Decision-making in suicidal behavior: A systematic review and meta-analysis

Sastre-Buades, Aina; Alacreu‐Crespo, Adrián; Courtet, Philippe; Baca‐García, Enrique; Barrigón, María Luisa

doi:10.1016/j.neubiorev.2021.10.005

Cited by 31 publications

(17 citation statements)

References 105 publications

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“…There were no signi cant differences between the suicide attempters and control participants for those measures. This nding is in line with previous literature on decision-making de cits in suicidal patients [6,8,13].…”

Section: Discussionsupporting

confidence: 92%

“…It has been found that suicide attempters and ideators exhibit varying levels of cognitive control [10,11]. This difference can be expressed as a narrow time perspective and impaired decision-making and reasoning abilities [11][12][13]. Some suicide attempters exhibit a preference for immediate rewards over future rewards, a behavior known as delay discounting [12,13].…”

Section: Introductionmentioning

confidence: 99%

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Decision-making in suicidal acute psychiatric patients

Reiråskag,

Brokke,

Rohde

et al. 2024

Preprint

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Background Suicidality is a major health problem. Decision-making deficits, including a lack of cognitive control (e.g., impulsivity and risk-taking behavior), have been associated with an increased risk of suicide. Methods This study examined decision-making in a clinical group of 23 adult, suicidal acute psychiatric patients and compared their data to that of a control group of 17 healthy adults using the Cambridge Gambling Task (CGT) from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Group differences in outcomes on the six CGT subtests were compared using chi-square tests, t tests, and Mann‒Whitney U tests where appropriate. Multiple regression analysis was used to explore whether background variables were associated with CGT outcomes. Results The main findings were significantly lower scores for risk-taking, quality of decision-making, and risk adjustment in the clinical group than in the control group. Within the clinical group, differences were observed in which suicide ideators scored worse in some measures than did suicide attempters. These findings suggest that suicidal acute psychiatric patients may struggle with making low-risk decisions that are considered reasonable. Conclusion These results support the potential for cognitive control training, specifically aimed at enhancing decision-making abilities, in suicide prevention efforts. The observed decision-making deficits in suicidal patients underscore the importance of further investigating these findings in a larger population to solidify the foundation for targeted interventions.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Decision-making in suicidal acute psychiatric patients

Reiråskag,

Brokke,

Rohde

et al. 2024

Preprint

View full text Add to dashboard Cite

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“…Firstly, we observed an increased gambling behavior and a lower overall mood in STB patients (S + ), as compared to non-STB patients (S -) and HC, replicating previous findings (8)(9)(10)(11). Secondly, using an approach-avoidance prospect theory model, we found heighted approach motivation in S + than Sand HC, which explained increased gambling choices for STB, suggesting over-reactivity of Pavlovian system to approach risky options.…”

Section: Discussionsupporting

confidence: 87%

“…These findings provide new insights to the putative dynamics underpinning STB, and offer potential markers for the early prediction, screening, detection, and intervention of suicidal behavior. Our results indeed suggest that STB patients’ mood would be less sensitive to certain outcomes than control without STB, which would lead them to take more risk regardless the gain at stake and therefore to potentially experience more suboptimal outcomes than controls(8). These results would explain the observed increase in risk-taking behaviors in STB such as substance use, early onset of sexual intercourse and physical fighting independent of psychiatric diagnosis.…”

Section: Discussionmentioning

confidence: 66%

Mood computational mechanisms underlying increased risk behavior in suicidal patients

Wang,

Nan,

et al. 2023

Preprint

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Suicidal thoughts and behaviors (STB) are one of leading causes of death worldwide. Although literature has consistently reported increased risk behavior in patients with STB and has proposed mood problems as the core of STB, cognitive and affective computational mechanisms underlying increased risky behavior remain unclear. Here, we asked 83 adolescent inpatients with affective disorders, where 58 patients with STB (S+) and 25 without STB (S-), and 118 gender/age-matched healthy control (HC) to make decisions between certain vs. gamble option with momentary mood ratings. After identifying increased risk behavior in S+than S-and HC, we used approach-avoidance prospect theory model and momentary mood model to quantify patients’ behavior and mood. Choice data analysis showed that heighted approach motivation mediated an increase in gambling choices with STB severity, suggesting impaired Pavlovian approach system in STB resulting in higher gambling in gains. Mood model showed lower mood sensitivity to certain reward in S+than S-and HC, which further explained increased gambling decisions in STB, offering a mood computational account for increased risk behavior in STB. These results remain significant after controlling for demographic and clinical variables and medication factors. Overall, our findings revealed cognitive and affective computational mechanisms underlying increased risk behavior in STB. This work has important implications for prevention and intervention of suicide, especially for clinical populations.

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“…The transition from suicide ideation to action is known to be associated with impaired decision-making, with likely unique characteristics and biases [13][14][15]. More specifically, when compared to people without a history of suicide attempts or healthy controls, suicide attempters have more negative evaluations of the future, and paradoxically more aversion to loss and risk [16], suggesting that they may choose suicide as a way to solve current dilemmas and stress to get immediate "reward" outcome [17].…”

Section: Introductionmentioning

confidence: 99%

Potential neuropsychological mechanism involved in the transition from suicide ideation to action – a resting-state fMRI study implicating the insula

Fang,

Law,

et al. 2023

Eur. Psychiatr.

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Background Understanding the neural mechanism underlying the transition from suicidal ideation to action is crucial but remains unclear. To explore this mechanism, we combined resting-state functional connectivity (rsFC) and computational modeling to investigate differences between those who attempted suicide(SA) and those who hold only high levels of suicidal ideation(HSI). Methods A total of 120 MDD patients were categorized into SA group (n=47) and HSI group (n=73). All participants completed a resting-state functional MRI scan, with three subregions of the insula and the dorsal anterior cingulate cortex (dACC) being chosen as the region of interest (ROI) in seed-to-voxel analyses. Additionally, 86 participants completed the balloon analogue risk task (BART), and a five-parameter Bayesian modeling of BART was estimated. Results In the SA group, the FC between the ventral anterior insula (vAI) and the superior/middle frontal gyrus (vAI-SFG, vAI-MFG), as well as the FC between posterior insula (pI) and MFG (pI-MFG), were lower than those in HSI group. The correlation analysis showed a negative correlation between the FC of vAI-SFG and psychological pain avoidance in SA group, whereas a positive correlation in HSI group. Furthermore, the FC of vAI-MFG displayed a negative correlation with loss aversion in SA group, while a positive correlation was found with psychological pain avoidance in HSI group. Conclusion In current study, two distinct neural mechanisms were identified in the insula which involving in the progression from suicidal ideation to action. Dysfunction in vAI FCs may gradually stabilize as individuals experience heightened psychological pain, and a shift from positive to negative correlation patterns of vAI-MFC may indicate a transition from state to trait impairment. Additionally, the dysfunction in PI FC may lead to a lowered threshold for suicide by blunting the perception of physical harm.

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Decision-making in suicidal behavior: A systematic review and meta-analysis

Cited by 31 publications

References 105 publications

Decision-making in suicidal acute psychiatric patients

Decision-making in suicidal acute psychiatric patients

Mood computational mechanisms underlying increased risk behavior in suicidal patients

Potential neuropsychological mechanism involved in the transition from suicide ideation to action – a resting-state fMRI study implicating the insula

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