An Exploration of the Co-Occurrence of Hallucinations and Suicidal Mental Imagery Among Psychiatrically Hospitalised Adolescents at High Risk for Suicide.

Introduction: Adolescents with psychosis-spectrum symptoms are at particularly high risk for suicide, however, little is known about how suicidal cognitions manifest in this population. Suicidal cognitions can occur as verbal thoughts and/or mental images of suicide, and mental images may be indicative of a higher risk for suicidal behaviours. Suicidal mental imagery could be a salient and important suicide-related risk factor for adolescents with hallucinations in particular, however, the co-occurrence of these phenomena has yet to be studied. In a sample of psychiatrically hospitalised adolescents, we hypothesize that hallucinations will be associated with increased suicidal mental imagery and suicide attempts.

Methods: This chart review study included data from 219 adolescents admitted to a psychiatric inpatient unit. Adolescents completed an assessment battery probing hallucinations, suicidal cognitions, and suicide attempts.

Results: Adolescents with past-month hallucinations had higher rates of past-week suicidal verbal thoughts and suicidal mental imagery, but not suicide attempts, compared to those without hallucinations. Adolescents with hallucinations reported a younger onset of suicidal mental imagery, and they endorsed more frequent imagery. Past-month hallucinations were significantly and positively associated with suicidal mental imagery, beyond the effects of internalising symptoms. Suicidal mental imagery was positively associated with past-week suicide attempts, but past-month hallucinations were not.

Conclusions: Our findings indicate that hallucinations are linked to suicidal mental imagery, an important yet under-studied risk factor for suicidal behaviour. These data highlight the need for more research exploring suicidal mental imagery among high-risk adolescents experiencing hallucinations to inform suicide risk assessment and intervention.