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Mild Traumatic Brain Injury Burden Moderates the Relationship Between Cognitive Functioning and Suicidality in Iraq/Afghanistan-Era Veterans

Published online by Cambridge University Press:  16 November 2018

Laura D. Crocker*
Research Service, VA San Diego Healthcare System, San Diego, California Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California
Amber V. Keller
Research Service, VA San Diego Healthcare System, San Diego, California
Sarah M. Jurick
San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
Jessica Bomyea
Research Service, VA San Diego Healthcare System, San Diego, California Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California Department of Psychiatry, University of California San Diego, San Diego, California
Chelsea C. Hays
San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
Elizabeth W. Twamley
Research Service, VA San Diego Healthcare System, San Diego, California Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California Department of Psychiatry, University of California San Diego, San Diego, California
Amy J. Jak
Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California Department of Psychiatry, University of California San Diego, San Diego, California Psychology Service, VA San Diego Healthcare System, San Diego, California
Correspondence and reprint requests to: Corresponding author: Laura Crocker, 3350 La Jolla Village Drive, MC 151B, San Diego, CA 92161. E-mail:


Objectives: Suicidal ideation (SI) is highly prevalent in Iraq/Afghanistan-era veterans with a history of mild traumatic brain injury (mTBI), and multiple mTBIs impart even greater risk for poorer neuropsychological functioning and suicidality. However, little is known about the cognitive mechanisms that may confer increased risk of suicidality in this population. Thus, we examined relationships between neuropsychological functioning and suicidality and specifically whether lifetime mTBI burden would moderate relationships between cognitive functioning and suicidal ideation. Methods: Iraq/Afghanistan-era Veterans with a history of mTBI seeking outpatient services (N = 282) completed a clinical neuropsychological assessment and psychiatric and postconcussive symptom questionnaires. Results: Individuals who endorsed SI reported more severe post-traumatic stress disorder (PTSD), depression, and postconcussive symptoms and exhibited significantly worse memory performance compared to those who denied SI. Furthermore, mTBI burden interacted with both attention/processing speed and memory, such that poorer performance in these domains was associated with greater likelihood of SI in individuals with a history of three or more mTBIs. The pattern of results remained consistent when controlling for PTSD, depression, and postconcussive symptoms. Conclusions: Slowed processing speed and/or memory difficulties may make it challenging to access and use past experiences to solve current problems and imagine future outcomes, leading to increases in hopelessness and SI in veterans with three or more mTBIs. Results have the potential to better inform treatment decisions for veterans with history of multiple mTBIs. (JINS, 2019, 25, 79–89)

Regular Research
Copyright © The International Neuropsychological Society 2018. This is a work of the U.S. Government and is not subject to copyright protection in the United States. 

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