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Etzel L, Miskey HM, Webb JB, Demakis GJ, Harris HL, Shura RD. An Executive Functioning Composite Does Not Moderate the Relationship Between Combat Exposure and Posttraumatic Stress Disorder Symptom Clusters. Arch Clin Neuropsychol 2024; 39:11-23. [PMID: 37565825 DOI: 10.1093/arclin/acad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/30/2023] [Accepted: 06/07/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is prevalent among U.S. combat Veterans, and associated with poor health and wellbeing. As combat experiences are likely to significantly modify self-, other-, and society-oriented cognitions and heighten risk for PTSD, examination of related cognitive processes may yield new treatment strategies. The cognitive model of PTSD suggests that persistent threat perceptions contribute to symptom worsening. Thus, cognitive processes of shifting perspectives or generating novel interpretations may be particularly relevant to lessen PTSD symptoms. This cross-sectional study examined executive functioning as a moderator to the relationship between combat exposure and PTSD symptom clusters among post-9/11 Veterans. METHOD Data from 168 Veterans were drawn from a larger study examining post-deployment mental health and cognitive function. An executive functioning composite derived from Wisconsin Card Sorting Test Perseveration Errors, WAIS-III Similarities, Trail Making Test B, and Stroop Color-Word Inhibition scores was computed. Path analysis was used to test the moderation model. RESULTS After accounting for age, sex, and estimated premorbid functioning, results indicated that combat exposure was associated with all symptom clusters on the PTSD Checklist-Military. Executive functioning was not significantly associated with the PTSD symptom clusters and did not moderate the relationship between combat exposure and any of the PTSD symptom clusters. CONCLUSIONS Combat exposure is an important dimension of risk related to PTSD in Veterans that warrants regular screening. Moderation by executive functioning was not observed despite theoretical support. Future work could test methodological and sampling reasons for this finding to determine if theoretical adjustment is necessary.
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Affiliation(s)
- Lena Etzel
- Health Psychology Ph.D. Program, University of North Carolina at Charlotte, Charlotte, NC, USA
- W. G. (Bill) Hefner VA Medical Center, Research & Academic Affairs, Salisbury, NC, USA
| | - Holly M Miskey
- W. G. (Bill) Hefner VA Medical Center, Mental Health and Behavioral Sciences, Salisbury, NC, USA
- VA VISN 6 Mid Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA
- Wake Forest School of Medicine, Department of Neurology, Winston-Salem, NC, USA
- University of North Carolina at Charlotte, Department of Psychological Science, Charlotte, NC, USA
| | - Jennifer B Webb
- Health Psychology Ph.D. Program, University of North Carolina at Charlotte, Charlotte, NC, USA
- University of North Carolina at Charlotte, Department of Psychological Science, Charlotte, NC, USA
| | - George J Demakis
- Health Psychology Ph.D. Program, University of North Carolina at Charlotte, Charlotte, NC, USA
- University of North Carolina at Charlotte, Department of Psychological Science, Charlotte, NC, USA
| | - Henry L Harris
- University of North Carolina at Charlotte, Department of Counseling, Charlotte, NC, USA
| | - Robert D Shura
- W. G. (Bill) Hefner VA Medical Center, Research & Academic Affairs, Salisbury, NC, USA
- VA VISN 6 Mid Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA
- Wake Forest School of Medicine, Department of Neurology, Winston-Salem, NC, USA
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Assessment of Executive Function in Patients with Traumatic Brain Injury with the Wisconsin Card-Sorting Test. Brain Sci 2020; 10:brainsci10100699. [PMID: 33019772 PMCID: PMC7600451 DOI: 10.3390/brainsci10100699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
This review aimed at providing a brief and comprehensive summary of recent research regarding the use of the Wisconsin Card-Sorting Test (WCST) to assess executive function in patients with traumatic brain injury (TBI). A bibliographical search, performed in PubMed, Web of Science, Scopus, Cochrane Library, and PsycInfo, targeted publications from 2010 to 2020, in English or Spanish. Information regarding the studies’ designs, sample features and use of the WCST scores was recorded. An initial search eliciting 387 citations was reduced to 47 relevant papers. The highest proportion of publications came from the United States of America (34.0%) and included adult patients (95.7%). Observational designs were the most frequent (85.1%), the highest proportion being cross-sectional or case series studies. The average time after the occurrence of the TBI ranged from 4 to 62 years in single case studies, and from 6 weeks up to 23.5 years in the studies with more than one patient. Four studies compared groups of patients with TBI according to the severity (mild, moderate and/or severe), and in two cases, the studies compared TBI patients with healthy controls. Randomized control trials were seven in total. The noncomputerized WCST version including 128 cards was the most frequently used (78.7%). Characterization of the clinical profile of participants was the most frequent purpose (34.0%). The WCST is a common measure of executive function in patients with TBI. Although shorter and/or computerized versions are available, the original WCST with 128 cards is still used most often. The WCST is a useful tool for research and clinical purposes, yet a common practice is to report only one or a few of the possible scores, which prevents further valid comparisons across studies. Results might be useful to professionals in the clinical and research fields to guide them in assessment planning and proper interpretation of the WCST scores.
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Iovine-Wong PE, Nichols-Hadeed C, Thompson Stone J, Gamble S, Cross W, Cerulli C, Levandowski BA. Intimate Partner Violence, Suicide, and Their Overlapping Risk in Women Veterans: A Review of the Literature. Mil Med 2019; 184:e201-e210. [DOI: 10.1093/milmed/usy355] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/17/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Paige E Iovine-Wong
- Department of Community Health and Health Behavior, University of Buffalo School of Public Health and Health Professions, 401 Goodyear Road, Buffalo, NY
| | - Corey Nichols-Hadeed
- Laboratory of Interpersonal Violence and Victimization, Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY
| | - Jennifer Thompson Stone
- Laboratory of Interpersonal Violence and Victimization, Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY
| | - Stephanie Gamble
- Laboratory of Interpersonal Violence and Victimization, Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, 400 Fort Hill Ave, Canandaigua, NY
| | - Wendi Cross
- Laboratory of Interpersonal Violence and Victimization, Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, 400 Fort Hill Ave, Canandaigua, NY
| | - Catherine Cerulli
- Laboratory of Interpersonal Violence and Victimization, Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY
| | - Brooke A Levandowski
- Department of Obstetrics and Gynecology, Clinical and Translational Science Institute, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY
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