Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan;19(1):e13626.
doi: 10.1111/eip.13626. Epub 2024 Nov 8.

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

Elizabeth C Thompson  1   2   3 , Katherine Visser  1   2 , Margaret Nail  1   2 , Hannah R Lawrence  4 , Jeffrey Hunt  2   3 , Jennifer C Wolff  1   2   3
Affiliations

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

Elizabeth C Thompson et al. Early Interv Psychiatry. 2025 Jan.

Abstract

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.

Keywords: perceptual abnormalities; psychosis spectrum; suicidal cognitions; suicidal ideation; suicide attempt.

PubMed Disclaimer

References

    1. Álvarez, A., A. Guàrdia, A. González‐Rodríguez, et al. 2022. “A Systematic Review and Meta‐Analysis of Suicidality in Psychotic Disorders: Stratified Analyses by Psychotic Subtypes, Clinical Setting and Geographical Region.” Neuroscience and Biobehavioral Reviews 143: 104964. https://doi.org/10.1016/j.neubiorev.2022.104964.
    1. Ayesa‐Arriola, R., E. G. Alcaraz, B. V. Hernández, et al. 2015. “Suicidal Behaviour in First‐Episode Non‐Affective Psychosis: Specific Risk Periods and Stage‐Related Factors.” European Neuropsychopharmacology 25, no. 12: 2278–2288. https://doi.org/10.1016/j.euroneuro.2015.09.008.
    1. Barrett, E. A., K. Sundet, A. Faerden, et al. 2010. “Suicidality Before and in the Early Phases of First Episode Psychosis.” Schizophrenia Research 119, no. 1–3: 11–17. https://doi.org/10.1016/j.schres.2010.03.022.
    1. Bornheimer, L. A., V. Hong, J. Li Verdugo, L. Fernandez, and C. A. King. 2022. “Relationships Between Hallucinations, Delusions, Depression, Suicide Ideation, and Plan Among Adults Presenting With Psychosis in Psychiatric Emergency Care.” Psychosis 14, no. 2: 109–119. https://doi.org/10.1080/17522439.2021.1912815.
    1. Capra, C., D. J. Kavanagh, L. Hides, and J. G. Scott. 2015. “Subtypes of Psychotic‐Like Experiences Are Differentially Associated With Suicidal Ideation, Plans and Attempts in Young Adults.” Psychiatry Research 228, no. 3: 894–898. https://doi.org/10.1016/j.psychres.2015.05.002.

LinkOut - more resources