Date of Award

2026

Document Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Psychology

First Advisor

Ki Eun (Kay) Shin, Ph.D.

Second Advisor

Ruth Nirenberg, Psy.D.

Third Advisor

Stefanie Iwanciw, Psy.D.

Abstract

People utilize two different modes of cognition, experiencing thoughts as mental images or verbal thoughts. Mental imagery tends to be more emotionally arousing and vivid than verbal thoughts, and most suicidal individuals report experiencing suicidal imagery in addition to verbal thoughts. Increasing evidence suggests that suicidal mental imagery is associated with heightened suicide risk, including greater likelihood of prior suicide attempts (e.g., Lawrence et al., 2021). However, suicide risk assessments primarily focus on verbal suicidal thoughts and rarely assess suicidal mental imagery, potentially contributing to the low rates of suicide-related disclosure and challenges identifying individuals at risk. The present study examined the prevalence of different suicidal thought types (predominantly verbal, predominantly imaginal, and equally verbal and imaginal) and whether the suicidal thought type was associated with suicidal ideation severity, lifetime suicide attempts, and suicide-related disclosure among community-based adults with lifetime suicidal ideation. Participants whose suicidal thoughts were equally verbal and imaginal reported greater suicidal ideation severity than those with predominantly verbal suicidal thoughts. Suicidal thought type was not significantly associated with lifetime suicide attempt history. However, participants with predominantly imaginal suicidal thoughts had significantly lower odds of disclosing one’s suicidality to mental health professionals than those with predominantly verbal suicidal thoughts. Findings suggest suicidal mental imagery as a marker of elevated clinical severity and highlight the importance of assessing suicidal mental imagery in suicide risk assessment and clinical interviewing practices.

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