Executive Dysfunction and Suicide in Psychiatric Outpatients and Inpatients

描述(由申请人提供)： 项目概述最近的研究表明，有自杀行为的退伍军人有创伤性脑损伤(TBI)的病史，有脑损伤病史的退伍军人有自杀行为。现有的研究还表明，自杀和执行功能障碍(例如，决策能力受损)之间存在关联。到目前为止，还没有一项明确的研究来探索作为一个多维结构(即决策、冲动、概念形成和攻击性)的执行功能障碍与具有中到重度脑外伤病史的脆弱人群中的自杀行为之间的关系。有必要加强对这一高危人群的了解，以促进制定适当的评估战略和干预措施。这项研究将在自杀和脑外伤相互作用的背景下评估决策。调查结果还将允许进行探索性分析，目的是确定执行职能衡量标准的表现与心理困扰之间的联系。为此，本研究试图比较四组明确的退伍军人的测试表现：(1)有中至重度脑外伤且有自杀行为史的退伍军人；(2)有中至重度脑外伤且无自杀行为史的退伍军人；(3)无脑外伤且有自杀行为史的退伍军人；(4)无脑外伤且无自杀行为史的退伍军人。这项赠款建议直接支持康复研究和开发目标，即最大限度地提高脑外伤患者的功能恢复，方法是：1)提高临床医生识别中重度脑损伤患者自杀行为的神经心理相关性的能力；2)确定与影响治疗反应和康复的现实行为相对应的执行功能心理测量学指标；3)促进创新型评估技术和心理社会干预措施(如安全规划)的建立，以最大限度地减少脑外伤相关损害所致自杀行为管理的并发症；以及4)为这一领域的进一步和亟需的研究奠定基础。最终，这项研究的发现将有助于临床医生识别患有脑外伤的退伍军人有自杀行为的风险，并为进一步研究脑外伤幸存者的认知、情绪困扰和自杀行为之间的关系奠定基础。

DESCRIPTION (provided by applicant): Project Summary 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.