title: 'Flash-forwards' and suicidal ideation: A prospective investigation of mental imagery, entrapment and defeat in a cohort from the Hong Kong Mental Morbidity Survey.
abstract: 'Flash-forwards' - mental images of suicide - have been reported in selected Caucasian samples. Perceptions of defeat and entrapment are considered to be associated with suicidal ideation. We aimed to investigate (1) the presence of suicidal flash-forwards in people with recent suicidal ideation versus those without such ideation in an Asian sample, and (2) associations between suicidal flash-forwards, and perceptions of entrapment accounting for suicidal ideation. Eighty two suicidal and 80 non-suicidal participants from the Hong Kong Mental Morbidity Survey completed questionnaires including suicidal ideation, presence of suicidal flash-forward images, defeat and entrapment, at baseline and seven weeks later. Suicidal 'flash-forwards' were present only in suicidal cases. People with recent suicidal ideation and suicidal flash-forwards had more severe suicidal ideation than those without flash-forwards. Compared to those without suicidal ideation, people with recent suicidal ideation reported higher entrapment and defeat levels. Resolution of suicidal ideation over time was associated with fewer suicidal flash-forwards and reduced entrapment perceptions. At baseline and seven weeks, suicidal ideation was predicted by an interaction between suicidal flash-forwards presence and perceptions of entrapment. Mental imagery of suicide appears to be associated with suicidal ideation, and may represent a novel target in suicidal risk assessment and prevention.
authors: Department of Psychiatry, Kowloon Hospital, 147A, Argyle Street, Hong Kong. Electronic address: ngmk@ha.org.hk.
authors: Roger M K
authors: RMK
authors: Ng
authors: MRC Cognition and Brain Sciences Unit, Cambridge, UK. Electronic address: martina.disimplicio@mrc-cbu.cam.ac.uk.
authors: Martina
authors: M
authors: Di Simplicio
authors: Oxford Centre for Cognitive Therapy, University of Oxford, UK. Electronic address: f.v.mcmanus@stir.ac.uk.
authors: Freda
authors: F
authors: McManus
authors: Oxford Centre for Cognitive Therapy, University of Oxford, UK. Electronic address: helen.kennerley@btinternet.com.
authors: Helen
authors: H
authors: Kennerley
authors: MRC Cognition and Brain Sciences Unit, Cambridge, UK and Department of Clinical Neuroscience, Karolinska Institutet, Sweden. Electronic address: emily.holmes@mrc-cbu.cam.ac.uk.
authors: Emily A
authors: EA
authors: Holmes
mesh_terms: D000328:Adult; D005260:Female; D006723:Hong Kong; D006801:Humans; D007092:Imagination / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology*
keywords: Cognition; Imagery; Risk factors; Suicidal ideation; Suicide