Establishing Relationships and Developing a Therapeutic Target for Impulsivity and Suicidality Among Veterans with Traumatic Brain Injury and Co-occurring Conditions

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This Career Development Award level 1 (CDA1) has two aims. First, the candidate will examine the relationship between impulsivity and suicidality among Veterans with traumatic brain injury (TBI) across a broad range of severities. This is important because impulsivity, which is exhibited in up to 40% of individuals with TBI, has been identified as an independent risk factor for completing suicide among those without a history of TBI. Since impulsivity is a major risk factor for making a suicide attempt, the candidate will examine the relationship between impulsivity and suicidality in a dataset compiled from existing psychological and neuropsychological testing data collected for [200] Veterans with TBI from mild to severe. She will also complete chart reviews on these patients to supplement the collected data. Veterans who participated in the original studies had common co-occurring psychiatric conditions. This will allow the candidate to explore how TBI and psychiatric conditions interact and influence impulsivity and suicidality. The candidate’s second aim is to utilize existing neuroimaging data to identify specific brain areas implicated in impulsivity and suicidality among those with TBI. The candidate will use volumetric and resting state functional connectivity MRI images to accomplish the second aim. Completing these aims are the candidate’s short-term goals. This research is critical as suicide is a major issue among Veterans within the VA system. Veterans are 22% more likely to die by suicide than civilians. Veterans with TBI are even more likely to die by suicide than those without TBI. It is important to characterize the link between impulsivity and suicidality to create possible treatments for suicidality. Further, identifying a neural correlate of these behavioral problems will help to develop biologic targets. Presently, there are no proposed biologic treatments to manage TBI related impulsivity in Veterans to prevent suicide. Understanding the relationship between TBI impulsivity and suicidality will help to identify key behavioral targets and the underlying neural correlates. This project will help the candidate and her team to create a neuroanatomically informed treatment strategy. Ultimately, the candidate’s long-term career goal is to become an independent clinical researcher in the VA system with expertise in TBI and suicidality. She hopes to leverage this expertise to create novel treatments. As such, she will complete a careful training plan under the mentorship of a strong, multidisciplinary training team involving ample meetings with experts in fields relating to the above research, hands-on training in research skills and coursework complementary to the research. The planned research is innovative, as it explores novel proposed mechanisms underlying suicidality within the Veteran population. It is significant, as it may lead to a new, effective treatment for suicidality in Veterans with TBI. The impact of this project is multifaceted. The project will improve understanding of the links between TBI, impulsivity and suicidality. It will also strengthen the candidate’s research skills and invest in a new promising young VA clinician-scientist for a career in independent post-TBI rehabilitation research, focused on neuropsychiatric outcomes with expertise in suicidality.