Impulsivity and Psychiatric Diagnoses as Mediators of Suicidal Ideation and Suicide Attempts Among Veterans With Traumatic Brain Injury
Open accessAbstract
OBJECTIVE: Traumatic brain injury (TBI) is a risk factor for suicide, but questions related to mechanisms remain unanswered. Impulsivity is a risk factor for suicide and is a common sequela of TBI. The authors explored the relationships between TBI and both suicidal ideation and suicide attempts and explored whether impulsivity and comorbid psychiatric diagnoses mediate these relationships. METHODS: This cross-sectional retrospective chart review study included 164 veterans enrolled in a previous study. Sixty-nine veterans had no TBI history, and 95 had a TBI history (mild, N=44; moderate, N=13; severe, N=12; and unclear severity, N=26). To examine the associations between TBI and suicidal ideation or suicide attempts, as well as potential mediators of these relationships, chi-square tests, t tests, and logistic regression models were used. RESULTS: Unadjusted analyses indicated that veterans with TBI were more likely to report suicidal ideation; however, in analyses controlling for mediators, this relationship was no longer significant. Among veterans with TBI, suicidal ideation was related most strongly to high impulsivity (odds ratio=15.35, 95% CI=2.43-96.79), followed by depression (odds ratio=5.73, 95% CI=2.53-12.99) and posttraumatic stress disorder (odds ratio=2.57, 95% CI=1.03-6.42). TBI was not related to suicide attempts, yet suicide attempts were related to high impulsivity (odds ratio=6.95, 95% CI=1.24-38.75) and depression (odds ratio=3.89, 95% CI=1.56-9.40). CONCLUSIONS: These findings suggest that impulsivity, followed by psychiatric diagnoses, most strongly mediate the relationships between TBI and both suicidal ideation and suicide attempts. Impulsivity may be mechanistically related to, and serve as a future treatment target for, suicidality among veterans with TBI.
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In the authors' laboratory's previous chart review study, negative urgency impulsivity most strongly mediated the relationship between a history of TBI and SI and SAs.
“Our laboratory’s previous work built upon these findings and completed a chart review study that found negative urgency impulsivity most strongly mediated the relationship between a history of TBI and SI and SAs [43].”
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- Authors
- Aaronson, A. L., Smith, B., Krese, K., Barnhart, M., Adamson, M., de Wit, H., Philip, N. S., Brenner, L. A., Bender-Pape, T., & Herrold, A. A.
- Affiliations
- Shirley Ryan AbilityLab (US)
- Mental Health Service Line (Aaronson) and Research Service Line (Smith, Bender-Pape, Herrold), Edward J. Hines Veterans Administration Hospital, Hines, Ill.; Department of Psychiatry, University of Illinois, Chicago (Aaronson); Brain Innovation Center, Shirley Ryan AbilityLab, Chicago (Krese); Chicago Association for Research and Education in Science, Hines, Ill. (Krese); Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans...
- ORCID
- Venue
- The Journal of Neuropsychiatry and Clinical Neurosciences
- Published
- 2024-04
- Volume
- 36
- Issue
- 2
- Pages
- 125-133
- ISSN
- 0895-0172 (ISSN-L)
- 1545-7222
- PMC
- PMC11018458
- OpenAlex
- W4390706586
- Cited by
- 6
- References
- 41
- Citations by year
- 2025: 3 · 2024: 3
- FWCI
- 3.01
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Neuropsychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Defense
- U.S. Department of Veterans Affairs (IK2 RX004298, I50RX002864, IK1 RX003082, I01 RX002916)
- Office of Research and Development
- University of Oxford
- National Institutes of Health
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- traumatic brain injury, impulsivity, suicidal ideation, suicide attempts, veterans, depression, post-traumatic stress disorder, psychiatric comorbidity, mediation, suicidality
- MeSH terms
- Brain Injuries, Traumatic, Cross-Sectional Studies, Humans, Impulsive Behavior, Retrospective Studies, Risk Factors, Suicide, Attempted, Veterans, Suicidal Ideation
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