater ongoing symptom burden and risk. This study found that suicidal mental imagery was present in 38.1% of attempters and clustered with higher depression and suicidality scores, supporting its value as a routine postattempt assessment target.
Design
hospital-based cross-sectional study
N
63 participants
Population
individuals attending the hospital for psychiatric treatment with a history of attempted suicide within the preceding 6 months, who were aged 12 years and above
Duration
Data were collected from June 2023 to April 2024.
Key Findings
- Mental imagery was present in 38.1% of participants.
- Participants with mental imagery had higher depressive symptom severity, with mean PHQ-9 scores of 14.67 (SD=2.39) versus 12.36 (SD=4.26) in the nonimagery group (t = −2.426, P = .018; 95% CI of mean difference, −4.21 to −0.405).
- Participants with mental imagery had higher suicidality scores, with mean MINI scores of 50.42 (SD = 10.55) versus 42.97 (SD = 13.95) without mental imagery (t = −2.245, P = .028; 95% CI, −14.07 to −0.814).
- Mental imagery was more common in participants with past psychiatric history: mental illness was present in 95.8% of the imagery group versus 69.2% of the nonimagery group (χ2 = 6.42, P = .01).
- Mental imagery was associated with female sex and no income source: 25.4% were female and 12.7% were male among those with mental imagery (χ2 = 4.72, P = .036), and 79.2% of the imagery group versus 51.3% of the nonimagery group reported no income source (χ2 = 4.89, P = .027); a multivariable model including PHQ-9, suicidality, sex, and occupation was significant (model χ2 (4) = 14.774, P = .005) and explained approximately 20.9% to 28.4% of the variance in mental imagery.
Clinical Bottom Line
In suicide attempters, suicidal mental imagery identifies a subgroup with higher depression and suicidality scores. Asking directly about imagery during postattempt assessment can improve risk formulation beyond standard symptom review alone.
Practice Implications
- Routinely ask postattempt patients whether they experience internally generated images of the attempt or its aftermath, because 38.1% of this sample reported mental imagery.
- Prioritize imagery assessment in attempters with greater depressive burden or suicidality, as PHQ-9 scores were 14.67 versus 12.36 and MINI suicidality scores were 50.42 versus 42.97 in those with versus without imagery.
- Maintain a lower threshold to probe for imagery in patients with a psychiatric history, since mental illness was present in 95.8% of the imagery group versus 69.2% of the nonimagery group.
- Use demographic context to sharpen follow-up planning: imagery was associated with female sex and lack of income source, with 79.2% of the imagery group reporting no income source.
