Executive functioning and suicidal behavior among veterans with and without a history of traumatic brain injury

Arch Phys Med Rehabil. 2015 Aug;96(8):1411-8. doi: 10.1016/j.apmr.2015.04.010. Epub 2015 Apr 28.


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).

Design: 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.

Setting: Veterans Health Administration.

Participants: 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.

Interventions: Not applicable.

Main outcome measures: 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.

Keywords: Brain injuries; Rehabilitation; Suicide; Veterans.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Brain Injuries / complications*
  • Decision Making
  • Executive Function*
  • Female
  • Humans
  • Male
  • Mental Disorders / complications
  • Mental Disorders / diagnosis
  • Middle Aged
  • Neuropsychological Tests
  • Socioeconomic Factors
  • Suicide, Attempted / psychology*
  • United States
  • United States Department of Veterans Affairs
  • Veterans / psychology*