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 effective strategies to reduce the massive impact of youth suicide. This paper discusses ‘suicidal flashforwards’ as a potential novel target. Suicidal flashforwards are vivid mental images of future death or suicide – a form of suicidal cognition that has received very little attention in both research and clinical practice to date. Here we present a brief review of relevant literature and propose potential clinical and cognitive factors associated with suicidal flashforwards, and the progression from suicidal flashforwards to suicidal behaviours (e.g., suicide attempt). In addition, we present data from our pilot study on suicidal flashforwards, which is the first study to examine this phenomenon in young people. Thirty-three young people (aged 16-25) with current or recent (in past 4 weeks) suicidal ideation, who received treatment at a local youth mental health clinic for a mood disorder participated in the study. Our findings suggest that suicidal flashforwards are very common in this population (reported by 97% of the sample), and are experienced as vivid, real, distressing and intrusive. Importantly, we found an association between higher ratings of distressing effects of suicidal flashforwards and the number of previous suicide attempts, while no associations with attempts were found for characteristics of verbal suicidal thoughts. These findings highlight the importance of suicidal flashforwards as a potential target for risk management and treatment strategies for suicide. Future larger studies that aim to understand the clinical, cognitive and biological mechanisms underlying suicidal flashforwards are needed to identify targets for appropriate preventions and interventions.