In this series of article reviews, we will dissect the latest research papers important to mental health education and advocacy.

September 24, 2023 – 7 min read

Value-Based Decision Making in Mental Illness: A Meta-Analysis by Dahlia Mukherjee and Joseph W. Kable.

Introduction to Article

This is a meta-analysis study conducted by Mukherjee and Kable in 2014 to study whether mental illness affects decision-making. For the sake of the study, value-based decision-making is the process of evaluating risks and rewards before making a decision. The authors chose this topic for their meta-analysis to determine a consensus.


The authors used a range of criteria to select the studies they used. The first and most important was that they used the Iowa Gambling Task (IGT) to determine decision-making ability. The IGT has individuals choose cards among four decks (A, B, C, and D) with a numerical loss or gain attached to each card. Decks C and D have moderate risk and result in a net gain, while decks A and B are higher risk (larger gains and losses) and result in a net loss. Performance on this task is determined by the number of cards drawn from these decks: the more cards an individual picks from decks C and D, the better they will perform on this task. The studies were included if they had a control group, used the IGT, focused only on adults, and used an interview format from the DSM-IV to determine diagnosis (as opposed to simple self-reporting). All in all, the authors found 63 studies to compare mentally ill individuals with non-clinical individuals and 40 to compare individuals with different kinds of mental illness.


The authors found that individuals with mental illness performed reliably worse on the IGT than those without. The authors did not find an association between the type of mental illness and performance on the IGT.


One potential limitation of this study is that decision-making ability was determined with only one test. While the authors indicated that it was the most popular test to assess decision-making, a future study could include a more comprehensive battery of tests to paint a fuller picture of decision-making ability.

ARE U Takeaways

  • The major takeaway is that people with mental illness often experience significant impairment in decision-making. These individuals may forego consistently positive gains in favor of riskier and high-reward behavior.
  • The most interesting takeaway from this study is that the result was not significantly impacted by the kind of mental illness, meaning that assigning a productive value to one mental illness over another (i.e., someone with anxiety would be a more effective worker than someone with depression) may not be based in science.


Mukherjee, D., & Kable, J. W. (2014). Value-based decision making in mental illness. Clinical Psychological Science, 2(6), 767–782.