Executive functioning and suicidal behavior among veterans with and without a history of traumatic brain injury.
OBJECTIVE
To examine the relationship between executive dysfunction, as a multidimensional construct (ie, decision-making, impulsivity, aggression, concept formation), and suicide attempt (SA) history in a high-risk sample of veterans with moderate to severe traumatic brain injury (TBI).


METHODS
Observational, 2×2 factorial design. To estimate group differences, linear regression was used to model the primary and secondary outcomes of interest as a function of history of SA, TBI, and the interaction between the 2 variables. Additionally, to determine the pattern of performance over the course of the Iowa Gambling Test (IGT), scores were modeled across the 5 IGT blocks by using a varying-coefficient model.


METHODS
Veterans Health Administration.


METHODS
Veterans (N=133; no SA/no TBI, n=48; no SA/yes TBI, n=51; yes SA/no TBI, n=12; yes SA/yes TBI, n=22) completed the study measures.


METHODS
Not applicable.


METHODS
IGT, Immediate and Delayed Memory Test, State-Trait Anger Expression Inventory-2, Wisconsin Card Sorting Test.


RESULTS
All groups demonstrated learning over the course of the IGT, except for veterans with a history of both SA and TBI. No group differences were identified on other measures of executive functioning.


CONCLUSIONS
These findings highlight the potential, unique decision-making challenges faced by veterans with a history of TBI and SA. Specialized interventions focused on overall distress reduction and means restriction may be required to prevent future self-directed violence.
Rocky Moutain Mental Illness Research, Education, and Clinical Center (MIRECC), Denver, CO; Department of Psychiatry, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO; Department of Neurology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO; Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO. Electronic address: lisa.brenner@va.gov.
Lisa A
LA
Brenner
Rocky Moutain Mental Illness Research, Education, and Clinical Center (MIRECC), Denver, CO; Department of Psychiatry, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO; Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO.
Nazanin
N
Bahraini
Rocky Moutain Mental Illness Research, Education, and Clinical Center (MIRECC), Denver, CO; Department of Psychiatry, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO; Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO.
Beeta Y
BY
Homaifar
Rocky Moutain Mental Illness Research, Education, and Clinical Center (MIRECC), Denver, CO; Department of Psychiatry, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO.
Lindsey L
LL
Monteith
Department of Psychiatry, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO; Veterans Health Administration, Eastern Colorado Health Care System, Denver, CO.
Herbert
H
Nagamoto
Rocky Moutain Mental Illness Research, Education, and Clinical Center (MIRECC), Denver, CO.
Brooke
B
Dorsey-Holliman
Rocky Moutain Mental Illness Research, Education, and Clinical Center (MIRECC), Denver, CO; Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO.
Jeri E
JE
Forster
D000328:Adult; D001930:Brain Injuries / Q000150:complications*; D003657:Decision Making; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000175:diagnosis; D008875:Middle Aged; D009483:Neuropsychological Tests; D012959:Socioeconomic Factors; D013406:Suicide, Attempted / Q000523:psychology*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*
Brain injuries; Rehabilitation; Suicide; Veterans