The decision neuroscience perspective on suicidal behavior: evidence and hypotheses

Area of Science:

• Neuroscience
• Psychiatry
• Decision Science

Background:

• Suicide attempts are often regretted, and addiction and gambling are overrepresented in individuals who attempt or die by suicide.
• This suggests potential impairments in decision-making processes among suicidal individuals.
• Decision neuroscience offers tools to investigate these decision processes and their neural underpinnings.

Purpose of the Study:

• To investigate decision-making processes in suicidal individuals.
• To elucidate the neural substrates associated with disadvantageous decision-making in suicide attempters.
• To explore the relationship between decision-making deficits and different suicide attempt characteristics.

Main Methods:

• Review of early studies linking suicide attempts to gambling task performance.
• Functional magnetic resonance imaging (fMRI) combined with reinforcement learning computational modeling.
• Behavioral studies assessing delay discounting and social decision-making.

Main Results:

• Impaired decision-making in suicide attempters correlates with disrupted expected value signals in the ventromedial prefrontal cortex.
• Increased delay discounting is associated with low-lethality/poorly planned attempts, multiple attempts, and co-occurring addiction.
• Well-planned, serious suicide attempts show intact or diminished delay discounting, while high-lethality attempts are linked to impaired social decision-making.

Conclusions:

• Decision-making impairments, often related to impulsivity, may characterize different pathways to suicide.
• Suicidal responses to social stressors may stem from automatic processes overriding goal-directed computations.
• This research highlights the role of decision neuroscience in understanding suicide.