Future-Oriented Mental Imagery and Adolescent Suicide Risk

Suicidal thoughts are prevalent, distressing, and among the strongest risk factors for suicide attempts among adolescents. Intervening on suicidal thoughts therefore has potential to reduce impairment for the substantial number of adolescents who report suicidal thoughts while also preventing the first incidence of suicide attempt. One particularly promising avenue for new gains in suicide research and treatment is the examination of positive future thinking. In adults, deficits in positive future thinking are associated concurrently and prospectively with increased suicidal thoughts. Far less is known, however, regarding links between positive future thinking and suicidal thoughts among adolescents. In addition, no research has evaluated positive future-oriented mental imagery among adolescents despite this being a developmental period in which mental imagery abilities peak, suicidal thoughts increase, and youth become more oriented to the future. The study proposed here will determine whether compared with verbal thinking, mentally imagining positive future events leads adolescents to experience greater positive affect and less suicidal thoughts. If found, mental imagery of positive future events could be fostered in intervention contexts to improve affect and reduce suicide risk in adolescents.

A sample of 126 adolescents with past-year suicidal ideation will complete a remote baseline session in which they complete self-report measures of suicidal thoughts and behaviors and are experimentally induced to either mentally imagine or verbally think about positive future events in a between-subjects design. Adolescents will then complete a 2-week ecological momentary assessment (EMA) period where they report on daily experiences of positive future-oriented mental imagery, positive future-oriented verbal thinking, positive affect, and suicidal thoughts ranging in severity (ideation, desire, intent, perceived inability to keep self safe). The study has three aims: (1) test whether adolescents respond to induced positive future-oriented mental imagery with greater increases in positive affect than to induced positive future-oriented verbal thoughts, (2) determine whether positive future-oriented mental imagery more strongly predicts decreases in adolescents suicidal thoughts than positive future-oriented verbal thoughts in daily life, and (3) examine whether increases in positive affect mediate the proximal association between positive future-oriented mental imagery and decreases in suicidal thoughts in daily life. We expect that adolescents will experience greater increases in positive affect in response to the induction of positive future-oriented mental imagery compared with the induction of positive future-oriented verbal thoughts and that positive future-oriented mental imagery will more strongly predict decreases in suicidal thoughts than positive-future oriented verbal thoughts in daily life. We also expect that increases in positive affect will mediate the association between positive future-oriented mental imagery and decreases in suicidal thoughts. This study has the potential to identify positive future-oriented mental imagery as a new protective factor for suicidal thoughts in adolescents, one that could be assessed and intervened on to ultimately reduce suicide risk during this critical developmental period.

Alejandro Szmulewicz, MD, PhD President and Fellows of Harvard College through the Harvard T.H. Chan School of Public Health