Les enquêtes de santé conduites récemment auprès de populations d’adolescents et de jeunes adultes ont mis en lumière des taux alarmants d’idées suicidaires. Un défi important que doit relever tout clinicien face à un patient suicidaire est l’évaluation du risque de passage à l’acte et la prise en charge thérapeutique des pensées et des conduites en lien avec le suicide. Dans ce contexte, la mise en évidence récente chez ces patients d’images mentales intrusives extrêmement fréquentes et vivaces en lien avec le suicide, les flashforwards suicidaires, pourrait ouvrir la voie à d’importantes avancées dans notre capacité à évaluer et aider les patients en prise avec une problématique suicidaire. C’est ce sujet qu’évoque Arnaud Pictet dans cet entretien avec Jean-Pierre Bouchard.

Recent surveys have shown an alarming increase in suicidal behaviours in adolescents and young adults, a population known to be associated with high levels of stress, anxiety, and depression. Despite the great improvements made over the years in the way we understand and address suicidality in the clinic, it remains extremely challenging and complex for the clinicians to assess risk and help patients alleviate their suicidal thoughts. In this context, recent studies have shown that a particular form of intrusive mental imagery of suicide, called “flashforwards” in analogy with the flashbacks in PTSD, could play a pivotal role in suicidal behaviour. More specifically, suicidal flashforwards have been shown to be associated with greater severity of suicidal symptoms and a greater likelihood of engaging in actual suicidal behaviour. This in line with the broader evidence of a powerful impact of mental imagery on emotion and behaviour, while in the specific of context of suicidality these flashforwards could be seen as real marker of suicidal risk and severity. Frequent exposure to suicidal scenarios through repeated experience of intrusive imagery may induce habituation to this outcome and thus increase the person's acquired ability to do so. Beyond assessment of suicidal risk, exploring suicidal images offers privileged access to the emotional states, cognitions, and behavioural responses that patients experience when they feel at their most depressed and despairing. Further, recently developed intervention methods designed to specifically target these suicidal images could hold promise in helping patients to deal with their suicidality. These are the subjects that Arnaud Pictet evokes in this interview with Jean-Pierre Bouchard.