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Original Investigation
August 28, 2019

Delay Discounting as a Transdiagnostic Process in Psychiatric Disorders: A Meta-analysis

Author Affiliations
  • 1Peter Boris Centre for Addictions Research, St Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
  • 2Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
  • 3Department of Applied Behavioral Science, University of Kansas, Lawrence, Kansas
  • 4Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, Kansas
JAMA Psychiatry. Published online August 28, 2019. doi:10.1001/jamapsychiatry.2019.2102
Key Points

Question  Is delay discounting a transdiagnostic process in psychiatric disorders?

Findings  In this meta-analysis of 57 effect sizes from 43 studies across 8 diagnostic categories, robust differences in delay discounting were observed between people with psychiatric disorders and controls. Most individuals with disorders (including depression, bipolar disorder, schizophrenia, borderline personality disorder, bulimia nervosa, and binge-eating disorder) exhibited steeper discounting compared with controls, whereas those with anorexia nervosa exhibited shallower discounting compared with controls.

Meaning  Evidence from this study suggests that delay discounting decision-making is a robust transdiagnostic process across a range of psychiatric disorders and may be a viable target for treatment interventions.

Abstract

Importance  Delay discounting is a behavioral economic index of impulsive preferences for smaller-immediate or larger-delayed rewards that is argued to be a transdiagnostic process across health conditions. Studies suggest some psychiatric disorders are associated with differences in discounting compared with controls, but null findings have also been reported.

Objective  To conduct a meta-analysis of the published literature on delay discounting in people with psychiatric disorders.

Data Sources  PubMed, MEDLINE, PsycInfo, Embase, and Web of Science databases were searched through December 10, 2018. The psychiatric keywords used were based on DSM-IV or DSM-5 diagnostic categories. Collected data were analyzed from December 10, 2018, through June 1, 2019.

Study Selection  Following a preregistered Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol, 2 independent raters reviewed titles, abstracts, and full-text articles. English-language articles comparing monetary delay discounting between participants with psychiatric disorders and controls were included.

Data Extraction and Synthesis  Hedges g effect sizes were computed and random-effects models were used for all analyses. Heterogeneity statistics, one-study-removed analyses, and publication bias indices were also examined.

Main Outcomes and Measures  Categorical comparisons of delay discounting between a psychiatric group and a control group.

Results  The sample included 57 effect sizes from 43 studies across 8 diagnostic categories. Significantly steeper discounting for individuals with a psychiatric disorder compared with controls was observed for major depressive disorder (Hedges g = 0.37; P = .002; k = 7), schizophrenia (Hedges g = 0.46; P = .004; k = 12), borderline personality disorder (Hedges g = 0.60; P < .001; k = 8), bipolar disorder (Hedges g = 0.68; P < .001; k = 4), bulimia nervosa (Hedges g = 0.41; P = .001; k = 4), and binge-eating disorder (Hedges g = 0.34; P = .001; k = 7). In contrast, anorexia nervosa exhibited statistically significantly shallower discounting (Hedges g = –0.30; P < .001; k = 10). Modest evidence of publication bias was indicated by a statistically significant Egger test for schizophrenia and at the aggregate level across studies.

Conclusions and Relevance  Results of this study appear to provide empirical support for delay discounting as a transdiagnostic process across most of the psychiatric disorders examined; the literature search also revealed limited studies in some disorders, notably posttraumatic stress disorder, which is a priority area for research.

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