Xie Weizhen, Li Huanhuan, Luo Xinwei, Fu Rong, Ying Xiangyu, Wang Ning, Yin Qifeng, Zou Yingmin, Cui Yanyan, Wang Xiang, Shi Chuan
Renmin University of China.
J Clin Psychol. 2014 Jul;70(7):681-92. doi: 10.1002/jclp.22055. Epub 2013 Dec 4.
Psychological pain may be helpful in conceptualizing suicidal behavior, in that high motivation to avoid pain combined with painful feelings may contribute to an increased risk of suicide. However, no experimental study has tested this hypothesis. The aim of the present study is to provide empirical evidence for the relationship between anhedonia, pain avoidance motivation, and suicidal ideation.
The sample comprised 40 depressed outpatients and 20 healthy control subjects. All participants completed the Beck Scale for Suicide Ideation (BSS), Beck Depression Inventory, Psychache Scale, Three-Dimensional Psychological Pain Scale, the monetary incentive delay (MID), and affective incentive delay (AID) tasks. Based on BSS scores, clinical participants were divided into high suicidal ideation (HSI) and low suicidal ideation (LSI) groups.
In the AID task, the HSI group had longer response times (RTs) under the reward condition than those under the punishment condition (p = .002). The LSI and control groups had shorter RTs under the reward condition compared with those under the neural condition (p <.001 and p = .008, respectively). The LSI group also had shorter RTs under the reward condition than under the punishment condition (p = .003). Pain arousal (r = -.33, p <.01) and BSS scores were significantly negatively correlated with differences in RTs between neutral and reward conditions. Pain avoidance (r = .35, p <.01) and BSS scores were positively correlated with differences in RTs between neutral and punishment conditions.
The AID task was more sensitive than the MID task for the detection of participants' motivation in approaching hedonic experiences and avoiding pain. A suicidal mindset is manifested as decreased motivation to experience hedonia and increased motivation to avoid pain, which could be strong predictors of suicidal behavior.
心理痛苦可能有助于理解自杀行为，因为强烈的避免痛苦动机与痛苦感受相结合可能会增加自杀风险。然而，尚无实验研究验证这一假设。本研究的目的是为快感缺失、疼痛回避动机和自杀意念之间的关系提供实证依据。
样本包括40名抑郁症门诊患者和20名健康对照者。所有参与者均完成了贝克自杀意念量表（BSS）、贝克抑郁量表、精神痛苦量表、三维心理疼痛量表、金钱奖励延迟（MID）任务和情感奖励延迟（AID）任务。根据BSS得分，将临床参与者分为高自杀意念（HSI）组和低自杀意念（LSI）组。
在AID任务中，HSI组在奖励条件下的反应时间（RTs）比惩罚条件下更长（p = .002）。与中性条件相比，LSI组和对照组在奖励条件下的RTs更短（分别为p <.001和p = .008）。LSI组在奖励条件下的RTs也比惩罚条件下更短（p = .003）。疼痛唤起（r = -.33，p <.01）和BSS得分与中性和奖励条件之间RTs的差异显著负相关。疼痛回避（r = .35，p <.01）和BSS得分与中性和惩罚条件之间RTs的差异正相关。
AID任务在检测参与者接近享乐体验和避免疼痛的动机方面比MID任务更敏感。自杀心态表现为体验享乐的动机降低和避免疼痛的动机增加，这可能是自杀行为的有力预测指标。
