Decision‐making biases in suicide attempters with major depressive disorder: A computational modeling study using the balloon analog risk task (BART)

Abstract

Background In the last decade, suicidality has been increasingly theorized as a distinct phenomenon from major depressive disorder (MDD), with unique psychological and neural mechanisms, rather than being mostly a severe symptom of MDD. Although decision‐making biases have been widely reported in suicide attempters with MDD, little is known regarding what components of these biases can be distinguished from depressiveness itself. Methods Ninety‐three patients with current MDD (40 with suicide attempts [SA group] and 53 without suicide attempts [NS group]) and 65 healthy controls (HCs) completed psychometric assessments and the balloon analog risk task (BART). To analyze and compare decision‐making components among the three groups, we applied a five‐parameter Bayesian computational modeling. Results Psychological assessments showed that the SA group had greater suicidal ideation and psychological pain avoidance than the NS group. Computational modeling showed that both MDD groups had higher risk preference and lower ability to learn and adapt from within‐task observations than HCs, without differences between the SA and NS patient groups. The SA group also had higher loss aversion than the NS and HC groups, which had similar loss aversion. Conclusions Our BART and computational modeling findings suggest that psychological pain avoidance and loss aversion may be important suicide risk factor that are distinguishable from depression illness itself.

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

“…Our study also shows a significant inter-correlation between psychological pain avoidance and loss aversion ( r = 0.31, p = 0.004), and initial belief of burst ( r = −0.30, p = 0.005), reproducing a prior finding [44]. Daniel and colleagues reported that individuals who are ready to commit suicide have a tendency to exaggerate their perceived losses and minor losses are perceived as being so overwhelming that they reinforce their suicide behavior [52].…”

“…Our study's finding that the SA group had higher psychological pain avoidance than the HSI group is consistent with those reported by Li and colleagues [25,49]. In terms of risk decision-making, our finding that the SA group had greater loss aversion than the HSI group is similar to those from Liu and colleagues using similar methodology [44], and others employing different decision tasks or models [26,50]. Furthermore, the SA group showed a lower estimation of the probability of balloon explosion than the HSI group, which is consistent with the results of Liu et.…”

“…We adopted the five-parameter model of BART based on the Exponential Weight Updating (EW) model and built a hierarchical Bayesian model using the hBayesDM tools [ 43 ] in the R platform (version 3.6.2). The EW model has exhibited good performance in suicide-related studies based on previous research [ 44 ]. The final five parameters were: ψ (prior belief of burst, index of the initial belief about the probability of exploding), ξ (updating exponent, index of how quickly participants update their beliefs based on observations), ρ (risk preference, index of tendency to avoid risk), τ (inverse temperature, index of the deterministic or random of the choice), and λ (loss aversion, index of the tendency to avoid loss) [ 21 ] (see for all BART and behavioral model-related details).…”

The Effects of Depressive Symptoms and Self-Perceived Social Value on Adolescent Social Risk-Taking

“…However, each pump increases the chance of the balloon bursting. Other studies, however, showed higher levels of risk-taking on the BART in depressed individuals compared to healthy controls 10 .…”

Suicide and economic uncertainty: New findings in a global setting

“…concept of negativity bias refers to the assumption that adverse circumstances are generally more substantial, potent, capturing in combinations, and resourceful than their positive counterparts (Abdou et al, 2022). The principle of loss aversion in prospect theory is relevant to this negativity bias, which holds that people are more motivated by the threat of loss than by the promise of gain (Liu et al, 2022). People in high-income countries have more to lose due to economic uncertainty than those in the middle-and low-income countries; thus, it stands to reason that this is where we see the strongest association between economic uncertainty and suicide.…”