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Cognitions in bipolar affective disorder and unipolar depression: imagining suicide
Open accessAbstract
Hales SA, Deeprose C, Goodwin GM, Holmes EA. Cognitions in bipolar affective disorder and unipolar depression: imagining suicide. Bipolar Disord 2011: 13: 651–661. © 2011 The Authors. Journal compilation © 2011 John Wiley & Sons A/S. Objective: Bipolar disorder has the highest rate of suicide of all the psychiatric disorders. In unipolar depression, individuals report vivid, affect‐laden images of suicide or the aftermath of death (flashforwards to suicide) during suicidal ideation but this phenomenon has not been explored in bipolar disorder. Therefore the authors investigated and compared imagery and verbal thoughts related to past suicidality in individuals with bipolar disorder (n = 20) and unipolar depression (n = 20). Methods: The study used a quasi‐experimental comparative design. The Structured Clinical Interview for DSM‐IV was used to confirm diagnoses. Quantitative and qualitative data were gathered through questionnaire measures (e.g., mood and trait imagery use). Individual interviews assessed suicidal cognitions in the form of (i) mental images and (ii) verbal thoughts. Results: All participants reported imagining flashforwards to suicide. Both groups reported greater preoccupation with these suicide‐related images than with verbal thoughts about suicide. However, compared to the unipolar group, the bipolar group were significantly more preoccupied with flashforward imagery, rated this imagery as more compelling, and were more than twice as likely to report that the images made them want to take action to complete suicide. In addition, the bipolar group reported a greater trait propensity to use mental imagery in general. Conclusions: Suicidal ideation needs to be better characterized, and mental imagery of suicide has been a neglected but potentially critical feature of suicidal ideation, particularly in bipolar disorder. Our findings suggest that flashforward imagery warrants further investigation for formal universal clinical assessment procedures.
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“However, this does not account for the role of imagery in cases when it deters individuals from engaging in self-harm or attempting suicide (Hales et al., 2011; McEvoy et al., 2017).”
From The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness (2021) · cites this paper as Hales et al., 2011
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“In contrast, some individuals allow themselves to experience reminders of goals that would be negatively impacted upon by their death from suicide (Hales et al., 2011; Crane et al., 2012).”
From The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness (2021) · cites this paper as Hales et al., 2011
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“We hypothesize that mental imagery increases the likelihood of enactment as it acts as a form of cognitive rehearsal for the behaviour”
From The integrated motivational–volitional model of suicidal behaviour (2018) · cites this paper as [63]
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“In addition, individuals who are in crisis can experience imagery related to suicide, such as images of desired outcomes or unwanted consequences (Hales et al., 2011).”
From The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness (2021) · cites this paper as Hales et al., 2011
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“The role of these images may be complex in suicide, since both ideators and attempters experience suicide imagery, and imagery deters some individuals from engaging in self-harm and attempting suicide (Hales et al., 2011; McEvoy et al., 2017).”
From The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness (2021) · cites this paper as Hales et al., 2011
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“Suicidal individuals can experience “flash-forward” images of their potential suicide, containing images of methods and potential desired and undesired consequences, such as family members’ reactions (Hales et al., 2011).”
From The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness (2021) · cites this paper as Hales et al., 2011
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“This in turn may influence whether individuals attempt suicide (Holmes et al., 2007b; Hales et al., 2011).”
From The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness (2021) · cites this paper as Hales et al., 2011
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Metadata
- Authors
- Hales, S. A., Deeprose, C., Goodwin, G. M., & Holmes, E. A.
- Affiliations
- University of Oxford (GB)
- Corresponding author
- Hales, Susie A
- Venue
- Bipolar Disorders
- Publisher
- Wiley
- Published
- 2011-11
- Volume
- 13
- Issue
- 7-8
- Pages
- 651-661
- ISSN
- 1398-5647 (ISSN-L)
- 1399-5618
- PMC
- PMC3443362
- OpenAlex
- W2118935759
- Cited by
- 157
- References
- 37
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 13 · 2023: 20 · 2022: 9 · 2021: 12 · 2020: 11 · 2019: 11 · 2018: 11 · 2017: 7 · 2016: 13 · 2015: 13 · 2014: 6 · 2013: 6 · 2012: 6
- FWCI
- 4.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Bipolar Disorders (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- PEARL (University of Plymouth) (submittedVersion)
- PEARL (University of Plymouth) (submittedVersion, other-oa)
- Funders
- Sanofi
- Wellcome Trust (WT088217)
- Lupina Foundation
- National Institute for Health and Care Research (NF-SI-0510-10102)
- Servier
- Medical Research Council
- Economic and Social Research Council
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- bipolar disorder, major depressive disorder, suicidal ideation, mental imagery, suicidal cognitions, suicide risk assessment
- MeSH terms
- Adult, Bipolar Disorder, Cognition Disorders, Depressive Disorder, Female, Humans, Imagination, Male, Middle Aged, Neuropsychological Tests, Psychiatric Status Rating Scales, Psychometrics, Surveys and Questionnaires, Suicide, Diagnostic and Statistical Manual of Mental Disorders
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