Altering Preferences for Suicide Crisis Resources Using the Decoy Nudge: Evidence of Context-Dependent Effects in Suicide Prevention Decision Making

Objective: Suicide is the 10th leading cause of death in the United States. There are several important decisions that could confer later risk to a suicide attempt (e.g., how to store lethal means). Therefore, understanding how people make decisions that are relevant for suicide risk is an important area of study for suicidology. Human behavior diverges from perfectly rational economic decision making according to observable patterns based on predictable cognitive processes. Nudges attempt to diminish, leverage. or circumvent these deviations to increase the probability of a desired choice being selected or behavior being performed. One deviation from rationality is that human choice is context dependent. This deviation can be observed by introducing an objectively inferior alternative option (a decoy) into a choice array that alters an individual's preference. Using decoys could be one way to nudge people toward best practices in suicide prevention work. Method: This study examined if decoys could reliably alter participant preferences for suicide prevention resources using a hypothetical scenario in three separate online samples (i.e., general population. participants with recent suicidal thoughts. gun owners). Results: Our results found that introducing a slightly (but objectively) worse version of an existing suicide prevention resource increased the preference toward the slightly better option. Conclusions: These findings indicate that using decoys could be an effective nudge for influencing people's preference toward best practices. Most important, these findings highlight the importance of context effects on choice preference in suicide research and prevention efforts, as well as suggest irrational decision-making processes in suicide-relevant decision making.