Past suicide attempt is associated with a weaker decision-making bias to actively escape from suicide-related stimuli.

Abstract

Theory and evidence suggest that people attempt suicide to escape acute distress. However, little is known about why people select suicide instead of other ways to escape (e.g., alcohol/drug use). One possibility is that suicide-related stimuli in one's environment (e.g., suicide methods) bias this decision, particularly when such stimuli elicit little aversion. We tested whether suicide-related stimuli bias decisions to escape acute distress. We recruited 360 adults with past 3-month active suicidal thoughts and behaviors (STB; n = 120), elevated psychiatric symptoms without STB (n = 152), or no symptoms/STB (n = 88). Participants explicitly rated personalized suicide pictures (e.g., pointing a gun up at oneself) and positive contrasts and completed a behavioral task, where they made decisions to escape an acutely distressing noise in relation to these stimuli. We used a computational model of task performance to capture latent biases hypothetically influencing decision making. We assessed STB 3 months later. Results indicated that people with a past suicide attempt exhibited much lower suicide aversion than others. In the behavioral task, the suicidal group made more impulsive escape decisions in relation to suicide versus positive stimuli. The computational model helped explain this effect, capturing a latent bias driven by the suicide stimuli. Within the suicidal group, weaker biases mediated the association between lower suicide aversion and higher odds of past suicide attempt. These results provide evidence of novel, specific, incrementally valid, and objectively assessed suicide-attempt correlate and suggest that decision science is useful for understanding mechanisms increasing risk for suicide and other escape-related phenomena involving stimulus-driven processes (e.g., substance misuse, and anxiety). (PsycInfo Database Record (c) 2025 APA, all rights reserved).