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. Author manuscript; available in PMC: 2026 Jan 27.
Published in final edited form as: J Affect Disord. 2025 Dec 14;397:120920. doi: 10.1016/j.jad.2025.120920

Pessimistic Repetitive Thought, Goal-Oriented Repetitive Thought, and Positive Indulging about the Future as Predictors of Suicide Ideation among Treatment-Seeking Adolescents

Lucy Liotta a, Adriana Espinosa b, Ana Ortin-Peralta c,d, Peggilee Wupperman e, Regina Miranda a,*
PMCID: PMC12834532  NIHMSID: NIHMS2132446  PMID: 41401905

Abstract

Repetitive thinking about the future plays a crucial role in adolescent suicide ideation, yet the specific forms of future-oriented repetitive thought that predict suicide ideation, and their psychological mechanisms, remain understudied. This study investigated how three dimensions of future-oriented repetitive thought predicted suicide ideation among treatment-seeking adolescents and whether depressive symptoms mediated the relationship. Adolescents (N = 119; ages 12–19) who presented to the emergency department or outpatient treatment with recent suicide ideation or attempts completed a measure capturing three dimensions of future-oriented repetitive thought: pessimistic repetitive future thinking, repetitive thinking about future goals, and positive indulging about the future. They also completed self-report measures of depressive symptoms and suicide ideation at baseline and 3-month follow-up. Pessimistic repetitive thinking had a significant direct effect on suicide ideation at 3 months (c’ = 0.44, 95% CI [0.01, 0.86]). Both pessimistic repetitive thinking (ab = 0.39, 95% CI [0.09, 0.70]) and positive indulging (ab = 0.54, 95% CI [0.03, 1.00]) showed a significant indirect effect on suicide ideation through increased depressive symptoms at 3 months. Repetitive thinking about future goals was not significantly associated with either depressive symptoms or suicide ideation at follow-up. These findings extend our understanding of the cognitive processes underlying suicide ideation among adolescents, highlighting pessimistic future thinking and positive indulging as a potential intervention target distinct from traditional constructs like rumination. Results suggest that how adolescents repetitively think about their futures, particularly their tendency to engage in pessimistic future-oriented repetitive thought, may be important in maintaining suicide ideation.

Keywords: Repetitive thought, future expectancies, suicide ideation, depression, adolescents

1. Introduction

Suicide ideation (SI), suicide attempts (SA), and suicide deaths are major public health concerns across the lifespan, with adolescence, ages 10 to 19 years old, being a particularly high-risk period for the onset and peak of SI and SA (Gaylor et al., 2023). Recent data suggest that in the United States, about one in five high school students seriously considers attempting suicide and about one in ten attempts suicide in a given year (CDC, 2024). While cognitive factors, particularly depression and future-oriented cognition, are well-documented predictors of SI and SA among adolescents (Miranda-Mendizabal et al., 2019; Ribeiro et al., 2018), the specific mechanisms that give rise to maladaptive future-oriented cognition and subsequent suicidal thoughts and behaviors have been less well studied. The present study sought to fill this gap by investigating the relationship between different dimensions of future-oriented repetitive thought, depressive symptoms, and SI to clarify the cognitive processes underlying SI among treatment-seeking adolescents.

1.1. Future-oriented Repetitive Thought and Suicide Ideation

Existing constructs of repetitive thought often implicated in depression and suicide-related risk, such as rumination and worry, focus on negative content and outcomes (Kerkhof & Spijker, 2011; Law & Tucker, 2018). Unlike rumination, which focuses on negative, past-oriented thoughts, future-oriented repetitive thought (FoRT) is a broader construct involving mental rehearsal in considering whether positive or negative outcomes happen in one’s future (Andersen & Limpert, 2001; Miranda et al., 2017b, 2023). It is a cognitive process, rather than a cognitive product (see Beck & Haigh, 2014) – meaning, it involves the process of thinking about the possibility of future outcomes occurring rather than simply having a particular expectation about the future. It shares some similarities with worry, a key feature of anxiety disorders, particularly in its focus on future events (Liang et al., 2021). However, unlike worry, which primarily involves the anticipation of negative outcomes, FoRT can include the consideration of both positive and negative future possibilities (Miranda et al., 2017b). This broader scope is especially pertinent in understanding the development of adolescent depression, SI, and SAs, which have been characterized by a reduced positive outlook and an inability to imagine a clear future for oneself (Tang et al., 2023). Three distinct dimensions of FoRT have been identified: pessimistic repetitive future thinking (FoRT-PT) (i.e., perseverating on the possibility of negative or the absence of positive future outcomes), repetitive thinking about future goals (FoRT-FG) (i.e., mental rehearsal of goal-directed activities needed to obtain desired outcomes), and positive indulging about the future (FoRT-PI) (i.e., repeatedly fantasizing about desired future outcomes as if they were actually occurring) (Miranda et al., 2017b; see also Oettingen, 2015).

1.2. The Relationship Between Future-oriented Repetitive Thought, Depression, and Suicide-Related Risk

The constructs of FoRT have demonstrated unique associations with depressive symptoms, SI, and SA among adolescent and young adult samples. For instance, studies have found that pessimistic future-oriented repetitive thought (FoRT-PT) is concurrently and prospectively associated with depressive symptoms and SI severity. A study of an ethnoracially diverse sample of young adults found that FoRT-PT predicted increases in depressive symptoms over time, which in turn predicted greater SI severity (Miranda et al., 2023b). Among adolescents, in particular, a recent meta-analysis concluded that negative future-related thinking (broadly conceptualized to include higher hopelessness, lower positive future expectations/optimism, and lower hope) predicted subsequent depressive symptoms, even after adjusting for baseline depressive symptoms (Tang et al., 2024), but such research has not, to our knowledge, considered the impact of future-oriented thinking as a repetitive thought process among adolescents (i.e., it has focused on whether people expect positive or negative outcomes to occur rather than the process of mentally rehearsing/thinking about the possibility of those outcomes occurring or not occurring). Researchers have previously suggested that the extended mental rehearsal of pessimistic thinking may strengthen future-event schemas, making negative outcomes seem inevitable as individuals misattribute their cognitive fluency in generating negative future scenarios as evidence of their likelihood or certainty (Andersen et al., 1992; Andersen & Limpert, 2001; Miranda et al., 2023b).

Positive future thinking – usually conceptualized as the ability to anticipate a positive or desired future – has also been implicated in the development of depressive symptoms and SI, with the consensus being that a lack of positive future thinking confers risk for both outcomes (Cha et al., 2024; Kirtley et al., 2018). Research with a community sample of adolescents and young adults found that daily positive future thinking – operationalized via a question, administered daily over 6 days, asking whether participants were looking forward to their day – was associated with lower past-week SI (Kirtley et al., 2022).

Beyond the reduced quantity of positive future thought, the ability to envision ways to achieve a future goal differs among individuals with depression, SI, and SA. A recent study found that adolescents with SI had significant difficulty generating action-related details when imagining future events (Cha et al., 2024). Furthermore, a strong future orientation, the ability to think about and plan for future goals, was found to be protective against hopelessness and depressive symptoms among adolescents following emotional victimization experiences (Hamilton et al., 2015). Younger adults (ages 24 or below) hospitalized for self-harm (with some suicidal intent) who struggled with goal regulation, specifically the ability to disengage from unattainable goals and reengage with new ones, demonstrated greater vulnerability to self-harm repetition (O’Connor et al., 2012). Furthermore, adults who engaged in non-suicidal self-injury were able to generate the same number of future goals as individuals without a history of non-suicidal self-injury, but rated their goals as less specific, less in their control, and less likely to be achieved (Vincent et al., 2004). This suggests that specific aspects of positive future thinking, particularly how vividly one can imagine taking concrete actions toward goals and one’s perceived ability to achieve those goals, may be more relevant to understanding suicide-related risk, rather than the overall ability to generate positive future goals.

Although positive future thinking has traditionally been viewed as protective against depression and suicidal thoughts and behaviors (MacLeod & O’Connor, 2018), research has also revealed that certain forms of positive future thinking may confer psychological risk among adolescents and adults. Positive indulging about the future (i.e., fantasizing about desired future outcomes without thinking about the attainability of the outcomes; see Oettingen & Mayer, 2002) is one form of positive future thinking with both maladaptive and adaptive relationships to depression and suicide-related risk. For example, previous research among both children and adults suggests that while fantasizing about a positive future (i.e., positive indulging) initially reduces depressive symptoms, it is associated with increased depressive symptoms longitudinally (Oettingen et al., 2016). One plausible explanation for these findings is that thinking about positive future events without considering potential obstacles can impede motivation and goal attainment, leading to disappointment when expectations go unfulfilled (Oettingen et al., 2016; Pollak et al., 2021). Relatedly, a higher degree of self-focused thoughts may contribute to risk of a suicide attempt through heightened self-criticism when individuals perceive themselves as failing to meet idealized and often unrealistic social standards (Kirtley et al., 2018). In addition, a study with a community sample of adolescents found that unrealistic positive future thinking (measured by the proportion of anticipated positive events adolescents generated that did not occur during a 6-month follow-up) was found to strengthen the relationship between defeat/entrapment and subsequent SI (Pollak et al., 2021), suggesting that generating unattainable positive future expectations may increase vulnerability to SI. However, the study did not test the relationship between unrealistic positive future thinking and SI severity. Similarly, among a sample of adolescents with a history of SI or SAs, only highly novel positive future thinking (i.e., thinking about events that were low in similarity to those experienced previously) predicted greater SI severity 6 months later, whereas positive future thinking low in novelty did not (Nam & Cha, 2024). These findings suggest that the relationship between positive future thinking and psychological outcomes depends on the specific characteristics of future thinking, with unrealistic positive future thinking potentially increasing vulnerability and goal-oriented positive future thinking decreasing vulnerability to depression and suicidal thoughts and behaviors. As with studies of negative future thinking among adolescents, studies of positive future thinking among adolescents have also, thus far, tended to focus on cognitive products rather than process.

1.3. Depressive Symptoms as a Potential Mediator

Beck’s cognitive model of depression proposes that negative, distorted cognitions about oneself, one’s experiences, and one’s future lead to depression and, in severe cases, SI (Beck et al., 1976; Beck & Bredemeier, 2016). According to this model, individuals with depression develop a negative cognitive schema that filters information to confirm their negative beliefs, creating cognitive distortions that maintain depressive symptoms (Beck & Bredemeier, 2016). In line with this model, multiple large-scale studies have established depression as one of the strongest correlates and/or predictors of SI and SA among adolescents (Bridge et al., 2006; Lu & Keyes, 2023; Nock et al., 2013), with approximately 50–65% of adolescents experiencing a depressive episode reporting SI (Avenevoli et al., 2015).

Building on Beck’s model, the hopelessness theory of depression proposes that hopelessness, which is conceptualized as the expectation of negative outcomes and absence of positive ones, is thought to be a proximal cause of depression (Abramson et al., 1989). While some researchers suggest hopelessness emerges from rumination about negative moods (Nolen-Hoeksema et al., 2008; Smith et al., 2006), others propose it stems from the cognitive process of repetitively thinking about future events (Andersen & Limpert, 2001; Miranda et al., 2017b, 2023). In line with the hopelessness theory of depression, Andersen and colleagues conceptualized hopelessness as depressive predictive certainty, which is the point where individuals are 100% certain that negative outcomes will occur in their future and that positive outcomes will not occur (Andersen, 1990; Andersen & Limpert, 2001). They suggested that, over time, people who engaged in pessimistic FoRT (what they termed “rumination about the future” (Andersen & Limpert, 2001, p. 314) developed cognitive fluency in generating pessimistic predictions – i.e., that as individuals repeatedly engaged in this process, they might misattribute the automaticity of these predictions to their inevitability, increasing their susceptibility to the maladaptive effects of these thoughts (Schacter et al., 2012; Segerstrom, 2003), and thus increasing vulnerability to depressive symptoms. One study with young adults found that FoRT-PT was indirectly associated with SI through the serial relationship between decreased cognitive fluency in anticipating positive future outcomes, increased depressive predictive certainty, and increased depressive symptoms (Miranda et al., 2023b). Taken together, these theoretical frameworks and empirical findings support the hypothesis that depressive symptoms may mediate the relationship between FoRT and SI among adolescents.

Despite growing evidence linking the constructs of FoRT to both depressive symptoms and SI, it remains unclear whether depressive symptoms explain how the different types of future-oriented repetitive thinking contribute to SI among adolescents, particularly those already experiencing suicidal thoughts and behaviors. This is a significant gap in our understanding of the specific mechanisms through which future-oriented cognition might maintain or exacerbate SI among adolescents. Clarifying these mediational pathways could help inform interventions by identifying which aspects of future-oriented repetitive thinking contribute most strongly to depressive symptoms and subsequent SI severity among high-risk adolescents.

1.3. The Current Study

Given that adolescence is characterized by an increase in suicidal thoughts and behaviors (Gaylor et al., 2023) and a focus on future goals (Nurmi, 1991, 2005), understanding how future-oriented repetitive thinking confers risk or protects against SI can provide valuable insights into the development and prevention of suicide-related risk. The current study investigated the prospective relationship between three dimensions of FoRT and SI severity in a clinical sample of adolescents and whether depressive symptoms would mediate these relationships. We hypothesized that pessimistic repetitive future thinking (FoRT-PT) and positive indulging (FoRT-PI) at baseline would predict increased depressive symptoms at follow-up and, in turn, increased SI severity. In addition, we hypothesized that repetitive thinking about future goals (FoRT-FG) would show a negative indirect relationship with SI through decreased depressive symptoms at follow-up. These findings may help to clarify which cognitive processes maintain or exacerbate suicide-related risk over time among adolescents already experiencing suicidal thoughts or behaviors.

2. Method

2.1. Participants

This study involved secondary analysis of data from adolescents, ages 12–19, who presented for clinical care shortly after recent SI or SA, and participated in a larger study of adolescent SI between November 2017 and January 2023 in the Northeastern United States (see Miranda et al., 2023a, sample 2; Miranda et al., 2025; Schaeffer et al., 2025; Shikh et al., 2025). From an initial sample of 163 adolescents, our final sample for the present study only included participants who completed both the baseline and 3-month follow-up sessions (N = 119). Participants were recruited from four clinical sites: the emergency department (ED) of a public hospital in New York City (n = 102), two outpatient clinics in New York City (n = 8), and an adolescent inpatient department and transitional living program at a private hospital in Connecticut (n = 9). Adolescents were eligible to participate if they were between 12 and 19 years old, endorsed SI or SA(s) – with or without SI – within the prior two weeks, were fluent in English, and had a parent/caregiver who was fluent in either English or Spanish. Adolescents who presented with non-suicidal self-injury (NSSI) (i.e., self-harm without intent to die), but did not report SI or SA, were excluded from the study. Further exclusion criteria included being in foster care or unable to provide consent (e.g., if experiencing drowsiness or acute psychosis, or having a pervasive intellectual disability or receptive/expressive language disorder that prevented comprehension of questions). Participant demographic information, including age, ethnoracial distribution, gender, sex, and sexual orientation, can be found in Table 1.

Table 1.

Demographic Characteristics of Total Sample (N = 119)

M (SD) n (%)
Age 15.26 (1.92)
Gender+
 Cisgender female 72 (61)
 Cisgender male 28 (24)
 Transgender or gender diverse 18 (14)
Sexual orientation+
 Heterosexual 45 (38)
 Bisexual 38 (32)
 Gay or lesbian 7 (6)
 Other a 18 (15)
 None/not sure 10 (6)
Sex assigned at birth
 Female 92 (77)
 Male 27 (23)
Ethnoracial distribution
 Hispanic/Latine (multiracial) 65 (55)
 Black, Hispanic 26 (22)
 Black, Non-Hispanic 18 (15)
 Other b 10 (8)
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a

Other includes asexual, pansexual, or queer.

b

Other includes Multiracial and White, Non-Hispanic.

+

One person did not provide information.

2.2. Procedure

Potentially eligible participants were identified by clinicians in the emergency department, inpatient, or outpatient departments at each respective site and were asked if the study team could approach the adolescents and one of their parents/caregivers with further information about the research study. Once recruited, parents/caregivers provided parental permission in either English or Spanish for adolescents to participate (if under the age of 18 years old), and adolescents provided informed assent or consent (if age 18 or above) in English. Adolescents completed a baseline session within two weeks of their most recent SI or SA. Participants were followed up 2–4 weeks after baseline to complete measures unrelated to the current analyses (see Schaeffer et al., 2025; Shikh et al., 2025) and 3 months later. Each participant was interviewed by a trained research assistant either at the hospital or clinic from which they were recruited, a research lab at a public college in New York, NY, or remotely via phone or Zoom. Self-report measures were also completed independently by adolescents. Adolescents received $25 at the initial baseline session and between $20-$30 for participating in the 3-month follow-up, depending on how many measures they completed during the session. To assess participant risk in subsequent follow-ups, interviewers screened participant responses for recent SI or SA. If a participant endorsed recent SI (within the past two weeks) or a SA (within the past month), they were further assessed at the end of the session using a High Risk Questionnaire (HRQ) developed by the study team (Miranda et al., 2022). This study was approved by the Institutional Review Boards (IRBs) of the City University of New York (CUNY), NYC Health + Hospitals/Lincoln, and the Visiting Nurse Service of New York.

2.3. Measures

2.3.1. Demographics.

Demographic information was collected through adolescent self-reports during the first and second baseline sessions, including age, race, ethnicity, gender identity, sex, and sexual orientation.

2.3.2. Future-oriented Repetitive Thought.

Adolescents completed the Future-oriented Repetitive Thought Scale (FoRT; Miranda et al., 2017b) at baseline to assess the extent to which they repeatedly thought about the likelihood of positive or negative events happening in their futures. This 16-item scale measures three subtypes of FoRT: pessimistic repetitive future thinking (FoRT-PT; “I think about the possibility of good things not happening in the future”), repetitive thinking about future goals (FoRT-FG; i.e., “I imagine the steps I need to take to get things that I want in life”), and positive indulging about the future (FoRT-PI; i.e., “I daydream about the things that I want to happen”) (Miranda et al., 2017b). Participants rated how often they thought about their future in these ways using a 4-point Likert scale from 0 (Never) to 3 (Almost always).

The FoRT scale has previously shown good internal consistency reliability (α = .76) among a young adult sample (Miranda et al., 2017b), and the scale’s factor structure has been validated in samples of university students in the United States (Miranda et al., 2017b) and China (Liu et al., 2024). The FoRT scale also demonstrated adequate psychometric properties in the current sample.1 Internal consistency reliability was excellent (α = .90), with each subscale showing good to excellent internal consistency: FoRT-PT (α = .90), FoRT-PI (α = .78), and FoRT-FG (α = .85). Total FoRT-PT scores ranged from 0 to 24 (M = 13.07, SD = 6.32), FoRT-PI scores ranged from 0 to 12 (M = 6.01, SD = 3.20), and FoRT-FG scores ranged from 0 to 12 (M = 6.48, SD = 3.37).

2.3.3. Suicide Ideation.

The Suicidal Ideation Questionnaire-Junior (SIQ-JR; Reynolds, 1987) was administered at baseline and the 3-month follow-up visit to assess SI severity in the previous month. The SIQ-JR is a 15-item scale designed to measure the past-month frequency of SI among adolescents, including thoughts of being better off dead (e.g., “I thought that killing myself would solve my problems,”), of wanting to share their suicidal intent with others (e.g., “I thought about telling people I plan to kill myself,”), and of killing oneself (e.g., “I thought about when I would kill myself”). Each item was rated on a six-point Likert scale from 1 (Almost every day) to 6 (I never had this thought) (Note: the original scale goes from 1 to 7, but due to an error, one response option – “couple of times a month” – was not included, therefore, response options were on 6-point rather than 7-point scale). All items were reverse-coded to a scale from 0 (I never had this thought) to 5 (Almost every day), so that higher scores indicated more frequent SI. Items were then summed to create a total SI score ranging from 0 to 75. We were unable to compare total scores in the present sample to the recommended clinical cutoff of 31 for the SIQ-JR, because of our modified 6-point vs. a 7-point scale. A recent systematic review found that the internal consistency of the SIQ-JR was excellent (α = .91-.95) (Courtney et al., 2024). Internal consistency reliability in the current sample was α = .94 at baseline and α = .93 at the 3-month follow-up. Scores ranged from 0 to 75 (M = 33.05, SD = 19.36) at baseline and from 0 to 60 (M = 19.91, SD = 14.93) at the 3-month follow-up.

2.3.4. Depressive Symptoms.

Depressive symptoms were assessed at baseline and the 3-month follow-up using the Patient Health Questionnaire for Adolescents (PHQ-A; Johnson et al., 2002). The PHQ-A is a 13-item self-report questionnaire used to assess depressive symptoms among adolescents within the last two weeks using DSM-IV criteria. Adolescents were asked to rate the severity of various depressive symptoms in the previous two weeks using a 4-point Likert scale ranging from 0 (Not at all) to 3 (Nearly every day). A total score is generated by summing the first 9 items and has a clinical cut-off score of 10. The PHQ-A has previously demonstrated excellent internal consistency (α = .89) (Johnson et al., 2002). In the current sample, internal consistency was α = .86 at baseline and α = .88 at the 3-month follow-up. Scores ranged from 0 to 27 (M = 15.27, SD = 6.73) at baseline and from 0 to 27 (M = 10.61, SD = 7.36) at the 3-month follow-up.

2.4. Data Analysis

Pearson correlations examined the bivariate associations between FoRT-PT, FoRT-PI, FoRT-FG, depressive symptoms at baseline and 3 months, and SI severity at baseline and 3 months. To test our mediation hypotheses, we conducted mediation analyses using Model 4 of the Process Macro, version 4.2 (Hayes, 2022). We examined whether depressive symptoms at 3 months mediated the relationship between baseline FoRT subscales and SI severity at 3 months, adjusting for baseline SI and depressive symptoms. Bootstrapped confidence intervals for the indirect effects were calculated using 5,000 replications. Due to detected heteroscedasticity in the Breusch-Pagan tests (p < .01), the heteroscedasticity-consistent (HC3) estimator was used for robust standard errors. Missing values for baseline SIQ-JR (n = 2), SIQ-JR at 3 months (n = 3), baseline PHQ-A (n = 1), and PHQ-A at 3 months (n = 1) were imputed using multivariate normal imputation, via SPSS Version 31.0, before conducting analyses. Little’s MCAR test was not significant, χ2 (24) = 23.56, p = .49, indicating data were missing completely at random. A post hoc power analysis conducted using the PAMLj module of Jamovi, version 2.6 (The Jamovi Project, 2024) indicated that a sample size of at least 109 would be sufficient to detect a minimum indirect effect of β = 0.09 with at least 80% power. Thus, our sample size of 119 provided sufficient power for our analyses.

To assess for potential attrition bias, we compared participants who completed the 3-month follow-up (n = 119) with those who completed only the baseline assessment (n = 44) on demographic and clinical characteristics. Chi-square analyses revealed a significant difference in ethnoracial distribution, χ2(3) = 7.92, p < .05, with a higher proportion of Hispanic/Latine participants only completing the baseline assessment (71%) compared to the 3-month follow-up (55%). No significant differences were found for sex at birth, χ2(1) = 0.00, p = .99, gender identity, χ2(1) = 0.04, p = .84, or sexual orientation, χ2(1) = 1.32, p = .25. Independent samples t-tests showed no significant differences in age, t(161) = 0.30, p = .76, baseline SI severity, t(157) = 1.05, p = .30, baseline depressive symptoms, t(160) = 0.09, p = .93, FoRT-PF, t(157) = 0.47, p = .64, or FoRT-PI, t(157) = 1.07, p = .29, between those who were excluded versus those who were included. However, participants who only completed the baseline assessment reported significantly higher FoRT-FG (M = 7.70, SD = 3.21) compared to participants who also completed the 3-month follow-up (M = 6.48, SD = 3.37), t(157) = 2.01, p < .05.

3. Results

3.1. Correlations

Correlations can be found in Table 2. Pessimistic future-oriented repetitive thought (FoRT-PT) was significantly and positively correlated with baseline SI severity, baseline depressive symptoms, depressive symptoms at 3 months, and SI severity at 3 months. Repetitive thinking about future goals (FoRT-FG) was not significantly related to baseline SI severity, baseline depressive symptoms, SI at 3 months, or depressive symptoms at 3 months. Positive indulging about the future (FoRT-PI) was significantly associated with baseline SI severity, baseline depressive symptoms, depressive symptoms at 3 months, and SI severity at 3 months. Depressive symptoms at 3 months were correlated with SI at 3 months. Variance Inflation Factors (VIF) and tolerance values were calculated to test for multicollinearity among predictors. VIF values ranged from 1.03 to 1.82 across all three models, with corresponding tolerance estimates ranging from 0.55 to 0.97. Notably, the VIFs were well below common thresholds of 5 or 10 indicating low collinearity, and low shared variance among model variables.

Table 2.

Descriptives and Bivariate Correlations Between Symptom Measures and Future-oriented Repetitive Thinking

Variable M (SD) 1 2 3 4 5 6 7
1. Pessimistic repetitive future thinking (FoRT-PT) 13.07 (6.32) —
2. Repetitive thinking about future goals (FoRT-FG) 6.48 (3.37) .24** —
3. Positive indulging about the future (FoRT-PI) 6.01 (3.20) .55** .57** —
4. Suicide ideation severity (Baseline) 33.05 (19.36) .54** .03 .31** —
5. Suicide ideation severity (3 months) 19.91 (14.93) .49** .16 .34** .36** —
6. Depressive symptoms (Baseline) 15.27 (6.73) .57** −.08 .31** .46** .40** —
7. Depressive symptoms (3 months) 10.61 (7.36) .42** .08 .30** .17 .68** .50** —
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Note.

**

p < .01;

*

p < .05. N = 119

3.2. Mediation Results

Pessimistic repetitive future thinking (FoRT-PT) was associated with higher depressive symptoms at 3 months, a = 0.31, SE = 0.13, 95% CI [0.06, 0.56], and depressive symptoms were significantly associated with greater SI severity at 3 months, b = 1.27, SE = 0.15, 95% CI [0.97, 1.57]. There was a significant indirect effect of FoRT-PT on SI through depressive symptoms, ab = 0.39, Bootstrapped SE = 0.16, 95% Bootstrapped CI [0.09, 0.70], β = 0.17 (medium effect size). The direct effect of FoRT-PT on SI was statistically significant after accounting for the mediator, c’ = 0.44, SE = 0.22, 95% CI [0.01, 0.86]. See Figure 1.

Figure 1. Mediation Model with Baseline Pessimistic Future Thinking as a Predictor of Suicide Ideation at 3-Month Follow-Up.

Figure 1

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**p < .01; *p < .05. Analyses adjusted for baseline suicide ideation and baseline depressive symptoms. c = total effect; Pessimistic Future Thinking predicting Suicide Ideation (3 months). c’ = direct effect; Pessimistic Future Thinking predicting Suicide Ideation (3 months), adjusting for depressive symptoms (3 months). Coefficients shown are unstandardized.

Positive indulging (FoRT-PI) was significantly associated with greater depressive symptoms at 3 months, a = 0.41, SE = 0.19, 95% CI [0.04, 0.78], and depressive symptoms were significantly associated with greater SI severity at follow-up, b = 1.31, SE = 0.15, 95% CI [1.02, 1.60]. There was also a statistically significant indirect effect of FoRT-PI on SI at follow-up through depressive symptoms at 3 months, ab = 0.54, Bootstrapped SE = 0.25, 95% CI [0.03, 1.00], β = 0.12 (medium effect size). The direct effect of FoRT-PT on SI severity was not statistically significant, c’ = 0.41, SE = 0.32, 95% CI [−0.22, 1.04], suggesting that depressive symptoms mediated the relation between positive indulging and SI. See Figure 2.

Figure 2. Mediation Model with Baseline Positive Indulging as a Predictor of Suicide Ideation at 3-Month Follow-Up.

Figure 2

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**p < .01; *p < .05. Analyses adjusted for baseline suicide ideation and baseline depressive symptoms. c = total effect; Positive Indulging predicting Suicide Ideation (3 months). c’ = direct effect; Positive Indulging predicting Suicide Ideation (3 months), adjusting for depressive symptoms (3 months). Coefficients shown are unstandardized.

Repetitive thinking about future goals (FoRT-FG) was not significantly associated with depressive symptoms at 3 months, a = 0.27, SE = 0.17, 95% CI [−0.06, 0.60]. However, depressive symptoms were positively associated with greater SI severity at 3 months, b = 1.31, SE = 0.14, 95% CI [1.04, 1.59]. The indirect effect of FoRT-FG on SI at follow-up through depressive symptoms at 3 months was not statistically significant, ab = 0.36, Bootstrapped SE = 0.22, Bootstrapped 95% CI [−0.04, 0.83], β = 0.08 (small effect size). The direct effect of FoRT-FG on SI was also not statistically significant, c’ = 0.43, SE = 0.29, 95% CI [−0.14, 1.00]. See Figure 3. Final regression models are shown in Table 3.

Figure 3. Mediation Model with Baseline Future Goals as a Predictor of Suicide Ideation at 3-Month Follow-Up.

Figure 3

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**p < .01; *p < .05. Analyses adjusted for baseline suicide ideation and baseline depressive symptoms. c = total effect; Future Goals predicting Suicide Ideation (3 months). c’ = direct effect; Future Goals predicting Suicide Ideation (3 months), adjusting for depressive symptoms (3 months). Coefficients shown are unstandardized.

Table 3.

Final Regression Models Predicting Suicide Ideation at 3-Month Follow-Up

Model 1 b S.E. p 95 % CI R 2
Predictors
FoRT-PT (baseline) 0.44 0.22 .04* 0.01, 0.86 0.55
Depressive symptoms (3 mo.) 1.27 0.15 < .01** 0.97, 1.57
Covariates
Suicide ideation (baseline) 0.15 0.07 .03* 0.01, 0.29
Depressive symptoms (baseline) −0.24 0.22 .27 −0.68, 0.19
Model 2 b S.E. p 95 % CI R 2
Predictors
FoRT-PI (baseline) 0.41 0.32 0.22 −0.24, 1.06 0.54
Depressive symptoms (3 mo.) 1.31 0.15 < .01** 1.01, 1.61
Covariates
Suicide ideation (baseline) 0.19 0.06 <.01** 0.08, 0.30
Depressive symptoms (baseline) −0.14 0.18 .46 −0.50, 0.23
Model 3 b S.E. p 95 % CI R 2
Predictors
FoRT-FG (baseline) 0.43 0.29 .13 −0.14, 1.00 0.54
Depressive symptoms (3 mo.) 1.31 0.14 < .01** 1.04, 1.59
Covariates
Suicide ideation (baseline) 0.20 0.07 .01* 0.05, 0.34
Depressive symptoms (baseline) −0.07 0.20 .71 −0.48, 0.33
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**

p < .01;

*

p < .05. FoRT = Future-oriented repetitive thought; PT = Pessimistic future thinking; PI = Positive indulging about the future; FG = Repetitive thinking about future goals

4. Discussion

This study sought to investigate the relationships between the three dimensions of future-oriented repetitive thought, depressive symptoms, and SI among a longitudinal sample of adolescents with a history of SI or SA. Our analyses revealed that pessimistic repetitive future thinking (FoRT-PT) and positive indulging (FoRT-PI) at baseline had a significant indirect effect on SI severity at the 3-month follow-up via depressive symptoms, but that goal-oriented repetitive thought (FoRT-FG) was neither directly nor indirectly related to SI.

Our study adds to emerging evidence that FoRT-PT is a distinct cognitive process pertinent to SI and extends previous work on future-oriented cognition in suicide-related risk among young adults (Miranda et al., 2023b) to adolescents, a population for whom future thinking may be particularly salient (Steinberg et al., 2009). These findings highlight FoRT-PT as a key cognitive process and vulnerability factor in the pathway to SI among adolescents, with additional research needed to determine mechanisms that lead from FoRT to depression. For instance, a past study found that reduced cognitive fluency in thinking about positive future outcomes and being certain when predicting either the occurrence of negative future outcomes or an absence of positive future outcomes were implicated in the indirect pathway from FoRT-PT to future depressive symptoms and SI among young adults (Miranda et al., 2023b).

Regarding FoRT-PI, we found a significant indirect effect on SI through increased depressive symptoms at the 3-month follow-up. This finding aligns with past research suggesting that positive fantasies about the future may increase depressive symptoms over time (Oettingen et al, 2016). Research has shown that unrealistic positive future thinking can strengthen rather than buffer against the relationship between psychological distress and SI among adolescents, with adolescents engaging in higher proportions of unrealized positive expectations showing greater vulnerability to SI when experiencing defeat or entrapment (Pollak et al., 2021). Additionally, studies have found that indulging in positive future fantasies can lead to reduced goal attainment and increased depressive symptoms over time when anticipated outcomes fail to materialize among both adults and children (Oettingen et al., 2016). Previous research suggests this may occur through a process whereby positive fantasies create unrealistic expectations that, upon disengagement when goals prove unattainable, can trigger rumination and subsequent depressive symptoms (Macrynikola et al., 2017). However, additional research is needed to further elucidate this mechanistic pathway.

Contrary to our hypotheses, we did not find a significant direct effect of repetitive thinking about future goals (FoRT-FG) on SI, nor did we find an indirect relationship through depressive symptoms. This result appears to contrast with prior research on the relationship between future goals, depressive symptoms, and SI. For instance, among a community sample of adolescents, a strong future orientation was protective against hopelessness and depressive symptoms (Hamilton et al., 2015), although the research was conducted with a community sample of adolescents with relatively low rates of clinically significant depressive symptoms. It may be that repetitive thinking about future goals does not necessarily lead to generating achievable goals among adolescents experiencing SI, thus lessening its impact. Future research should examine the circumstances under which helping adolescents with recent SI or SA develop more concrete and achievable future goals might enhance the potential protective effects of future-goal-oriented thinking.

4.1. Clinical Implications

Our findings point to several potential targets for clinical intervention. One key target for clinical intervention is modifying pessimistic future thinking processes, which appear particularly important for reducing depressive symptoms and suicide-related risk among adolescents. As suggested previously (Miranda et al., 2017a), treatment may involve either interrupting pessimistic future-oriented mental rehearsal or helping individuals correctly attribute their pessimistic certainty to cognitive fluency rather than to the accuracy of their anticipations. For instance, one study found that young adults high in depressive symptoms who practiced making optimistic future-event predictions showed increased fluency and decreased depressive predictive certainty, and another study found that induced optimism decreased hopelessness over a 3-week period, regardless of SI or SA history, in a different sample of young adults (Matuza et al., 2023), suggesting that optimism training could be an effective intervention approach (Miranda et al., 2017a). Addressing the cognitive processes that maintain hopelessness is a critical intervention target. This could be done through approaches like Dialectical Behavior Therapy for adolescents (DBT-A; Rathus et al., 2020), which teaches specific skills for managing distress and building a life worth living through concrete goal setting and problem-solving strategies.

A second important intervention area involves helping adolescents balance positive future thinking with realistic planning to address potentially maladaptive aspects of positive indulging. Techniques derived from Mental Contrasting with Implementation Intentions (Oettingen & Reininger, 2016) could be beneficial, as this approach encourages individuals to contrast desired future states with current reality and develop specific plans to overcome obstacles. This structured approach might prevent the potential negative consequences of unrealistic positive fantasizing while preserving the motivational benefits of a positive future orientation. Similarly, a cognitive bias modification study found that training to promote adaptive interpretations (e.g., non-catastrophizing) reduced anxiety immediately post-training compared to a control condition that prompted participants to make positively and negatively valenced interpretations of events (Podina et al., 2020). This approach is further supported by a recent trial of a Positive Events Training program, which demonstrated that improving future thinking specificity, perceived control, and perceived likelihood of positive future events led to modest reductions in anhedonia (Bogaert et al., 2024). Mindfulness-based approaches might also help adolescents develop metacognitive awareness of repetitive future-oriented thought patterns, allowing them to disengage from unproductive cycles of pessimistic or unrealistic thinking (Ames et al., 2014).

4.2. Strengths and Limitations

Strengths of this study include a longitudinal design, an ethnoracially diverse sample, and a clinical sample. Our longitudinal design provides stronger evidence for temporal relationships than cross-sectional research. The ethnoracially diverse sample enhances generalizability and addresses significant gaps in suicide-related research, which has historically overrepresented non-Hispanic White samples (Cha et al., 2018). Our clinical sample of adolescents with recent SI or SA is particularly valuable, as many studies on future thinking have examined community samples of adolescents or adults with lower suicide-related risk.

Several limitations should be considered when interpreting our findings. Although our sample was ethnoracially diverse, it was drawn from clinical settings in a specific geographic region (Northeastern US), potentially limiting generalizability. Additionally, our reliance on self-report measures may be subject to reporting biases. Though our longitudinal design provides stronger evidence for temporal relationships than a cross-sectional design, the mediator and outcome being measured at the same timepoint is not ideal for establishing temporal mediation (Cole & Maxwell, 2003). While we controlled for baseline levels of both depressive symptoms and SI, the concurrent assessment of depressive symptoms and SI at 3-month follow-up limits our ability to establish the temporal precedence of depressive symptoms. A stronger design would have included an assessment point between baseline and the 3-month follow-up to separately measure changes in depressive symptoms before assessing SI. Future research should test the proposed mediational pathways using longitudinal designs with separate timepoints to assess the predictor, mediator, and outcome variables (Cole & Maxwell, 2003). Lastly, the timing of our assessments, while appropriate for examining longitudinal relationships, may not have captured the potentially dynamic nature of these cognitive processes. Future research should consider ecological momentary assessment methodologies to capture how these cognitive processes may fluctuate in daily life (Kleiman et al., 2017).

4.3. Conclusion

How adolescents repetitively think about their futures, particularly their tendency to engage in pessimistic future thinking, may be a crucial factor in the development and maintenance of SI via depressive symptoms. Our findings revealed that pessimistic repetitive future thinking indirectly, through increased depressive symptoms, predicted higher SI severity. These results shed light on how adolescents develop maladaptive future-event schemas through repetitive pessimistic forecasting. Understanding these cognitive mechanisms may help clinicians assist adolescents in altering maladaptive future-event schemas that increase vulnerability to depressive symptoms and SI. By targeting pessimistic repetitive future thinking and helping adolescents develop positive, but realistic future perspectives, interventions may more effectively reduce suicide-related risk in this vulnerable population.

Acknowledgments

Thanks to Jhovelis Mañaná, Christina Rombola, Jackaira Espinal, Sandra Runes, Muhammad Waseem, Samuel Ball, Andrew Gerber, Alice Greenfield, and members of the Laboratory for the Study of Youth Cognition and Suicide at Hunter College for their assistance with participant recruitment and/or data collection. This study was funded, in part, by NIH Grant MH091873, UL1TR002384, and by the Kaiser Permanente Center for Gun Violence Research and Education.

Footnotes

1

A confirmatory factor analysis, using Jamovi, version 2.5.3.0 (The Jamovi Project, 2024), examined the fit of the three-factor model in the overall sample. Model fit was adequate, χ2(101) = 222.32, p < .01, Comparative Fit Index (CFI) = .90 (> .90 indicates good fit), Tucker Lewis Index (TLI) = .89 (> .90 indicates good fit), Root Mean Square Error of Approximation (RMSEA) = .087 (< .08 indicates adequate fit), 90% CI = .07, .10 (Hu & Bentler, 1999). While some fit indices fall below conventional cut-offs, the moderate correlations between subscales (FoRT-PF and FoRT-FG, r = .55; FoRT-PF and FoRT-PI, r = .57; FoRT-FG and FoRT-PI, r = .24) support the theoretical three-factor structure with related but non-redundant subscales.

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