Suicidal imagery in a previously depressed community sample.
This study sought to replicate previous findings of vivid suicide-related imagery in previously suicidal patients in a community sample of adults with a history of depression. Twenty-seven participants were interviewed regarding suicidal imagery. Seventeen participants reported prior suicidal ideation or behaviour in the clinical assessment, and the vast majority of these also reported experiencing suicide-related imagery when at their most depressed and despairing, in many cases in the form of flash-forwards to imagined future suicidal acts. Interestingly, five of the 10 participants who did not report suicidal ideation or behaviour in the clinical interview also described prominent imagery related to themes of death and suicide, but in several cases, these images were associated with meanings that seemed to act to reduce the likelihood of subsequent suicidal acts. Severity of prior suicidality was associated with lower levels of imagery-related distress and higher levels of imagery-related comfort. These findings support the idea that suicide-related imagery is an important component in the phenomenology of depression and despair and hint at potentially important differences in the meaning associated with such imagery between those individuals who report experiencing suicidal ideation or behaviour when depressed and those who do not. The findings are consistent with Joiner's model of acquired capability for suicide through habituation to pain and fear of suicide and suggest that it may be useful to tackle such imagery directly in the treatment of suicidal patients.
Department of Psychiatry, University of Oxford, UK. catherine.crane@psych.ox.ac.uk
Catherine
C
Crane
Dhruvi
D
Shah
Thorsten
T
Barnhofer
Emily A
EA
Holmes
D000328:Adult; D001293:Attitude to Death; D003866:Depressive Disorder / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D007092:Imagination; D007406:Interview, Psychological; D008297:Male; D011569:Psychiatric Status Rating Scales; D012111:Residence Characteristics; D012307:Risk Factors; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology; D059020:Suicidal Ideation
Psychol Sci. 2007 Mar;18(3):199-203
17444910
J Clin Psychiatry. 1998;59 Suppl 20:22-33;quiz 34-57
9881538
J Affect Disord. 2006 Apr;91(2-3):189-94
16488023
Memory. 2004 Jul;12(4):389-402
15487536
Behav Res Ther. 2008 Dec;46(12):1251-8
18990364
J Clin Psychiatry. 2009 Jan;70(1):19-24
19026258
J Behav Ther Exp Psychiatry. 2007 Dec;38(4):423-34
18037390
Arch Gen Psychiatry. 1982 Aug;39(8):905-10
7103679
Emotion. 2005 Dec;5(4):489-97
16366752
Soc Sci Med. 2010 May;70(10):1626-32
20207465
Suicide Life Threat Behav. 1999 Spring;29(1):1-9
10322616
J Anxiety Disord. 2006;20(3):328-41
16564436
Br J Psychiatry. 2007 Jan;190:11-7
17197651
Behav Modif. 2008 Jan;32(1):77-108
18096973
Behav Res Ther. 2007 Dec;45(12):3077-87
17632075
Suicide Life Threat Behav. 2007 Aug;37(4):397-408
17896880
J Consult Clin Psychol. 2008 Feb;76(1):45-51
18229982