Patients With Affective Disorders and Suicide Attempts Show Short-Sightedness

These study results provide preliminary evidence of the role of disadvantageous intertemporal choice in the suicidal process.

Among patients with affective disorder, an individual’s history of attempted suicides has implications of “short-sightedness” following social exclusion, according to study findings published in Journal of Psychiatric Research.

Inpatients (N=64) aged 13 to 44 years with an affective disorder were recruited from Southern Medical University in China. The participants were told they were playing a virtual ball-tossing game with 2 patients in other inpatient wards. Participants who were assigned to an exclusion condition received the ball 2 times at the beginning of a 30-throw ball tossing game and those who were assigned to the control condition received the ball on roughly one-third of ball passes. After the game, participants were asked whether they felt excluded and completed the Monetary Choice Questionnaire (MCQ), which challenged the participants to choose an immediate but small monetary reward or a larger but delayed reward.

Participants had either no history of suicide attempt (n=22), a single suicide attempt (n=24), or multiple suicide attempts (n=18). Participants in the cohort with multiple suicide attempts included more girls or women (P =.003), and had greater Generalized Anxiety Disorder Scale (GAD-7; P =0.000) and Beck Depression Inventory-II (BDI-II; P =0.000) scores than the other groups. Among the groups that comprised a previous suicide attempt, participants in the group with multiple attempts had higher Beck Scale for Suicidal Ideation-Chinese Version (BSI-CV) scores (P =.013).

Individuals assigned to the exclusion condition reported more severe feelings of exclusion (mean, 2.89) than the nonexclusion condition (mean, 6.21; P <.001) on a 9-point scale, in which lower scores indicated greater severity.

This study found that an exaggerated preference for immediate rewards was associated with social exclusion and a history of suicide attempt among individuals with affective disorders.

Stratified by suicide history and condition, all 3 groups had overall similar subjective immediate values after the exclusion ball toss condition (range, 516.67-555.77) and scores were correlated across groups (r, 0.255; P <.05). Following the nonexclusion condition, the cohort with no suicide attempt (mean, 758.33) and a single suicide attempt (mean, 712.50) reported similar increases to subjective immediate values, but the cohort with multiple suicide attempts reported lower subjective immediate values than they did after the exclusion intervention (mean, 403.57).

Overall, suicide history (F[2,58], 4.121; P =.021) and the social exclusion-by-suicide history interaction (F[2,58], 4.057; P =.022) were significant predictors of subjective immediate values. Similar findings were observed in the analysis which controlled for covariates.

The major limitation of this study was the lack of a healthy control comparator cohort.

Study authors concluded, “This study found that an exaggerated preference for immediate rewards was associated with social exclusion and a history of suicide attempt among individuals with affective disorders. There was an exaggerated preference for immediate rewards among multiple-suicide attempters under the nonexclusion condition compared to single-suicide attempters or nonsuicidal patients. Single-suicide attempters and nonsuicidal patients were more short-sighted after being excluded, while multiple-suicide attempters appeared relatively indifferent to the social exclusion situations.”


Fang Y, Tan X, Du Q, et al. The effect of social exclusion on intertemporal choice in suicide attempters: a preliminary experimental study. J Psychiatr Res. 2022;156:62-68. doi:10.1016/j.jpsychires.2022.10.011