Decision-making in suicidal behavior: A systematic review and meta-analysis
Abstract
Impaired decision-making (DM) is well-known in suicidal behavior (SB). We aimed to review the evidence on DM and its mediating factors in SB and perform a meta-analysis on DM assessed using the Iowa Gambling Task (IGT). We conducted a search on databases of papers published on DM and SB up to 2020: 46 studies were included in the systematic review, and 18 in the meta-analysis. For meta-analysis, we compared DM performance between suicide attempters (SAs) and patients (PCs) or healthy controls (HCs). The systematic review showed that SAs have greater difficulties in all DM domains. The meta-analysis found worse IGT performance among SAs in comparison with PCs and HCs. A meta-regression did not find differences for age, gender, psychiatric disorder, and clinical status. Our findings indicate that SAs exhibited deficits in DM under conditions of risk though not ambiguity. Worse DM was independent of age, gender, psychiatric disorder, and suggested that DM impairment could be considered a cognitive trait of suicidal vulnerability, a risk factor and an attribute of SAs.
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Acute suicidality might interfere with decision-making.
“Moreover, suicidality might complicate MAID assessment: the fluctuating nature of suicidality13 may hamper assessment of the consistency of the death wish,14 and acute suicidality might interfere with decision-making.15”
From Requests for Medical Assistance in Dying by Young Dutch People With Psychiatric Disorders (2025) · cites this paper as [15]
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Requests for Medical Assistance in Dying by Young Dutch People With Psychiatric Disorders
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Self-citationSuicide prevention and ketamine: insights from computational modeling
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- Authors
- Sastre-Buades, A., Alacreu-Crespo, A., Courtet, P., Baca-Garcia, E., & Barrigon, M. L.
- Affiliations
- Hospital Son Llatzer (ES)
- Centre National de la Recherche Scientifique (FR)
- Venue
- Neuroscience & Biobehavioral Reviews
- Publisher
- Elsevier BV
- Published
- 2021-12
- Volume
- 131
- Pages
- 642-662
- ISSN
- 0149-7634 (ISSN-L)
- OpenAlex
- W3202269980
- Cited by
- 64
- References
- 24
- Citations by year
- 2026: 12 · 2025: 18 · 2024: 15 · 2023: 12 · 2022: 7
- FWCI
- 1.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Neuroscience & Biobehavioral Reviews (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Zaguan (University of Zaragoza Repository) (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, suicidal behavior, suicide attempts, Iowa Gambling Task, risk assessment, ambiguity, impulsivity, mental illness
- MeSH terms
- Decision Making, Gambling, Humans, Neuropsychological Tests, Suicide, Attempted, Suicidal Ideation
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