Decision-Making Competence and Attempted Suicide
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OBJECTIVE: The propensity of people vulnerable to suicide to make poor life decisions is increasingly well documented. Do they display an extreme degree of decision biases? The present study used a behavioral-decision approach to examine the susceptibility of low-lethality and high-lethality suicide attempters to common decision biases that may ultimately obscure alternative solutions and deterrents to suicide in a crisis. METHOD: We assessed older and middle-aged (42-97 years) individuals who made high-lethality (medically serious) (n = 31) and low-lethality suicide attempts (n = 29). Comparison groups included suicide ideators (n = 30), nonsuicidal depressed participants (n = 53), and psychiatrically healthy participants (n = 28). Attempters, ideators, and nonsuicidal depressed participants had nonpsychotic major depression (DSM-IV criteria). Decision biases included sunk cost (inability to abort an action for which costs are irrecoverable), framing (responding to superficial features of how a problem is presented), underconfidence/overconfidence (appropriateness of confidence in knowledge), and inconsistent risk perception. Data were collected between June 2010 and February 2014. RESULTS: Both high- and low-lethality attempters were more susceptible to framing effects as compared to the other groups included in this study (P ≤ .05, ηp2 = 0.06). In contrast, low-lethality attempters were more susceptible to sunk costs than both the comparison groups and high-lethality attempters (P ≤ .01, ηp2 = 0.09). These group differences remained after accounting for age, global cognitive performance, and impulsive traits. Premorbid IQ partially explained group differences in framing effects. CONCLUSIONS: Suicide attempters' failure to resist framing may reflect their inability to consider a decision from an objective standpoint in a crisis. Failure of low-lethality attempters to resist sunk cost may reflect their tendency to confuse past and future costs of their behavior, lowering their threshold for acting on suicidal thoughts.
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Problems with emotional and motivational components of decision-making can be partially compensated by the patient's intellectual abilities.
“Также проблемы с эмоциональными и мотивационными компонентами принятия решений могут частично компенсироваться за счет интеллектуальных способностей пациента (Szanto et al., 2015).”
From Когнитивные механизмы дисфункционального принятия решений при психических расстройствах (2025) · cites this paper as Szanto et al., 2015
The Discussion (page unavailable) says that IQ partially explained suicide attempters’ greater susceptibility to framing effects and describes decision-making as a balance between deliberative and affective processes. It does not show that intellectual abilities compensate for problems with emotional or motivational components of decision-making; that compensatory claim goes beyond the finding. (LLM, conf=0.78)
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What Is Suicidal Behavior, and Can It Be Prevented?
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I Predict, Therefore I Cannot Be
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I Think, Therefore I Do Not Want to Be
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The Neuroscience of Suicidal Behavior: References
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The Neuroscience of Suicidal Behavior: Preface
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The Neuroscience of Suicidal Behavior: Index
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Exploring Perceived Utility of Living vs. Dying in Relation to Suicidal Ideation Over Time
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- Authors
- Szanto, K., de Bruin, W. B., Parker, A. M., Hallquist, M. N., Vanyukov, P. M., & Dombrovski, A. Y.
- Affiliations
- RAND Corporation (US)
- University of Pittsburgh (US)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2015-12-23
- Volume
- 76
- Issue
- 12
- Pages
- e1590-e1597
- ISSN
- 0160-6689 (ISSN-L)
- PMC
- PMC4697276
- OpenAlex
- W1525456132
- Cited by
- 75
- References
- 49
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 14 · 2020: 9 · 2019: 4 · 2018: 29 · 2017: 4 · 2016: 3
- FWCI
- 14.90
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- PubMed Central (acceptedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
- Funders
- National Institute on Aging (K18AG042166)
- National Institute of Mental Health (R01MH100095, K01MH097091, K23MH086620, R01MH085651)
- 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
- suicide attempters, decision bias, framing effects, sunk cost effect, overconfidence, underconfidence, risk perception, suicidal ideation, major depressive disorder, premorbid intelligence, older adults, middle-aged adults
- MeSH terms
- Adult, Aged, Aged, 80 and over, Decision Making, Major Depressive Disorder, Depressive Disorder, Major, Female, Humans, Male, Middle Aged, Suicide, Attempted, Mental Competency, Suicidal Ideation
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