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Decision-making competence and attempted suicide.

ABSTRACT: The propensity of people vulnerable to suicide to make poor life decisions is increasingly well documented. Do they display an extreme degree of decision biases? The present study used a behavioral-decision approach to examine the susceptibility of low-lethality and high-lethality suicide attempters to common decision biases that may ultimately obscure alternative solutions and deterrents to suicide in a crisis.We assessed older and middle-aged (42-97 years) individuals who made high-lethality (medically serious) (n = 31) and low-lethality suicide attempts (n = 29). Comparison groups included suicide ideators (n = 30), nonsuicidal depressed participants (n = 53), and psychiatrically healthy participants (n = 28). Attempters, ideators, and nonsuicidal depressed participants had nonpsychotic major depression (DSM-IV criteria). Decision biases included sunk cost (inability to abort an action for which costs are irrecoverable), framing (responding to superficial features of how a problem is presented), underconfidence/overconfidence (appropriateness of confidence in knowledge), and inconsistent risk perception. Data were collected between June 2010 and February 2014.Both high- and low-lethality attempters were more susceptible to framing effects as compared to the other groups included in this study (P ? .05, ?p2 = 0.06). In contrast, low-lethality attempters were more susceptible to sunk costs than both the comparison groups and high-lethality attempters (P ? .01, ?p2 = 0.09). These group differences remained after accounting for age, global cognitive performance, and impulsive traits. Premorbid IQ partially explained group differences in framing effects.Suicide attempters' failure to resist framing may reflect their inability to consider a decision from an objective standpoint in a crisis. Failure of low-lethality attempters to resist sunk cost may reflect their tendency to confuse past and future costs of their behavior, lowering their threshold for acting on suicidal thoughts.

SUBMITTER: Szanto K

PROVIDER: S-EPMC4697276 | biostudies-literature | 2015 Dec

REPOSITORIES: biostudies-literature

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Decision-making competence and attempted suicide.

Szanto Katalin K Bruine de Bruin Wändi W Parker Andrew M AM Hallquist Michael N MN Vanyukov Polina M PM Dombrovski Alexandre Y AY

The Journal of clinical psychiatry 20151201 12

<h4>Objective</h4>The propensity of people vulnerable to suicide to make poor life decisions is increasingly well documented. Do they display an extreme degree of decision biases? The present study used a behavioral-decision approach to examine the susceptibility of low-lethality and high-lethality suicide attempters to common decision biases that may ultimately obscure alternative solutions and deterrents to suicide in a crisis.<h4>Method</h4>We assessed older and middle-aged (42-97 years) indi ...[more]

PMID: 26717535

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Project description:BackgroundThe current state of evidence regarding measures that assess evidence-informed decision-making (EIDM) competence attributes (i.e., knowledge, skills, attitudes/beliefs, behaviours) among nurses is unknown. This systematic review provides a narrative synthesis of the psychometric properties and general characteristics of EIDM competence attribute measures in nursing.MethodsThe search strategy included online databases, hand searches, grey literature, and content experts. To align with the Cochrane Handbook of Systematic Reviews, psychometric outcome data (i.e., acceptability, reliability, validity) were extracted in duplicate, while all remaining data (i.e., study and measure characteristics) were extracted by one team member and checked by a second member for accuracy. Acceptability data was defined as measure completion time and overall rate of missing data. The Standards for Educational and Psychological Testing was used as the guiding framework to define reliability, and validity evidence, identified as a unified concept comprised of four validity sources: content, response process, internal structure and relationships to other variables. A narrative synthesis of measure and study characteristics, and psychometric outcomes is presented across measures and settings.ResultsA total of 5883 citations were screened with 103 studies and 35 unique measures included in the review. Measures were used or tested in acute care (n?=?31 measures), public health (n?=?4 measures), home health (n?=?4 measures), and long-term care (n?=?1 measure). Half of the measures assessed a single competence attribute (n?=?19; 54.3%). Three measures (9%) assessed four competence attributes of knowledge, skills, attitudes/beliefs and behaviours. Regarding acceptability, overall missing data ranged from 1.6-25.6% across 11 measures and completion times ranged from 5 to 25?min (n?=?4 measures). Internal consistency reliability was commonly reported (21 measures), with Cronbach's alphas ranging from 0.45-0.98. Two measures reported four sources of validity evidence, and over half (n?=?19; 54%) reported one source of validity evidence.ConclusionsThis review highlights a gap in the testing and use of competence attribute measures related to evidence-informed decision making in community-based and long-term care settings. Further development of measures is needed conceptually and psychometrically, as most measures assess only a single competence attribute, and lack assessment and evidence of reliability and sources of established validity evidence.RegistrationPROSPERO #CRD42018088754.

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Decision-making competence and attempted suicide.

Publications

Decision-making competence and attempted suicide.

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