Decision Skills Influence Risk of Suicide among Severely Depressed

Given the often tragic daily news, determining when a severely depressed individual is at risk for suicide has become an important societal issue.

While experts explain that only a small minority of people who faces challenges or who live with severe depression commits suicide, they recognize that some people are more vulnerable than others.

A series of studies has now shown that the way in which a person makes decisions may be a factor that determines whether that person is protected from or vulnerable to suicide.

Investigators discovered high-risk decision-making was prevalent among many parents of individuals who committed suicide, which may serve to explain its apparent “inheritability”.

The work by Dr. Fabrice Jollant, Assistant Professor of Psychiatry at McGill University and collegues, appears in the Journal of Psychiatric Research. In the article, Jollant explains how difficulty making effective decisions can predispose an individual to suicide, and by the same token, can lead to potential solutions for prevention.

Suicidal thoughts must be studied indirectly, say the researchers. Previous studies have focused on individuals who have attempted suicide. Here, in order to understand the vulnerability to suicide and study the family dimension, Dr. Jollant and his colleagues focused on the close relatives of individuals who committed suicide, including parents, brothers, and sisters who are in good mental health.

In the study, family members underwent neuropsychological tests. “We know that the close relatives of people who commit suicide carry certain traits linked to suicide vulnerability, even if they have never expressed them through a suicidal attempt,” Dr. Jollant explained.

One of these tests is a betting game, where the players must win as much money as possible by choosing cards from among several piles. Some piles carry more risk: they sometimes pay off big, but they lose over the long term. Other piles are safer: the pay offs are small, but the losses are also small.

Researchers discovered that individuals from families without suicides learn to choose the piles that pay off over the long term, the relatives of suicide completers continue to make high-risk choices, even after numerous attempts. This behavior suggests a higher degree of difficulty in learning from their experiences.

Functional MRI scans of the brain confirmed that certain areas of the prefrontal cortex used for decision-making function differently among these individuals — with brain involvement similar to those who have attempted suicide.

According to Dr. Jollant, “People who have a tendency to make risky decisions lean toward solutions that provide short-term benefits despite the high risk, instead of solutions that are safer over the long term. They also have difficulty identifying alternative solutions when faced with a problem.”

This can explain the link between decision-making and suicide. “Within the context of a major depression, this difficulty making good decisions can translate into choosing death, which is a solution that ends the suffering immediately, despite its irreparable consequences, without seeing any alternative solutions.”

Researchers also believe that poor life choices in general creates a variety of stress factors. “We have specifically demonstrated that individuals who make risky decisions experience more problems in their personal relationships, which represent classic triggers for suicidal crises,” Dr. Jollant added.

The study also points toward possible solutions for at-risk individuals, which must be confirmed by additional research over the coming years.

Dr. Jollant went on to say, “Beyond decision-making, we also found that the close relatives of suicide victims who were in good mental health performed very well in other tests, demonstrating the ability to control their thoughts.

“This may counterbalance their difficulty in making proper decisions, and may have protected them from suicide. We can foresee developing psychotherapies that focus on decision-making and other cognitive functions in order to reduce the vulnerability to suicide.”

Another option may be the use of neurostimulation to help individuals who exhibit suicidal tendencies. Dr. Berlim, a Researcher at the Douglas Institute, and Dr. Jollant have already demonstrated that the decision-making test scores for individuals who are in good mental health can be improved by stimulating certain areas of the brain with a mild electric current using electrodes affixed to the skull.

Medications that target decision-making represent another research approach.

All together investigators believe that improving decision-making, while not the only factor to prevent suicide, is a promising new approach for therapeutic interventions.

Source: McGill University/EurekAlert
Depressed woman photo by shutterstock.