1. Exploration-Exploitation and Suicidal Behavior in Borderline Personality Disorder and Depression.
- Author
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Tsypes, Aliona, Hallquist, Michael N., Ianni, Angela, Kaurin, Aleksandra, Wright, Aidan G. C., and Dombrovski, Alexandre Y.
- Subjects
SUICIDAL behavior ,ATTEMPTED suicide ,SUICIDAL ideation ,MENTAL illness ,MENTAL depression ,BORDERLINE personality disorder - Abstract
Key Points: Question: Is the inability to explore multiple alternatives and take advantage of the best options associated with suicidal behavior? Findings: In 2 case-control studies of adults with borderline personality disorder and depression, inability to fully explore available options was associated with medically serious suicide attempts. In an ambulatory study, this pattern predicted suicidal ideation. Meaning: The findings suggest that the inability to explore a full range of solutions in a state of suicidal crisis may prevent one from discovering alternatives to attempting suicide; exploring novel ways to cope may help individuals build their safety plans. This case-control study explores the exploration-exploitation dilemma in suicidal behavior. Importance: Clinical theory and behavioral studies suggest that people experiencing suicidal crisis are often unable to find constructive solutions or incorporate useful information into their decisions, resulting in premature convergence on suicide and neglect of better alternatives. However, prior studies of suicidal behavior have not formally examined how individuals resolve the tradeoffs between exploiting familiar options and exploring potentially superior alternatives. Objective: To investigate exploration and exploitation in suicidal behavior from the formal perspective of reinforcement learning. Design, Setting, and Participants: Two case-control behavioral studies of exploration-exploitation of a large 1-dimensional continuous space and a 21-day prospective ambulatory study of suicidal ideation were conducted between April 2016 and March 2022. Participants were recruited from inpatient psychiatric units, outpatient clinics, and the community in Pittsburgh, Pennsylvania, and underwent laboratory and ambulatory assessments. Adults diagnosed with borderline personality disorder (BPD) and midlife and late-life major depressive disorder (MDD) were included, with each sample including demographically equated groups with a history of high-lethality suicide attempts, low-lethality suicide attempts, individuals with BPD or MDD but no suicide attempts, and control individuals without psychiatric disorders. The MDD sample also included a subgroup with serious suicidal ideation. Main Outcomes and Measures: Behavioral (model-free and model-derived) indices of exploration and exploitation, suicide attempt lethality (Beck Lethality Scale), and prospectively assessed suicidal ideation. Results: The BPD group included 171 adults (mean [SD] age, 30.55 [9.13] years; 135 [79%] female). The MDD group included 143 adults (mean [SD] age, 62.03 [6.82] years; 81 [57%] female). Across the BPD (χ
2 3 = 50.68; P <.001) and MDD (χ2 4 = 36.34; P <.001) samples, individuals with high-lethality suicide attempts discovered fewer options than other groups as they were unable to shift away from unrewarded options. In contrast, those with low-lethality attempts were prone to excessive behavioral shifts after rewarded and unrewarded actions. No differences were seen in strategic early exploration or in exploitation. Among 84 participants with BPD in the ambulatory study, 56 reported suicidal ideation. Underexploration also predicted incident suicidal ideation (χ2 1 = 30.16; P <.001), validating the case-control results prospectively. The findings were robust to confounds, including medication exposure, affective state, and behavioral heterogeneity. Conclusions and Relevance: The findings suggest that narrow exploration and inability to abandon inferior options are associated with serious suicidal behavior and chronic suicidal thoughts. By contrast, individuals in this study who engaged in low-lethality suicidal behavior displayed a low threshold for taking potentially disadvantageous actions. [ABSTRACT FROM AUTHOR]- Published
- 2024
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