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Impulsive Choice and Psychological Pain in Acutely Suicidal Depressed Patients

Cáceda, Ricardo MD, PhD; Durand, Dante MD; Cortes, Edmi MD; Prendes-Alvarez, Stefania MD, MPH; Moskovciak, Tori PsyD; Harvey, Philip D. PhD; Nemeroff, Charles B. MD, PhD

doi: 10.1097/PSY.0000000000000075
Original Articles

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.

From the Psychiatric Research Institute (R.C.), University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Psychiatry and Behavioral Sciences (D.D., E.C., S.P.-A., T.M., P.D.H., C.B.N.), University of Miami Miller School of Medicine, Miami, Florida; and Research Service (P.D.H.), Miami VA Medical Center, Miami, Florida.

Address correspondence and reprint requests to Ricardo Cáceda, MD, PhD, Brain Imaging Research Center, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham St, Slot #554, Little Rock, AR 72205. E-mail:

Received for publication October 15, 2013; revision received April 13, 2014.

Previous presentation: A summary of these results was presented at the annual meeting of the American College of Neuropsychopharmacology in 2012.

Copyright © 2014 by American Psychosomatic Society
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