混合方法研究识别出自杀意象的五种亚型及其与自杀行为的关系

Objective: Mental imagery about suicide is a commonly experienced risk factor for suicide, but subtypes and their relationships to behaviour remain largely unexplored. This study aims to identify and describe common themes in suicide imagery content, perceived function, and subjective meaning in relation to suicide behaviour. Method: Participants (N=20) provided quantitative and qualitative data about content, perceived function, and subjective meaning across 30 unique instances of suicide imagery via online surveys and semi-structured interviews. Results: Framework Analysis resulted in five key themes: (a) Determination imagery depicting a single action script detailing a chosen suicide method, (b) Solution imagery highlighting wanted impacts of suicide, (c) Mental Exercise or fantasy imagery, (d) Discouraging imagery of unwanted impacts of suicide, and (e) Consideration imagery weighing up different methods. Determination and Solution imagery were commonly associated with suicide behaviour. Imagery prior to attempt was often deliberately constructed, wanted, and prolonged (Median duration = 90 minutes). Conclusions: Findings suggest that imagery themes may vary on dimensions reflecting facilitation and deterrence of behaviour, which may interact to produce ambivalence. In addition to volitional impacts via suicide action script rehearsal, suicide imagery may increase motivation towards suicide. Prior to attempt, suicide imagery may be acceptable, comforting, or even sought after. This study provides a nuanced understanding of suicide imagery subtypes in relation to suicide behaviour and provides a framework to assist clinicians in assessment and formulation.