The Impact of Depression on Self-Other Discrepancies in Decision Making

Perceived Social Norms Guide Health Care Decisions for Oneself and Others: A Cross-Sectional Experiment in a US Online Panel

BACKGROUND

Global aging has increased the reliance on surrogates to make health care decisions for others. We investigated the differences between making health care decisions and predicting health care decisions, self-other differences for made and predicted health care decisions, and the roles of perceived social norms, emotional closeness, empathy, age, and gender.

METHODS

Participants (N = 2037) from a nationally representative US panel were randomly assigned to make or to predict a health care decision. They were also randomly assigned to 1 of 5 recipients: themselves, a loved one 60 y or older, a loved one younger than 60 y, a distant acquaintance 60 y or older, or a distant acquaintance younger than 60 y. Hypothetical health care scenarios depicted choices between relatively safe lower-risk treatments with a good chance of yielding mild health improvements versus higher-risk treatments that offered a moderate chance of substantial health improvements. Participants reported their likelihood of choosing lower- versus higher-risk treatments, their perceptions of family and friends' approval of risky health care decisions, and their empathy.

RESULTS

We present 3 key findings. First, made decisions involved less risk taking than predicted decisions, especially for distant others. Second, predicted decisions were similar for others and oneself, but made decisions were less risk taking for others than oneself. People predicted that loved ones would be less risk taking than distant others would be. Third, perceived social norms were more strongly associated than empathy with made and predicted decisions.

LIMITATIONS

Hypothetical scenarios may not adequately represent emotional processes in health care decision making.

CONCLUSIONS

Perceived social norms may sway people to take less risk in health care decisions, especially when making decisions for others. These findings have implications for improving surrogate decision making.

HIGHLIGHTS

People made less risky health care decisions for others than for themselves, even though they predicted others would make decisions similar to their own. This has implications for understanding how surrogates apply the substituted judgment standard when making decisions for patients.Perceived social norms were more strongly related to decisions than treatment-recipient (relationship closeness, age) and decision-maker (age, gender, empathy) characteristics. Those who perceived that avoiding health care risks was valued by their social group were less likely to choose risky medical treatments.Understanding the power of perceived social norms in shaping surrogates' decisions may help physicians to engage surrogates in shared decision making.Knowledge of perceived social norms may facilitate the design of decision aids for surrogates.

Self-other discrepancies in electrophysiological response to outcome evaluation in the Balloon Analogue Risk Task

The topic of self-other differences in decision-making has gained considerable attention in recent years. Despite a broad range of behavior studies that have shown self-other discrepancy in decision-making, few neuroimaging studies with event-related potentials (ERPs) have directly compared decisions made for oneself with those made for others. It remains controversial whether self-other differences of outcome evaluations in gambling tasks can also be shown in brain potentials. In this study, we used event-related potentials with a Balloon Analogue Risk Task (BART) paradigm, a sequential, dynamic decision-making task to examine the effects of self-other differences on evaluation outcome in brain activity. Feedback Related Negativity (FRN) and P300 components were analyzed with respect to feedback valence (win vs. loss) and beneficiary (self vs. stranger). The ERP results showed that when making decisions for oneself, the negative outcome feedback evoked a larger P300 compared to making decisions for a stranger. However, there was no significant effect of self-other differences when the outcome feedback was positive. In contrast, regardless of whether the feedback was positive or negative, the FRN amplitude was insensitive to the self-other manipulation. Furthermore, we found that both components were modulated by the valence of the feedback. More pronounced FRN and P300 were induced when the feedback was negative, relative to when the feedback was positive. Our findings indicate that brain responses to outcome evaluation on the BART may be divided into an early semi-automatic processing stage and a later cognitive appraisal stage and that the self-other differences in sequential, dynamic decision-making tasks under uncertainty mainly affect the allocation of attention resources in the late cognitive processing stage.

Relationship Between Loneliness and Depression Among Chinese Junior High School Students: The Serial Mediating Roles of Internet Gaming Disorder, Social Network Use, and Generalized Pathological Internet Use

This study aimed to explore the mediating effects of internet gaming disorder, social network use, and generalized pathological internet use (GPIU) on the association between loneliness and depression. A total of 2211 junior high school students completed questionnaires regarding loneliness, internet gaming disorder, social network use, GPIU, and depression (aged 10-16 years). The results of a structural equation model revealed that (a) the path coefficient of loneliness to depression was significantly positive, (b) loneliness could not predict depression through GPIU directly, but (c) loneliness could predict depression through internet gaming disorder to GPIU, (d) loneliness could predict depression through social network use to GPIU, and (e) loneliness could not predict depression through internet gaming disorder to social network use to GPIU. These results provided significant implications for the prevention and reduction of depression in Chinese junior high school students.

Are mindful people more risk-averse? Effects of trait and state mindfulness on risk preference in decision-making

The current research investigated whether various aspects of mindfulness were differentially associated with risk preference in decision-making. In Studies 1 and 2, attention and present-focus aspects of trait mindfulness were associated with lower risk preference in making monetary gains. In Study 3, participants completed either a mindfulness training or listened to a comparable control recording. Compared to the control condition, subjects in the mindfulness condition were more risk-averse in making choices for monetary gains. The attention and present-focus aspects of state mindfulness mediated this connection. Study 4 introduced a loss framing, where attention and present-focus no longer associated with lower risk preference, but awareness and acceptance aspects of trait mindfulness associated with higher risk preference in avoiding monetary losses. The results suggest that different aspects of mindfulness have potential for mitigating risk preference, but such potential is limited depending on the framing of a decision context.

What Factors Moderate Self-Other Discrepancies in Decision Making? Results from a Vaccination Scenario

When we make risky decisions for others, we tend to follow social norms about risks. This often results in making different decisions for others than we would make for ourselves in a similar situation (i.e., self-other discrepancies). In an experiment, we investigated self-other discrepancies in young adults' decisions to purchase a vaccine against a sexually-transmitted virus for themselves or for another person (i.e., the target of the decision). When the target's preferences were in line with social norms, surrogates showed large self-other discrepancies in line with these norms. When the target's preferences were contrary to social norms, surrogates did not show self-other discrepancies in line with these preferences; instead they still followed social norms, F(1, 140) = 21.45, p < .001, η p 2 = .13. Surrogates with lower numeracy, F(2, 128) = 3.44, p = .035, η p 2 = .05, and higher empathy, F(2, 128) = 3.72, p = .027, η p 2 = .06, showed self-other discrepancies more in line with the target's preferences, even when these were contrary to the norm. Surrogates whose own risk attitudes were contrary to social norms showed larger self-other discrepancies, F(1, 128) = 5.38, p = .022, η p 2 = .04. These results demonstrate that perceived social norms about risk can predict self-other discrepancies in risky decisions, even when the target's preferences are known and at odds with the social norm. Further, the surrogates' numeracy, empathy, and propensity to take risks influence the extent to which risky decisions for others resemble risky decisions for oneself.

Costs and benefits of realism and optimism

PURPOSE OF REVIEW

What is the relationship between rationality and mental health? By considering the psychological literature on depressive realism and unrealistic optimism, it was hypothesized that, in the context of judgments about the self, accurate cognitions are psychologically maladaptive and inaccurate cognitions are psychologically adaptive. Recent studies recommend being cautious in drawing any general conclusion about the style of thinking and mental health.

RECENT FINDINGS

Recent investigations suggest that people with depressive symptoms are more accurate than controls in tasks involving time perception and estimates of personal circumstances, but not in other tasks. Unrealistic optimism remains a robust phenomenon across a variety of tasks and domains, and researchers are starting to explore its neural bases. However, the challenge is to determine to what extent and in what way unrealistic optimism is beneficial.

SUMMARY

We should revisit the hypothesis that optimistic cognitions are psychologically adaptive, whereas realistic thinking is not. Realistic beliefs and expectations can be conducive to wellbeing and good functioning, and wildly optimistic cognitions have considerable psychological costs.