Depression In Men Research Articles

Fertility Related Quality of Life, Gonadal Function and Erectile Dysfunction in Male Partners of Couples with Unexplained Infertility.

We sought to determine whether lower fertility related quality of life or depression in men of couples with unexplained infertility is associated with low total testosterone levels, abnormal semen quality or erectile dysfunction. This study is a secondary analysis of a large, multicenter, randomized controlled trial in couples with unexplained infertility. Male partners underwent baseline semen analysis with measurement of fasting total testosterone and gonadotropin. They also completed surveys, including the FertiQOL (Fertility Quality of Life), the PHQ-9 (Patient Health Questionnaire-9) and the IIEF (International Index of Erectile Function). The primary study outcomes were total testosterone with low total testosterone defined as less than 264 ng/dl, semen parameters and the IIEF score. We performed multivariable logistic regression analyses adjusted for patient age, race, body mass index, education, smoking, alcohol use, infertility duration and comorbidity. A total of 708 men with a mean ± SD age of 34.2 ± 5.6 were included in study. Of the men 59 (8.3%) had a PHQ-9 score of 5 or greater, which was consistent with depression, 99 (14.0%) had low total testosterone and 63 (9.0%) had mild or worse erectile dysfunction. Neither the FertiQOL score nor depression was associated with total testosterone or any semen parameter. The FertiQOL score was inversely associated with erectile dysfunction (for every 5-point score decline AOR 1.30, 95% CI 1.16-1.46). Depressed men were significantly more likely to have erectile dysfunction than nondepressed men (AOR 6.31, 95% CI 3.12-12.77). In men in couples with unexplained infertility lower fertility related quality of life and depression are strongly associated with erectile dysfunction. However, neither is associated with spermatogenesis or testosterone levels. Erectile dysfunction in infertile men merits longitudinal investigation in future studies.

Neuropsychological changes in efavirenz switch regimens.

Efavirenz is associated with side effects involving the central nervous system. However, it remains largely unknown whether switching off EFV improves neuropsychological performance. We utilized data from the Multicenter AIDS Cohort Study (MACS). Participants were categorized by their use of EFV: never on EFV (No EFV), continuously on EFV (No Switch-OFF) and on EFV and then switched off (Switch-OFF). Baseline time points were defined as visits when first neuropsychological data were available. In Analysis 1, we compared neuropsychological and Center for Epidemiological Studies-Depression Scale (CES-D) scores before and after EFV switch in Switch-OFF group, aligning participants at the time of switch. Analysis 2 evaluated trajectory of neuropsychological/CES-D score among the three groups. This analysis included 1989 HIV-seropositive participants with neuropsychological data (1675 in No EFV, 44 in No Switch-OFF, and 270 in Switch-OFF group). At baseline, participants had a median age of 37 years, median CD4 cell count 442 cells/μl, and 22.9% viral suppression rate. In Analysis 1, neuropsychological and CES-D scores did not show clinically significant changes over 2 years prior to and 4 years after switch in Switch-OFF group. In Analysis 2, trends in neuropsychological and CES-D scores in the three different groups did not show significant differences during a median of 3.2 years of follow-up. Discontinuation of EFV is not associated with changes in neuropsychological performance or severity of depression in men. Furthermore, we did not observe differences among participants who were never on EFV, continuously on EFV, and on EFV and then switched off.

Gender Variability of Perceived Stress and Negative Inferential Feedback in Depression.

Background:The role of negative inferential feedback and perceived stress in hopelessness depression is known. However, studies on their gender variability are lacking. The difference in various domains of negative inferential feedback and its impact on cognitive hopelessness, depression, and outcome of psychotherapy between men and women has been hypothesized.Aims:This study analyzed the difference in stress levels and hopelessness in the form of negative inferential feedback in depressed men and women.Methodology:In all, 35 men and 35 women suffering from depression were recruited. They were first assessed on the Hamilton's Depression Rating Scale, and their sociodemographical details were recorded. They were then administered the Perceived Stress Scale (PSS) and the Adaptive Inferential Feedback Questionnaire.Results:Perceived stress in depressed women showed a positive correlation with negative inferential feedback (r = 0.39, P = 0.04). Levels of depression were comparable in the two genders. Comparison between the two genders showed no difference in proportion across the levels of severity of depression (χ2 = 5.44, P = 0.14). Depressed women rated higher stress, mainly in the helplessness domain of the PSS (P = 0.04). Women were shown to have more negative inferential feedback and attribute their hopelessness to more stable and global causes when compared with men (P = 0.04).Conclusion:Depressed women perceive more stress and receive more negative feedback, than men, to negative life events. Women attribute their hopelessness to more stable and global causes when compared with men.

Risk of depression following prostate cancer work-up: A nationwide study.

5061 Background: Little is known about the psychological impact of undergoing evaluation for prostate cancer (PCa). We investigated the risk of developing a depression following PCa work-up with benign and malignant findings, respectively, compared with cancer-free men. Methods: A nationwide cohort of men who underwent prostate needle biopsies in Denmark from 1997–2011 was identified through the Danish Prostate Cancer Registry. Primary outcome was indication of moderate to severe depression defined as hospital contact for depression or first redemption of a prescribed antidepressant. For comparison, we selected a minimum of five age-matched cancer-free men per man who had undergone PCa specific diagnostic work-up. We excluded men with other cancer, major psychiatric disorder or use of antidepressants up to three years before study entry. Information on outcome and covariates (age, period, cohabitation status, income quintile and comorbidity) were retrieved from National Danish registries. We illustrated the risk of depression by cumulative incidence functions. Data were analyzed using Cox models adjusted for possible confounders. Results: We identified 54,766 men who underwent work-up including transrectal biopsies of the prostate, among these, 21,419 biopsy sets were benign and 33,347 men were diagnosed with PCa. We found an increasing cumulative incidence of depression in all groups. However, men diagnosed with PCa had a significantly higher risk throughout up to 18 years of follow-up. The adjusted hazard ratio (HR) of depression in men diagnosed with PCa was increased throughout follow-up with the highest risk in the two years following diagnosis (HR 2.77, 95% CI 2.66–2.87). After undergoing biopsies, men with benign results had an increased risk of depression (HR 1.22, 95% CI 1.14–1.31) in the first two years compared with cancer-free men; hereafter, we found no difference. Conclusions: We found an increased risk of depression in men following diagnostic work-up for PCa compared with a matched background population. In men diagnosed with PCa, the risk remained increased throughout the study period. Future studies are needed to further analyze the impact of stage and treatment modalities.

Working-Class Men's Constructions of Help-Seeking When Feeling Depressed or Sad.

In this study, we conducted interviews with 12 working-class men employed in industrial and manual labor to identify their constructions of help-seeking in response to feeling depressed or sad. The semistructured interview format explored participant men’s understanding and reactions to depression or sadness, their experiences of depression and reluctance to seek help, and their own and others’ reactions to seeking help for feeling depressed or sad. Utilizing the consensual qualitative research methodology, four domains emerged: Concern About Threat and Stigma, Being a Man Means Not Seeking Help, Experiences of Safety and Relief, and Conditions That Reduce Threat and Stigma. The results suggest the need to account for men’s experiences of both negative influences (e.g., masculinity injunctions, stigma, and threat to manhood status), as well as adaptive influences (e.g., contexts that reduce stigma) when addressing men’s help-seeking for depression and sadness. The domains are illustrative of several theoretical frameworks including social-psychological models of social norms and stigma, precarious manhood theory, inclusive masculinity theory, as well as convergence with other research examining working-class men. Implications are discussed for outreach and practice addressing men’s depression and help-seeking.

Sex-Specific Effects of Stress on Mood-Related Gene Expression

Women are twice as likely as men to be diagnosed with major depressive disorder (MDD). Recent studies report distinct molecular changes in depressed men and women across mesocorticolimbic brain regions. However, it is unclear which sex-related factors drive distinct MDD-associated pathology. The goal of this study was to use mouse experimental systems to investigate sex-specific mechanisms underlying the distinct molecular profiles of MDD in men and women. We used unpredictable chronic mild stress to induce an elevated anxiety-/depressive-like state and “four core genotypes” (FCG) mice to probe for sex-specific mechanisms. As predicted, based on previous implications in mood, stress impacted the expression of several dopamine-, GABA-, and glutamate-related genes. Some of these effects, specifically in the prefrontal cortex, were genetic sex-specific, with effects in XX mice but not in XY mice. Stress also impacted gene expression differently across the mesocorticolimbic circuit, with increased expression of mood-related genes in the prefrontal cortex and nucleus accumbens, but decreased expression in basolateral amygdala. Our results suggest that females are sensitive to the effects of chronic stress, partly due to their genetic sex, independent of gonadal hormones. Furthermore, these results point to the prefrontal cortex as the node in the mesocorticolimbic circuitry with the strongest female-specific effects.

Symptoms of depression are associated with physical inactivity but not modified by gender or the presence of a cardiovascular disease; a cross-sectional study

BackgroundDepressive symptomatology may act as a barrier to enhance physical activity. This phenomenon is predominantly found in patients with an established cardiovascular disease (CVD) and in female patients. This cross-sectional study investigated (1) the association between symptoms of depression and physical inactivity, and (2) whether this association is different between primary and secondary prevention patients, and between men and women.MethodsThe study design concerns a secondary analysis of baseline data from a randomized clinical trial, including primary and secondary prevention patients (n = 2184; mean age 71.6 ± 8.94), from 34 general practitioner panels. The Rapid Assessment of Physical Activity questionnaire (RAPA) was used to measure patient reported activity levels. Symptoms of depression were determined using the Patient Health Questionnaire (PHQ-9). Multilevel linear regression analysis was used to explore the association between symptoms of depression and physical activity while adjusting for confounders. Gender and whether or not having a CVD were considered as potential effect modifiers for the association between symptoms of depression and inactivity.ResultsSymptoms of depression were associated with lower levels of physical activity. This association was neither different for men and women nor for primary and secondary prevention patients.ConclusionIn primary care patients’ symptoms of depression were associated with physical inactivity. This association was not modified by gender or the presence of a CVD. Future research should focus on lifestyle interventions aiming at the increase of physical activity levels, while emphasizing on improving symptoms of depression in men, women, and patients both with and without a history of CVD.

114 The Impact Of Intralesional Xiaflex On Psychosocial Outcomes in Men with Peyronie’s Disease (PD)

Peyronie’s disease (PD) is associated with significant bother and even depression in some men. To evaluate bother and depression in men with PD patients undergoing treatment with ILX. Men meeting the criteria for ILX underwent up to 8 injections divided into 4 cycles. At-home modeling was conducted by the patients. Curvature assessment was done prior to treatment, mid-treatment (after ILX #4) and after completion (ILX #8). All ILX patients completed validated questionnaires including the Peyronie’s Disease Questionnaire bother domain (PDQB, max score 16) and the Center for Epidemiologic Studies Depression Scale (CES-D, max score 60). Greater than 10° change was considered significant. Comparison between patients who improved, remained unchanged or worsened was performed. Overall and subgroup analyzes were done including Wilcoxon-Mann-Whitney, Friedman and Kruskal Wallis test. 48 patients are currently evaluable. Mean age was 57±9.6 years. Mean PD duration was 17±28.4 months. Mean curvature, CESD score and PDQB score for each time point are reported in Table 1. Only curvature significantly improved. On sub-group analyzes of patients who improved vs. those who worsened, after ILX#4, there was a mean change on CESD of -1.06 vs -4.3 and PDQB of -1.2 vs +1.5, respectively. After ILX #8, those changes were: CESD +3.5 vs. +3.6 and PDQ of -3 vs -1 respectively. None of them were significantly different across groups at any treatment point. Finally, to evaluate clinically significant PD related bother and depressive symptoms during treatment, percentage of patients with PDQB>9 and CESD>16 was calculated. The percentage of patients with PDQ>9 and CESD>16 were 60% and 27% at baseline, 59% and 27% after ILX#4, and 50% and 39% after ILX#8, respectively. Despite this trend towards decreased bother, differences did not reach statistical significance.

Men and perinatal depression

Depression as a result of becoming a parent is increasingly recognised in men and not solely as a disease affecting women. However, as the author discusses, signs and symptoms of perinatal depression in men can differ from those seen in women. Therefore, a modified approach is needed, not least in the tools used to identify the condition.

Forgotten Fathers: Postpartum Depression in Men

Although postpartum depression is common and well-studied in mothers, many fathers also experience symptoms. This qualitative study investigated fathers’ experiences of postpartum depression. Data from secondary sources such as blogs, websites, forums, and chat rooms were analyzed using a combination of phenomenological and content analysis methods to understand father’s experiences of paternal postpartum depression. Six themes emerged from the data including fathers’ needing education, adhering to gender expectations, repressing feelings, being overwhelmed, resentment of baby, and the experience of neglect. These data provide useful information that can aid health care providers, researchers, clinicians, and families in understanding the experience of paternal postpartum depression and in better coping with the challenges these families face.

The depression status of empty nesters in eastern rural China

We used the Geriatric Depression Scale to investigate the depression status of empty nesters living in eastern rural China (N = 967). The results showed that more than half of the participants suffered relatively severe depression and that their mental health was not favorable. Gender, age, level of education, and marital status had a significant influence on depression status. The degree of depression of men was lower than that of women. As participants’ age increased, the degree of depression first rose until the age of 84 and then fell thereafter. The depression of unmarried empty nesters was relatively severe compared to that of married ones. Finally, a higher level of education corresponded with a lower degree of depression. There are varied factors affecting the psychological status of empty nesters in China. To improve their mental state, the government, society, and family need to collaborate and take comprehensive measures.

The association between intimate partner violence onset and gender-specific depression: A longitudinal study of a nationally representative sample

BackgroundIntimate partner violence (IPV) is a serious social problem that is often hidden, unnoticed or ignored. However, few studies have explored the effects of partner violence onset and/or persistence on the mental health of individuals. Thus, we aimed to investigate the association between IPV onset and depressive symptoms in both married men and women. MethodsIn this study, nationally representative data from the Korea Welfare Panel Study were employed to track 1040 men and 3732 women for a period of six years (2010–2015). Depressive symptoms were scored according to the 11-item Center for Epidemiologic Studies Depression Scale (CES-D-11). ResultsOf our study population, 415 men (39.9%) and 866 women (23.2%) suffered from continuous intimate partner violence, meaning that they reported experience of IPV in both the previous and current year of investigation. Such subjects had significantly higher CES-D-11 scores (men β: 1.745, p ≤ 0001; women β: 1.970, p ≤ 0001) as did subjects whose partners turned violent from non-violent (men β: 1.623, p ≤ 0001; women β: 1.594, p ≤ 0001) than those with continuously non-violent partners (reference group). Subjects whose partners turned non-violent from violent continued to be more depressed (men β: 0.312, p ≤ 009; women β: 0.880, p ≤ 000) than those with continuously non-violent partners. Through subgroup analysis, we also found that lower SES, as a covariate relative to educational attainment, household income, and economic status, was associated with worsened depression following IPV onset. Unemployed women with consistently violent partners (β: 2.957, p ≤ .0001) and unemployed men with newly violent partners (β: 3.010, p ≤ .0001) were more depressed than the employed or self-employed. ConclusionOur findings reveal that continuous IPV, as well as its onset, can have serious consequences for the mental health of its victims.

Androgen deprivation therapy and depression in men with prostate cancer treated with definitive radiation therapy.

There is no consensus on the association between the use of androgen deprivation therapy (ADT) and the risk of developing depression. This study investigated the association between ADT use and the development of depression, outpatient psychiatric services, inpatient psychiatric services, and suicide in a homogeneous group of men with prostate cancer (PC) treated with definitive radiation therapy (RT) after controlling for multiple sources of selection bias. This was a retrospective, observational cohort study of 39,965 veterans with PC who were treated with definitive RT and were diagnosed by the US Department of Veterans Affairs health care system between January 1, 2001, and October 31, 2015. Exposure was ADT initiation within 1year of the PC diagnosis. The primary outcome was new development of depression. Secondary outcomes were outpatient psychiatric use, inpatient psychiatric use, and suicide. During follow-up, 934 patients were newly diagnosed with depression, 7825 patients used outpatient psychiatric services, 358 patients used inpatient psychiatric services, and 54 patients committed suicide. In the multivariable competing risks regression model, ADT was associated with the development of depression (subdistribution hazard ratio [SHR], 1.50; 95% confidence interval [CI], 1.32-1.71; P<.001). ADT was also associated with outpatient psychiatric utilization (SHR, 1.21; 95% CI, 1.16-1.27; P<.001). Finally, ADT was not associated with inpatient psychiatric utilization or suicide. An increase in the risk of depression and the use of outpatient psychiatric services was observed in a large cohort of men with PC who received ADT with definitive RT. These results may provide further evidence for the long-term risks of ADT for psychiatric health in the treatment of PC.

Men, masculinities, depression: Implications for mental health services from a Delphi expert consensus study.

Tailoring psychological treatments to men's specific needs has long been a concern considering that many men are reluctant to seek or engage with professional help. The present study aimed to seek consensus via an expert panel regarding essential aspects to include in practitioner training programs for those working with men experiencing depression. A 2-round Delphi study was conducted to gain consensus among practitioners, researchers, and educators about the importance of a pool of 30 potential training program components across the following 6 domains: masculinity frameworks; impact of gender on clinical practice; depression in men; assessment and formulation; male-specific adaptations to treatment and; language and communication. The panelists comprised 53 multidisciplinary international experts in the men's mental health. Panelists were asked to rate each item on a 5-point likert scale from should not be included to essential. Consensus was defined as >80% of respondents scoring within 2 points on the Likert scale. After 2 Delphi rounds, consensus was reached for 22 of 30 items, and a further 2 items approached consensus. All items focused on features of depression among men and the impact of masculinities on clinical practice were endorsed. Items related to suicidality and depression diagnosis received the highest consensus, and the language and communication domain received limited support and was removed. This study provides a set of consensus-based recommendations for practitioner training. The recommendations offer actionable, gender-specific adaptations to psychological treatments for depression in men to be developed and trialed in practitioner training programs.

Personality Profile and Clinical Correlates of Patients With Substance Use Disorder With and Without Comorbid Depression Under Treatment.

Background: Among patients with substance use disorder (SUD), major depressive disorder (MDD) is highly prevalent. Even though, personality plays an important role in treatment outcomes for individuals with SUD and SUD + MDD, few studies have explored personality characteristics in these samples. This study aims to describe personality for patients with SUD taking into account the comorbid MDD, using the Alternative Five Factor Model (AFFM). We also aim to compare SUD + MDD patients with population norms and to elucidate possible personality clinical correlates.Methods: For our study, 116 male patients undergoing for SUD treatment were divided in two groups: SUD only (N = 58) and SUD + MDD (N = 58). To examine personality, we used the Zuckerman-Kuhlman Personality Questionnaire and multiple analyses of covariance were performed to identify differences. In a first analysis, age was introduced as a covariate whereas in a second analysis the continuous variables that showed to have a discriminant value for the groups were added as covariates. Variables predicting the presence of dual diagnosis and personality clinical correlates were analyzed by logistic and linear regression models, respectively. We observed that patients with SUD + MDD show distinctive personality characteristics compared with patients with SUD only and population norms.Results: According to the AFFM, SUD + MDD patients are characterized by higher Neuroticism-Anxiety (positively associated to depressive symptoms) and Impulsivity; and by lower Parties and Friends. Moreover, the probability of having a dual depressive disorder was represented by the amount of medications and substances used. The preference for hard work and the energy self-reported levels (Work Activity trait) are linked to these clinical variables rather than to the presence/absence of a dual depressive disorder.Conclusions: Even when controlling clinical variables related to a higher probability of having a dual depressive disorder, the Neuroticism-Anxiety is a personality trait that strongly differentiates between SUD only and SUD + MDD patients. Further investigation is needed to explore the role of this personality trait as endophenotype in dual depressive men. Our results underline the importance of a dimensional understanding of personality and its clinical correlates among patients with SUD + MDD; this approach could provide us information on specific treatment strategies to improve the prognosis of patients.

Emotional regulation and depression in a sample of separated and divorced Chilean adults

Previous studies have described the increase in depressive symptoms in divorced and separated individuals. However, the factors associated with depression have been little explored in this particular context. The aim of the present study was to assess the degree to which difficulties in emotional regulation are associated with depressive symptomatology in divorced and separated individuals. A sample of 1189 Chilean individuals, separated or divorced, completed self-reported measures of difficulties in emotional regulation and depression. The results obtained allow us to conclude that difficulties in emotional regulation, over other individual factors, such as early risk situations or circumstances of separation, are associated with higher rates of depression in men and women, explaining 41% of the variance of the depressive symptomatology. Emotional regulation difficulties are associated with greater depressive symptomatology in divorced/separated individuals. We discuss the clinical implications of these results, as well as future lines of research.

Associations between testosterone and metabolic syndrome in depressed and non-depressed older men and women.

ObjectivesOlder age and major depressive disorder (MDD) are both risk factors for the development of cardiovascular diseases. Testosterone has been associated with MDD and metabolic syndrome (MetS) in men, although associations in women are less clear. Therefore, we investigated whether testosterone is associated with MetS and whether this association is different for depressed and non‐depressed older men and women.MethodsIn this prospective cohort study, 478 participants (349 patients with MDD and 129 controls) aged between 60 and 93 years from the Netherlands Study of Depression in Older Persons were included. Total testosterone (TT) and sex‐hormone binding globulin levels were measured using a second‐generation radioimmune assay. Free testosterone (FT) was calculated based on TT. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria.ResultsA higher risk for MetS was found in men with low FT and TT (odds ratio [OR]: 0.67, 95% confidence interval [95%CI]: 0.47‐0.95 and OR: 0.51, 95%CI: 0.34‐0.75), and in women with high FT (OR: 1.41, 95%CI: 1.08‐1.82). Strong associations in the same direction were found with adiposity, glucose, and plasma lipid MetS components at baseline, but not with changes in these components at 2‐year follow‐up. The associations did not significantly differ between MDD patients and controls.ConclusionsIndependently of having MDD, low testosterone levels in men and, in contrast, high testosterone levels in women were significantly associated with MetS and its components.

Unemployment, Self-esteem, and Depression: Differences between Men and Women.

Although there is a vast bibliography on the negative consequences of unemployment for mental health, there are no studies that analyze the differences between men and women in relation to the consequences that unemployment could have simultaneously on self-esteem and depression. The main objective of this study was to analyze whether, unemployment is differentially associated with the self-esteem of men and women, and to test whether this circumstance can be considered a psychological mechanism by which we could explain differences in depression for men and women. Results show that self-esteem is a mediating variable (indirect effect = .11; 90% CI [.04, .19]), considering its differential impact on depression, but this mediation is moderated by the gender of the respondents (b = .21, 90% IC [.01, .40]. In summary, unemployment is associated with lower self-esteem, which in turn is related to greater depressive symptoms. This relationship is only observed for men and not for women.

Mental health, functional ability, and health-related quality of life in elderly patients attending a tertiary hospital of Patna

Background: With changing socioeconomic, demographic, and development scenario, there is a cultural shift in looking after the elderly population which may lead to depression in this age group. Materials and Methods: The study was a hospital-based cross-sectional study conducted in the orthopedic department of a tertiary care setting on 157 elderly individuals. This study was conducted with objectives to estimate the proportion of depression using the Geriatric Depression Scale Short Form (GDS-SF) questionnaire along with its associated factors in geriatric population coming to the orthopedic department of the institute. The study tools were GDS-SF, Katz Index of Independence in activities of daily living (ADL), the Lawton instrumental ADL, and health-related quality of life by the Centers for Disease Control. Results: The proportion of depressed individuals was 70/157 (44.6%) using GDS as a tool. The maximum number was in the age group of 60–74 years. Women outnumbered men (51.3% vs. 38.31%) for depression. The depression using GDS score was more prevalent in rural elderly, illiterate, and elderly who were economically dependent on their children and who belonged to lower middle socioeconomic status. Approximately 98% of the study participants were found to be independent using ADL. Approximately 60% males and 68% females were dependent for the instrumental ADL using Lawton score. Most of the study participants had arthritis as a major impairment sharing almost equal proportion among males and females. Conclusion: The current study concludes that there is a very high proportion of elderly subjects who are experiencing depression using the GDS-SF tool. There should be regular screening for this disease in this age group even in a tertiary care setting.

Cognitive Behavioural Therapy Suicide Prevention (CBT-SP) imagery intervention: a case report

Abstract Very little clinical work or research to date has focused on the prioritization of suicidal imagery intervention in the stabilization of risk. Current Cognitive Behavioural Therapy Suicide Prevention (CBT-SP) does not specifically address suicidal imagery as a priority intervention. This paper prioritizes imagery modification as the central task of therapy with the suicidal client. This is a single subject case review describing specific imagery interventions used to destabilize the comforting component of suicidal images, de-glamourize the suicidal image as a problem-solving method and the reconstruction of new images to offset the emotional grasp of both ‘flash-forward’ violent suicidal images and suicidal ‘daydreaming’ rumination. It is hypothesized that when suicidal images become less emotionally charged, the desire to act upon suicide decreases. Focusing on imagery intervention as a priority aims to stabilize risk in a more clinically specific and targeted way. Rob is a 19-year-old depressed young man with chronic suicidal ideation/images with repeated suicide attempts. All GP referrals are of a crisis nature since the age of 16. He was referred to a CBT clinician with specific training and experience in CBT-SP who proposed the following brief imagery intervention. Socialization to treatment rationale was pivotal at the outset to help facilitate strong therapeutic alliance, ‘buy-in’ to the intended de-glamourization of suicide planning/daydreaming/rumination and the effects of intrusive ‘flash-forward’ images on emotional well-being. Therapy was facilitated weekly, supported by telephone contact, on an out-patient basis in the HSE (Health Service Executive) Irish Adult Mental Health service. The care plan and interventions were supported by access to the 24-hour acute Adult Mental Health services, as required. There was no requirement for direct client engagement with the acute services. Rob engaged with five treatments of CBT-SP imagery intervention and full stabilization of risk to self by suicide was achieved. At the time of writing, Rob is alive, has no engagement with the services and no further GP referral requests for intervention. Despite Rob leaving therapy before full completion, brief targeted suicidal imagery intervention was observed to stabilize the risk of suicidal behaviour. This young man has completed his schooling, engaged in ‘life’ planning rather than ‘death’ planning and has not required further intervention from this service. Further research is required to engage frontline clinicians on the merits of suicidal imagery assessment in routine clinical practice. Key learning aims (1) To assess for imagery and violent day dreaming in suicidal patients. (2) Conceptualizing suicidal rumination and daydreaming as being a maladaptive problem-solving technique in overcoming psychological pain. (3) Use of suicide-specific assessment. (4) Ask about the presence of suicidal imagery as part of routine mental health assessment with the suicidal client.