Decision-making in suicidal behavior: A systematic review and meta-analysis

• Published in: Neuroscience and biobehavioral reviews Vol. 131; pp. 642 - 662
• Main Authors: Sastre-Buades, Aina, Alacreu-Crespo, Adrián, Courtet, Philippe, Baca-Garcia, Enrique, Barrigon, Maria Luisa
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01-12-2021; Elsevier
• Subjects: Decision Making; Gambling - psychology; Human health and pathology; Humans; Iowa gambling task; Life Sciences; Neurons and Cognition; Neuropsychological Tests; Suicidal behavior; Suicidal Ideation; Suicide; Suicide attempt; Suicide, Attempted - psychology; Decision-making; Suicidal behavior; Iowa gambling task; Suicide; Suicide attempt
• ISSN: 0149-7634; 1873-7528
• DOI: 10.1016/j.neubiorev.2021.10.005

•Decision-making impairment in suicidal behavior showed reinforcement learning deficit.•The impairment was described under risk but not under ambiguity conditions.•It was independent of clinical status and seemed to be a cognitive stable trait.
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.