Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4085 — Neurocognitive Risk Factors Detect Past-Year Suicide Attempt among Veterans at High Risk for Suicide

Lead/Presenter: Alejandro Interian
All Authors: Interian A (VA New Jersey Healthcare System) Kline A (Rutgers - Robert Wood Johnson Medical School) Chesin M (William Paterson University) Stanley B (Columbia University) King A (New Jersey Healthcare System) Latorre M (New Jersey Healthcare System) Miller R (New Jersey Healthcare System) St. Hill L (Rutgers - Bloustein School of Planning and Public Policy) Keilp J (Columbia University)

Objectives:
Part of the VHA's strategy for reducing suicide has focused on identifying and providing enhanced care to Veterans at high-risk for suicide. However, suicide risk assessment is complicated by the fact that risk factors are ubiquitous in high-risk groups and offer limited specificity for determining risk. For example, previously identified factors (e.g., mental health diagnosis, substance use, previous suicide behavior) would be largely present in mental health settings and in groups identified as high-risk for suicide. Thus, factors that can differentiate risk among Veterans already known to be at high-risk for suicide are needed to improve planning and clinical management. Holding such promise, neurocognitive tests have differentiated individuals who have made a suicide attempt from those who have not. The present study aims to extend this previous research by examining the ability of neurocognitive tests to detect a recent suicide attempt, within a group of Veterans who nearly all have a lifetime history of suicide behavior.

Methods:
Participants were Veterans (n = 117) considered high-risk for suicide, recruited after an index suicide event, ranging from severe suicidal ideation to suicide attempt. Data consisted of history of suicidal thoughts and behaviors; psychiatric diagnosis; self-report questionnaires (depression, hopelessness); and computerized neurocognitive testing of attention (Stroop tests), impulsivity (Go- No Go), and memory recognition. The key outcome was past-year suicide attempt.

Results:
Nearly all participants (93.2%) had some form of lifetime suicide behavior (actual/aborted/interrupted attempt, preparatory behavior) and the majority had a previous suicide attempt (60.8% past-year/82.9% lifetime). Several established (suicidal ideation, diagnosis) and neurocognitive factors (attention, impulsivity) were significantly associated with past-year suicide attempt in univariate analyses. Multivariate analyses showed that poorer neurocognitive performance was significantly associated with past-year suicide attempt, independent of the effects of established risk factors.

Implications:
Results extend previous neurocognitive findings by showing their ability to differentiate risk within a sample that represents the high end of the suicide risk spectrum, with nearly all reporting suicide behavior. The current results also highlight impulsivity and attentional functioning as potential targets for intervention.

Impacts:
Establishing targets for suicide risk assessment and possible intervention are critical for developing clinical innovations for VHA care of high-risk Veterans.