Oldershaw A, Grima E, Jollant F, Richards C, Simic M, Taylor L, Schmidt U
King's College London, Institute of Psychiatry, London, UK.
Psychol Med. 2009 Jan;39(1):95-104. doi: 10.1017/S0033291708003693. Epub 2008 Jun 23.
Healthy adolescents, and adults who engage in reward-driven, risky behaviours, demonstrate poor decision-making ability. Decision making in deliberate self-harm (DSH), a reward-driven, high-risk behaviour, has received little attention. This study assessed decision making and problem solving in adolescents with current or past SH.
Decision making and problem solving were assessed using the Iowa Gambling Task (IGT) and the Means-Ends Problem-Solving Procedure (MEPS) respectively in 133 adolescents (57 healthy and 22 depressed controls with no SH history and 54 with SH history). A second analysis separated the SH group into current (n=30) and past (n=24) SH.
The collective performance of adolescents with SH history did not differ from depressed or healthy adolescents on the IGT. However, current self-harming adolescents had a trend towards more high-risk choices (p=0.06) than those with previous SH history and were the only group not to significantly improve over time, persisting with high-risk strategy throughout. Those who no longer self-harmed learnt to use a low-risk strategy similar to healthy and depressed controls. Recency of last SH episode correlated with IGT performance. Depressed participants performed well on the IGT but poorly on the MEPS. By contrast, both collective and divided SH groups had comparable MEPS scores to healthy controls, all performing better than depressed participants.
Poor decision making is present in adolescents who currently self-harm but not in those with previous history; improvement in decision-making skills may therefore be linked to cessation of self-harm. Depressed adolescents who do and do not self-harm may have distinct characteristics.
健康的青少年以及从事受奖励驱动的危险行为的成年人，其决策能力较差。蓄意自我伤害（DSH）是一种受奖励驱动的高风险行为，对此行为中的决策过程鲜有关注。本研究评估了当前或过去有过自我伤害行为的青少年的决策和问题解决能力。
分别使用爱荷华赌博任务（IGT）和手段 - 目的问题解决程序（MEPS）对133名青少年进行决策和问题解决能力评估，其中包括57名健康青少年、22名无自我伤害史的抑郁对照青少年以及54名有自我伤害史的青少年。第二次分析将自我伤害组分为当前有自我伤害行为的青少年（n = 30）和过去有过自我伤害行为的青少年（n = 24）。
有自我伤害史的青少年在IGT上的总体表现与抑郁或健康青少年并无差异。然而，当前有自我伤害行为的青少年比有过自我伤害史的青少年有做出更多高风险选择的趋势（p = 0.06），并且是唯一一组未随时间显著改善的群体，始终坚持高风险策略。那些不再自我伤害的青少年学会了采用类似于健康和抑郁对照青少年的低风险策略。最后一次自我伤害事件的近期性与IGT表现相关。抑郁参与者在IGT上表现良好，但在MEPS上表现不佳。相比之下，自我伤害组总体和细分后的两组在MEPS得分上与健康对照相当，且都比抑郁参与者表现更好。
当前有自我伤害行为的青少年存在决策能力差的情况，但有过自我伤害史的青少年并非如此；因此，决策技能的提高可能与停止自我伤害有关。有和没有自我伤害行为的抑郁青少年可能具有不同的特征。
