Associations of Neural and Behavioral Measures of Reward Responsiveness and Valuation with Suicidal Ideation and Attempt History in Acute Clinical and Community Adolescents

Abstract

Adolescence comprises a period of risk for suicidal thoughts and behaviors (STB), which presents a large public health and individual mental health burden. Previous research implicates alterations of reward processing in STBs, such that suicide ideation (SI) may be related to blunting of reward responsiveness and suicide attempt (SA) related to a preference for immediate compared to delayed rewards, with mixed evidence for associations between SA and reward responsiveness. Much of this work has focused on community samples and has not directly tested SI vs. SA effects, despite evidence of distinct risk processes for each. Further, little past work has examined self-report and neural measures in the same study. The current study aimed to examine associations between reward responsiveness and reward valuation and SI and SA in a group of combined clinically high-risk and community adolescents, using self-report and electrocochleogram (EEG). Participants were 102 adolescents 14-17 years old enrolled from a psychiatric hospital and the community, who completed clinical interviews, self-report measures, including the Monetary Choice Questionnaire to assess delay discounting, and a Monetary Incentive Delay EEG task to elicit the reward positivity (RewP), an event-related potential which captures responses to reward cues, in response to immediate and delayed rewards. Results indicated no associations between self-reported delay discounting and SI or SA. Adolescents with an SA history were trending to show significantly greater levels of neural reward responsiveness (RewP) than those without a SA history; there were no significant associations with SI and reward responsiveness. Further, there were no significant effects of SA or SI on response to RewP to immediate vs delayed rewards. The results provide an understanding of overall reward responsiveness for adolescents with SA history. This is preliminary evidence that SA may be associated with experiencing heightened salient rewards and is aligned with theory that suicide can provide relief that is rewarding in times of extreme psychological distress.