Value-Based Choice, Contingency Learning, and Suicidal Behavior in Mid- and Late-Life Depression
Open accessAbstract
Background Suicidal behavior is associated with impaired decision making in contexts of uncertainty. Existing studies, however, do not definitively address whether suidice attempers have 1) impairment in learning from experience or 2) impairment in choice based on comparison of estimated option values. Our reinforcement learning model-based behavioral study tested these hypotheses directly in middle-aged and older suicide attempters representative of those who die by suicide.Methods Two samples (sample 1, n = 135; sample 2, n = 125) of suicide attempters with depression (n attempters = 54 and 39, respectively), suicide ideators, nonsuicidal patients with depression, and healthy control participants completed a probabilistic three-choice decision-making task. A second experiment in sample 2 experimentally dissociated long-term learned value from reward magnitude. Analyses combined computational reinforcement learning and mixed-effects models of decision times and choices.Results With regard to learning, suicide attempters (vs. all comparison groups) were less sensitive to one-back reinforcement, as indicated by a reduced effect on both choices and decision times. Learning deficits scaled with attempt lethality and were partially explained by poor cognitive control. With regard to value-based choice, suicide attempters (vs. all comparison groups) displayed abnormally long decision times when choosing between similarly valued options and were less able to distinguish between the best and second-best options. Group differences in value-based choice were robust to controlling for cognitive performance, comorbidities, impulsivity, psychotropic exposure, and possible brain damage from attempts.Conclusions Serious suicidal behavior is associated with impaired reward learning, likely undermining the search for alternative solutions. Attempted suicide is associated with impaired value comparison during the choice process, potentially interfering with the consideration of deterrents and alternatives in a crisis.
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High-lethality attempters have greater impairment of reward learning, which hampers the search for alternative solutions.
“High-lethality attempters have greater impairment of reward learning, hampering the search for alternative solutions (34), but they have less delayed discounting (i.e., they can suppress the desire for immediate satisfaction in favor of delayed reward) (35) and perform better on an object alternation task, indicating greater executive control and response organization (25).”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [34]
High-lethality suicide attempters are generally more deliberate and planned than low-lethality attempters.
“Decision making differs in high-lethality suicide attempters relative to low-lethality attempters because the former are generally more deliberate and planned.”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [34]
Learning deficits in suicide attempters scale with attempt lethality and are partly explained by impaired cognitive control.
“These learning deficits scale with attempt lethality and are partially explained by impaired cognitive control (34), the most consistent deficit found in suicide attempters (17, 22, 24).”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [34]
Mental pain and suicidality have been associated with many cognitive function impairments, including decision-making.
“mental pain and suicidality have been associated with many cognitive function impairments,36 including decision-making.37”
From “Nothing Hurts Less Than Being Dead”: Psychological Pain in Case Descriptions of Psychiatric Euthanasia and Assisted Suicide from the Netherlands: « Rien ne fait moins mal qu’être mort »: La douleur psychologique dans les descriptions de cas d’euthanasie et de suicide assisté psychiatrique aux Pays-Bas (2020) · cites this paper as [37]
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- Authors
- Dombrovski, A. Y., Hallquist, M. N., Brown, V. M., Wilson, J., & Szanto, K.
- Affiliations
- University of Pittsburgh (US)
- Pennsylvania State University (US)
- Corresponding author
- Dombrovski, Alexandre Y.
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2019-03
- Volume
- 85
- Issue
- 6
- Pages
- 506-516
- ISSN
- 0006-3223 (ISSN-L)
- PMC
- PMC6380943
- OpenAlex
- W2896058277
- Cited by
- 65
- References
- 48
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 7 · 2023: 9 · 2022: 12 · 2021: 13 · 2020: 13 · 2019: 1 · 2018: 1
- FWCI
- 8.21
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (R01MH100095, R01MH048463, K01MH097091, R01MH085651)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- suicidal behavior, suicide attempters, geriatric depression, value-based choice, contingency learning, reward learning, decision making under uncertainty, decision time, cognitive control, suicidal ideation
- MeSH terms
- Late Onset Disorders, Adult, Age Factors, Aged, Aged, 80 and over, Choice Behavior, Decision Making, Depression, Female, Humans, Learning Disabilities, Male, Middle Aged, Reinforcement, Psychology, Suicide, Attempted, Case-Control Studies, Suicidal Ideation
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