Cognitive modelling to assess decision-making impairments in patients with current depression and with/without suicide history
Open accessAbstract
It has been reported that decision making is impaired in suicide attempters. Decision making is a complex process and little is known about its different components. Yet, this information would help to understand the functioning of suicidal minds. In this study, the Prospect Valence-Learning (PVL) computational model was applied to the Iowa Gambling Task (IGT) to investigate and compare decision-making components in patients with affective disorder and with/without history of suicide attempts and in healthy controls. To this aim, 116 inpatients with current major depressive episode (among whom 62 suicide attempters) and 38 healthy controls were recruited. Decision-making performance was measured using the IGT. The Bayesian computational PVL model was applied to compare the feedback sensitivity, loss aversion, learning/memory, and choice consistency components of decision making in the different groups. Depressive symptomatology was assessed using the Beck Depression Inventory short form (BDI-SF). The total IGT net score and the loss aversion and learning/memory scores were lower in suicide attempters than in healthy controls. The choice consistency score was low in all patients (with/without suicide history) compared with healthy controls. Moreover, patients with high BDI score showed a positive relationship between the choice consistency score and suicide attempt. These findings suggest that decision-making impairment in depressed patients with and without suicidal history might be the result of underlying problems in feedback processing and task learning, which influence the building of long-term strategies. All these impairments should be targeted in therapeutic strategies for suicidal patients.
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In one recent study of the Iowa Gambling Task, Bayesian analysis of decision-making performance demonstrated that suicide attempters exhibited greater loss aversion than depressed controls or healthy volunteers.
“For example, in one recent study of the Iowa Gambling Task, Bayesian analysis of decision-making performance demonstrated that suicide attempters exhibited greater loss aversion than depressed controls or healthy volunteers (63); similar approaches to the suicide-specific tasks may provide further insight into how suicide-related biases change after an intervention.”
From New methods for assessing rapid changes in suicide risk (2021) · cites this paper as [63]
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Influences of sleep, cortisol reactivity, and risk/reward-based decision-making on suicide
Law, K. C., O’Connell, K. L., Jacobson, S. V., Baer, M. M., Baker, P. M., & Tull, M. T. (2024) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2024.101975 · Cited by 2 · see citing works
de León-Martínez, S., Ruiz, M., Parra, E., Giglioli, I. A. C., Courtet, P., López‐Castromán, J., Artés-Rodrı́guez, A., Baca‐García, E., Porras‐Segovia, A., & Barrigón, M. L. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-058486 · Cited by 2 · see citing works
Self-citationChronic corticosterone impaired effortful motivation and risky decision-making in mice
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Self-citationPsychiatric patients are more vulnerable to the Spanish euthanasia law?
Alacreu‐Crespo, A., Giner, L., & Courtet, P. (2021) · Revista de Psiquiatría y Salud Mental (English Edition) · doi:10.1016/j.rpsmen.2021.01.001 · Cited by 1 · see citing works
Self-citationMood computational mechanisms underlying increased risk behavior in adolescent suicidal patientsPreprint
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“Specifically, some studies found heighted loss aversion in STB(14,15), while others observed the opposite pattern(16).”
Mood computational mechanisms underlying increased risk behavior in adolescent suicidal patientsPreprint
Wang, Z., Nan, T., Lu, F., Yu, Y., Cai, X., He, Z., Luo, Y., Wang, T., & Blain, B. (2025) · eLife · doi:10.7554/elife.108002 · Cited by 1 · see citing works
“Specifically, some studies found heightened loss aversion in STB in the context of the balloon analog risk task and the gambling task ( Liu et al., 2022 ; Baek et al., 2017 ), while others observed the opposite pattern using the Iowa gambling task ( Alacreu-Crespo et al., 2020 ).”
Controverses au sujet du suicide assisté chez les personnes atteintes de troubles psychiatriques
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Self-citationA Review of the Relationship betweenDepression and Risk-Taking
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“In patients with a major depressive episode with a suicide attempt, the loss aversion and recency parameters were lower than those in controls (26).”
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Impaired decision-making in child sexual offenders: Findings and prospects
Lacambre, M., Alacreu‐Crespo, A., Huguet, H., Mura, T., & Courtet, P. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.12.035
Self-citationTroubles bipolaires et risque suicidaire
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Self-citationMood computational mechanisms underlying increased risk behavior in adolescent suicidal patientsPreprint
Wang, Z., Nan, T., Lu, F., Yu, Y., Cai, X., He, Z., Luo, Y., Wang, T., & Blain, B. (2025) · eLife · doi:10.7554/elife.108002.1
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“For example, while some studies using the Iowa Gambling Task (IGT) indicate a greater propensity for risk-taking among depressed patients compared to healthy controls, 13 other studies have reported reduced risk-taking 14 or no significant differences.”
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Molins, F., Paz, M., & Serrano, M. Á. (2026) · The Spanish Journal of Psychology · doi:10.1017/sjp.2026.10019
“Lastly, these studies often oversimplify decision-making as a single dimension, disregarding its multifaceted cognitive sub-processes (Alacreu-Crespo et al., 2020).”
Zerekidze, A., Bahlmann, L., Petzold, J., Li, M., Čolić, L., Walter, M., Pereira, F., Abbar, M., Jollant, F., & Wagner, G. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1791411
Linked multimodal brain alterations in depression with suicidal risk
Wang, M., Yan, Y., Tao, Y., Amos, T. J., Wei, J., Zhao, L., Ni, R., Yang, X., & Ma, X. (2026) · Cerebral Cortex · doi:10.1093/cercor/bhag164
Computational modelling of decision-making in suicide attemptersPreprint
Grandé, C., Zorzi, L. D., Abbar, M., Wagner, G., & Jollant, F. (2026) · medRxiv · doi:10.64898/2026.10.09.26365056
- Authors
- Alacreu-Crespo, A., Guillaume, S., Sénèque, M., Olié, E., & Courtet, P.
- Affiliations
- Inserm (FR)
- Venue
- European Neuropsychopharmacology
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 36
- Pages
- 50-59
- ISSN
- 0924-977X (ISSN-L)
- OpenAlex
- W3028566326
- Cited by
- 50
- References
- 61
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 7 · 2023: 11 · 2022: 11 · 2021: 9
- FWCI
- 3.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- European Neuropsychopharmacology (acceptedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
- Keywords
- decision-making, depression, suicide attempts, Iowa Gambling Task, loss aversion, feedback sensitivity, learning and memory, decision consistency, major depressive episode, suicidal behavior
- MeSH terms
- Adult, Aged, Cognition, Decision Making, Major Depressive Disorder, Female, Gambling, Humans, Male, Middle Aged, Suicide, Attempted, Young Adult, Suicidal Ideation
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