From Thought to Action: An Exploratory Study of Underappreciated Suicidal Rehearsal

Suicidal rehearsal is a crucial intermediate type between suicidal thoughts and suicidal attempts, yet it has received limited attention due to insufficient empirical research. This study aimed to investigate its clinical characteristics. Participants were recruited from a pool of 11,390 college students. A total of 244 students (mean age = 18.47, 52.05% male) with a lifetime history of suicidality consented to participate and completed self-report measures assessing the acquired capability for suicide, current symptoms, suicide risk, and demographic characteristics. A total of 15.57% of participants with a lifetime history of suicidal ideation and/or attempts reported engaging in suicidal rehearsal. Suicidal ideators who had suicidal rehearsals reported higher acquired capability for suicide and higher suicide risk and lower anxiety scores than those without such rehearsals. Suicidal rehearsal was associated with greater odds of several factors, including anxiety, fearlessness about death, suicidal planning, and suicidal preparation. In addition, individuals who reported rehearsal had higher odds of reporting aborted, interrupted, and actual suicidal attempts. Suicidal rehearsal is relatively common among individuals with suicidality and may represent a more action-oriented form of suicidal behavior. Clinically, it is important to screen for suicidal rehearsal, especially in individuals reporting suicidal ideation or planning. Future research should focus on developing standardized tools to assess suicidal rehearsal and integrating these measures into routine suicide risk assessments.