When to quit: Calibration of voluntary persistence and attempted suicide in depression.

BACKGROUND: During a suicidal crisis, people may repeatedly reconsider how to respond as distress continues and prospects for relief change. One hypothesis links suicidal behavior to a preference for immediate escape over future rewards, but delay discounting findings are mixed. These studies typically assess choices between sooner and later rewards, leaving unresolved how people decide whether to persist as time costs accumulate. We examined re-engagement after setbacks and calibration of persistence in depression and attempted suicide.

METHODS: Adults from a mid- to late-life depression cohort (N = 277; 87 attempters, 59 ideators, 63 depressed non-suicidal, 68 controls) completed the Willingness-to-Wait task, in which waiting up to 3 s maximized reward, whereas longer waits were counterproductive. Immediate quitting - taking the smaller reward without waiting - was modeled with multilevel logistic regression; quitting latency once waiting began with Cox mixed-effects models. Exploratory analyses examined attempt lethality and age of first attempt. Sensitivity analyses accounted for impulsivity, cognition, and personality.

RESULTS: All groups were more likely to quit immediately after losses than wins, but this difference was largest in attempters. Once a wait began, attempters and depressed non-suicidal participants overpersisted relative to controls. Earlier age of first attempt, but not attempt lethality, was linked with stronger loss-triggered quitting. Findings were robust to confounds.

CONCLUSIONS: Depression was associated with maladaptive overpersistence, whereas a history of suicide attempts was additionally associated with loss-triggered disengagement. Dynamic tasks that separate re-engagement after failure from stopping decisions may help clarify decision processes relevant to suicidal behavior.