title: The decision neuroscience perspective on suicidal behavior: evidence and hypotheses.
abstract: OBJECTIVE
  Suicide attempts are usually regretted by people who survive them. Furthermore, addiction and gambling are over-represented among people who attempt or die by suicide, raising the question whether their decision-making is impaired. Advances in decision neuroscience have enabled us to investigate decision processes in suicidal people and to elucidate putative neural substrates of disadvantageous decision-making.
  
  
  RESULTS
  Early studies have linked attempted suicide to poor performance on gambling tasks. More recently, functional MRI augmented with a reinforcement learning computational model revealed that impaired decision-making in suicide attempters is paralleled by disrupted expected value (expected reward) signals in the ventromedial prefrontal cortex. Behavioral studies have linked increased delay discounting to low-lethality/poorly planned attempts, multiple attempts, and the co-occurrence of attempted suicide and addiction. This behavioral tendency may be related to altered integrity of the basal ganglia. By contrast, well-planned, serious suicide attempts were associated with intact/diminished delay discounting. One study has linked high-lethality suicide attempts and impaired social decision-making.
  
  
  CONCLUSIONS
  This emerging literature supports the notion that various impairments in decision-making - often broadly related to impulsivity - may mark different pathways to suicide. We propose that aggressive and self-destructive responses to social stressors in people prone to suicide result from a predominance of automatic, Pavlovian processes over goal-directed computations.
authors.affiliation: aUniversity of Pittsburgh, Department of Psychiatry, Pittsburgh bPenn State University, Department of Psychology, State College, Pennsylvania, USA.
authors.forename: Alexandre Y
authors.initials: AY
authors.lastname: Dombrovski
authors.forename: Michael N
authors.initials: MN
authors.lastname: Hallquist
mesh_terms: D003657:Decision Making / Q000502:physiology*; D006801:Humans; D013406:Suicide, Attempted