Executive Dysfunction and Suicide in Psychiatric Outpatients and Inpatients
Condition: Traumatic Brain Injury; Suicidality
MeSH terms: Brain Injuries; Brain Injuries, Traumatic; Suicide
Study type: Observational

Summary: 
      Those with traumatic brain injury (TBI) are at increased risk for suicidal behavior, and
      suicidality is associated with executive dysfunction. In the aim of highlighting an important
      risk factor, this study will assess decision making in the context of an interaction between
      suicide and TBI. Findings will also allow for exploratory analyses aimed at identifying
      associations between performance on measures of executive functioning and psychological
      distress. The long-term objective of this study is to increase understanding regarding
      executive dysfunction, as a multidimensional construct, with the ultimate goal of
      conceptualizing assessment tools and interventions aimed at decreasing suicidality in the
      at-risk population of veterans with a history of TBI.
    

Detailed description: 
      Recent studies indicate that veterans who engage in suicidal behavior have a history of
      traumatic brain injury (TBI), and veterans with a history of TBI engage in suicidal behavior.
      Existing research also suggests an association between suicidality and executive dysfunction
      (e.g., impaired decision making). To date a clearly defined study has not been conducted to
      explore the relationship between executive dysfunction as a multidimensional construct (i.e.,
      decision making, impulsivity, concept formation, and aggression) and suicidal behavior in the
      vulnerable population of those with a history of moderate to severe TBI. Increased
      understanding regarding this at-risk population is necessary to facilitate the creation of
      appropriate assessment strategies and interventions. This study will assess decision making
      in the context of an interaction between suicide and TBI. Findings will also allow for
      exploratory analyses aimed at identifying associations between performance on measures of
      executive functioning and psychological distress. Toward this end, the present study seeks to
      compare test performance among four well-defined groups of veterans: (1) those with moderate
      to severe TBI and a history of suicidal behavior; (2) those with moderate to severe TBI and
      no history of suicidal behavior; (3) those with no TBI and a history of suicidal behavior;
      (4) and those with no TBI and no history of suicidal behavior. This grant proposal is in
      direct support of the Rehabilitation Research and Development goal of maximizing functional
      recovery in those with TBI by potentially: 1) increasing clinicians' ability to identify
      neuropsychological correlates of suicidal behavior for those with moderate to severe TBI; 2)
      identifying psychometrically sound measures of executive functioning that correspond to
      real-life behaviors that impact treatment response and recovery; 3) facilitating the creation
      of innovative assessment techniques and psychosocial interventions (e.g., safety planning) to
      minimize complications in the management of suicidal behavior due to TBI-related impairments;
      and 4) creating a basis for further and much-needed research in this area. Ultimately,
      findings from this study would both contribute to clinicians' ability to identify veterans
      with TBI who are at risk for suicidal behavior, and create a foundation on which to base
      further research regarding the relationships between cognition, emotional distress, and
      suicidality in TBI survivors.
    

Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        The participants in this observational study will be all individuals willing and eligible
        from the following populations: 1) those admitted to the locked inpatient psychiatric unit
        at the Eastern Colorado Health Care System (ECHCS) Denver VA Medical Center (VAMC); 2)
        those seeking outpatient mental health, rehabilitative, or psychological or other services
        at the Denver VAMC or Colorado Springs Community Based Outpatient Clinic (CBOC) or other
        CBOC's; 3) those in an ECHCS domiciliary (e.g., Valor Point); 4) those on existing clinical
        and research databases; and 5) veterans in the community not seeking care within the
        Veterans Health Administration (VHA).
      
Keywords: Traumatic Brain Injury; Suicide; Executive Function