Journal
PSYCHOSOMATIC MEDICINE
Volume 76, Issue 6, Pages 445-451Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/PSY.0000000000000075
Keywords
suicide; suicidal ideation; depression; cognition; pain; delay discounting
Categories
Funding
- Arsht Foundation
- Community Alliance Against AIDS
- Abbott Labs
- Amgen
- Boehringer Ingelheim
- BMS
- Genentech
- Pharma Neuroboost
- Roche Pharma
- Shire Pharma
- Sunovion Pharma
- Takeda Pharma
- National Institutes of Health
- Agency for Healthcare Research and Quality
- AstraZeneca Pharmaceuticals
- PharmaNeuroBoost
- CeNeRx BioPharma
- NovaDel Pharma
- Reevax Pharma
- American Psychiatric Publishing
- Xhale
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Objective: Despite identification of several risk factors, suicide prediction and prevention is still a clinical challenge. Suicide can be seen as a consequence of poor decision making triggered by overwhelming psychological pain. We examined the relationship of choice impulsivity and psychological pain in depressed patients with acute suicidality. Methods: Impulsive choice (delay discounting), psychological pain, and clinical characteristics were assessed in four groups of adults (N = 20-22): a) depressed patients within 72 hours after a suicide attempt, b) depressed patients with active suicidal ideation, c) nonsuicidal depressed patients, and d) healthy controls. Results: Impulsive choice was higher in the suicide attempt (0.114 [0.027]) and ideation (0.099 [0.020]) groups compared with nonsuicidal depressed (0.079 [0.020]) and healthy (0.066 [0.019]) individuals (F(3,79) = 3.06, p = .042). Psychological pain data showed a similar profile (F(3,78) = 43.48, p < .001), with 43.4 (2.9) rating of psychological pain for the suicide attempt, 54.3 (2.2) for suicide ideation, 37.0 (3.2) for nonsuicidal depressed, and 13.7 (0.5) for healthy groups. Within the suicide attempt group, persisting suicidal ideation was associated with more severe depression (36.6 [2.9] versus 21.5 [3.1], p = .007) and choice impulsivity (0.134 [0.03] versus 0.078 [0.04], p = .015). Both measures normalized within a week: depression (29.9 [2.6] versus 14.4 [3.0], p = .006) and choice impulsivity (0.114 [0.026] versus 0.066 [0.032], p = .019). Conclusions: Transient impulsive choice abnormalities are found in a subset of those who attempt suicide. Both, suicidal ideation and behavior were associated with choice impulsivity and intense psychological pain.
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