Hot Publication - Szanto et al.

Decision-making Competence and Attempted Suicide
Szanto K, Bruine de Bruin W, Parker AM, Hallquist MN, Vanyukov PM, and Dombrovski AY.
Journal of Clinical Psychiatry, Published online

Decision biases are systematic deviations from normative (rational) choices that aim to provide the decision maker with the maximum likelihood of the desired outcome. While the propensity of people vulnerable to suicide to make poor life decisions is increasingly well documented, little is known about whether these individuals display an extreme degree of decision biases.  Using a behavioral-decision approach, Dr. Katalin Szanto and her colleagues examined 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.

The investigators assessed individuals ages 42-97 years old 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 based on 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. 

Findings from this study indicate that both high- and low-lethality attempters were more susceptible to framing effects as compared to the other groups included in this study. In contrast, low-lethality attempters were more susceptible to sunk costs than both the comparison groups and high-lethality attempters. The investigators also reported that these group differences remained after accounting for age, global cognitive performance, and impulsive traits. Premorbid IQ partially explained group differences in framing effects.

This study lays the ground work for future research investigating whether suicide attempters' failure to resist framing may reflect their inability to consider a decision from an objective standpoint in a crisis.  It also has important implications for investigators wanting to examine whether failure of low-lethality attempters to resist sunk cost may also reflect their tendency to confuse past and future costs of their behavior, lowering their threshold for acting on suicidal thoughts.

Katalin Szanto, MD, Michael N. Hallquist, PhD, Polina M. Vanyukov, PhD, and Alexandre Y. Dombrovski, MD (Department of Psychiatry, University of Pittsburgh)

Wändi Bruine de Bruin, PhD (Centre for Decision Research, Leeds University Business School, Leeds, West Yorkshire, United Kingdom)

Andrew M. Parker, PhD (RAND Corporation)

This article appears in the Journal of Clinical Psychiatry. Click here to view the abstract.