A new JAMA Psychiatry study published last week by Pitt School of Medicine researchers describes patterns of decision-making in people who attempt suicide, focusing on how they explore alternative options. The study is a step toward developing tools for mental health professionals to tailor interventions to patients’ decision patterns.
Aliona Tsypes, Ph.D.
“People appear to follow different paths leading to the decision to end their life. The most dangerous one involves being unable to find and explore potential alternative solutions,” said lead author Dr. Aliona Tsypes, assistant professor of psychiatry at Pitt.
Many of Dr. Tsypes’s patients describe being in a state of tunnel vision and black-and-white thinking – a sense of narrowing where suicide felt like the only option. To understand the processes driving this, Tsypes studied people’s decision-making under uncertainty and time pressure – crucial aspects of a suicidal crisis not previously accounted for in laboratory experiments.
Behavioral findings from more than 300 participants revealed that individuals who had made serious suicide attempts almost ending in death were unable to shift away from unrewarded choices, under-exploring alternatives. In contrast, individuals who had made less medically serious suicide attempts displayed excessive behavioral shifts.
Alexandre Dombrovski, M.D.
“Many people think of suicide as the ultimate escape from unbearable suffering,” said senior author of the study Dr. Alex Dombrovski. “However, our studies show that it is often a decision accident, an outcome of decision processes gone awry.”
These results suggest different intervention strategies: Whereas people prone to underexploring may benefit from trying out novel ways to cope that could be implemented in future crises, people with overly flexible choices may benefit from evaluating the long-term consequences of their contemplated actions.
“All in all, there is no such thing as a ‘typical’ suicide; instead, there are distinct pathways,” Tsypes said. “Our next immediate step is to understand how what we see in the lab relates to what people experience in real life.”
Tsypes’s ongoing research also integrates behavioral experiments with brain oscillation recordings to understand these processes at the neural level, potentially informing targeted approaches to help people in crisis.
“In the future, we will assess people’s decision-making in the clinic, as we now assess memory or gait,” Dombrovski said.
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