How Does Decision-Making Differ Across Mental Health Conditions?

What you need to know

• The study compared decision-making abilities across 20 different mental health conditions using a computerized gambling task
• Almost all conditions showed at least mild impairment in decision-making compared to controls
• Binge eating disorder showed the largest impairments, while gambling disorder showed moderate impairments
• The findings suggest decision-making deficits may be more widespread across mental health conditions than previously thought

Understanding decision-making in mental health

Making good decisions is an important life skill that many of us take for granted. But for people living with mental health conditions, the process of weighing options and choosing the best course of action can sometimes be challenging.

A recent study set out to explore how decision-making abilities differ across a wide range of mental health conditions. The researchers were particularly interested in aspects of decision-making related to risk-taking and gambling behaviors.

How the study worked

The study included 572 young adults between the ages of 18-29. Participants were recruited from the general community in Minneapolis and Chicago. To be included, they had to have gambled at least 5 times in the past year.

Each participant underwent a thorough psychiatric evaluation to screen for various mental health conditions. They were then asked to complete a computerized test called the Cambridge Gambling Task.

In this task, participants see 10 boxes on a screen that are either red or blue. A yellow token is hidden in one of the boxes. The participant has to guess whether the token is in a red box or a blue box, and then bet a portion of their points on their guess being correct.

The task is designed to measure three key aspects of decision-making:

1. Overall betting behavior - Do they tend to make large or small bets?
2. Quality of decisions - How often do they choose the most logical color based on probability?
3. Risk adjustment - Do they adjust their bets based on the odds of winning?

The researchers then compared the performance of people with each mental health condition to controls (people without that particular condition) to see how their decision-making differed.

Widespread impairments in decision-making

One of the most striking findings was that almost all of the mental health conditions studied were associated with at least mild impairment in decision-making compared to controls. This suggests that difficulties with certain aspects of decision-making may be more common across mental health conditions than previously recognized.

Some key findings for specific conditions included:

Binge Eating Disorder: Showed the largest impairments across all aspects of decision-making measured. This was somewhat surprising, as binge eating is not typically thought of as a condition closely linked to decision-making deficits.

Gambling Disorder: Showed moderate impairments across all measures. People with gambling disorder tended to make larger bets overall.

Post-Traumatic Stress Disorder (PTSD): Showed particularly large impairments in the quality of decision-making. People with PTSD were less likely to choose the most logical color option.

Depression and Obsessive-Compulsive Disorder (OCD): Both showed moderate impairments in decision-making quality.

Intermittent Explosive Disorder: Associated with a tendency to make much larger bets and poor adjustment of betting based on risk.

Risk adjustment a widespread challenge

One of the most common impairments seen across conditions was in risk adjustment - the ability to flexibly adjust betting behavior based on the odds of winning. Half of the mental health conditions assessed showed moderate to large impairments in this area.

The researchers suggest two possible explanations for poor risk adjustment:

1. Some conditions may make people more risk-averse and rigid in their thinking, less likely to pursue rewards.

2. Other conditions may make people more prone to taking risks, so they are less likely to adjust their behavior even when the odds are poor.

What do these findings mean?

These results highlight that decision-making impairments may be more widespread across mental health conditions than previously recognized. Even conditions not typically associated with cognitive deficits showed some degree of impairment compared to controls.

The researchers suggest that a better understanding of these decision-making challenges could help clinicians:

• More accurately assess risks associated with different conditions
• Develop more targeted treatment approaches
• Understand patient behavior and choices better

For example, cognitive training focused on improving decision-making skills is being explored as a potential treatment for gambling disorder. The findings of this study suggest similar approaches could potentially benefit people with other conditions as well.

Limitations to consider

While this study provides valuable insights, there are some important limitations to keep in mind:

• The study focused on young adults with an average age of 22. The findings may not generalize to other age groups.

• The sample sizes for some of the less common conditions were relatively small.

• The study couldn’t control for the effects of medications or substance use that might impact cognition.

• As a cross-sectional study (looking at one point in time), it can’t determine whether mental health conditions cause decision-making impairments or vice versa.

Conclusions

• Decision-making impairments appear to be common across a wide range of mental health conditions, not just those typically associated with cognitive deficits.

• Binge eating disorder showed surprisingly large impairments, while gambling disorder showed moderate impairments across all measures.

• Many conditions were associated with difficulty adjusting behavior based on risk, which could have important real-world implications.

• A better understanding of decision-making challenges in mental health could lead to improved risk assessment and more targeted treatments.

This study highlights the complex cognitive profiles associated with various mental health conditions. It suggests that considering decision-making abilities may be important across a broader range of disorders than previously thought.

Future research with larger samples and looking at changes over time will be crucial to better understand the relationship between mental health and decision-making. This could ultimately lead to new approaches for helping people with mental health conditions navigate the challenges of daily life and achieve better outcomes.