Risky decision-making under stress in individuals with suicidal history: emotion regulation strategies and a...

Risky decision-making is linked to suicidal behavior, but the effects of acute stress and emotion regulation strategies are less understood. This study compared risky decision-making patterns between a clinical group (with suicidal history) and a control group under stress versus non-stress conditions, exploring the moderating role of emotion regulation strategies.

In a 2 × 2 between-subjects design, 122 participants (52 in clinical group, 70 in control group) were assigned to the stress (induced by Trier Social Stress Test) or non-stress condition. Risky decision-making was assessed using the Balloon Analogue Risk Task, analyzed via generalized linear mixed models. Emotion regulation strategies (cognitive reappraisal vs expressive suppression) were examined as moderators.

Acute stress increased risk-taking, most markedly between the control group under stress and the clinical group without stress (e.g., for pumps on non-exploded trials: rate ratio = 0.768, p = .019). A significant three-way interaction was found across outcomes (e.g., for mean pumps on non-exploded trials: β = 0.306, p = .034), revealing that high expressive suppression amplified stress effects only in the clinical group. Furthermore, within the clinical group, antipsychotic use significantly buffered against stress-induced risk-taking (e.g., for non-exploded trials under stress: rate ratio = 1.581, p = .002). Temporal dynamics showed the clinical group's stress response peaked earlier than controls.

Acute stress promotes risk-taking through a complex interplay of temporal dynamics, maladaptive emotion regulation, and pharmacotherapy. In individuals with suicidal history, stress effects emerge earlier, are amplified by expressive suppression strategies, and are buffered by antipsychotic medication.