Decision-making in suicidal acute psychiatric patients

Decision-making in suicidal acute psychiatric patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Decision-making in suicidal acute psychiatric patients Marie Aaslie Reiråskag, Silje Støle Brokke, Gudrun Rohde, Thomas Bjerregaard Bertelsen, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4257846/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Suicidality is a major health problem. Decision-making deficits, including a lack of cognitive control (e.g., impulsivity and risk-taking behavior), have been associated with an increased risk of suicide. Methods This study examined decision-making in a clinical group of 23 adult, suicidal acute psychiatric patients and compared their data to that of a control group of 17 healthy adults using the Cambridge Gambling Task (CGT) from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Group differences in outcomes on the six CGT subtests were compared using chi-square tests, t tests, and Mann‒Whitney U tests where appropriate. Multiple regression analysis was used to explore whether background variables were associated with CGT outcomes. Results The main findings were significantly lower scores for risk-taking, quality of decision-making, and risk adjustment in the clinical group than in the control group. Within the clinical group, differences were observed in which suicide ideators scored worse in some measures than did suicide attempters. These findings suggest that suicidal acute psychiatric patients may struggle with making low-risk decisions that are considered reasonable. Conclusion These results support the potential for cognitive control training, specifically aimed at enhancing decision-making abilities, in suicide prevention efforts. The observed decision-making deficits in suicidal patients underscore the importance of further investigating these findings in a larger population to solidify the foundation for targeted interventions. Cambridge Gambling Task Decision-making Preventing suicide Background Suicide, defined as a fatal act initiated and carried out by the actors themselves [ 1 ], represents a major public health challenge [ 2 ]. A considerable portion of the population experiences aspects of suicidality, such as thoughts, tendencies, behavior, and intent [ 3 ]. However, most individuals with suicidal ideation do not act on it [ 4 ]. It is possible that the difference, at least in part, between those who have thoughts about suicide and those who attempt suicide is related to executive dysfunction[ 5 – 7 ], impulsivity, and risk taking [ 8 , 9 ] as part of suicidal acts. It has been found that suicide attempters and ideators exhibit varying levels of cognitive control [ 10 , 11 ]. This difference can be expressed as a narrow time perspective and impaired decision-making and reasoning abilities [ 11 – 13 ]. Some suicide attempters exhibit a preference for immediate rewards over future rewards, a behavior known as delay discounting [ 12 , 13 ]. Among the limited studies available, one notable finding came from a study involving 40 suicide ideators and 37 ideators with a history of suicide attempts. This analysis revealed that suicide attempters displayed poorer attention control and better problem-solving abilities than did suicide ideators [ 7 ]. A literature review by Saffer and Klonsky [ 14 ] investigated the relationship between suicide attempters and ideators and revealed only 14 studies that compared these two groups. The majority of these studies suggested that there was no significant difference between attempters and ideators, except for in domains such as inhibition and decision making. A retrospective study of 92 psychiatric outpatient clients revealed that suicide attempters and ideators exhibit varying levels of cognitive control [ 11 ]. An interesting line of research on cognitive functions in suicidal patients has focused on the Cambridge Gambling Task (CGT) [ 15 ]. The CGT is a tool for assessing decision-making under conditions of uncertainty but not under conditions of ambiguity [ 16 ]. The CGT is a sensible tool for assessing orbitofrontal functioning and is known to detect reliable differences in risk-sensitive decision making between individuals who have attempted suicide and those who have not [ 17 – 19 ]. In a study with participants recruited from a general population, 304 young adults (aged 18–29, 70% males) were tested, and 14.8% were identified as (broadly defined) suicidal. Of these, 5.3% had a history of suicide attempts. That study concluded that impaired decision making, as measured with the CGT, was associated with suicidality [ 18 ]. Ackerman and colleagues studied CGT performance in 14 adolescent suicide attempters and 14 nonattempter comparison subjects aged 15–19 years. They found that adolescents with a history of suicide attempt display increased risk taking and greater difficulty in predicting probable outcomes [ 17 ]. The studies by Chamberlain and Ackerman were both conducted on a young population. Adolescents and young adults have underdeveloped brain regions necessary for cognitive control, which can be observed as heightened risk taking and increased impulsivity [ 20 ]. It is therefore necessary to examine whether the above results are replicable in an adult population. A study on older suicide attempters (age > 60 years) with depression concluded that test subjects had a deficit in risk-sensitive decision-making as measured with the CGT [ 19 ]. That study did not include adults younger than 60 years of age. Therefore, further research is necessary to replicate the results in a population with a broader range of adults. Given the prevalence and costs associated with suicide and the importance of understanding cognitive processes related to how decision-making and neurocognitive factors affect suicidal thoughts, there is a need for studies differentiating between suicidal patients and healthy adults. The current study aimed to investigate CGT decision-making in adult suicidal acute psychiatric patients, both suicide ideators and suicide attempters, and compare the results with those of healthy adults. To our knowledge, this is the first study to examine decision-making as measured by the CGT in an adult population aged 18 to 65 years. Based on the abovementioned literature, we hypothesized that suicidal acute psychiatric patients and control participants would have different outcomes in decision-making tasks. Furthermore, we hypothesized that there could be a difference within the patient group. However, as the literature differs regarding the direction of these differences, both within patient groups and between adults and adolescents, we chose not to hypothesize about that direction. Methods Participants We included 23 acute psychiatric patients and a control group comprising 17 people. The clinical group was recruited from an ongoing study at Sørlandet Hospital. Patients with suicidal ideation between the ages of 18 and 65 years who were referred for acute psychiatric treatment were asked to participate. The main inclusion criterion for the clinical group was suicide risk. Potential participants with severe substance abuse, IQ < 70 or inability to read, speak, or write Norwegian were excluded. We recruited control participants by strategically placing posters around the hospital, aiming to recruit healthy individuals aged between 18 and 65 years. The study was approved by the Regional Committee for Medical and Health Research Ethics (2013/1664/REK sør øst,14/00969-2-522), and written informed consent was obtained. Measures Columbia Suicide History Form (CSHF) The CSHF is a validated tool for the assessment and differentiation of the severity of suicidality. It has shown good convergent and divergent validity with other multi-informant suicidal ideation and behavior scales [ 21 ]. The form is structured as a screening interview with five questions on suicide ideation, seven questions on the intensity of ideation, six questions on suicidal behavior, and two questions on lethality evaluations of actual suicide attempts. The interview covers both suicidal behavior during the previous month and lifetime history of suicidal behavior for all the questions. Suicide attempts are also categorized by the first, latest, and most deadly attempt. The instrument was used to identify suicidal ideators and separate them from participants with a history of attempted suicide. The severity of suicidality was identified in the clinical group and was graded from 1 to 5 according to the CSHF. The clinicians involved in the research process and data collection were all trained to complete the screening interview. Their training included watching a video made by the CSHF developers and observing an interview between a researcher and a patient. The CGT from the Cambridge Neuropsychological Test Automated Battery (CANTAB) [ 15 ] The CGT was used to assess impulsivity, decision-making, and risk-taking behavior. This instrument is used to measure risk-taking behavior and decision-making under uncertainty [ 22 ]. The CGT is a validated and standardized computer-based test [ 23 ]. The CGT is suitable for assessing young and old subjects, is culture- and language-independent, and is highly sensitive to disorder-related impairment and cognitive enhancement [ 15 ]. The six outcome measures in the CGT are as follows: Delay aversion was represented by the difference in percentage bets between the ascending and descending conditions (CGT1). Deliberation time (milliseconds) was represented by the mean time taken to make a box color response (CGT2). This measure indicated the participant’s latencies in making a choice response on which color to bet upon. The overall proportion bet was represented by the mean proportion of points bet across trials (CGT3). The quality of decision-making was represented by the mean proportion of trials where the participants selected the correct color outcome (CGT4). Risk adjustment was represented by the extent to which betting behavior is moderated by the ratio of boxes (CGT5). Higher scores represented a greater proportion of bets when most boxes are congruent with the color chosen (i.e., the reasonable choice). Risk taking was represented by the mean proportion of points bet on trials where the most likely outcome was chosen (CGT6) [ 22 ]. Wechsler Abbreviated Scale of Intelligence (WASI) [ 24 ] The two subtests “Matrix reasoning” and “Similarities” were used to estimate IQ. Concurrent validity for the WASI has been established with other measures of intelligence, such as the WISC–IV and KBIT–2 [ 25 ]. The Norwegian translation used in this study, the WASI, has been found to retain basic psychometric properties and be a valid measure of intelligence [ 26 ]. Beck Depression Inventory (BDI) [ 27 ]. The BDI was used to measure current depression severity. The BDI has been found to be a reliable and valid measure for the assessment of depression [ 28 ]. The internal consistency of the BDI is approximately 0.9, and the test-retest reliability ranges from 0.73 to 0.96. [ 29 ]. Statistical analyses Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 27 [ 30 ]. Differences between the clinical and control groups were examined using chi-square tests for categorical data and independent t tests for continuous outcomes. For differences in the CGT2 and CGT4 scores, nonparametric Mann‒Whitney U tests were used. Next, one-way ANOVAs were used to test differences in the CGT task scores among the control participants, ideators, and attempters. For the ANOVA on CGT2 and CGT4scores, a Kruskal‒Wallis test was used as a nonparametric alternative. Tukey’s post hoc test was used for multiple comparisons. A p value < 0.05 was considered to indicate statistical significance. There were no relevant missing data, and all analyses were performed with complete cases. Results Based on the CSHF, the sample consisted of 11 (47.83%) ideators, 12 (52.17%) attempters, and 17 healthy control participants. None of the healthy control participants reported suicidal intention or a history of suicide attempt. The clinical and control groups significantly differed on measures of depression, self-reported impulsivity and attention ( p < 0.05). Furthermore, there was a significant difference between the healthy control participants and the clinical group for the CGT4 score ( U = 267, df = 38, p = 0.05, d = 0.37). Likewise, compared to the control participants, the clinical group had significantly lower scores on the CGT5 ( t( 38) = 2.62, p = 0.01, d = 0.84). There were no significant differences between the clinical and nonclinical groups for any of the other measures (see Table 1 for further details). There were significant differences among the control participants, ideators, and suicide attempters for the CGT1 (F(2,37) = 4.56, p = 0.02) and on the CGT5 (F(2,37) = 5.25, p < 0.01) scores, whereas there were no between-group differences for the CGT2, CGT3, CGT4 or CGT6 scores. Post hoc tests showed that ideators had higher scores on the CGT1 than did control participants (p = 0.02, d = 1.16) and attempters (p = 0.06, d = 0.99), whereas there was no difference between attempters and control participants (p = 0.89, d = 0.17). In line with this, post hoc tests showed that ideators had lower scores on the CGT5 than did control participants (p < 0.01, d = 1.29). See Table 3 for further details. Table 1 ABOUT HERE Table 2 ABOUT HERE Table 3 ABOUT HERE Discussion Compared to suicide attempters and control participants, patients who scored high in suicidal ideation also scored higher in delay aversion and had lower scores in risk adjustment on the CGT. There were no significant differences between the suicide attempters and control participants for those measures. This finding is in line with previous literature on decision-making deficits in suicidal patients [ 6 , 8 , 13 ]. Within-group differences in decision making have been observed among clinical patients in previous studies [ 11 , 14 , 31 ]. The nature of the differences within the clinical group, and thus the explanation or meaning of it, differs within the literature and from our findings. As in the Ackerman study, we observed a difference between suicidal patients and healthy control participants; however, while Ackerman et al. [ 17 ] observed that increased risk-taking behavior was prevalent in adolescent suicide attempters, we did not observe that phenomenon in our study sample. The Ackerman study is one of few to use the CGT to assess decision-making deficits, and those investigators did not include ideators in their sample. In another study using the CGT, Chamberlain et al. (2013) concluded that impaired decision making exists in young adults with suicidality [ 18 ]. The participants in Chamberlain et al. were drawn from a population of nontreatment-seeking young adults. There were relatively few participants (n = 16; 5.3%) with a history of suicide attempts, and the majority of the participants (70%) were males. Therefore, it is difficult to compare their results with those obtained in our study, because our study population included treatment-seeking patients, had an even distribution of attempters and ideators, and had no significant difference between the numbers of male and female participants. The difference in age can play an important role in understanding some of the differences between our study and the studies with adolescent and young-adult participants. One study on suicidal patients using the CGT to measure decision making in an older population revealed poorer attention control and better problem-solving abilities among suicide attempters than among suicide ideators [ 7 ]. Furthermore, Clark et al. (2011) reported that compared with depressed individuals with no history of suicidality and nondepressed individuals, older individuals with suicide attempts and major depression had impaired decision-making quality, as measured with the CGT. That study helps us to understand the role of depression in the associations investigated in our study, as the clinical group was significantly more depressed than the control participants were in our study, and we did not include a comparison group of depressed individuals. To our knowledge, our study is the first to investigate decision making as measured with the CGT in a population of adults aged 18 to 65 years, i.e., including both young and older adults. In contrast to Greenman’s [ 4 ] hypothesis, our results suggest that cognitive impairments are more pronounced in suicide ideators than in suicide attempters. This could imply that factors beyond neurocognitive dysfunction, such as emotional dysregulation or poor psychological resilience, might play a more significant role in actual suicide attempts [ 32 ]. Some theories have focused on suicide as an escape from emotional or psychological pain [ 33 – 35 ]. Klonsky and May [ 31 ] described a model of the development of suicidal ideation. This three-step theory of suicide proposes that pain (often emotional or psychological) combined with hopelessness is required for the development of suicidal ideation. Suicidal ideation becomes stronger in the presence of disrupted connectedness. In this model, the difference between ideation and behavior and the and progression from the former to the latter is determined by the individual’s capacity for suicide, which is dependent on genetic factors, practical factors, and habituation to pain, fear, and death through life experiences [ 36 ]. These theories may explain some of the differences among the clinical groups. In a study by Kelp et al. [ 9 ]a smaller subgroup of attempters with more violent methods showed a pattern of poorer executive function. Another recent study by Brokke et al. [ 37 ] adds to the knowledge of the association between aggression and differences within groups of suicidal patients and can add to the understanding of the progression from ideation to attempt, which was not captured in our study. Qui and Klonsky investigated decision-making styles rather than deficits [ 38 ]. The results of their study suggest that there is a difference in decision-making styles between nonsuicidal individuals and individuals with suicidal ideation and between individuals with suicidal ideation and attempters. When common predictors of suicidality were considered, only spontaneous decision-making styles differed between attempters and ideators, and there was no difference between ideators and healthy control participants. The absence of distinct cognitive deficits in suicide attempters compared to control participants observed in our study may be attributed to various factors. Differences in the cognitive task used, the age of participants [ 20 ], or their treatment history could influence these results. Additionally, cognitive differences in suicide attempters might be more subtle and not adequately captured by the CGT. Future research could include a multifaceted approach to understanding cognitive functions in suicidal behavior, incorporating a range of cognitive assessments, and considering developmental factors. Furthermore, this study underscores the complexity of cognitive control in suicidal ideation and attempts. The current study is subject to several limitations, and conclusions should be drawn with caution. The above-average IQ scores in both the clinical and control groups could influence the generalizability of the findings. Future studies should consider a broader IQ range to better understand the interplay between intelligence and suicidal behavior. Additionally, the exclusion of individuals with severe substance abuse might have led to a loss of insight into a significant subset of the population at risk for suicide. Finally, we detected within-group differences in some parts of the test between males and females. The differences were not significant but should be further investigated in a larger population. Conclusion Our findings contribute to the nuanced understanding of the cognitive aspects of suicidal behavior in adults. These findings highlight the importance of considering a range of neurocognitive functions and emotional factors in understanding and treating suicidality. Given the small sample size, future research with larger cohorts and a broader range of cognitive assessments is essential to validate and expand upon these findings. Abbreviations CGT: Cambridge Gambling Task CSHF: Columbia Suicide History Form CANTAB: Camebridge Neuropsychological Test Automated Battery CGT 1: Cambridge Gambling Task, subsection 1 CGT 2: Cambridge Gambling Task, subsection 2 CGT 3: Cambridge Gambling Task, subsection 3 CGT 4: Cambridge Gambling Task, Subsection 4 CGT 5: Cambridge Gambling Task, Subsection 5 CGT 6: Cambridge Gambling Task, Subsection 6 WASI: Wechsler Abbrivated Scale of Intelligence BDI: Beck Depression Inventory ANOVA: Analysis of Variance IQ: Interligence Quotient BIS: Barrett Impulsivity Scale OR: Odds Ratios Declarations Ethics The study was ethically approved by the Regional Committee for Medical and Health Research Ethics (2013/1664/REK sør øst,14/00969-2-522), All methods were performed in accordance with relevant guidelines and regulations. All patients provided written consent for participation and were informed that they could withdraw their consent at any time without giving any reason. Availability of Data and Materials The anonymized datasets are available from the corresponding author upon reasonable request. Competing Interests The authors declare that they have no competing interests. Funding The research was funded in collaboration between University of Oslo and Sørlandet Hospital HF. Authors' Contributions SSB was responsible for the study and obtained ethical approval MR, GR and VØH contributed to the conceptualization and design of the paper. SSB and MR contributed to the data preparation. MR, GR and TBB contributed to the formal analysis. MR wrote the original draft. All the authors contributed to the writing and editing of the manuscript. All the authors have read and agreed to the published version of the manuscript. Acknowledgments We extend our thanks to the Crisis resolution team at Sørlandet hospital for the tremendous effort put down in data collection, Sørlandet Hospital, and the University of Agder, which have made this work possible. 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BMC Psychiatry. 2022;22(1):753. Qiu T, Klonsky ED. Deciding to die: the relations of decision-making styles to suicide ideation and attempts. Int J Cogn Ther. 2021;14:341–61. Tables Table I: Demographic characteristics of suicidal patients and healthy control participants. Characteristic Patients ( n = 23) Control ( n = 17) p M SD M SD Age, years 32.87 15.55 40.06 9.39 .10 IQ 108.09 9.66 113.47 10.52 .11 Depression (BDI) 25.43 10.87 2.63 4.62 < .01 Self-reported impulsivity (BIS) 71.34 9.77 61.30 8.57 < .01 Attention (BIS) 21.09 4.18 15.02 3.57 < .01 Motivation (BIS) 23.44 4.64 21.76 3.68 .23 Nonplanning (BIS) 27.14 4.18 24.52 4.59 .07 CGT-1 Delay Aversion 0.36 0.23 .25 0.13 .08 CGT-2 Deliberation time 2408.46 1155.78 2165.60 529.66 .43 CGT-3 Overall proportion bet 48.65 13.93 50.59 14.51 .67 CGT-4 Quality of decision-making 67.45 41.21 95.35 6.24 <.01 CGT-5 Risk adjustment 0.77 0.85 1.56 1.06 <.02 CGT-6 Risk taking 39.30 26.59 54.53 15.19 .04 Note. N = 40. The proportion of female participants was 65% for patients and 70% for control participants. Estimated intelligence (IQ) was measured by the Matrix and Similarities subtests of the Wechsler Abbreviated Scale of Intelligence. Depression was measured by the Beck Depression Index (BDI). The self-reported impulsivity, attention, motivation and nonplanning measures represent the total score and the attention, motivation, and nonplanning subscores of the Barret Impulsiveness Scale version 11 (BIS). The CGT-1 to CGT-6 represent the 6 subtests of the CGT. Between-group differences were estimated using independent two-tailed t tests with 38 degrees of freedom. Table II Clinical characteristics of suicidal patients Characteristic n % Main diagnosis in patients, ICD-10 F 10-19 disorders related to substance use 1 4.34 F 30-39 affective disorders 10 43.47 F 40-48 neurotic and stress-related disorders 7 30.43 F 60-69 personality disorders 4 17.39 Unspecified diagnosis 2 8.70 Psychotropics currently prescribed Antidepressants 6 26.09 Antipsychotics 4 17.39 Mood stabilizers 2 8.70 Hypnotics 8 34.78 Anxiolytics 6 26.09 Central stimulants 1 4.34 Suicidality in patients Ideators 11 47.83 Attempters 12 52.17 Note. N = 23. Information on the main diagnosis and currently prescribed psychotropics was gathered from personal health records for each patient. Sucidality was identified using the Columbia Suicide History Form. Table III Variable F value p value Tukey’s post hoc test p value Control vs. ideators Control vs. attempters Ideators vs. Attempters CGT1 4.56 .02 .02 .89 .06 CGT2 3.11 .21 .31 .65 .20 CGT3 CGT4 CGT5 CGT6 1.42 3.94 5.25 0.93 .25 .14 <.01 .40 .81 .93 <.01 .94 .47 .20 .33 .53 .25 .31 .18 .43 Logistic regressions predicting suicidal patients vs. healthy control participants Model Independent variables OR 95% CI p LL UL 1 Self-reported impulsivity (BIS) 1.0 0.82 1.14 0.66 Depression (BDI) 1.52 1.08 2.15 0.02 CGT-1 Delay Aversion 254.64 0.11 605452.86 0.16 2 Self-reported impulsivity 0.96 0.83 1.11 0.60 Depression (BDI) 1.47 1.12 1.94 0.00 CGT-2 Deliberation time 1,0 0.99 1.00 0.85 3 Self-reported impulsivity (BIS) 0.96 0.82 1.14 0.66 Depression (BDI) 1.49 1.14 1.95 0.00 CGT-3 Overall proportion bet 1.06 0.94 1.20 0.37 4 Self-reported impulsivity (BIS) 0.96 0.83 1.11 0.56 Depression (BDI) 1.51 1.11 2.06 0.00 CGT-4 Quality of decision-making 1.02 0.94 1.10 0.66 5 Self-reported impulsivity (BIS) 0.98 0.83 1.15 0.79 Depression (BDI) 1.51 1.11 2.04 0.00 CGT-5 Risk adjustment 0.41 0.10 1.72 0.22 6 Self-reported impulsivity (BIS) 0.96 0.83 1.12 0.61 Depression (BDI) 1.49 1.14 1.94 0.00 CGT-6 Risk taking 1.02 0.94 1.11 0.57 Note. N = 40. CI = confidence interval; LL = lower limit; UL = upper limit. Depression was measured by the Beck Depression Index (BDI). Self-reported impulsivity is measured by the total score of the Barret Impulsiveness Scale version 11 (BIS). The CGT-1 to CGT-6 represent the 6 subtests of the CGT. Each model (1–6) represents a separate logistic regression model predicting membership in the patient group or the control group. The results are reported as odds ratios (ORs). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4257846","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":291521658,"identity":"3fde5359-8652-4e02-aeca-ecb560d7013c","order_by":0,"name":"Marie Aaslie Reiråskag","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCElEQVRIiWNgGAWjYJCCAxCKsQFIJDAwsDfARIjWwnOAsBZkANQikYBfiW772YcHPjDYMZi3N7d9+PEnTV4+8o3hgR8Md+RwaTE7k25wcAZDMoPMmYPNM3vbcgw33s4xONjD8MwYp5YDaQyHeRiYGSQkEpsZeBsqGDfOzjE4wMNwOLEBl5bzzxgO/2GoZ5CQf9jM+OdPhf3GmWcMDv7Bp+UG0BYGIJKQYGxm5mHLSZwvwWNwGK8tN54xHOwxOM4jwZPYzCzblpa8gSet4LCMwWHcfjmfxvzhR0W1nAT78ceMb/4k285vP7z545uKwzhDDAIMGHgQ7AMQERKAPC4/jIJRMApGwYgFABVRWpYUV6z9AAAAAElFTkSuQmCC","orcid":"","institution":"University of Agder","correspondingAuthor":true,"prefix":"","firstName":"Marie","middleName":"Aaslie","lastName":"Reiråskag","suffix":""},{"id":291521659,"identity":"e805501b-d563-4dbb-a21f-1c49954e169b","order_by":1,"name":"Silje Støle Brokke","email":"","orcid":"","institution":"Sørlandet Hospital HF","correspondingAuthor":false,"prefix":"","firstName":"Silje","middleName":"Støle","lastName":"Brokke","suffix":""},{"id":291521660,"identity":"ad5dad98-88a1-4f3a-81ed-38ff64948b16","order_by":2,"name":"Gudrun Rohde","email":"","orcid":"","institution":"University of Agder","correspondingAuthor":false,"prefix":"","firstName":"Gudrun","middleName":"","lastName":"Rohde","suffix":""},{"id":291521661,"identity":"c993c4bf-ccd9-482e-b9c4-e6b134ae8d27","order_by":3,"name":"Thomas Bjerregaard Bertelsen","email":"","orcid":"","institution":"Sørlandet Hospital HF","correspondingAuthor":false,"prefix":"","firstName":"Thomas","middleName":"Bjerregaard","lastName":"Bertelsen","suffix":""},{"id":291521662,"identity":"d1bbd522-4283-4dd3-a38b-619b31af295f","order_by":4,"name":"Nils Inge Landrø","email":"","orcid":"","institution":"University of Oslo","correspondingAuthor":false,"prefix":"","firstName":"Nils","middleName":"Inge","lastName":"Landrø","suffix":""},{"id":291521663,"identity":"8b2dd7a5-dc63-449e-8cd7-ce56b4d352ad","order_by":5,"name":"Vegard Øksendal Haaland","email":"","orcid":"","institution":"Sørlandet Hospital HF","correspondingAuthor":false,"prefix":"","firstName":"Vegard","middleName":"Øksendal","lastName":"Haaland","suffix":""}],"badges":[],"createdAt":"2024-04-12 12:42:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4257846/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4257846/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55313046,"identity":"2327bcab-14f1-4b18-b0ec-e279d4dbcf84","added_by":"auto","created_at":"2024-04-25 15:04:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":575184,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4257846/v1/95daf73d-f984-4116-8e80-4e65671ee19f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Decision-making in suicidal acute psychiatric patients","fulltext":[{"header":"Background","content":"\u003cp\u003eSuicide, defined as a fatal act initiated and carried out by the actors themselves [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], represents a major public health challenge [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A considerable portion of the population experiences aspects of suicidality, such as thoughts, tendencies, behavior, and intent [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, most individuals with suicidal ideation do not act on it [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. It is possible that the difference, at least in part, between those who have thoughts about suicide and those who attempt suicide is related to executive dysfunction[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], impulsivity, and risk taking [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] as part of suicidal acts. It has been found that suicide attempters and ideators exhibit varying levels of cognitive control [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This difference can be expressed as a narrow time perspective and impaired decision-making and reasoning abilities [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Some suicide attempters exhibit a preference for immediate rewards over future rewards, a behavior known as delay discounting [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong the limited studies available, one notable finding came from a study involving 40 suicide ideators and 37 ideators with a history of suicide attempts. This analysis revealed that suicide attempters displayed poorer attention control and better problem-solving abilities than did suicide ideators [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A literature review by Saffer and Klonsky [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] investigated the relationship between suicide attempters and ideators and revealed only 14 studies that compared these two groups. The majority of these studies suggested that there was no significant difference between attempters and ideators, except for in domains such as inhibition and decision making. A retrospective study of 92 psychiatric outpatient clients revealed that suicide attempters and ideators exhibit varying levels of cognitive control [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAn interesting line of research on cognitive functions in suicidal patients has focused on the Cambridge Gambling Task (CGT) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The CGT is a tool for assessing decision-making under conditions of uncertainty but not under conditions of ambiguity [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The CGT is a sensible tool for assessing orbitofrontal functioning and is known to detect reliable differences in risk-sensitive decision making between individuals who have attempted suicide and those who have not [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In a study with participants recruited from a general population, 304 young adults (aged 18\u0026ndash;29, 70% males) were tested, and 14.8% were identified as (broadly defined) suicidal. Of these, 5.3% had a history of suicide attempts. That study concluded that impaired decision making, as measured with the CGT, was associated with suicidality [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Ackerman and colleagues studied CGT performance in 14 adolescent suicide attempters and 14 nonattempter comparison subjects aged 15\u0026ndash;19 years. They found that adolescents with a history of suicide attempt display increased risk taking and greater difficulty in predicting probable outcomes [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The studies by Chamberlain and Ackerman were both conducted on a young population. Adolescents and young adults have underdeveloped brain regions necessary for cognitive control, which can be observed as heightened risk taking and increased impulsivity [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. It is therefore necessary to examine whether the above results are replicable in an adult population.\u003c/p\u003e \u003cp\u003eA study on older suicide attempters (age\u0026thinsp;\u0026gt;\u0026thinsp;60 years) with depression concluded that test subjects had a deficit in risk-sensitive decision-making as measured with the CGT [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. That study did not include adults younger than 60 years of age. Therefore, further research is necessary to replicate the results in a population with a broader range of adults.\u003c/p\u003e \u003cp\u003eGiven the prevalence and costs associated with suicide and the importance of understanding cognitive processes related to how decision-making and neurocognitive factors affect suicidal thoughts, there is a need for studies differentiating between suicidal patients and healthy adults. The current study aimed to investigate CGT decision-making in adult suicidal acute psychiatric patients, both suicide ideators and suicide attempters, and compare the results with those of healthy adults. To our knowledge, this is the first study to examine decision-making as measured by the CGT in an adult population aged 18 to 65 years.\u003c/p\u003e \u003cp\u003eBased on the abovementioned literature, we hypothesized that suicidal acute psychiatric patients and control participants would have different outcomes in decision-making tasks. Furthermore, we hypothesized that there could be a difference within the patient group. However, as the literature differs regarding the direction of these differences, both within patient groups and between adults and adolescents, we chose not to hypothesize about that direction.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eWe included 23 acute psychiatric patients and a control group comprising 17 people.\u003c/p\u003e \u003cp\u003eThe clinical group was recruited from an ongoing study at S\u0026oslash;rlandet Hospital. Patients with suicidal ideation between the ages of 18 and 65 years who were referred for acute psychiatric treatment were asked to participate. The main inclusion criterion for the clinical group was suicide risk. Potential participants with severe substance abuse, IQ\u0026thinsp;\u0026lt;\u0026thinsp;70 or inability to read, speak, or write Norwegian were excluded.\u003c/p\u003e \u003cp\u003e We recruited control participants by strategically placing posters around the hospital, aiming to recruit healthy individuals aged between 18 and 65 years. The study was approved by the Regional Committee for Medical and Health Research Ethics (2013/1664/REK s\u0026oslash;r \u0026oslash;st,14/00969-2-522), and written informed consent was obtained.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eColumbia Suicide History Form (CSHF)\u003c/h2\u003e \u003cp\u003eThe CSHF is a validated tool for the assessment and differentiation of the severity of suicidality. It has shown good convergent and divergent validity with other multi-informant suicidal ideation and behavior scales [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The form is structured as a screening interview with five questions on suicide ideation, seven questions on the intensity of ideation, six questions on suicidal behavior, and two questions on lethality evaluations of actual suicide attempts. The interview covers both suicidal behavior during the previous month and lifetime history of suicidal behavior for all the questions. Suicide attempts are also categorized by the first, latest, and most deadly attempt. The instrument was used to identify suicidal ideators and separate them from participants with a history of attempted suicide. The severity of suicidality was identified in the clinical group and was graded from 1 to 5 according to the CSHF. The clinicians involved in the research process and data collection were all trained to complete the screening interview. Their training included watching a video made by the CSHF developers and observing an interview between a researcher and a patient.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eThe CGT from the Cambridge Neuropsychological Test Automated Battery (CANTAB) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/h2\u003e \u003cp\u003eThe CGT was used to assess impulsivity, decision-making, and risk-taking behavior. This instrument is used to measure risk-taking behavior and decision-making under uncertainty [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The CGT is a validated and standardized computer-based test [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The CGT is suitable for assessing young and old subjects, is culture- and language-independent, and is highly sensitive to disorder-related impairment and cognitive enhancement [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe six outcome measures in the CGT are as follows:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDelay aversion was represented by the difference in percentage bets between the ascending and descending conditions (CGT1).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDeliberation time (milliseconds) was represented by the mean time taken to make a box color response (CGT2). This measure indicated the participant\u0026rsquo;s latencies in making a choice response on which color to bet upon.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe overall proportion bet was represented by the mean proportion of points bet across trials (CGT3).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe quality of decision-making was represented by the mean proportion of trials where the participants selected the correct color outcome (CGT4).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eRisk adjustment was represented by the extent to which betting behavior is moderated by the ratio of boxes (CGT5). Higher scores represented a greater proportion of bets when most boxes are congruent with the color chosen (i.e., the reasonable choice).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eRisk taking was represented by the mean proportion of points bet on trials where the most likely outcome was chosen (CGT6) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eWechsler Abbreviated Scale of Intelligence (WASI) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/h2\u003e \u003cp\u003eThe two subtests \u0026ldquo;Matrix reasoning\u0026rdquo; and \u0026ldquo;Similarities\u0026rdquo; were used to estimate IQ. Concurrent validity for the WASI has been established with other measures of intelligence, such as the WISC\u0026ndash;IV and KBIT\u0026ndash;2 [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The Norwegian translation used in this study, the WASI, has been found to retain basic psychometric properties and be a valid measure of intelligence [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eBeck Depression Inventory (BDI)\u003c/b\u003e [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe BDI was used to measure current depression severity. The BDI has been found to be a reliable and valid measure for the assessment of depression [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The internal consistency of the BDI is approximately 0.9, and the test-retest reliability ranges from 0.73 to 0.96. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using IBM SPSS Statistics for Windows, Version 27 [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Differences between the clinical and control groups were examined using chi-square tests for categorical data and independent \u003cem\u003et\u003c/em\u003e tests for continuous outcomes. For differences in the CGT2 and CGT4 scores, nonparametric Mann‒Whitney U tests were used. Next, one-way ANOVAs were used to test differences in the CGT task scores among the control participants, ideators, and attempters. For the ANOVA on CGT2 and CGT4scores, a Kruskal‒Wallis test was used as a nonparametric alternative. Tukey\u0026rsquo;s post hoc test was used for multiple comparisons. A \u003cem\u003ep\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to indicate statistical significance. There were no relevant missing data, and all analyses were performed with complete cases.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eBased on the CSHF, the sample consisted of 11 (47.83%) ideators, 12 (52.17%) attempters, and 17 healthy control participants. None of the healthy control participants reported suicidal intention or a history of suicide attempt. The clinical and control groups significantly differed on measures of depression, self-reported impulsivity and attention (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Furthermore, there was a significant difference between the healthy control participants and the clinical group for the CGT4 score (\u003cem\u003eU\u003c/em\u003e\u0026thinsp;=\u0026thinsp;267, df\u0026thinsp;=\u0026thinsp;38, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.37). Likewise, compared to the control participants, the clinical group had significantly lower scores on the CGT5 (\u003cem\u003et(\u003c/em\u003e38)\u0026thinsp;=\u0026thinsp;2.62, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.84). There were no significant differences between the clinical and nonclinical groups for any of the other measures (see Table\u0026nbsp;1 for further details).\u003c/p\u003e \u003cp\u003eThere were significant differences among the control participants, ideators, and suicide attempters for the CGT1 (F(2,37)\u0026thinsp;=\u0026thinsp;4.56, p\u0026thinsp;=\u0026thinsp;0.02) and on the CGT5 (F(2,37)\u0026thinsp;=\u0026thinsp;5.25, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) scores, whereas there were no between-group differences for the CGT2, CGT3, CGT4 or CGT6 scores. Post hoc tests showed that ideators had higher scores on the CGT1 than did control participants (p\u0026thinsp;=\u0026thinsp;0.02, d\u0026thinsp;=\u0026thinsp;1.16) and attempters (p\u0026thinsp;=\u0026thinsp;0.06, d\u0026thinsp;=\u0026thinsp;0.99), whereas there was no difference between attempters and control participants (p\u0026thinsp;=\u0026thinsp;0.89, d\u0026thinsp;=\u0026thinsp;0.17). In line with this, post hoc tests showed that ideators had lower scores on the CGT5 than did control participants (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, d\u0026thinsp;=\u0026thinsp;1.29). See Table\u0026nbsp;3 for further details.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;1 ABOUT HERE\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;2 ABOUT HERE\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;3 ABOUT HERE\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCompared to suicide attempters and control participants, patients who scored high in suicidal ideation also scored higher in delay aversion and had lower scores in risk adjustment on the CGT. There were no significant differences between the suicide attempters and control participants for those measures. This finding is in line with previous literature on decision-making deficits in suicidal patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWithin-group differences in decision making have been observed among clinical patients in previous studies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The nature of the differences within the clinical group, and thus the explanation or meaning of it, differs within the literature and from our findings. As in the Ackerman study, we observed a difference between suicidal patients and healthy control participants; however, while Ackerman et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] observed that increased risk-taking behavior was prevalent in adolescent suicide attempters, we did not observe that phenomenon in our study sample. The Ackerman study is one of few to use the CGT to assess decision-making deficits, and those investigators did not include ideators in their sample. In another study using the CGT, Chamberlain et al. (2013) concluded that impaired decision making exists in young adults with suicidality [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The participants in Chamberlain et al. were drawn from a population of nontreatment-seeking young adults. There were relatively few participants (n\u0026thinsp;=\u0026thinsp;16; 5.3%) with a history of suicide attempts, and the majority of the participants (70%) were males. Therefore, it is difficult to compare their results with those obtained in our study, because our study population included treatment-seeking patients, had an even distribution of attempters and ideators, and had no significant difference between the numbers of male and female participants.\u003c/p\u003e \u003cp\u003eThe difference in age can play an important role in understanding some of the differences between our study and the studies with adolescent and young-adult participants. One study on suicidal patients using the CGT to measure decision making in an older population revealed poorer attention control and better problem-solving abilities among suicide attempters than among suicide ideators [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Furthermore, Clark et al. (2011) reported that compared with depressed individuals with no history of suicidality and nondepressed individuals, older individuals with suicide attempts and major depression had impaired decision-making quality, as measured with the CGT. That study helps us to understand the role of depression in the associations investigated in our study, as the clinical group was significantly more depressed than the control participants were in our study, and we did not include a comparison group of depressed individuals. To our knowledge, our study is the first to investigate decision making as measured with the CGT in a population of adults aged 18 to 65 years, i.e., including both young and older adults. In contrast to Greenman\u0026rsquo;s [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] hypothesis, our results suggest that cognitive impairments are more pronounced in suicide ideators than in suicide attempters. This could imply that factors beyond neurocognitive dysfunction, such as emotional dysregulation or poor psychological resilience, might play a more significant role in actual suicide attempts [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Some theories have focused on suicide as an escape from emotional or psychological pain [\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Klonsky and May [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] described a model of the development of suicidal ideation. This three-step theory of suicide proposes that pain (often emotional or psychological) combined with hopelessness is required for the development of suicidal ideation. Suicidal ideation becomes stronger in the presence of disrupted connectedness. In this model, the difference between ideation and behavior and the and progression from the former to the latter is determined by the individual\u0026rsquo;s capacity for suicide, which is dependent on genetic factors, practical factors, and habituation to pain, fear, and death through life experiences [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. These theories may explain some of the differences among the clinical groups.\u003c/p\u003e \u003cp\u003eIn a study by Kelp et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]a smaller subgroup of attempters with more violent methods showed a pattern of poorer executive function. Another recent study by Brokke et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] adds to the knowledge of the association between aggression and differences within groups of suicidal patients and can add to the understanding of the progression from ideation to attempt, which was not captured in our study.\u003c/p\u003e \u003cp\u003eQui and Klonsky investigated decision-making styles rather than deficits [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The results of their study suggest that there is a difference in decision-making styles between nonsuicidal individuals and individuals with suicidal ideation and between individuals with suicidal ideation and attempters. When common predictors of suicidality were considered, only spontaneous decision-making styles differed between attempters and ideators, and there was no difference between ideators and healthy control participants. The absence of distinct cognitive deficits in suicide attempters compared to control participants observed in our study may be attributed to various factors. Differences in the cognitive task used, the age of participants [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], or their treatment history could influence these results. Additionally, cognitive differences in suicide attempters might be more subtle and not adequately captured by the CGT.\u003c/p\u003e \u003cp\u003eFuture research could include a multifaceted approach to understanding cognitive functions in suicidal behavior, incorporating a range of cognitive assessments, and considering developmental factors. Furthermore, this study underscores the complexity of cognitive control in suicidal ideation and attempts.\u003c/p\u003e \u003cp\u003eThe current study is subject to several limitations, and conclusions should be drawn with caution. The above-average IQ scores in both the clinical and control groups could influence the generalizability of the findings. Future studies should consider a broader IQ range to better understand the interplay between intelligence and suicidal behavior. Additionally, the exclusion of individuals with severe substance abuse might have led to a loss of insight into a significant subset of the population at risk for suicide. Finally, we detected within-group differences in some parts of the test between males and females. The differences were not significant but should be further investigated in a larger population.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur findings contribute to the nuanced understanding of the cognitive aspects of suicidal behavior in adults. These findings highlight the importance of considering a range of neurocognitive functions and emotional factors in understanding and treating suicidality. Given the small sample size, future research with larger cohorts and a broader range of cognitive assessments is essential to validate and expand upon these findings.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eCGT: Cambridge Gambling Task\u003c/p\u003e \u003cp\u003eCSHF: Columbia Suicide History Form\u003c/p\u003e \u003cp\u003eCANTAB: Camebridge Neuropsychological Test Automated Battery\u003c/p\u003e \u003cp\u003eCGT 1: Cambridge Gambling Task, subsection 1\u003c/p\u003e \u003cp\u003eCGT 2: Cambridge Gambling Task, subsection 2\u003c/p\u003e \u003cp\u003eCGT 3: Cambridge Gambling Task, subsection 3\u003c/p\u003e \u003cp\u003eCGT 4: Cambridge Gambling Task, Subsection 4\u003c/p\u003e \u003cp\u003eCGT 5: Cambridge Gambling Task, Subsection 5\u003c/p\u003e \u003cp\u003eCGT 6: Cambridge Gambling Task, Subsection 6\u003c/p\u003e \u003cp\u003eWASI: Wechsler Abbrivated Scale of Intelligence\u003c/p\u003e \u003cp\u003eBDI: Beck Depression Inventory\u003c/p\u003e \u003cp\u003eANOVA: Analysis of Variance\u003c/p\u003e \u003cp\u003eIQ: Interligence Quotient\u003c/p\u003e \u003cp\u003eBIS: Barrett Impulsivity Scale\u003c/p\u003e \u003cp\u003eOR: Odds Ratios\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Ethics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was ethically approved by the Regional Committee for Medical and Health Research Ethics (2013/1664/REK s\u0026oslash;r \u0026oslash;st,14/00969-2-522), All methods were performed in accordance with relevant guidelines and regulations. All patients provided written consent for participation and were informed that they could withdraw their consent at any time without giving any reason.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe anonymized datasets are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was funded in collaboration between University of Oslo and S\u0026oslash;rlandet Hospital HF.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSSB was responsible for the study and obtained ethical approval MR, GR and V\u0026Oslash;H contributed to the conceptualization and design of the paper. SSB and MR contributed to the data preparation. MR, GR and TBB contributed to the formal analysis. MR wrote the original draft. All the authors contributed to the writing and editing of the manuscript. All the authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our thanks to the Crisis resolution team at S\u0026oslash;rlandet hospital for the tremendous effort put down in data collection, S\u0026oslash;rlandet Hospital, and the University of Agder, which have made this work possible. Additiononallt we greatly appreciate an give thanks to Kristen Hagen for help and support in the process of preparing and submitting the final draft of the paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDe Leo D, Goodfellow B, Silverman M, Berman A, Mann J, Arensman E, Hawton K, Phillips M, Vijayakumar L, Andriessen K. International study of definitions of English-language terms for suicidal behaviours: a survey exploring preferred terminology. BMJ open. 2021;11(2):e043409.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBertolote JM, Fleischmann A. A global perspective in the epidemiology of suicide. 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaul E, Tsypes A, Eidlitz L, Ernhout C, Whitlock J. Frequency and functions of non-suicidal self-injury: Associations with suicidal thoughts and behaviors. 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Assessment of depression: the depression inventory. S. Karger; 1974.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGebrie MH. An analysis of beck depression inventory 2nd edition (BDI-II). 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAt B. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev. 1988;8:77\u0026ndash;100.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIBM Corp N. IBM SPSS statistics for windows. In.: IBM corp Armonk, NY; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKlonsky ED, Dixon-Luinenburg T, May AM. The critical distinction between suicidal ideation and suicide attempts. World psychiatry. 2021;20(3):439.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRibeiro JD, Linthicum KP, Joiner TE, Huang X, Harris LM, Bryen CP. Do suicidal desire and facets of capability for suicide predict future suicidal behavior? A longitudinal test of the desire\u0026ndash;capability hypothesis. J Abnorm Psychol. 2021;130(3):211.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaumeister RF. Suicide as escape from self. Psychol Rev. 1990;97(1):90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams M. Cry of pain: understanding suicide and the suicidal mind. Hachette UK; 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShneidman ES. Commentary: Suicide as psychache. J Nerv Ment Dis 1993.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurton H, Berry K, Danquah A, Pratt D. The relationship between emotion dysregulation and suicide ideation and behaviour: A systematic review. J Affect disorders Rep. 2021;5:100136.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrokke SS, Landr\u0026oslash; NI, Haaland V\u0026Oslash;. Impulsivity and aggression in suicide ideators and suicide attempters of high and low lethality. BMC Psychiatry. 2022;22(1):753.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQiu T, Klonsky ED. Deciding to die: the relations of decision-making styles to suicide ideation and attempts. Int J Cogn Ther. 2021;14:341\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable I: Demographic characteristics of suicidal patients and healthy control participants.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePatients (\u003cem\u003en\u003c/em\u003e = 23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eControl (\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e108.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e113.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDepression (BDI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; .01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSelf-reported impulsivity (BIS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e71.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; .01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAttention (BIS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; .01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMotivation (BIS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNonplanning (BIS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCGT-1 Delay Aversion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCGT-2 Deliberation time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2408.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1155.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2165.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e529.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCGT-3 Overall proportion bet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCGT-4 Quality of decision-making\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e67.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e95.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026lt;.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCGT-5 Risk adjustment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026lt;.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCGT-6 Risk taking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote. N\u003c/em\u003e = 40. The proportion of female participants was 65% for patients and 70% for control participants. Estimated intelligence (IQ) was measured by the Matrix and Similarities subtests of the Wechsler Abbreviated Scale of Intelligence. Depression was measured by the Beck Depression Index (BDI). The self-reported impulsivity, attention, motivation and nonplanning measures represent the total score and the attention, motivation, and nonplanning subscores of the Barret Impulsiveness Scale version 11 (BIS). The CGT-1 to CGT-6 represent the 6 subtests of the CGT. Between-group differences were estimated using independent two-tailed\u0026nbsp;\u003cem\u003et\u003c/em\u003e tests with 38 degrees of freedom.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable II\u003c/p\u003e\n\u003cp\u003eClinical characteristics of suicidal patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.53078202995009%\" valign=\"top\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.153078202995008%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.316139767054908%\" valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.53078202995009%\" valign=\"top\"\u003e\n \u003cp\u003eMain diagnosis in patients, ICD-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.153078202995008%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.316139767054908%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.53078202995009%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;F 10-19 disorders related to substance use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.153078202995008%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.316139767054908%\" valign=\"top\"\u003e\n \u003cp\u003e4.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.53078202995009%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;F 30-39 affective disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.153078202995008%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.316139767054908%\" valign=\"top\"\u003e\n \u003cp\u003e43.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.53078202995009%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;F 40-48 neurotic and stress-related disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.153078202995008%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.316139767054908%\" valign=\"top\"\u003e\n \u003cp\u003e30.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.53078202995009%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;F 60-69 personality disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.153078202995008%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.316139767054908%\" valign=\"top\"\u003e\n \u003cp\u003e17.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.53078202995009%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Unspecified diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.153078202995008%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.316139767054908%\" valign=\"top\"\u003e\n \u003cp\u003e8.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.53078202995009%\" valign=\"top\"\u003e\n \u003cp\u003ePsychotropics currently prescribed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.153078202995008%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.316139767054908%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.53078202995009%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Antidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.153078202995008%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.316139767054908%\" valign=\"top\"\u003e\n \u003cp\u003e26.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.53078202995009%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Antipsychotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.153078202995008%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.316139767054908%\" valign=\"top\"\u003e\n \u003cp\u003e17.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.53078202995009%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Mood stabilizers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.153078202995008%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.316139767054908%\" valign=\"top\"\u003e\n \u003cp\u003e8.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.53078202995009%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Hypnotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.153078202995008%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.316139767054908%\" valign=\"top\"\u003e\n \u003cp\u003e34.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.53078202995009%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Anxiolytics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.153078202995008%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.316139767054908%\" valign=\"top\"\u003e\n \u003cp\u003e26.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.53078202995009%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Central stimulants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.153078202995008%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.316139767054908%\" valign=\"top\"\u003e\n \u003cp\u003e4.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.53078202995009%\" valign=\"top\"\u003e\n \u003cp\u003eSuicidality in patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.153078202995008%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.316139767054908%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.53078202995009%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Ideators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.153078202995008%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.316139767054908%\" valign=\"top\"\u003e\n \u003cp\u003e47.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.53078202995009%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Attempters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.153078202995008%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.316139767054908%\" valign=\"top\"\u003e\n \u003cp\u003e52.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote. N\u003c/em\u003e = 23. Information on the main diagnosis and currently prescribed psychotropics was gathered from personal health records for each patient. Sucidality was identified using the Columbia Suicide History Form.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable III\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"605\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.694214876033058%\" valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.694214876033058%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eF\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.694214876033058%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"49.917355371900825%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Tukey\u0026rsquo;s post hoc test\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.694214876033058%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.694214876033058%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.694214876033058%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"49.917355371900825%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;p\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eControl vs. ideators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eControl vs. attempters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eIdeators vs. Attempters\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eCGT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e4.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eCGT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e3.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eCGT3\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCGT4\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCGT5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCGT6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.94\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.25\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e.25\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.14\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;.01\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e.81\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.93\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;.01\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e.47\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.20\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.33\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e.25\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.31\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.18\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLogistic regressions predicting suicidal patients vs. healthy control participants\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"611\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eIndependent variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.150572831423894%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eLL\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eUL\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eSelf-reported impulsivity (BIS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eDepression (BDI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eCGT-1 Delay Aversion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e254.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e605452.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"89.85270049099836%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eSelf-reported impulsivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eDepression (BDI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eCGT-2 Deliberation time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e1,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"89.85270049099836%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eSelf-reported impulsivity (BIS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eDepression (BDI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e1.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eCGT-3 Overall proportion bet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"89.85270049099836%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eSelf-reported impulsivity (BIS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eDepression (BDI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eCGT-4 Quality of decision-making\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"89.85270049099836%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eSelf-reported impulsivity (BIS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eDepression (BDI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eCGT-5 Risk adjustment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"89.85270049099836%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eSelf-reported impulsivity (BIS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eDepression (BDI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e1.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.37152209492635%\" valign=\"top\"\u003e\n \u003cp\u003eCGT-6 Risk taking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" valign=\"top\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.747954173486088%\" valign=\"top\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.402618657937808%\" valign=\"top\"\u003e\n \u003cp\u003e1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.183306055646481%\" valign=\"top\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote. N\u003c/em\u003e = 40. CI = confidence interval; \u003cem\u003eLL\u003c/em\u003e = lower limit; \u003cem\u003eUL\u0026nbsp;\u003c/em\u003e= upper limit. Depression was measured by the Beck Depression Index (BDI). Self-reported impulsivity is measured by the total score of the Barret Impulsiveness Scale version 11 (BIS). The CGT-1 to CGT-6 represent the 6 subtests of the CGT. Each model (1\u0026ndash;6) represents a separate logistic regression model predicting membership in the patient group or the control group. The results are reported as odds ratios (ORs).\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cambridge Gambling Task, Decision-making, Preventing suicide","lastPublishedDoi":"10.21203/rs.3.rs-4257846/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4257846/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSuicidality is a major health problem. Decision-making deficits, including a lack of cognitive control (e.g., impulsivity and risk-taking behavior), have been associated with an increased risk of suicide.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study examined decision-making in a clinical group of 23 adult, suicidal acute psychiatric patients and compared their data to that of a control group of 17 healthy adults using the Cambridge Gambling Task (CGT) from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Group differences in outcomes on the six CGT subtests were compared using chi-square tests, t tests, and Mann‒Whitney U tests where appropriate. Multiple regression analysis was used to explore whether background variables were associated with CGT outcomes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe main findings were significantly lower scores for risk-taking, quality of decision-making, and risk adjustment in the clinical group than in the control group. Within the clinical group, differences were observed in which suicide ideators scored worse in some measures than did suicide attempters. These findings suggest that suicidal acute psychiatric patients may struggle with making low-risk decisions that are considered reasonable.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThese results support the potential for cognitive control training, specifically aimed at enhancing decision-making abilities, in suicide prevention efforts. The observed decision-making deficits in suicidal patients underscore the importance of further investigating these findings in a larger population to solidify the foundation for targeted interventions.\u003c/p\u003e","manuscriptTitle":"Decision-making in suicidal acute psychiatric patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-17 10:46:09","doi":"10.21203/rs.3.rs-4257846/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"203122b7-ebe9-4500-ab47-cca6335bd47e","owner":[],"postedDate":"April 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-25T14:37:10+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-17 10:46:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4257846","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4257846","identity":"rs-4257846","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}