Identifying differences between depressed adolescent suicide ideators and attempters

Abstract

Background: Adolescent depression and suicide are pressing public health concerns, and identifying key differences among suicide ideators and attempters is critical. The goal of the current study is to test whether depressed adolescent suicide attempters report greater anhedonia severity and exhibit aberrant effort-cost computations in the face of uncertainty.

Methods: Depressed adolescents (n=101) ages 13-19 years were administered structured clinical interviews to assess current mental health disorders and a history of suicidality (suicide ideators=55, suicide attempters=46). Then, participants completed self-report instruments assessing symptoms of suicidal ideation, depression, anhedonia, and anxiety as well as a computerized effort-cost computation task.

Results: Compared with depressed adolescent suicide ideators, attempters report greater anhedonia severity, even after concurrently controlling for symptoms of suicidal ideation, depression, and anxiety. Additionally, when completing the effort-cost computation task, suicide attempters are less likely to pursue the difficult, high value option when outcomes are uncertain. Follow-up, trial-level analyses of effort-cost computations suggest that receipt of reward does not influence future decision-making among suicide attempters, however, suicide ideators exhibit a win-stay approach when receiving rewards on previous trials.

Limitations: Findings should be considered in light of limitations including a modest sample size, which limits generalizability, and the cross-sectional design.

Conclusions: Depressed adolescent suicide attempters are characterized by greater anhedonia severity, which may impair the ability to integrate previous rewarding experiences to inform future decisions. Taken together, this may generate a feeling of powerlessness that contributes to increased suicidality and a needless loss of life.

Keywords: Adolescence; Anhedonia; Depression; Reward processing; Suicide.

Figure 1. Effort-Cost Computation Task Schema

Note. ECCT sample trial in which the high effort decision (i.e., difficult option) was selected in the 50% probability condition.

Figure 2

Figure 2A. Probability of Selecting Difficult Option in Uncertain Trials (50% Probability) Figure 2B. Probability of Selecting Difficult Option for Certain Trials (100% Probability) Note. ^**p ≤0.01; + < 0.09; Probability of selecting difficult option among depressed suicide ideators (n = 52) and suicide attempters (n = 46) for (A) 50% probability and (B) 100% probability of receiving reward value; The Group X Value interaction was significant in Figure 2B but not Figure 2A.

Figure 2

Figure 2A. Probability of Selecting Difficult Option in Uncertain Trials (50% Probability) Figure 2B. Probability of Selecting Difficult Option for Certain Trials (100% Probability) Note. ^**p ≤0.01; + < 0.09; Probability of selecting difficult option among depressed suicide ideators (n = 52) and suicide attempters (n = 46) for (A) 50% probability and (B) 100% probability of receiving reward value; The Group X Value interaction was significant in Figure 2B but not Figure 2A.

Figure 3. Impact of Reward Receipt on Effort-Cost Computations in Selecting Difficult Trials for the 50% Probability Condition

Note. ^*p < .05; Probability of suicide ideators (n = 50) and suicide attempters (n = 46) selecting difficult option in trials following reward or no reward in difficult trials within the 50% condition.