Frequently Asked Questions

In this study, 38.1% of participants reported suicidal mental imagery. The sample included 63 individuals receiving psychiatric treatment after a suicide attempt within the previous 6 months, so this prevalence reflects a postattempt clinical population rather than the general population.

Yes. Participants with suicidal mental imagery had higher PHQ-9 depression scores than those without imagery: mean 14.67 (SD=2.39) versus 12.36 (SD=4.26). This difference was statistically significant (t = 2212.426, P = .018; 95% CI of mean difference, 2214.21 to 2210.405).

Yes. Participants with suicidal mental imagery had higher MINI suicidality scores than those without imagery: mean 50.42 (SD=10.55) versus 42.97 (SD=13.95). The difference was statistically significant (t = 2212.245, P = .028; 95% CI, 2214.07 to 2210.814).

In this sample, suicidal mental imagery was significantly associated with female sex, lack of income source, and past psychiatric history. Among those with mental imagery, 25.4% of the total sample were female and 12.7% were male (c72 = 4.72, P = .036). Mental imagery was also more common in participants without an income source (79.2% vs 51.3% in the nonimagery group; c72 = 4.89, P = .027) and in those with mental illness history (95.8% vs 69.2%; c72 = 6.42, P = .01).

Yes. A history of mental illness was present in 95.8% of participants with suicidal mental imagery compared with 69.2% of those without imagery, and this association was statistically significant (c72 = 6.42, P = .01).

Suicidal mental imagery was assessed using a pragmatic proxy derived from clinical questioning rather than a dedicated imagery instrument. The authors defined it as internally generated, event-focused sensory representations related to self-harm or the suicidal act, including features such as modality, vividness, controllability or intrusiveness, frequency, timing, and associated distress.

This was a hospital-based cross-sectional study of 63 participants in Kozhikode, India, recruited from June 2023 to April 2024. Because the study was cross-sectional, it provides a single time-point snapshot and cannot establish causality between suicidal mental imagery and depression, suicidality, or other associated factors.

• The cross-sectional design cannot infer causality.
• The sample size was small, which limits generalizability.
• There was no nonsuicidal control group, so conclusions about imagery specificity are limited.
• Self-report measures may have introduced recall bias.
• Unmeasured confounders could have affected the observed associations.
• The suicidal mental imagery measure was a proxy rather than a validated dedicated instrument, which may have underestimated or misclassified imagery.

Yes. A multivariable logistic regression model including PHQ-9 score, suicidality, sex, and occupation significantly distinguished participants with versus without mental imagery (model c72 (4) = 14.774, P = .005). The model explained approximately 20.9% to 28.4% of the variance in mental imagery.

The study supports routinely asking about suicidal mental imagery during postattempt assessment. The authors' clinical points also recommend using a pragmatic, low-burden screening approach, recognizing measurement limits, and targeting imagery directly in safety planning and early interventions.