(PS3-39) The Relationship of Global Perception of One’s Health to Treatment-related Risk Preferences

Abstract Text:

Background: Depression and chronic pain both are highly debilitating (Gutiérrez-Rojas et al., 2020; Cohen et al., 2021). Effective treatments exist, though all carry risks (e.g., side-effects, loss of time and resources), and positive outcomes are never guaranteed. Thus, the choice of whether to pursue care is complex. Individual risk tolerance may influence decisions (Baek et al., 2017; Smoski et al., 2008), likely including treatment-related decisions. Individuals may appraise their need for treatment based on specific symptoms as well as on a more general or overall perception of one’s health. Indeed, other general metrics such as life satisfaction were found to be associated with treatment-related risk preferences (Young et al., 2023). The aim of this study is therefore to explore whether the overall perception of one’s health is related to risk preferences in the context of treatment-related decisions.

Methods: Participants were adults (21+) with depression and/or chronic pain, as ascertained by a structured (SCID; First et al. 2001) and unstructured clinical interviews and self-report measures (Brief Pain Inventory; Cleeland, 1991; Inventory of Depressive Symptomatology-Clinician; Rush et al. 1996). Participants evaluated their health states via three decision tasks: Direct scaling (DS) – a point on a continuous scale between death and perfect health, which can be considered as the overall measure of one’s health; time trade-off (TTO) -- a choice between current health for 10 years versus perfect health or milder level of disorder for fewer years; Standard Gamble (SG) -- a choice between a certain outcome (own health) or uncertain outcome (a hypothetical clinical trial of medication or surgery that could result in death as a risk or either perfect health or a milder level of the disorder as a benefit). Risk preference was defined as the discrepancy between SG and TTO ratings (Leykin et al., 2017). 

Results: Across all metrics, people reporting worse health on the Direct Scaling task were more risk averse (p < .001), controlling for demographic variables and, importantly, for symptom-based depression and pain levels. To better understand this effect, separate analyses were conducted for decisions about pain and about depression. Regarding depression, individuals with lower ratings on the DS task were consistently more risk averse (all ps < .05), regardless of whether the hypothetical clinical trial was surgery or medication, or whether expected improvements were mild or complete. However, regarding pain, all but one relationships between DS ratings and risk preferences were not significant. Interactions with group membership (depression, pain, comorbid) were tested, but none were significant.

Conclusions: Findings suggest that an overall sense of health is related to risk preferences in the context of treatment, even when controlling for the actual symptom level. However, the effect is more pronounced for decisions regarding depression rather than pain. Depressed individuals are more risk averse in pursuing treatment (Leykin et al., 2017), and the present findings further suggest that risk preferences may differ for decisions about mental versus physical disorders.