Suicide is an outcome of a decision process, but has rarely been investigated as such. Moreover, for many suicide-attempters, there is evidence that suicide is not a well-considered, deliberate, decision, but an impulsive one;many who attempt suicide but fail never try again, and even report great relief to be alive. Further supporting the idea that suicide is often irrational, the applicant has found in recent studies that people who attempt suicide make disadvantageous decisions in other contexts and exhibit impairments in value-based decision-making and reward/punishment-based learning. Behavioral economics is vitally concerned with when, why, and how people make suboptimal decisions, but, up until now, its theoretical perspectives and methods have not been applied to decisions surrounding suicide. One important factor that is particularly relevant to suicide is the role of emotion in decision making. Depression and suicide are clearly linked, but exactly how depression leads to suicide, or why it does so in some people but not in others, is not well understood. Behavioral economics can provide new insights into the decision processes that lead to suicidal behavior. Specifically, experimental approaches that probe affective influences on value-based decisions may help understand the dynamics of the suicidal crisis. The candidate, a psychiatrist who has carried out suicide prevention studies, has been recently focusing on identifying novel intervention targets. She now seeks to obtain theoretical and methodological training in behavioral economics to study biases in the handling of rewards, punishments, probability, timing, context, and risk perception, induced by affective states. G. Loewenstein's research on the role of emotions in decision-making and, specifically, his theory of """"""""hot/cold empathy gaps"""""""", provides a conceptual model of how emotional states distort the decision-maker's perspective and impact decisions. Thus, we propose to develop an empirical research program applying Loewenstein's ideas and behavioral economic research paradigms to the study of the suicidal crisis. The Social and Decision Sciences Department at the Carnegie Mellon University provides the venue for the training. The mentoring team will be led by Prof. Loewenstein and joined by his colleague, Dr. Bruine de Bruin, who is an expert in individual differences in decision processes. The pilot research project will help Dr. Szanto learn to design, implement, and interpret behavioral economic experiments that capture state-induced decision biases that may play a role in suicidal behavior.
Her first aim will be to relate individual differences on existing measures of empathy gap proneness to impulsive value-based decisions, poor decision competence, and real-life decision making.
Her second aim will be to develop and pilot experiments that specifically uncover associations between (a) proneness to empathy gaps induced by depressed mood and interpersonal rejection and (b) attempted suicide. Our study design will include race-, gender-, and education-equated groups of older adults: 40 suicide attempters, 40 non-suicidal depressed individuals, and 40 non-psychiatric controls.

Public Health Relevance

Decision competence generally appears to decline in old age, preceding other cognitive impairments, and may contribute to increased suicide rates in the elderly, who will be the focus of the proposed research. Applying behavioral economics theory and methods to the study of suicide, the proposed research program offers an experimental approach to understanding the dynamics of the suicidal crisis and may lead to novel preventive interventions.

National Institute of Health (NIH)
National Institute on Aging (NIA)
The Career Enhancement Award (K18)
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Special Emphasis Panel (ZRG1-BBBP-T (52))
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Nielsen, Lisbeth
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University of Pittsburgh
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United States
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de Bruin, Wändi Bruine; Dombrovski, Alexandre Y; Parker, Andrew M et al. (2016) Late-life Depression, Suicidal Ideation, and Attempted Suicide: The Role of Individual Differences in Maximizing, Regret, and Negative Decision Outcomes. J Behav Decis Mak 29:363-371
Szanto, Katalin; Bruine de Bruin, Wändi; Parker, Andrew M et al. (2015) Decision-making competence and attempted suicide. J Clin Psychiatry 76:e1590-7