Cognitive modelling to assess decision-making impairments in patients with current depression and with/without suicide history
A. Alacreu-Crespo abc S.Guillaume abc M.Sénèque abc E.Olié abc P.Courtet abc
a PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France
b Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
c FondaMental Foundation, Créteil, France
European Neuropsychopharmacology
Available online 23 May 2020
Highlights
• We applied the prospect valence-learning model to the Iowa gambling task.
• Decision making was altered in depressed patients with and without suicide history.
• Decision making was altered in depressed patients with and without suicide history.
• Loss aversion and learning were lower in suicide attempters than healthy controls.
• Choice consistency was lower in all depressed patients than in healthy controls.
• In severe depression, choice consistency was associated with suicide attempt.
Abstract
It
has been reported that decision making is impaired in suicide
attempters. Decision making is a complex process and little is known
about its different components. Yet, this information would help to
understand the functioning of suicidal minds. In this study, the
Prospect Valence-Learning (PVL) computational model was applied to the
Iowa Gambling Task (IGT) to investigate and compare decision-making
components in patients with affective disorder and with/without history
of suicide attempts and in healthy controls. To this aim, 116 inpatients
with current major depressive episode (among whom 62 suicide
attempters) and 38 healthy controls were recruited. Decision-making
performance was measured using the IGT. The Bayesian computational PVL
model was applied to compare the feedback sensitivity, loss aversion, learning/memory, and choice consistency
components of decision making in the different groups. Depressive
symptomatology was assessed using the Beck Depression Inventory short
form (BDI-SF). The total IGT net score and the loss aversion and learning/memory scores were lower in suicide attempters than in healthy controls. The choice consistency
score was low in all patients (with/without suicide history) compared
with healthy controls. Moreover, patients with high BDI score showed a
positive relationship between the choice consistency score and
suicide attempt. These findings suggest that decision-making impairment
in depressed patients with and without suicidal history might be the
result of underlying problems in feedback processing and task learning,
which influence the building of long-term strategies. All these
impairments should be targeted in therapeutic strategies for suicidal
patients.
Keywords Suicide Depression Decision making Cognitive modelling Reward processing