Decision-making impairment in emotional disorders
Lawrence, Amy Elizabeth
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Decision-making has become the focus of increased scientific attention in recent years. Attempts to characterize decision-making deficits in unipolar mood and anxiety disorders have, however, produced conflicting results. The current study examined two types of impairment, indecisiveness and risky decision-making, in a clinical sample of individuals with depression and/or anxiety. Depression and obsessive-compulsive disorder (OCD) symptoms were hypothesized to predict both self-reported indecisiveness and decision latency on behavioral tasks, with processing speed partially mediating the relationship between psychopathology and decision latency. It was hypothesized that symptoms of OCD and generalized anxiety disorder (GAD) would predict advantageous performance on a task assessing risky decision-making, and that executive functioning would partially mediate the relationship between psychopathology and risky decision-making. A sample of individuals (N = 74) who had recently undergone semi-structured diagnostic interviews was recruited for the current study. All participants were diagnosed with at least one unipolar mood or anxiety disorder, with the majority meeting criteria for two or more disorders. All participants completed the same study protocol, which included self-report measures, neuropsychological tests, and computer-administered decision-making tasks. Regression analyses and latent growth modeling were used to examine associations between psychopathology, decision-making, and neuropsychological variables. Self-reported depressive symptoms and OCD symptoms predicted self-reported indecisiveness. Contrary to prediction, psychopathology (when measured dimensionally via self-report measures or operationalized as the presence or absence of a depressive disorder, GAD, or OCD) did not predict decision latency, and there was no evidence of a mediating effect of processing speed. Self-reported depressive symptoms, but not self-reported symptoms of GAD or OCD, were positively associated with ratings of decision difficulty. On a measure of risky decision-making, a diagnosis of GAD and poorer set-shifting were both associated with less improvement in performance over the course of the task, whereas a diagnosis of OCD was associated with more improvement. Results are discussed in the context of the decision-making literature. Methodological challenges to the study of decision-making are addressed and ideas for future research are proposed.