Anhedonia and Pain Avoidance in the Suicidal Mind: Behavioral Evidence for Motivational Manifestations of Suicidal Ideation in Patients With Major Depressive Disorder

Xie, Weizhen; Li, Huanhuan; Luo, Xinwei; Fu, Rong; Ying, Xiangyu; Wang, Ning; Yin, Qi-feng; Zou, Ying-min; Cui, Yanyan; Wang, Xiang; Shi, Chuan

doi:10.1002/jclp.22055

Cited by 70 publications

(75 citation statements)

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“…Thus, we wished to examine whether (a) anhedonia was uniquely associated with suicidal ideation, as previously found in the literature (Nock & Kazdin, 2002;Winer, Nadorff, et al, 2014;Xie et al, 2014), and whether (b) anhedonia was uniquely associated with suicide attempts. To investigate the unique elements of anhedonia, we examined the relationship between anhedonia, suicidal ideation, and suicide attempts while holding other symptoms of depression constant.…”

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confidence: 94%

“…scores on the Children's Depression Anhedonia Subscale were more likely to express suicidal thoughts and behaviors, independent of depressed mood. Furthermore, in a sample of 40 depressed outpatients and 20 healthy controls, individuals with high levels of suicidal ideation and previous suicidal behaviors were less likely to respond to rewarding stimuli on a task assessing anhedonia (Xie et al, 2014).…”

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confidence: 95%

“…Anhedonia, or the loss of interest and/or pleasure in people or things, has recently received increased empirical and theoretical investigation (Treadway, Bossaller, Shelton, & Zald, 2012;Wardle, Treadway, Mayo, Zald, & de Wit, 2011;Winer, Veilleux, & Ginger, 2014), with recent evidence suggesting that anhedonia may be a unique predictor of psychopathology (Winer, Veilleux, et al, 2014), including suicidality (Nock & Kazdin, 2002;Winer, Nadorff, et al, 2014;Xie et al, 2014). For example, a recent study examining the relationship between anhedonia and suicidal ideation found that the level of anhedonia at baseline, as well as changes in anhedonia over time, predicted suicidal ideation at termination within a sample of 1,529 clinical inpatients, when holding constant (a) baseline suicidality and (b) cognitive symptoms of depression .…”

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confidence: 99%

“…Second, although Nock and Kazdin's (2002) pioneering study had adequate power to attempt to discriminate between suicidal ideation and attempts, their sample was limited to youth, and thus it is uncertain whether their findings generalize to adult populations. Third, although Xie et al (2014) included an innovative task to assess anhedonia, the lack of power of their sample required that they compare individuals with both suicidal ideation and previous attempts with other depressed and control groups, thus conflating ideation and attempts. Perhaps most importantly, none of these studies included an independently validated scale of anhedonia (i.e., not a subscale or task).…”

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confidence: 99%

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The Association between Anhedonia, Suicidal Ideation, and Suicide Attempts in a Large Student Sample

Winer¹,

Drapeau

Veilleux

et al. 2015

Archives of Suicide Research

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Depression is a significant risk factor for suicide. Evidence suggests that anhedonia may be a symptom of depression that is uniquely associated with suicidality. However, exactly how anhedonia is related to suicide is unclear. To provide more specific evidence regarding this association, we investigated relationships between anhedonia, suicidal ideation, and suicide attempts. A large combined undergraduate sample completed the novel Specific Loss of Interest and Pleasure Scale (SLIPS), the Center of Epidemiological Studies Depression Scale (CES-D), and the Suicidal Behaviors Questionnaire-Revised (SBQ-R). Anhedonia was associated with suicidal ideation, even when accounting for depressive symptoms. Additionally, anhedonia was not associated with suicide attempts when symptoms of depression were held constant. The current study provides novel evidence regarding the relationship between anhedonia and risk of attempting suicide. Future research can examine the role anhedonia plays in the unfolding of suicidal behavior over time.

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confidence: 94%

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confidence: 95%

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confidence: 99%

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confidence: 99%

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The Association between Anhedonia, Suicidal Ideation, and Suicide Attempts in a Large Student Sample

Winer¹,

Drapeau

Veilleux

et al. 2015

Archives of Suicide Research

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“…Values may prove important to help anchor patients to life and increase their intrinsic motivation to engage in meaningful actions [44]. This may be particularly significant in light of the fact that suicidal patients show a decreased motivation to hedonic experience and increased pain avoidance [45], as well as a reduced sense of purpose in life [46]. Contact with values may promote internal locus of control [47], thus decreasing suicidal risk [48].…”

Section: Discussionmentioning

confidence: 99%

Acceptance and Commitment Therapy for the Management of Suicidal Patients: A Randomized Controlled Trial

Ducasse

Jaussent

Arpon-Brand

et al. 2018

Psychother Psychosom

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Background: The management of suicidal crisis remains a major issue for clinicians, driving the development of new strategies to improve suicide prevention. Methods: We conducted a randomized controlled trial comparing a 7-week acceptance and commitment therapy (ACT) versus relaxation group, as adjunct to treatment as usual for adult outpatients suffering from a current suicidal behavior disorder. The primary outcome was the rate of change in the Columbia Suicide Severity Rating Scale suicidal ideation subscore (adding severity and intensity subscores). Secondary outcomes were the rates of change for depressive symptomatology, psychological pain, anxiety, hopelessness, anger, quality of life, and therapeutic processes. Assessments were performed in the 2 weeks preceding the beginning of the treatment (pretreatment assessment), and within 1 week (posttherapy assessment) and 3 months (follow-up assessment) after therapy completion. Results: Forty adults were included and randomized. The rate of change in ACT for suicidal ideation at the posttherapy assessment was higher than in the relaxation group (β [SE] = –1.88 [0.34] vs. –0.79 [0.37], respectively; p = 0.03). ACT effectiveness remained stable at the 3-month follow-up. We found a similar pattern of change for depressive symptomatology and anxiety, psychological pain, hopelessness, anger, and quality of life. Therapeutic processes improved more in the ACT group than in the relaxation group. Treatment adherence was high in the ACT group, all participants reported satisfaction with the program. Conclusions: Through its effectiveness in reducing suicidal ideation and improving the clinical dimensions associated with suicidal risk in patients suffering from a suicidal behavior disorder, ACT could be developed as an adjunctive strategy in programs for suicide prevention.

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Reward-Processing Behavior in Depressed Participants Relative to Healthy Volunteers

et al. 2020

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IMPORTANCE Dysfunctional reward processing is a leading candidate mechanism for the development of certain depressive symptoms, such as anhedonia. However, to our knowledge, there has not yet been a systematic assessment of whether and to what extent depression is associated with impairments on behavioral reward-processing tasks. OBJECTIVE To determine whether depression is associated with impairments in reward-processing behavior. DATA SOURCES The MEDLINE/PubMed, Embase, and PsycInfo databases were searched for studies that investigated reward processing using performance on behavioral tasks by individuals with depression and nondepressed control groups, published between January 1, 1946, and August 16, 2019. STUDY SELECTION Studies that contained data regarding performance by depressed and healthy control groups on reward-processing tasks were included in the systematic review and meta-analysis. DATA EXTRACTION AND SYNTHESIS Summary statistics comparing performance between depressed and healthy groups on reward-processing tasks were converted to standardized mean difference (SMD) scores, from which summary effect sizes for overall impairment in reward processing and 4 subcomponent categories were calculated. Study quality, heterogeneity, replicability-index, and publication bias were also assessed. MAIN OUTCOME AND MEASURES Performance on reward-processing tasks. RESULTS The final data set comprised 48 case-control studies (1387 healthy control individuals and 1767 individuals with major depressive disorder). The mean age was 37.85 years and 58% of the participants were women. These studies used tasks assessing option valuation (n = 9), reward bias (n = 6), reward response vigor (n = 12), reinforcement learning (n = 20), and grip force (n = 1). Across all tasks, depression was associated with small to medium impairments in reward-processing behavior (SMD = 0.345; 95% CI, 0.209-0.480). When examining reward-processing subcomponent categories, impairment was associated with tasks assessing option valuation (SMD = 0.309; 95% CI, 0.147-0.471), reward bias (SMD = 0.644; 95% CI, 0.270-1.017), and reinforcement learning (SMD = 0.352; 95% CI, 0.115-0.588) but not reward response vigor (SMD = 0.083; 95% CI, −0.144 to 0.309). The medication status of the major depressive disorder sample did not explain any of the variance in the overall effect size. There was significant between-study heterogeneity overall and in all subcomponent categories other than option valuation. Significant publication bias was identified overall and in the reinforcement learning category. CONCLUSIONS AND RELEVANCE Relative to healthy control individuals, individuals with depression exhibit reward-processing impairments, particularly for tests of reward bias, option valuation, and reinforcement learning. Understanding the neural mechanisms driving these associations may assist in designing novel interventions.

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Anhedonia and Pain Avoidance in the Suicidal Mind: Behavioral Evidence for Motivational Manifestations of Suicidal Ideation in Patients With Major Depressive Disorder

Cited by 70 publications

References 23 publications

The Association between Anhedonia, Suicidal Ideation, and Suicide Attempts in a Large Student Sample

The Association between Anhedonia, Suicidal Ideation, and Suicide Attempts in a Large Student Sample

Acceptance and Commitment Therapy for the Management of Suicidal Patients: A Randomized Controlled Trial

Reward-Processing Behavior in Depressed Participants Relative to Healthy Volunteers

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