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

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