Citation

Brenner LA, Bahraini N, Homaifar BY, Monteith LL, Nagamoto H, Dorsey-Holliman B, Forster J. Arch. Phys. Med. Rehabil. 2015; 96(8): 1411-1418.

Affiliation

Veterans Integrated Service Network (VISN) 19 Mental Illness Research, Education, and Clinical Center (MIRECC), Denver, Colorado; University of Colorado Denver, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, Colorado.

Copyright

(Copyright © 2015, Elsevier Publishing)

DOI

10.1016/j.apmr.2015.04.010

PMID

25933916

Abstract

OBJECTIVE: To examine the relationship between executive dysfunction, as a multidimensional construct (i.e., decision making, impulsivity, aggression, concept formation), and suicide attempt (SA) history in a high-risk sample of Veterans with moderate to severe TBI.

DESIGN: Observational, 2x2 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 group, and the interaction between these two 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, using a varying coefficient model. SETTING: Veterans Health Administration (VHA). PARTICIPANTS: One hundred and thirty-three Veterans completed study measures (No SA No TBI: n=48, No SA Yes TBI: n=51, Yes SA No TBI: n = 12, Yes SA Yes TBI: n = 22). EXPOSURE: History of moderate to severe TBI; History of SA. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: IGT, Immediate and Delayed Memory Test (IMT/DMT), State Trait Anger Expression Inventory (STAXI-2), Wisconsin Card Sorting Test (WCST).

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 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.

Language: en