Risk-Sensitive Decision-Making and Self-Harm in Youth Bipolar Disorder

Background: Youth with bipolar disorder (BD) are at high risk for suicide and have high rates of self-harm, which includes both suicide attempts and non-suicidal self-injury. Greater risk-taking has been associated with suicide attempts in youth with major depression, although there are no studies examining the relationship between risk-related decision-making and self-harm in youth with BD. We aimed to examine the association of suicide risk with risk-sensitive decision-making in a controlled sample of youth with BD. Methods: Eighty-one youth with BD (based on DSM-IV criteria; 52 youth with a history of self-harm [BDsH+]; 29 without a history of self-harm [BDsH_]) and 82 age-and sex-matched control youth aged 13-20 years were recruited between 2012 and 2020. Decision-making and risk-taking performance were assessed via the Cambridge Gambling Task within the Cambridge Neuropsychological Test Automated Battery (CANTAB). General linear models were used to examine differences between groups with control for age, sex, and IQ. Results: There was a significant difference in the overall proportion of points bet (F2,157=3.87, P=.02, n2 = 0.23) such that BDsH_ youth performed better than both BDsH+ (P=.02) and control youth (P=.04). Mean latency was significant (F3156=4.12, P=.017, n2=0.03), with BDsH_ youth deliberating longer than controls (P=.03). Risk-taking significantly differed between groups (F2157=3.83, P=.02, eta 2=0.23), with BDsH_ youth showing greater self-control compared to BDsH+ (P=.01) and control youth (P=.01). Conclusions: BDsH_ youth had greater self-control and lower risk-taking. We speculate this finding may be reflective of a compensatory process among BDsH_ youth serving a protective role in suicide risk. Future longitudinal studies are needed to examine the temporal association of neurocognition and self-harm among youth with BD.