Mild Traumatic Brain Injury Burden Moderates the Relationship Between Cognitive Functioning and Suicidality in Iraq/Afghanistan-Era Veterans

Abstract

Objective: Suicidal ideation (SI) is highly prevalent in Iraq/Afghanistan-era Veterans with a history of mild traumatic brain injury (mTBI), and multiple mTBIs impart even greater risk for poorer neuropsychological functioning and suicidality. However, little is known about the cognitive mechanisms that may confer increased risk of suicidality in this population. Thus, we examined relationships between neuropsychological functioning and suicidality and specifically whether lifetime mTBI burden would moderate relationships between cognitive functioning and suicidal ideation. Method: Iraq/Afghanistan-era Veterans with a history of mTBI seeking outpatient services (N=282) completed a clinical neuropsychological assessment and psychiatric and postconcussive symptom questionnaires. Results: Individuals who endorsed SI reported more severe PTSD, depression, and postconcussive symptoms and exhibited significantly worse memory performance compared to those who denied SI. Furthermore, mTBI burden interacted with both attention/processing speed and memory, such that poorer performance in these domains was associated with greater likelihood of SI in individuals with a history of three or more mTBIs. The pattern of results remained consistent when controlling for PTSD, depression, and postconcussive symptoms. Conclusions: Slowed processing speed and/or memory difficulties may make it challenging to access and utilize past experiences to solve current problems and imagine future outcomes, leading to increases in hopelessness and SI in Veterans with three or more mTBIs. Results have the potential to better inform treatment decisions for Veterans with history of multiple mTBIs.

Suicidal ideation in Iraq and Afghanistan veterans with mental health conditions at risk for homelessness.

“…The present study also did not identify a significant association between social support and SI as found in previous literature (Pietrzak et al, 2010). Moreover, our exploratory analyses did not identify associations between cognitive functioning and SI, differing from a previous study in OEF/OIF/OND Veterans that found an association between worse memory functioning and SI (Crocker et al, 2019). However, this earlier study was specific to Veterans with TBI, was not specific to Veterans at risk for homelessness, utilized different neuropsychological measures, and included a larger sample size.…”

“…Many of the risk factors for suicidality and homelessness among Veterans overlap, including traumatic brain injury (TBI) history, psychiatric conditions, substance use disorder, low income, low social support, and cognitive dysfunction (Brenner et al, 2017; Crocker et al, 2019; Kang & Bullman, 2008; Lemaire & Graham, 2011; Metraux et al, 2013; Office of Suicide Prevention, 2019; Pietrzak et al, 2010; Tanielian & Jaycox, 2008; Tsai & Rosenheck, 2015; Twamley et al, 2019). Research suggests that Veterans with a history of homelessness are particularly vulnerable to suicidal behaviors (e.g., Culhane et al, 2019; Metraux et al, 2013; Tsai & Cao, 2019; Tsai et al, 2018).…”

Repetitive mTBI is associated with age-related reductions in cerebral blood flow but not cortical thickness

“…Notably, a similar threshold has been observed in other behaviorally and psychiatrically focused civilian and military studies. 44,45 Preliminary work from our lab also suggests that compensatory neurovascular processes occur even in those with fewer than two injuries, but are not evident in those three or more injuries. 80 Relatedly, although Table 1 focuses on mechanisms of injury related to their “most significant TBI,” many individuals reported experiencing injuries of other or mixed mechanisms as well.…”

“…These groupings were also based on similar studies exploring the negative influence of repetitive head-trauma on behavior in other Veteran samples. 44,45…”

Depression influence on memory and executive functions in patients with post-traumatic stress disorder, victims of the army conflict in Colombia.

“…Depression as a neurophychiatric pathology has an effect on quality of life deterioration (QOL) and on the neurocognitive functioning of people with this pathology. The data obtained by different [11][12][13][14][15] researches have found that depressive symptomatology affects the storage, consolidation and evocation of information, specifically on the inmediate verbal memory and in every aspect of it, likewise; it was found that depression is related to executive deficits [16][17][18], associated to the subcortical and the prefrontal cortex, frontal interactions, preventing the patients from regulating their decission making in different contexts, data which is also related to a clinical profile of severe cortical subcortical atrophy [19][20][21].…”