双相障碍患者的风险决策偏好：来自三水平元分析的证据

doi:10.3724/SP.J.1041.2025.0100

摘要/Abstract

摘要： 本研究采用三水平元分析定量估计双相患者与健康个体的风险决策偏好差异, 并检验该差异是否受到样本特征和测量特征的调节。基于71篇文献和176个效应量的元分析发现, 双相患者比健康个体更偏好风险寻求(Hedges' g = 0.301), 且这一偏好在风险态度量表(Hedges' g = 0.624)、行为实验任务(Hedges' g = 0.252)和日常风险行为(Hedges' g = 0.312)中都稳定存在。同时, 该差异还受到年龄(β = 0.009)和心境阶段的调节, 其中不论心境阶段如何, 双相患者均比健康个体更偏好风险寻求(缓解期: Hedges' g = 0.245; <轻>躁狂期: Hedges' g = 0.604; 重性抑郁期: Hedges' g = 0.417)。此外, 在行为实验任务中, 该差异受到年龄(β = 0.012)和地区的调节。特别是欧洲(Hedges' g = 0.419)和南美洲(Hedges' g = 0.420)的患者, 以及在爱荷华赌博任务(Hedges' g = 0.396)和剑桥赌博任务(Hedges' g = 0.220)中的患者, 均比健康个体更偏好风险寻求; 而在日常态度和行为中, 该差异仅受到心境阶段的调节, <轻>躁狂期患者(Hedges' g = 0.747)比健康个体更偏好风险寻求。本研究首次通过多种风险决策偏好测量类型探讨双相障碍与风险决策的关系, 得出了较稳定的结果, 并提出未来研究应充分考虑心境阶段、任务类型等因素的影响, 深入挖掘双相障碍影响风险决策的心理机制, 为双相障碍的临床管理和心理教育提供参考。

关键词: 双相障碍, 风险决策, 元分析, 决策范式, 跨心境特异性

Abstract: Bipolar disorder (BD), one of six major mental disorders in China, manifests as recurrent episodes of (hypo)mania and major depression. Recently, researchers have increasingly focused on the cognitive and behavioral characteristics of BD patients. Notably, increased risk-taking might emerge as a typical symptom of BD, supported by evidence from BD patients' daily behaviors, empirical research, and neuroimaging studies. However, contradictory findings have been reported, with some studies failing to find differences in risk preferences between BD patients and healthy controls (HCs) and a few studies even indicating increased risk aversion among BD patients. Consequently, whether and to what extent BD is associated with alterations in risk preference remain unclear. Thus, this study involved a three-level meta-analysis to examine the relationship between BD and risky decision-making, encompassing studies utilizing various measures of risky decision-making (i.e., risk attitude scales, behavioral tasks, and daily risk behaviors). Moreover, we aimed to uncover potential moderators, including sample and measurement characteristics, to better address inconsistent findings.
A systematic literature search was conducted with the Web of Science, PubMed, Scopus, PsycINFO, CNKI (China National Knowledge Infrastructure), and WFD (Wan Fang Data) databases up to April 15, 2024, to identify studies investigating risky decision-making in BD patients and HCs. We calculated the standard mean differences (Hedges' g) in risky decision-making between BD patients and HCs. We conducted a three-level random-effects meta-analysis, including heterogeneity analysis, moderation analyses for sample and measurement characteristics, and assessments of publication bias.
Across 176 effect sizes in 71 cross-sectional studies, BD patients exhibited greater risk-seeking than HCs (Hedges' g = 0.301), regardless of whether it was measured via risk attitude scales (Hedges' g = 0.624), behavioral tasks (Hedges' g = 0.252) or daily risk behaviors (Hedges' g = 0.312). Moreover, this difference was also moderated by age (β = 0.009) and mood phase, where BD patients in any mood phase preferred more risk-seeking than HCs (euthymic: Hedges' g = 0.245; (hypo)mania: Hedges' g = 0.604; major depression: Hedges' g = 0.417). For behavioral tasks, age (β = 0.012) and region were found to have significant moderating effects. Specifically, significant effect sizes were observed for samples originating from Europe (Hedges' g = 0.419) and South America (Hedges' g = 0.420). Moreover, effect sizes were significant in studies using the Iowa Gambling Task (IGT; Hedges' g = 0.396) and Cambridge Gambling Task (Hedges' g = 0.220), and effect sizes in IGT studies were larger than in those employing the Classic Risky Choice Tasks. Regarding. With respect to daily attitudes/behaviors, mood phase was identified as a significant moderator. Notably, effect sizes for (hypo)manic patients (Hedges' g = 0.747) were significantly larger than those for euthymic patients. Moreover, compared with HCs, BD patients exhibited increased risk-seeking across the health (Hedges' g = 0.308), financial (Hedges' g = 0.331), and overall attitude (Hedges' g = 0.733) domains.
This study comprehensively explored the relationship between BD and risky decision-making via various measures, revealing a consistent pattern of increased risk-seeking among BD patients. These findings suggest that increased risk-taking might be a noteworthy symptom of BD and propose potential utility for its application in clinical management and psychoeducation. Furthermore, future studies should consider factors such as mood phase and task type and try to uncover the underlying psychological mechanisms through which BD affects risky decision-making.

Key words: Bipolar disorder, risky decision-making, meta-analysis, decision task, cross-mood specificity

中图分类号:

陆嘉琦, 李雨斯, 何贵兵. (2025). 双相障碍患者的风险决策偏好：来自三水平元分析的证据. 心理学报, 57(1), 100-124.

LU Jiaqi, LI Yusi, HE Guibing. (2025). Risky decision-making in bipolar disorder: Evidence from a three-level meta-analysis. Acta Psychologica Sinica, 57(1), 100-124.

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