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. 2024 Spring;36(2):125-133.
doi: 10.1176/appi.neuropsych.20230044. Epub 2024 Jan 9.

Impulsivity and Psychiatric Diagnoses as Mediators of Suicidal Ideation and Suicide Attempts Among Veterans With Traumatic Brain Injury

Alexandra L Aaronson  1 , Bridget Smith  1 , Kelly Krese  1 , Meghan Barnhart  1 , Maheen Adamson  1 , Harriet de Wit  1 , Noah S Philip  1 , Lisa A Brenner  1 , Theresa Bender-Pape  1 , Amy A Herrold  1
Affiliations

Impulsivity and Psychiatric Diagnoses as Mediators of Suicidal Ideation and Suicide Attempts Among Veterans With Traumatic Brain Injury

Alexandra L Aaronson et al. J Neuropsychiatry Clin Neurosci. 2024 Spring.

Abstract

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.

Keywords: Impulsivity; Major Depressive Disorder; Suicidal Ideation; Suicide Attempt; Traumatic Brain Injury; Veterans.

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Conflict of interest statement

Dr. de Wit serves as a scientific advisor to Awakn Life Sciences, Gilgamesh Pharmaceuticals, and the MIND Foundation, and she serves on the board of PharmaAla BioTech. Dr. Philip has received clinical trial support through Veterans Affairs contracts from Neurolief and Wave Neuroscience, he serves on the scientific advisory board of Pulvinar Neuro, and he serves as an advisor to Motif Neurotech. Dr. Brenner has received grant support from the Department of Defense, NIH, the State of Colorado, and the VA; she has received editorial remuneration from the Rand Corporation and Wolters Kluwer; she has received royalties from the American Psychological Association and Oxford University Press; and she has served as a consultant with sports leagues via her university affiliation. The other authors report no financial relationships with commercial interests.

Figures

FIGURE 1.
FIGURE 1.
Mediators of the effects of traumatic brain injury (TBI) on suicidal ideation among veteransa a The paths represent the following associations between variables: a1=TBI and posttraumatic stress disorder diagnosis; a2=TBI and major depressive disorder diagnosis; a3=TBI and high negative urgency impulsivity (top quartile for novel mentions of relevant behavior and mood state in the medical chart); b1=posttraumatic stress disorder diagnosis and suicidal ideation; b2=major depressive disorder diagnosis and suicidal ideation; b3=high negative urgency impulsivity and suicidal ideation; c1=unadjusted odds ratio between TBI and suicidal ideation, which was significant; and c2=adjusted odds ratio between TBI and suicidal ideation, which was not significant in the analysis that accounted for the three primary mediators.
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