Fatal Choice - Behavioral Economics of Vulnerability for Late-Life Suicide

描述(由申请人提供)：自杀是一个决策过程的结果，但很少作为这样的调查。此外，对于许多自杀未遂者来说，有证据表明，自杀不是一个经过深思熟虑、深思熟虑的决定，而是一种冲动的决定；许多试图自杀但失败的人再也没有尝试过，甚至报告说自己还活着，松了一口气。申请人进一步支持自杀往往是非理性的这一观点，在最近的研究中发现，试图自杀的人在其他情况下会做出不利的决定，并在基于价值的决策和基于奖惩的学习中表现出障碍。行为经济学非常关注人们何时、为什么以及如何做出次优决定，但到目前为止，它的理论观点和方法还没有被应用到围绕自杀的决定上。与自杀特别相关的一个重要因素是情绪在决策中的作用。抑郁症和自杀显然是有联系的，但抑郁症究竟是如何导致自杀的，或者为什么在一些人身上会导致自杀，而在另一些人身上却不是，人们还不太清楚。行为经济学可以为导致自杀行为的决策过程提供新的见解。具体地说，探索情感对基于价值的决策的影响的实验方法可能有助于理解自杀危机的动态。这位候选人是一名精神病学家，曾进行过自杀预防研究，最近一直专注于确定新的干预目标。她现在寻求获得行为经济学的理论和方法培训，以研究在处理奖励、惩罚、概率、时机、背景和风险感知方面的偏差，这些偏差是由情感状态引起的。勒文斯坦对情绪在决策中的作用的研究，特别是他的“冷/热移情差距”理论，提供了一个关于情绪状态如何扭曲决策者的视角和影响决策的概念模型。因此，我们建议开发一个应用洛文斯坦的思想和行为经济学研究范式来研究自杀危机的实证研究方案。卡内基梅隆大学的社会与决策科学系提供了培训场所。指导团队将由洛文斯坦教授领导，他的同事布鲁恩·德·布鲁因博士将加入，后者是决策过程中的个体差异专家。这个试点研究项目将帮助桑恩博士学习设计、实施和解释行为经济学实验，这些实验捕捉国家诱导的决策偏差，这些偏差可能在自杀行为中发挥作用。她的第一个目标将是将现有共鸣差距倾向性的个体差异与冲动的基于价值的决定、糟糕的决策能力和现实生活中的决策联系起来。她的第二个目标将是开发和试点实验，专门揭示(A)抑郁情绪和人际拒绝导致的同理心差距倾向与(B)自杀未遂之间的联系。我们的研究设计将包括种族、性别和教育程度相等的老年人群体：40名自杀未遂者、40名非自杀抑郁症患者和40名非精神控制组。 与公共健康相关：决策能力通常在老年时出现下降，先于其他认知障碍，并可能导致老年人自杀率增加，这将是拟议研究的重点。将行为经济学理论和方法应用于自杀的研究，为理解自杀危机的动力学提供了一种实验方法，并可能导致新的预防干预措施。

DESCRIPTION (provided by applicant): 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.