Impulsive Choice and Psychological Pain in Acutely Suicidal Depressed Patients
Abstract
OBJECTIVE: Despite identification of several risk factors, suicide prediction and prevention is still a clinical challenge. Suicide can be seen as a consequence of poor decision making triggered by overwhelming psychological pain. We examined the relationship of choice impulsivity and psychological pain in depressed patients with acute suicidality. METHODS: Impulsive choice (delay discounting), psychological pain, and clinical characteristics were assessed in four groups of adults (N = 20-22): a) depressed patients within 72 hours after a suicide attempt, b) depressed patients with active suicidal ideation, c) nonsuicidal depressed patients, and d) healthy controls. RESULTS: Impulsive choice was higher in the suicide attempt (0.114 [0.027]) and ideation (0.099 [0.020]) groups compared with nonsuicidal depressed (0.079 [0.020]) and healthy (0.066 [0.019]) individuals (F(3,79) = 3.06, p = .042). Psychological pain data showed a similar profile (F(3,78) = 43.48, p < .001), with 43.4 (2.9) rating of psychological pain for the suicide attempt, 54.3 (2.2) for suicide ideation, 37.0 (3.2) for nonsuicidal depressed, and 13.7 (0.5) for healthy groups. Within the suicide attempt group, persisting suicidal ideation was associated with more severe depression (36.6 [2.9] versus 21.5 [3.1], p = .007) and choice impulsivity (0.134 [0.03] versus 0.078 [0.04], p = .015). Both measures normalized within a week: depression (29.9 [2.6] versus 14.4 [3.0], p = .006) and choice impulsivity (0.114 [0.026] versus 0.066 [0.032], p = .019). CONCLUSIONS: Transient impulsive choice abnormalities are found in a subset of those who attempt suicide. Both, suicidal ideation and behavior were associated with choice impulsivity and intense psychological pain.
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Psychological pain might represent a phenomenon associated with the wish to die.
“suggesting that psychological pain might represent a phenomenon associated with the wish to die.”
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 [23]
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- Authors
- Cáceda, R., Durand, D., Cortes, E., Prendes-Alvarez, S., Moskovciak, T., Harvey, P. D., & Nemeroff, C. B.
- Affiliations
- University of Miami (US)
- Corresponding author
- Cáceda, Ricardo
- Venue
- Psychosomatic Medicine
- Published
- 2014-07
- Volume
- 76
- Issue
- 6
- Pages
- 445-451
- ISSN
- 0033-3174 (ISSN-L)
- OpenAlex
- W2058009426
- Cited by
- 113
- References
- 54
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 8 · 2023: 10 · 2022: 9 · 2021: 10 · 2020: 11 · 2019: 12 · 2018: 9 · 2017: 14 · 2016: 10 · 2015: 3 · 2014: 2
- FWCI
- 11.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychosomatic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- impulsive choice, delay discounting, psychological suffering, acute suicidality, suicide attempts, suicidal ideation, depression, decision-making, suicide risk, suicide prevention
- MeSH terms
- Adult, Depressive Disorder, Female, Humans, Impulsive Behavior, Male, Middle Aged, Pain, Severity of Illness Index, Suicide, Attempted, Suicidal Ideation, Delay Discounting
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