@article{ref1,
title="Mild traumatic brain injury and suicide risk among a clinical sample of deployed military personnel: evidence for a serial mediation model of anger and depression",
journal="Journal of psychiatric research",
year="2016",
author="Stanley, Ian H. and Joiner, Thomas E. and Bryan, Craig J.",
volume="84",
number="",
pages="161-168",
abstract="Research has demonstrated a robust link between traumatic brain injuries (TBIs) and suicide risk. Yet, few studies have investigated factors that account for this link. Utilizing a clinical sample of deployed military personnel, this study aimed to examine a serial meditation model of anger and depression in the association of mild TBI and suicide risk. A total of 149 military service members referred for evaluation/treatment of a suspected head injury at a military hospital participated in the present study (92.6% male; Mage = 27.9y). Self-report measures included the Suicidal Behaviors Questionnaire-Revised (SBQ-R), Automated Neuropsychological Assessment Metrics (ANAM) anger and depression subscales, and Behavioral Health Measure-20 depression subscale. A current mild TBI diagnosis was confirmed by a licensed clinical psychologist/physician. Overall, 84.6% (126/149) of participants met diagnostic criteria for a current mild TBI. Bootstrapped serial mediation analyses indicated that the association of mild TBI and suicide risk is serially mediated by anger and depression symptoms (bias-corrected 95% confidence interval [CI] for the indirect effect = 0.044, 0.576). An alternate serial mediation model in which depression symptoms precede anger was not statistically significant (bias-corrected 95% CI for the indirect effect = -0.405, 0.050). Among a clinical sample of military personnel, increased anger and depression statistically mediated the association of mild TBI and suicide risk, and anger appears to precede depression in this pathway. <br><br>FINDINGS suggest that therapeutically targeting anger may serve to thwart the trajectory to suicide risk among military personnel who experience a mild TBI. Future research should investigate this conjecture within a prospective design to establish temporality.<br><br>Copyright © 2016 Elsevier Ltd. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0022-3956",
doi="10.1016/j.jpsychires.2016.10.004",
url="http://dx.doi.org/10.1016/j.jpsychires.2016.10.004"
}