The Effects Of Stress And Emotional Regulation Strategies On Risky Decision-making In Suicidal Individuals

BackgroundSuicide is an extreme example of risky decision-making,that could be seen as a detrimental decision in the long run which is made for temporary relief.Therefore,it is an opportunity to reveal the mechanism of suicide from the perspective of decision-making.Decision-making is an cognitive activity and is influenced by stress and emotion regulation strategies.Before suicide,individuals often experience several negative life events or stress events,and have strong negative emotions.Thus,understanding the relationship between stress,emotional regulation strategies and risky decision-making among suicidal individuals are particularly important.ObjectsComparing risky decision-making between suicidal individuals and healthy controls in stress and no stress condition.Exploring the moderating effects of emotion regulation strategies in the relationship between stress and risky decision-making.MethodsStudy 1:Using the convenience sampling method,we adopted a 2×2 between-subjects study design and conducted a questionnaire-behavioral combined study.We used Trier Social Stress Test(TSST)to induce participant’s psychological stress and compared the performance of Balloon Analogue Risk Task(BART)between suicidal individuals and healthy controls.In addition,we analyzed the effect of clinical variables,such as medication and diagnosis,on the BART performance under different stress conditions.Study 2:Based on study 15 we assessed emotional regulation strategies in suicidal group by using Emotional Regulation Questionnaire(ERQ),and explored the moderating effects of cognitive reappraisal and expression suppression in the relationship between stress and BART performance.We respectively used TSST(experimental manipulation),total score of SSAI(subjective psychological indicator)and heart rate(objective physiological indicator)as indicators of stress level.ResultsStudy 1:(1)For BART adjusted pumps,the effect of Stress×Group and main effect of Group was not significant(Ps>0.05);main effect of Stress was significant,the BART score of stress group was higher than that of no stress group(F(1,118)=6.550,P=0.012).(2)Further analyses in suicidal group showed that the effect of Medieation×Stress was not significant(P=0.075);but the main effect of Stress was significant,stress group had higher score in BART task(F(1,61)=4.209,P=0.045);the main effect of Medication was significant,medication intake group had lower score in BART task(F(1,61)=4:490,P=0.038).(3)For anti-psychotic,the effect of Anti-psychotic×Stress was significant(F(1,61)=6.413,P=0.014):for no stress group,no difference was found between groups(95%CI=[-1.457,1.867],P=0.806);while for stress group,anti-psychotic intake group showed lower score(95%CI-[-3.895,-1.153],P<0.001).(4)For mood stabilizer,the effect of Mood Stabilizer×TSST was significant(F(1,61)=8.647,P=0.005):for no stress group,no difference was found between two groups(95%CI=[-1.349,1.691],P=0.823);while for stress group,mood stabilizer intake group had lower score in BART(95%CI=[-4.040,-1.471],P<0.001).Study 2:(1)The moderating effect of cognitive reappraisal in all models were not significant(Ps>0.050).(2)The moderating effect of expression suppression was exhibited in TSST(β=0.39,P=0.003)model:in low level of expression suppression,TSST do not affect BART performance(β=-0.14,P=0.407);while in high level of expression suppression,TSST significantly and positively affected BART performance(β=0.64,P=0.003).(2)The moderating effect of expression suppression was also exhibited in SSAIt1(β=0.30,P=0.037)model:in low level of expression suppression,TSST do not affected BART performance(β=-0.24,P=0.226),while in high level of expression suppression,TSST significantly and positively affected BART performance(β=0.40,P=0.036).Conclusion(1)Risky decision-making may not a sensitive indicator to distinguish suicidal individuals from healthy individuals.(2)Stress activates the decision pattern of "reward priority" in both healthy individuals and suicidal individuals.They show a higher risk-seeking tendency than that in the resting state.(3)Medication(mainly anti-psychotic and mood stabilizer)can inhibit risk seeking tendency in suicidal individuals,and this effect was lager in stress condition.(4)Expression suppression is a maladaptive emotional regulation strategy for suicidal individuals.Those have high level of expression suppression can not effectively buffer the effect of stress on risk seeking tendency.