Objective
Suicide prevention is a global target. Identifying mechanisms and alarm signals of subtypes of suicidal behavior is a first step to stratify treatment to suicide. The aim of this review was to overview the studies on decision-making in suicide to clarify correlates of decision-making in suicide and make indications on future researches.
Methods
The Web of Science, PubMed and Google Scholar databases were searched for studies published between 2005 and 2024, and additional reference searches were conducted, resulting in a total of 55 articles screened for inclusion. Articles published in English or Chinese peer-reviewed journals, including behavioral and imaging studies of suicide and decision-making.
Results & Discussion
Firstly, in terms of the research paradigms of suicidal studies on decision-making, we found that in addition to classic economical decision-making paradigms such as Iwoa Gambling task, Cambridge Gambling Task, Game Dice Task and delay discounting task, more ecological task such as Balloon Analogue Risk Task and reward-learning tasks have been recently used to investigate economic decision-making processing in individuals with suicidal ideation or attempts. Moreover, researchers used Monetary Incentive Delay Task and Ultimatum Game to examine the mechanisms of social decision-making in individuals with suicide behaviors. With behavioral paradigms as well as decision-making questionnaires, studies have shown behavioral impairments during social and non-social decision-making in suicidal individuals.
Furthermore, we demonstrated neural mechanisms of decision-making in suicide. Structural and functional alterations have been found not only in cortical value-integration areas such as ventral medial prefrontal cortex, orbital-frontal cortex and arterial cingulated cortex, but also in sub-cortical value-computation areas such as ventral striatum, putamen, amygdala during value-based decision-making in individuals with suicidal dispositions. These top-down regulation deficits and bottom-up emotion responses might characterize the decision-making dysfunction in suicidal individuals. Most studies focused on brain activation on specific areas but did not consider the dynamic network mechanisms during decision-making in suicide.
More importantly, individuals with different suicidal behaviors have shown different patterns of decision behavior and different neural mechanisms. It turns out that individuals with suicide attempt have not ability to integrate information, reward learning and plan and supervise. The available evidence also confirms that individuals with suicidal ideation are impaired in information integration and reward learning. However, few studies have been conducted to explore the ability of planning, monitoring and adjustment in individuals with suicidal ideation.
Conclusions
To conclude, it is crucial to identify objective and quantitative marker during suicide prevention. Researches on the relationship between suicide and decision-making promote better understandings of the psychological process of suicidal individuals, thus providing a new perspective for suicide prevention.

suicide, decision-making, behavior mechanism, neural mechanism