Differential Effects of Executive Functioning on Suicide Attempts

Burton, Cynthia; Vella, Lea; Weller, Jennifer A.; Twamley, Elizabeth W.

doi:10.1176/appi.neuropsych.23.2.173

Cited by 25 publications

(20 citation statements)

References 30 publications

(23 reference statements)

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“…In addition, future research should examine whether present results generalize to suicidal behaviors, specifically attempts, in individuals with a history of multiple mTBIs. Much of the previous research examining relationships between neuropsychological functioning and suicide attempts has implicated poorer executive functioning, particularly on tests of impulsivity and decision making, across various populations (Bredemeier & Miller, 2015; Burton et al, 2011; Jollant et al, 2005), including individuals with a history of moderate to severe TBI (Brenner et al, 2015; Homaifar et al, 2012). However, it has been proposed that distinct neuropsychological mechanisms may be involved in different aspects of suicidality (e.g., SI versus suicidal behaviors, high-lethality attempts versus low-lethality; Bredemeier & Miller, 2015; Burton et al, 2011; Keilp et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

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

Crocker

Keller

Jurick

et al. 2018

J Int Neuropsychol Soc

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Objective: 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. Method: 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 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 utilize 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.

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Section: Discussionmentioning

confidence: 99%

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

Crocker

Keller

Jurick

et al. 2018

J Int Neuropsychol Soc

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“…There is evidence that suicidal behavior is associated with an inability to inhibit irrelevant processing. For example, individuals with previous suicide attempts have performed worse on the Stroop task, thought to reflect the ability to inhibit a dominant but inappropriate response, compared to individuals with suicidal ideation ( 90 ).…”

Section: Discussionmentioning

confidence: 99%

Event-Related Potential Measures of Attention Capture in Adolescent Inpatients With Acute Suicidal Behavior

et al. 2018

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Impaired executive functions, modulated by the frontal lobes, have been suggested to be associated with suicidal behavior. The present study examines one of these executive functions, attentional control, maintaining attention to the task-at-hand. A group of inpatient adolescents with acute suicidal behavior and healthy controls were studied using a passively presented auditory optimal paradigm. This “optimal” paradigm consisted of a series of frequently presented homogenous pure tone “standards” and different “deviants,” constructed by changing one or more features of the standard. The optimal paradigm has been shown to be a more time-efficient replacement to the traditional oddball paradigm, which makes it suitable for use in clinical populations. The extent of processing of these “to-be-ignored” auditory stimuli was measured by recording event-related potentials (ERPs). The P3a ERP component is thought to reflect processes associated with the capturing of attention. Rare and novel stimuli may result in an executive decision to switch attention away from the current cognitive task and toward a probe of the potentially more relevant “interrupting” auditory input. On the other hand, stimuli that are quite similar to the standard should not elicit P3a. The P3a has been shown to be larger in immature brains in early compared to later adolescence. An overall enhanced P3a was observed in the suicidal group. The P3a was larger in this group for both the environmental sound and white noise deviants, although only the environmental sound P3a attained significance. Other deviants representing only a small change from the standard did not elicit a P3a in healthy controls. They did elicit a small P3a in the suicidal group. These findings suggest a lowered threshold for the triggering of the involuntary switch of attention in these patients, which may play a role in their reported distractibility. The enhanced P3a is also suggestive of an immature frontal central executive and may provide a promising marker for early identification of some of the risk factors for some of the cognitive difficulties linked to suicidality.

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“…Furthermore, there is also evidence for shared predisposition for suicide and autism spectrum disorders [28], [29], including failures with social problem solving [30]–[32], lower socialization [33], deficits in emotion recognition [29], [34] and executive functioning [35]–[39].…”

Section: Introductionmentioning

confidence: 99%

Possible Association between Suicide Committed under Influence of Ethanol and a Variant in the AUTS2 Gene

et al. 2013

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Backgroundrs6943555 in AUTS2 has been shown to modulate ethanol consumption. We hypothesized that rs6943555 might be associated with completed suicide.MethodsWe genotyped rs6943555 in 625 completed suicides and 3861 controls using real-time TaqMan Allelic Discrimination Assay. All individuals were Polish Caucasians.ResultsWe detected an association between suicide and rs6943555 A allele (OR = 1.17, P = 0.018 for allelic comparison, OR = 1.24, P = 0.013 for dominant, and OR = 1.18, P = 0.020 for co-dominant model of inheritance). The association remained significant after adjusting for age and gender (co-dominant: P = 0.002 and dominant model: P = 0.001). After stratifying suicides according to blood ethanol concentration (BAC≤ 20 mg/dl and BAC > 20 mg/dl) the association remained significant only for cases who committed suicide under influence of alcohol (co-dominant: OR = 1.37, P = 0.004 and dominant model: OR = 1.45, P = 0.006). To validate this finding we genotyped another cohort of 132 cases. We reproduced the association between rs6943555 A allele and suicide under influence of ethanol (allelic comparison: OR = 1.55, P = 0.023; co-dominant : OR = 1.54, P = 0.031; dominant model: OR = 1.84, P = 0.015). Analyzing pooled suicides with BAC >20 mg/dl (N = 300) we found the association of rs6943555 A allele not only vs. controls (allelic OR = 1.41, P = 0.00029) but also vs. cases with BAC ≤ 20 mg/dl (N = 449, allelic OR = 1.33, P = 0.019).ConclusionsIn our study rs6943555 A allele is associated with suicide committed after drinking ethanol shortly before death. The rs6943555 A allele may be linked to adverse emotional reaction to ethanol, which could explain the association with lower consumption in general population as well as the predisposition to suicide under influence of ethanol.

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Differential Effects of Executive Functioning on Suicide Attempts

Cited by 25 publications

References 30 publications

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

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

Event-Related Potential Measures of Attention Capture in Adolescent Inpatients With Acute Suicidal Behavior

Possible Association between Suicide Committed under Influence of Ethanol and a Variant in the AUTS2 Gene

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