Clinical, psychosocial and demographic factors affect decisions in SLE people

Abstract

Neurological and psychiatric manifestations affect most lupus individuals and include depression, anxiety, mood disorders, and cognitive dysfunction. Although there is evidence supporting suboptimal decision-making in lupus and its association with glucocorticoids consumption, it is not clear what variables impact such decisions. The aim of this study is to explore how social, clinical, psychological, and demographic factors impact social and temporal decision-making in people with lupus. Through a within-subjects experimental-design, our participants responded to social, clinical, psychological, and demographic electronic questionnaires. Then, they participated in two behavioral economics experiments: the third-party dictator game, and the delay discounting task. Our results show that hostility, and age are essential predictors of social decisions, whereas obsessive-compulsiveness and anxiety better predict temporal decisions. These variables behave as expected, but anxiety shows unexpected results: most anxious people act patiently and prefer delayed but bigger rewards. Finally, clinical factors are critical decision predictors for social and temporal decisions. When people are in remission, they tend to impose higher punishment on those who violate the social norm, and they also tend to prefer immediate rewards. When taking glucocorticoids, they also prefer immediate rewards, and as the dosage of glucocorticoids intake increases, they tend to impose higher punishment on norm violators. Clinicians, researchers, and practitioners must consider the side effects of glucocorticoids on decision-making.