The decision neuroscience perspective on suicidal behavior

Abstract

Purpose of review Suicide attempts are usually regretted by people who survive them. Furthermore, addiction and gambling are over-represented among people who attempt or die by suicide, raising the question whether their decision-making is impaired. Advances in decision neuroscience have enabled us to investigate decision processes in suicidal people and to elucidate putative neural substrates of disadvantageous decision-making. Recent findings Early studies have linked attempted suicide to poor performance on gambling tasks. More recently, functional MRI augmented with a reinforcement learning computational model revealed that impaired decision-making in suicide attempters is paralleled by disrupted expected value (expected reward) signals in the ventromedial prefrontal cortex. Behavioral studies have linked increased delay discounting to low-lethality/poorly planned attempts, multiple attempts, and the co-occurrence of attempted suicide and addiction. This behavioral tendency may be related to altered integrity of the basal ganglia. By contrast, well-planned, serious suicide attempts were associated with intact/diminished delay discounting. One study has linked high-lethality suicide attempts and impaired social decision-making. Summary This emerging literature supports the notion that various impairments in decision-making – often broadly related to impulsivity – may mark different pathways to suicide. We propose that aggressive and self-destructive responses to social stressors in people prone to suicide result from a predominance of automatic, Pavlovian processes over goal-directed computations.

Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies

“…1). A subset of studies provided preliminary findings of associations between neuroimaging measures and key risk factors for suicide, e.g., medical lethality of prior attempts, emotion dysregulation, anhedonia, impulsiveness, and reduced cognitive control (for reviews see [13][14][15]).…”

“…The DMPFC and the DLPFC together support top-down control of emotions and behaviors [17], cognitive flexibility, and complex decisionmaking [60]. Deficits in these processes are thought to have an important role in STBs, particularly in the transition from SI to behavior, as the threshold to acting is lowered by decreased top-down behavioral inhibition, and diminished flexibility in generating alternate and more adaptive behavioral choices [15,61]. Neuroimaging evidence suggests that the DMPFC (medial portions of BAs 8 and 9) is robustly recruited during tasks that require mental state inference [62,63].…”

Management of patients with an advance decision and suicidal behaviour: a systematic review

“…First, suicide ideation was considered to fluctuate and people could change their mind about their desire to die 7 8 31 32. Although suicide has been linked to impulsivity,33 34 studies show that not all suicides are impulsive 35. However, recent studies using ecological momentary assessment have shown that suicide ideation varies over short periods of time (ie, there are changes between hours and days)36 and follow-up studies with suicide survivors tend to acknowledge that they regret the suicide attempt 37.…”

New Evidences about Subjective Well-Being in Adolescence and Its Links with Neurocognitive Performance

“…A relevant number of children and adolescents would potentially present mental health difficulties throughout their life, having a clear impact not only on their personal lives but also on health and economic levels [47][48][49]. Impairments in neurocognitive domains have been found to be linked with psychological issues indicating a potential common underlying neurodevelopmental disorder, as well as links to cognitive functioning [40,46,50,51]. In particular, previous research analyzing more severe mental health problems and neurocognitive functioning are in line with the results found in this study.…”