Decision-making and cognitive control in adolescent suicidal behaviors: a qualitative systematic review of the literature

Abstract

Suicide and suicidal behaviors represent a leading cause of morbidity and mortality during adolescence. While several lines of evidence suggest that suicidal behaviors are associated with risky decisions and deficient cognitive control in laboratory tasks in adults, comparatively less is known about adolescents. Here, we systematically reviewed the literature on the association between these neurocognitive variables and adolescent suicidal behaviors. The online search strategy identified 17 neurocognitive studies examining either cognitive control or decision-making processes in adolescents with past suicidal behaviors. Several studies have reported that adolescents with a history of suicidal behaviors present neuropsychological differences in the cognitive control (using Go/NoGo, suicide Stroop Test, continuous performance test, suicide/death Implicit Association Test), and decision-making (Iowa Gambling Task, Cambridge Gambling Task, cost computation, delay discounting, loss aversion tasks) domains. Due to a lack of replication or conflicting findings, our systematic review suggests that no firm conclusion can be drawn as to whether altered decision-making or poor cognitive control contribute to adolescent suicidal behaviors. However, these results collectively suggest that further research is warranted. Limitations included scarcity of longitudinal studies and a lack of homogeneity in study designs, which precluded quantitative analysis. We propose remediating ways to continue neuropsychological investigations of suicide risk in adolescence, which could lead to the identification of novel therapeutic targets and predictive markers, enabling early intervention in suicidal youth.

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Acknowledgements

We would like to acknowledge the contribution of Dr. Valentin Mbekou, who, unfortunately, past away during the elaboration of the manuscript. Dr. Mbekou collaborated on the design of the review and had approved an earlier version. The authors also appreciated the editing work performed by Daysi Zentner on a previous version.

Funding

This work was supported by the Manulife Teen Mental Health Research Fund, without any involvement in the study or in the writing process. JR holds a grant from Manulife Teen Mental Health Research Fund. AG holds a training award from the Fonds de Recherche du Québec en Santé (FQR-S/MSSS training Program for specialty medicine residents with interest in pursuing a research career—Phase 1). MCG also holds a salary award from Fonds de Recherche du Québec en Santé (FRQ-S) (Junior 1). LP holds a doctoral award from FRQ-S. EL, VM, FJ have no financial disclosure.

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Gifuni, A.J., Perret, L.C., Lacourse, E. et al. Decision-making and cognitive control in adolescent suicidal behaviors: a qualitative systematic review of the literature. Eur Child Adolesc Psychiatry (2020). https://doi.org/10.1007/s00787-020-01550-3

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Keywords

  • Suicide attempt
  • Adolescence
  • Risky behaviors
  • Cognitive control
  • Decision-making
  • Neuropsychology