Behavioral Adaptation to Negative Social Cues in Depressed Patients According to Personal History of Suicide Attempt- COMPASS

Social interactions are part of daily life. To decide to interact with someone or not is a routine for humans. To ensure the quality of interpersonal relationships, emotional cues must be taken into account to adapt optimally the investigator's behavior.

Difficulties in interpersonal relationships often trigger suicidal behavior. Suicide attempters are characterized by an impaired decision - making associated with difficulties in familial relationships.

To date, little data on emotional recognition and social decision- making in clinical population is available.

The study aims to compare behavioral response to negative social cues in 82 depressed patients according to their history of suicide attempt using a computerized neuropsychological task.

To identify the nature of the mechanisms involved in social decisions, Mennella and coll. have developed a computerized task (waiting room task) in which the participant is asked to avoid or to approach individuals expressing negative emotional expressions, in this case: anger or fear. In practice, participants have to choose between two chairs to sit in a waiting room in which subjects expressing a neutral face or negative emotions are present. To make this choice they must press a specific keyboard button. In addition to that, in order to evaluate motivation, some of the trials are reversed, meaning that the choice made by the participant will result in the opposite result.

Using this task they have shown that: (1) anger is associated with more avoidance behavior than fear, (2) this behavior is goal- directed and, (3) the higher the level of impulsivity of the subjects, the less able they are to adapt their responses.

The proposed study will use this neuropsychological assessment, the waiting room task, to evaluate if depressed patients would avoid or approach individuals expressing negative facial emotions. The main objective is to compare behavioral adaptation to anger vs neutral cues among depressed patients with and without history of suicide attempt.

The study also aims to :

1. compare behavioral response to fear vs. neutral and anger vs. fear in depressed patients according to suicidal history ;
2. assess the modulation of behavioral adaptation by history of childhood maltreatment, level of impulsivity, anxiodepression and anhedonia;
3. correlate behavioral adaptation to negative cues (anger and fear) with decision-making performances using the Iowa Gambling Task.

The hypothesis is that depressed patients with a history of suicide attempt will exhibit anger specific hyper-responsiveness resulting in an increased avoidance behavior compared to subjects without suicidal history. It is expected that depressed suicide attempters will not have a different emotional reactivity compared to patients without suicidal history for another negative emotion, namely fear.

To that purpose, 82 depressed patients will be recruited in the study. Half of them will have a history of suicide attempt (suicide attempters) while the other half will have none (affective controls). Their participation will consist of an unique visit.

Eligibility Criteria:
Inclusion Criteria:

* Being between 18 and 65 years old
* Meeting the DSM-5 criteria for a current major depressive disorder
* For suicidal patients : having a lifetime history of suicide attempt
* For affective controls : having no personal history of suicide attempt
* Being able to understand the nature, purpose and methodology of the study
* Having signed the informed consent
* Being affiliated to a social security system

Exclusion Criteria:

* Current depressive episode with psychotic characteristics
* Mental retardation or sever medical co-morbidity
* Lifetime Diagnosis of schizophrenia or schizoaffective disorder
* Current manic or hypomanic episode
* Sensory or cognitive disability
* Pregnant or breastfeeding woman
* Deprivation of liberty (by judicial or administrative decision)
* Protection by law (guardianship or curatorship)
* Exclusion period in relation to another protocol
* Inability to understand, speak and write French