Executive Dysfunction and Suicide in Psychiatric Outpatients and Inpatients

描述（由申请人提供）： 最近的研究表明，从事自杀行为的退伍军人有创伤性脑损伤（TBI）的历史，有TBI历史的退伍军人从事自杀行为。现有的研究还表明自杀倾向和执行功能障碍之间存在关联（例如，决策障碍）。迄今为止，还没有进行明确定义的研究来探索执行功能障碍作为一个多维度结构（即，决策、冲动、概念形成和攻击性）和自杀行为。有必要增进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。这项研究将评估自杀和TBI之间相互作用的背景下的决策。调查结果还将允许探索性分析，旨在确定执行功能和心理困扰的措施性能之间的关联。为此，本研究旨在比较四组定义明确的退伍军人的测试表现：（1）中度至重度TBI和自杀行为史;（2）中度至重度TBI和无自杀行为史;（3）无TBI和自杀行为史;（4）和无TBI和无自杀行为史。该拨款提案直接支持康复研究与发展目标，即最大限度地提高TBI患者的功能恢复，可能通过：1）提高临床医生识别中度至重度TBI患者自杀行为的神经心理学相关性的能力; 2）识别与影响治疗反应和恢复的现实生活行为相对应的执行功能的心理测量学合理措施; 3）促进创新评估技术和心理社会干预措施的创建（例如，安全计划），以尽量减少并发症的管理自杀行为由于创伤性脑损伤相关的损害;和4）创建一个基础，进一步和急需的研究在这一领域。最终，这项研究的结果将有助于临床医生识别有自杀行为风险的TBI退伍军人的能力，并为进一步研究TBI幸存者的认知，情绪困扰和自杀倾向之间的关系奠定基础。 公共卫生相关性： 创伤性脑损伤（TBI）患者自杀行为的风险增加，自杀倾向与执行功能障碍有关。为了突出一个重要的风险因素，本研究将评估自杀和TBI之间相互作用的背景下的决策。调查结果还将允许探索性分析，旨在确定执行功能和心理困扰的措施性能之间的关联。本研究的长期目标是增加对执行功能障碍的理解，作为一个多维度的结构，最终目标是概念化评估工具和干预措施，旨在减少有TBI史的退伍军人高危人群的自杀行为。

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. PUBLIC HEALTH RELEVANCE: Project Narrative 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.