Objective:
Adolescence is a critical period for both heightened suicide risk and increased incidence, representing an important window for early intervention. Individuals with suicidal tendencies often experience regret during their decision-making processes, which is linked to counterfactual thinking. Counterfactual thinking is a psychological process where individuals contemplate alternative past behaviors, typically arising when decisions lead to negative outcomes. Regret is induced when a decision leads to a loss in personal benefit, while interpersonal regret occurs when a choice harms others. Existing research has identified maladaptive counterfactual decision-making in adolescents with suicidal tendencies. However, interpersonal issues are a significant risk factor for psychological crises such as suicide, and the behavioral mechanisms involved in interpersonal counterfactual decision-making in suicidal adolescents remain unclear. This study aims to investigate the behavioral characteristics of counterfactual processing in suicidal adolescents through the Interpersonal Risky Gambling Task (IRGT) and computational models, providing an empirical basis for understanding suicidal decision-making in this population.
Method:
A survey was conducted to measure the levels of state anxiety, trait anxiety, depression, and suicidal ideation among first- and second-year high school students from a school in western China. Based on the responses, participants were grouped into three categories: 41 adolescents with suicidal behavior (SA), 36 patients with no suicide attempts (PC), and 43 healthy controls (HC). These participants completed the IRGT. Additionally, the survey measured childhood abuse, rumination, hopelessness, and impulsivity to control for potential confounding effects. SPSS 26.0 was used for variance analysis and descriptive data analysis. In contrast, linear mixed-effects analysis was performed in R 4.0.5 using the lme4 package to evaluate the effects of expected values (e), risk variance (v), and anticipated regret (r) on decision-making.
Results:
In this study, participants completed decision tasks in both interpersonal and individual regret scenarios. Emotional responses were categorized into partial feedback and full feedback phases. The findings revealed that: (1) During the partial feedback phase, the main effects of outcomes and opportunity counterfactuals were significant for both scenarios, but the group main effects were not significant. Only in the individual regret scenario did a significant interaction occur between the group and outcome, with significant differences observed between PC and HC; (2) During the full feedback phase, the main effects of outcomes and agent counterfactuals were significant, and the group main effects were again insignificant. However, in both scenarios, significant interactions were observed between group and outcome and between group and agent counterfactuals, particularly between PC and HC.
Regarding behavioral decision-making, in the individual regret scenario, the main effects of expected values and anticipated regret were significant, with a significant interaction between the group and expected value. The interaction between group and risk was significant between PC and HC. In the interpersonal regret scenario, only the main effect of expected value was significant, with a significant interaction between the group and expected value between HC and SA.
Conclusion:
This study reveals the behavioral characteristics of interpersonal counterfactual processing in adolescents with suicidal behavior. The results show no significant differences in emotional responses between suicidal adolescents and healthy controls, and the impacts of actual outcomes and counterfactuals on emotions were also similar between the two groups. However, compared to healthy controls, adolescents with suicidal behavior exhibited lower levels of expectation in decision-making. The use of computational models to examine interpersonal counterfactual decision-making traits in suicidal adolescents helps to identify quantifiable indicators of suicide susceptibility. It provides support for further exploration of suicide risk factors and the development of targeted intervention strategies.
 

suicide,counterfactual thinking,regret