(PS9-A17) Distress and Comfort of Suicidal Mental Imagery and Verbal Thoughts as Potential Correlates of Suicidal Ideation

Objective.  Some research suggests that finding suicidal cognitions more comforting may indicate higher suicide risk (Crane et al., 2014). This is in line with Joiner’s interpersonal theory of suicide (Van Orden et al., 2010), which proposes that to transition from suicidal cognitions to suicidal behaviors, individuals must become desensitized to the fear and pain associated with death. Perceiving suicidal cognitions as comforting may be one indicator that an individual has acquired this capability for suicide. The present study examined the relation between how distressing and how comforting suicidal cognitions were and severity of suicidal ideation among psychiatrically hospitalized adolescents. We compared adolescents’ perceptions of how comforting and distressing  suicidal mental images and verbal thoughts were given recent research suggesting suicidal mental imagery to be associated with suicidal behavior over and above suicidal verbal thoughts (Lawrence et al., 2021). We expected that perceiving suicidal cognitions as more comforting would be associated with more severe suicidal ideation.

Method.  Participants were 52 adolescents ages 13-17 years currently experiencing psychiatric hospitalization. While on the inpatient unit, they completed the suicidal cognitions assessment (SCA; Lawrence et al., 2021), which assesses whether individuals have experienced suicidal mental images and suicidal verbal thoughts. If they have, they also report on how comforting and distressing those mental images and verbal thoughts are when at their most suicidal on scales ranging from 1 (not at all) to 5 (extremely). Adolescents also completed the Suicidal Ideation Questionnaire-Jr (Reynolds & Mazza, 1999) to assess severity of suicidal ideation over the past month.

Results. Participants experienced suicidal cognitions as moderately comforting (mental images: M = 2.08, SD = 1.41; verbal thoughts: M = 2.16, SD = 1.41) and as moderately distressing (mental images: M = 3.76, SD = 1.09; verbal thoughts: M = 3.63, SD = 1.34). Significant correlations were found between how comforting and distressing suicidal mental images (r = -0.41, p = 0.04) and verbal thoughts (r = -0.48, p = 0.02) were. Relatedly, there were significant correlations between comfort ratings for suicidal mental images and suicidal verbal thoughts (r = 0.87, p < 0.001), and between distress ratings for suicidal mental images and verbal thoughts (r = 0.63, p < 0.001). For both suicidal mental images and verbal thoughts, higher comfort ratings were associated with more severe suicidal ideation (mental images: r = 0.45, p = 0.03; verbal thoughts: r = 0.35, p = 0.04). Associations between how distressing suicidal cognitions were and the severity of adolescents’ suicidal ideation were not significant (ps > .05).

Conclusions. How comforting suicidal cognitions are perceived to be is more strongly associated with severity of suicidal ideation than how distressing they are perceived to be. Thus, inquiring about how comforting adolescents’ suicidal cognitions are may improve the accuracy of suicide risk assessment.