Lethal forethought: delayed reward discounting differentiates high- and low-lethality suicide attempts in old age.
Lethal forethought: delayed reward discounting differentiates high- and low-lethality suicide attempts in old age.
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DOI：
10.1016/j.biopsych.2010.12.025
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发表时间：
2011-07-15
影响因子：
10.6
通讯作者：
Clark, Luke
中科院分区：
文献类型：
--
作者：
Dombrovski, Alexandre Y.;Szanto, Katalin;Siegle, Greg J.;Wallace, Meredith L.;Forman, Steven D.;Sahakian, Barbara;Reynolds, Charles F., III;Clark, Luke
关键词：
自杀的决定可能是冲动的，但致命的自杀行为往往需要计划和深思熟虑。试图自杀的人在其他情况下会做出不利的决定，但我们对他们如何决定未来一无所知。推迟未来满足的意愿能否区分容易发生严重的、有预谋的自杀行为和不太严重的、无计划的自杀行为的个体？四组 60 岁以上的抑郁症参与者在较小的即时金钱奖励和较大的延迟金钱奖励之间做出选择：15 名进行了高致死性自杀尝试的人，14 名进行了低致死性自杀尝试的人，12 名认真考虑自杀的人，以及 42 名患有抑郁症但没有自杀念头史的人。参考组是 31 名精神健康的老年人。与非自杀性抑郁症和健康对照组相比，进行过低致死率尝试的个体表现出对立即奖励的过度偏好。与低致死率企图自杀的人相比，那些进行过高致死率自杀企图的人更愿意推迟未来的奖励。更有计划的自杀尝试也与愿意等待更大的奖励有关。在考虑了教育、整体认知功能、物质使用障碍、精神药物以及尝试可能造成的脑损伤后，这些影响没有变化。折扣率与债务相关，但与收入、绝望、抑郁严重程度、病前智商、首次尝试年龄或暴力手段的选择没有显着相关。虽然临床医生经常关注有自杀风险的患者的冲动性，但这些数据表明，识别非冲动性自杀老年人的生物学特征和治疗可能更为重要。
The decision to commit suicide may be impulsive, but lethal suicidal acts often involve planning and forethought. People who attempt suicide make disadvantageous decisions in other contexts, but nothing is known about the way they decide about the future. Can the willingness to postpone future gratification differentiate between individuals prone to serious, premeditated and less serious, unplanned suicidal acts? Four groups of depressed participants aged 60+ made choices between smaller immediate and larger delayed monetary rewards: 15 who made high-lethality suicide attempts, 14 who made low-lethality suicide attempts, 12 who seriously contemplated suicide, and 42 people with depression but no history of suicidal thoughts. The reference group was 31 psychiatrically healthy elders. Individuals who had made low-lethality attempts displayed an exaggerated preference for immediate rewards compared to non-suicidal depressed and healthy controls. Those who had carried out high-lethality suicide attempts were more willing to delay future rewards, compared to low-lethality attempters. Better planned suicide attempts were also associated with willingness to wait for larger rewards. These effects were unchanged after accounting for education, global cognitive function, substance use disorders, psychotropic medications, and possible brain injury from attempts. Discount rates were correlated with having debt but were not significantly associated with income, hopelessness, depressive severity, premorbid IQ, age at first attempt, or choice of violent means. While clinicians often focus on impulsivity in patients at risk for suicide, these data suggest that identifying biological characteristics and treatments for non-impulsive suicidal older people may be even more important.
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当解决方案是问题的一部分时：在老年人自杀案中解决问题。
影响因子：
4
作者：
Gibbs, Lawrence M.;Dombrovski, Alexandre Y.;Morse, Jennifer;Siegle, Greg J.;Houck, Patricia R.;Szanto, Katalin
通讯作者：
Szanto, Katalin
影响因子：
5.7
作者：
Ballard K;Knutson B
通讯作者：
Knutson B
影响因子：
25
作者：
Kable, Joseph W.;Glimcher, Paul W.
通讯作者：
Glimcher, Paul W.
影响因子：
7.6
作者：
Keilp, John G.;Oquendo, Maria A.;Mann, J. John
通讯作者：
Mann, J. John
影响因子：
17.7
作者：
Jollant, F;Bellivier, F;Courtet, P
通讯作者：
Courtet, P