Decision making and problem solving in adolescents who deliberately self-harm.
BACKGROUND
Healthy adolescents, and adults who engage in reward-driven, risky behaviours, demonstrate poor decision-making ability. Decision making in deliberate self-harm (DSH), a reward-driven, high-risk behaviour, has received little attention. This study assessed decision making and problem solving in adolescents with current or past SH.


METHODS
Decision making and problem solving were assessed using the Iowa Gambling Task (IGT) and the Means-Ends Problem-Solving Procedure (MEPS) respectively in 133 adolescents (57 healthy and 22 depressed controls with no SH history and 54 with SH history). A second analysis separated the SH group into current (n=30) and past (n=24) SH.


RESULTS
The collective performance of adolescents with SH history did not differ from depressed or healthy adolescents on the IGT. However, current self-harming adolescents had a trend towards more high-risk choices (p=0.06) than those with previous SH history and were the only group not to significantly improve over time, persisting with high-risk strategy throughout. Those who no longer self-harmed learnt to use a low-risk strategy similar to healthy and depressed controls. Recency of last SH episode correlated with IGT performance. Depressed participants performed well on the IGT but poorly on the MEPS. By contrast, both collective and divided SH groups had comparable MEPS scores to healthy controls, all performing better than depressed participants.


CONCLUSIONS
Poor decision making is present in adolescents who currently self-harm but not in those with previous history; improvement in decision-making skills may therefore be linked to cessation of self-harm. Depressed adolescents who do and do not self-harm may have distinct characteristics.
King's College London, Institute of Psychiatry, London, UK. anna.oldershaw@iop.kcl.ac.uk
A
A
Oldershaw
E
E
Grima
F
F
Jollant
C
C
Richards
M
M
Simic
L
L
Taylor
U
U
Schmidt
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D002648:Child; D015897:Comorbidity; D003657:Decision Making; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005715:Gambling / Q000523:psychology; D006801:Humans; D007360:Intelligence; D008131:London / Q000453:epidemiology; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011340:Problem Solving; D012309:Risk-Taking; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis