Poorer Inhibitory Control Uniquely Contributes to Greater Functional Disability in Post-9/11 Veterans.

OBJECTIVE Post-9/11 Veterans endorse greater self-reported functional disability than 80% of the adult population. Previous studies of trauma-exposed populations have shown that increased post-traumatic stress disorder (PTSD) and depressive symptoms are consistently associated with greater disability. Additionally, poorer cognitive performance in the domain of executive functions, particularly inhibitory control, has been associated with disability, though it is unclear if this effect is independent of and/or interacts with PTSD and depression. METHOD Three overlapping samples of n = 582, 297, and 183 combat-deployed post-9/11 Veterans completed comprehensive assessments of executive functions, PTSD and depressive symptoms, and self-reported World Health Organization Disability Assessment Schedule-II (WHODAS II). RESULTS Poorer performance on measures of inhibitory control (Delis-Kaplan Executive Functioning System Color-Word Interference-CWI Test and gradual-onset Continuous Performance Test-gradCPT), but not other executive functions, were significantly associated with greater disability on the WHODAS II (ρ's = -.13 and -.13, p = .002 and .026, respectively). CWI inhibitory control measures accounted for unique variance in disability after controlling for PTSD and depressive symptoms (R2 change = 0.02, p < .001). Further, CWI significantly moderated the effect of depressive symptoms on disability, such that better inhibitory control weakened the relationship between depression and disability. CONCLUSIONS Inhibitory control deficits are uniquely associated with increased disability in combat-deployed post-9/11 Veterans, and better inhibitory control abilities may serve as a protective factor for depressive symptoms leading to increased disability. KEY POINTS

[1]  E. Twamley,et al.  Baseline executive functioning moderates treatment-related changes in quality of life in veterans with posttraumatic stress disorder and comorbid traumatic brain injury. , 2022, Journal of traumatic stress.

[2]  W. Milberg,et al.  An executive function subtype of PTSD with unique neural markers and clinical trajectories , 2022, Translational Psychiatry.

[3]  Ian J. Stewart,et al.  Prevalence and correlates of self-reported cognitive difficulties in deployment-injured U.S. military personnel. , 2022, Journal of traumatic stress.

[4]  Francesca C. Fortenbaugh,et al.  Associations between changes in somatic and psychiatric symptoms and disability alterations in recent-era U.S. veterans. , 2022, Journal of traumatic stress.

[5]  W. Milberg,et al.  Punishment and reward normalize error-related cognitive control in PTSD by modulating salience network activation and connectivity , 2021, Cortex.

[6]  Jihyang Jun,et al.  Perceptual and response factors in the gradual onset continuous performance tasks , 2021, Attention, Perception, & Psychophysics.

[7]  J. Bean,et al.  Evidence for a Specific Association Between Sustained Attention and Gait Speed in Middle-to-Older-Aged Adults , 2021, Frontiers in Aging Neuroscience.

[8]  N. Kimbrel,et al.  Ecological momentary assessment (EMA) of mental health outcomes in veterans and servicemembers: A scoping review , 2020, Psychiatry Research.

[9]  A. Heinonen,et al.  Minimal clinically important difference and minimal detectable change of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) amongst patients with chronic musculoskeletal pain , 2020, Clinical rehabilitation.

[10]  Francesca C. Fortenbaugh,et al.  The Impact of Common Psychiatric and Behavioral Comorbidities on Functional Disability Across Time and Individuals in Post-9/11 Veterans. , 2020, Journal of traumatic stress.

[11]  Rishi Sharma,et al.  Demographic Profile and Service-Connection Trends of Posttraumatic Stress Disorder and Traumatic Brain Injury in US Veterans Pre- and Post-9/11. , 2020, Federal practitioner : for the health care professionals of the VA, DoD, and PHS.

[12]  Natania A. Crane,et al.  A Lifespan Model of Interference Resolution and Inhibitory Control: Risk for Depression and Changes with Illness Progression , 2020, Neuropsychology Review.

[13]  Christopher L. Asplund,et al.  Overlapping attentional networks yield divergent behavioral predictions across tasks: Neuromarkers for diffuse and focused attention? , 2019, NeuroImage.

[14]  C. Marmar,et al.  Predeployment neurocognitive functioning predicts postdeployment posttraumatic stress in Army personnel. , 2019, Neuropsychology.

[15]  N. Kimbrel,et al.  Using the World Health Organization Disability Assessment Schedule 2.0 to assess disability in veterans with posttraumatic stress disorder , 2019, PloS one.

[16]  Francesca C. Fortenbaugh,et al.  Trauma-related psychiatric and behavioral conditions are uniquely associated with sustained attention dysfunction. , 2019, Neuropsychology.

[17]  W. Milberg,et al.  Metabolic risk in older adults is associated with impaired sustained attention. , 2019, Neuropsychology.

[18]  W. Milberg,et al.  Clinically Significant Cognitive Dysfunction in OEF/OIF/OND Veterans: Prevalence and Clinical Associations , 2019, Neuropsychology.

[19]  Stefanie Schoeneberger,et al.  Executive functioning as a predictor of stroke rehabilitation outcomes , 2019, The Clinical neuropsychologist.

[20]  S. Dutra,et al.  Reward Ameliorates Posttraumatic Stress Disorder-Related Impairment in Sustained Attention , 2018, Chronic stress.

[21]  Jonathon R. Howlett,et al.  Attention Deficit Hyperactivity Disorder and Risk of Posttraumatic Stress and Related Disorders: A Prospective Longitudinal Evaluation in U.S. Army Soldiers. , 2018, Journal of traumatic stress.

[22]  D. Pine,et al.  Bias-contingent attention bias modification and attention control training in treatment of PTSD: a randomized control trial , 2018, Psychological Medicine.

[23]  J. Vasterling,et al.  Neurocognitive and Information Processing Biases in Posttraumatic Stress Disorder , 2018, Current Psychiatry Reports.

[24]  E. Twamley,et al.  Worse baseline executive functioning is associated with dropout and poorer response to trauma-focused treatment for veterans with PTSD and comorbid traumatic brain injury. , 2018, Behaviour research and therapy.

[25]  M. Bellgrove,et al.  A Hierarchical Model of Inhibitory Control , 2018, Front. Psychol..

[26]  S. Dutra,et al.  Psychological Flexibility Mitigates Effects of PTSD Symptoms and Negative Urgency on Aggressive Behavior in Trauma-Exposed Veterans , 2018, Personality disorders.

[27]  D. Stavrinos,et al.  Executive function mediates the relation between emotional regulation and pain catastrophizing in older adults , 2018 .

[28]  D. Stavrinos,et al.  Aggression, emotional self-regulation, attentional bias, and cognitive inhibition predict risky driving behavior. , 2017, Accident; analysis and prevention.

[29]  W. Milberg,et al.  A methodology for assessing deployment trauma and its consequences in OEF/OIF/OND veterans: The TRACTS longitudinal prospective cohort study , 2017, International journal of methods in psychiatric research.

[30]  A. Holmes,et al.  The Unique Health Needs of Post-9/11 U.S. Veterans , 2017, Workplace health & safety.

[31]  Francesca C. Fortenbaugh,et al.  Interpersonal early‐life trauma alters amygdala connectivity and sustained attention performance , 2017, Brain and behavior.

[32]  G. Shields,et al.  The relationships between rumination and core executive functions: A meta‐analysis , 2017, Depression and anxiety.

[33]  M. Bajo,et al.  Training on Working Memory and Inhibitory Control in Young Adults , 2016, Front. Hum. Neurosci..

[34]  Michael A. Regan,et al.  The impact of emotion, life stress and mental health issues on driving performance and safety , 2016 .

[35]  K. Haaland,et al.  Neurocognitive Correlates of Successful Treatment of PTSD in Female Veterans , 2016, Journal of the International Neuropsychological Society.

[36]  B. Mullan,et al.  Does inhibitory control training improve health behaviour? A meta-analysis , 2016, Health psychology review.

[37]  M. Paulus,et al.  Randomized Placebo-Controlled Trial of Methylphenidate or Galantamine for Persistent Emotional and Cognitive Symptoms Associated with PTSD and/or Traumatic Brain Injury , 2016, Neuropsychopharmacology.

[38]  R. Fonseca,et al.  Executive function impairments in depression and bipolar disorder: association with functional impairment and quality of life. , 2016, Journal of affective disorders.

[39]  Francesca C. Fortenbaugh,et al.  Sustained Attention Across the Life Span in a Sample of 10,000 , 2015, Psychological science.

[40]  L. French,et al.  Clinical utility of the Neurobehavioral Symptom Inventory validity scales to screen for symptom exaggeration following traumatic brain injury , 2015, Journal of clinical and experimental neuropsychology.

[41]  Rany Abend,et al.  Effect of Attention Training on Attention Bias Variability and PTSD Symptoms: Randomized Controlled Trials in Israeli and U.S. Combat Veterans. , 2015, The American journal of psychiatry.

[42]  Michael Esterman,et al.  Posttraumatic Psychological Symptoms are Associated with Reduced Inhibitory Control, not General Executive Dysfunction , 2015, Journal of the International Neuropsychological Society.

[43]  Michael C. Anderson,et al.  Failing to Forget , 2015, Psychological science.

[44]  William P. Milberg,et al.  Deployment-related psychiatric and behavioral conditions and their association with functional disability in OEF/OIF/OND veterans. , 2015, Journal of traumatic stress.

[45]  B. Schmeichel,et al.  Stopping anger and anxiety: Evidence that inhibitory ability predicts negative emotional responding , 2014, Cognition & emotion.

[46]  H. Belanger,et al.  Screening for Postdeployment Conditions: Development and Cross-Validation of an Embedded Validity Scale in the Neurobehavioral Symptom Inventory , 2014, The Journal of head trauma rehabilitation.

[47]  W. Milberg,et al.  The Boston Assessment of Traumatic Brain Injury–Lifetime (BAT-L) Semistructured Interview: Evidence of Research Utility and Validity , 2014, The Journal of head trauma rehabilitation.

[48]  M. Rosenberg,et al.  In the zone or zoning out? Tracking behavioral and neural fluctuations during sustained attention. , 2013, Cerebral cortex.

[49]  W. Milberg,et al.  Stress-Related Psychological Symptoms Are Associated with Increased Attentional Capture by Visually Salient Distractors , 2013, Journal of the International Neuropsychological Society.

[50]  Paul Kudlow,et al.  COGNITIVE DEFICITS AND FUNCTIONAL OUTCOMES IN MAJOR DEPRESSIVE DISORDER: DETERMINANTS, SUBSTRATES, AND TREATMENT INTERVENTIONS , 2013, Depression and anxiety.

[51]  D. Swick,et al.  Attentional bias for trauma-related words: exaggerated emotional Stroop effect in Afghanistan and Iraq war veterans with PTSD , 2013, BMC Psychiatry.

[52]  Yi-Chen Lee,et al.  The role of active inhibitory control in psychological well-being and mindfulness , 2012 .

[53]  Diane Swick,et al.  Impaired Response Inhibition in Veterans with Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury , 2012, Journal of the International Neuropsychological Society.

[54]  Jutta Joormann,et al.  Depression and rumination: Relation to components of inhibition , 2012, Cognition & emotion.

[55]  Jennifer A. Robinson,et al.  Neuropsychological Sequelae of PTSD and TBI Following War Deployment among OEF/OIF Veterans , 2012, Neuropsychology Review.

[56]  M. Paulus,et al.  Executive function and PTSD: Disengaging from trauma , 2012, Neuropharmacology.

[57]  Tom Brijs,et al.  Inhibitory Control and Reward Predict Risky Driving in Young Novice Drivers: A Simulator Study , 2017 .

[58]  T. Kimbrell,et al.  Does PTSD impair cognition beyond the effect of trauma? , 2011, The Journal of neuropsychiatry and clinical neurosciences.

[59]  J. Read,et al.  Attentional Control, Trauma, and Affect Regulation: A Preliminary Investigation , 2010 .

[60]  J. Joormann.  Cognitive Inhibition and Emotion Regulation in Depression , 2010 .

[61]  Ian H. Gotlib,et al.  Emotion regulation in depression: Relation to cognitive inhibition , 2010, Cognition & emotion.

[62]  Stefano Federici,et al.  International Literature Review on WHODAS II (World Health Organization Disability Assessment Schedule II) , 2009 .

[63]  J. J. McDonald,et al.  Stress, mental health, and cognition: a brief review of relationships and countermeasures. , 2007, Aviation, space, and environmental medicine.

[64]  John L. Bradshaw,et al.  Associations between laboratory measures of executive inhibitory control and self-reported impulsivity , 2006 .

[65]  R. Paul,et al.  Evaluating elements of executive functioning as predictors of instrumental activities of daily living (IADLs). , 2006, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[66]  S. Shinkai,et al.  Correlates of cognitive impairment and depressive symptoms among older adults in Korea and Japan , 2005, International journal of geriatric psychiatry.

[67]  I. Baron,et al.  Delis-Kaplan Executive Function System , 2004 .

[68]  Edith Kaplan,et al.  Reliability and validity of the Delis-Kaplan Executive Function System: An update , 2004, Journal of the International Neuropsychological Society.

[69]  A. Miyake,et al.  The relations among inhibition and interference control functions: a latent-variable analysis. , 2004, Journal of experimental psychology. General.

[70]  C. Pantelis,et al.  Normative Data From the Cantab. I: Development of Executive Function Over the Lifespan , 2003, Journal of clinical and experimental neuropsychology.

[71]  Kenneth Podell,et al.  Standard measures of executive function in predicting instrumental activities of daily living in older adults , 2002, International journal of geriatric psychiatry.

[72]  H. Christopher Frey,et al.  Identification and Review of Sensitivity Analysis Methods , 2002, Risk Analysis.

[73]  M. J. Emerson,et al.  The Unity and Diversity of Executive Functions and Their Contributions to Complex “Frontal Lobe” Tasks: A Latent Variable Analysis , 2000, Cognitive Psychology.

[74]  P. Lovibond,et al.  The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. , 1995, Behaviour research and therapy.

[75]  D. Charney,et al.  The development of a Clinician-Administered PTSD Scale , 1995, Journal of traumatic stress.

[76]  D. Tortorelli,et al.  Design sensitivity analysis: Overview and review , 1994 .

[77]  Gilbert A. Churchill,et al.  Caution in the Use of Difference Scores in Consumer Research , 1993 .

[78]  N. Bohnen,et al.  Modification of the stroop color word test improves differentiation between patients with mild head injury and matched controls. , 1992, The Clinical neuropsychologist.