Decision-Making Skills Moderate the Relationship between Psychological and Physical Pain with Suicidal Behavior in Depressed Patients

Abstract

Background: Physical and psychological pain play an important role in suicidal behaviour, which may be driven by the desire of relieving pain. Therefore, the decision of not attempting suicide in conditions of high pain involves substantial cognitive resources. Moreover, cognitive processes involved in decision-making might modulate the relationship between pain and suicidal behaviours or depression. Objectives: To investigate the decision-making modulatory role in the relationship between physical and psychological pain and suicidal ideation/act and depression. Methods: For this study, 118 inpatients with depression (77 suicide attempters) self-reported their level of physical and psychological pain, suicidal ideation (current and maximal within the last 15 days), and depressive symptomatology (Beck Depression Inventory questionnaire). Decision-making performance was measured with the Iowa Gambling Task (IGT). Results: In patients with high IGT scores, the levels of maximal psychological pain and suicidal ideation were positively correlated (b = 1.45, p < .001). In the group with low IGT scores, the level of current physical pain was correlated with depression (b = 1.05, p < .005). Conclusion: Better decision-making performance increases the likelihood of suicidal ideation, but not of suicide act in the context of psychological pain, suggesting that suicidal ideation is used as a coping mechanism.