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

Published online by Cambridge University Press:  16 November 2018

Laura D. Crocker*
Research Service, VA San Diego Healthcare System, San Diego, California Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California
Amber V. Keller
Research Service, VA San Diego Healthcare System, San Diego, California
Sarah M. Jurick
San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
Jessica Bomyea
Research Service, VA San Diego Healthcare System, San Diego, California Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California Department of Psychiatry, University of California San Diego, San Diego, California
Chelsea C. Hays
San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
Elizabeth W. Twamley
Research Service, VA San Diego Healthcare System, San Diego, California Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California Department of Psychiatry, University of California San Diego, San Diego, California
Amy J. Jak
Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California Department of Psychiatry, University of California San Diego, San Diego, California Psychology Service, VA San Diego Healthcare System, San Diego, California
Correspondence and reprint requests to: Corresponding author: Laura Crocker, 3350 La Jolla Village Drive, MC 151B, San Diego, CA 92161. E-mail:


Objectives: 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. Methods: 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 post-traumatic stress disorder (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 use 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. (JINS, 2019, 25, 79–89)

Regular Research
Copyright © The International Neuropsychological Society 2018. This is a work of the U.S. Government and is not subject to copyright protection in the United States. 

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Addis, D.R., Wong, A.T., & Schacter, D.L. (2007). Remembering the past and imagining the future: Common and distinct neural substrates during event construction and elaboration. Neuropsychologia, 45, 13631377. CrossRefGoogle ScholarPubMed
Bahraini, N.H., Simpson, G.K., Brenner, L.A., Hoffberg, A.S., & Schneider, A.L. (2013). Suicidal ideation and behaviours after traumatic brain injury: A systematic review. Brain Impairment, 14, 92112. CrossRefGoogle Scholar
Bailes, J.E., Dashnaw, M.L., Petraglia, A.L., & Turner, R.C. (2014). Cumulative effects of repetitive mild traumatic brain injury. Progress in Neurological Surgery, 28, 5062. CrossRefGoogle ScholarPubMed
Barnes, S.M., Walter, K.H., & Chard, K.M. (2012). Does a history of mild traumatic brain injury increase suicide risk in veterans with PTSD? Rehabilitation Psychology, 57, 1826. CrossRefGoogle ScholarPubMed
Beck, A.T., Steer, R.A., & Brown, G.K. (1996). Manual for Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
Belanger, H.G., Kretzmer, T., Vanderploeg, R.D., & French, L.M. (2010). Symptom complaints following combat-related traumatic brain injury: Relationship to traumatic brain injury severity and posttraumatic stress disorder. Journal of the International Neuropsychological Society, 16, 194199. CrossRefGoogle ScholarPubMed
Belanger, H.G., Spiegel, E., & Vanderploeg, R.D. (2010). Neuropsychological performance following a history of multiple self-reported concussions: A meta-analysis. Journal of the International Neuropsychological Society, 16, 262267. CrossRefGoogle ScholarPubMed
Bredemeier, K., & Miller, I.W. (2015). Executive function and suicidality: A systematic qualitative review. Clinical Psychology Review, 40, 170183. CrossRefGoogle ScholarPubMed
Brenner, L.A., Bahraini, N., Homaifar, B.Y., Monteith, L.L., Nagamoto, H., Dorsey-Holliman, B., & Forster, J.E. (2015). Executive functioning and suicidal behavior among veterans with and without a history of traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 96, 14111418. CrossRefGoogle ScholarPubMed
Brenner, L.A., Betthauser, L.M., Homaifar, B.Y., Villarreal, E., Harwood, J.E.F., Staves, P.J., & Huggins, J.A. (2011). Posttraumatic stress disorder, traumatic brain injury, and suicide attempt history among veterans receiving mental health services. Suicide and Life-Threatening Behavior, 41, 416423. CrossRefGoogle ScholarPubMed
Brenner, L.A., Ignacio, R.V., & Blow, F.C. (2011). Suicide and traumatic brain injury among individuals seeking veterans health administration services. Journal of Head Trauma Rehabilitation, 26, 257264. CrossRefGoogle ScholarPubMed
Brown, G.K., Beck, A.T., Steer, R.A., & Grisham, J.R. (2000). Risk factors for suicide in psychiatric outpatients: A 20-year prospective study. Journal of Consulting and Clinical Psychology, 68, 371377. CrossRefGoogle ScholarPubMed
Bryan, C.J., & Clemans, T.A. (2013). Repetitive traumatic brain injury, psychological symptoms, and suicide risk in a clinical sample of deployed military personnel. JAMA Psychiatry, 70, 686691. CrossRefGoogle Scholar
Burton, C.Z., Vella, L., Weller, J.A., & Twamley, E.W. (2011). Differential effects of executive functioning on suicide attempts. The Journal of Neuropsychiatry and Clinical Neurosciences, 23, 173179. doi:10.1176/appi.neuropsych.23.2.173 CrossRefGoogle ScholarPubMed
Cancelliere, C., Hincapié, C.A., Keightley, M., Godbolt, A.K., Côté, P., Kristman, V.L., … Cassidy, J.D. (2014). Systematic review of prognosis and return to play after sport concussion: Results of the international collaboration on mild traumatic brain injury prognosis. Archives of Physical Medicine and Rehabilitation, 95, S210S229. CrossRefGoogle ScholarPubMed
Cicerone, K.D., & Kalmar, K. (1995). Persistent postconcussion syndrome: The structure of subjective complaints after mild traumatic brain injury. The Journal of Head Trauma Rehabilitation, 10, 117.CrossRefGoogle Scholar
Cohen, J., Cohen, P., West, S.G., & Aiken, L.S. (2003). Applied multiple regression/correlation analysis for the behavioral sciences (3rd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
Conner, K.R., Bohnert, A.S., McCarthy, J.F., Valenstein, M., Bossarte, R., Ignacio, R., … Ilgen, M.A. (2013). Mental disorder comorbidity and suicide among 2.96 million men receiving care in the Veterans Health Administration health system. Journal of Abnormal Psychology, 122, 256263. CrossRefGoogle ScholarPubMed
Dams-O’Connor, K., Spielman, L., Singh, A., Gordon, W.A., Lingsma, H.F., Maas, A.I.R., … Vassar, M.J. (2013). The impact of previous traumatic brain injury on health and functioning: A TRACK-TBI study. Journal of Neurotrauma, 30, 20142020. CrossRefGoogle ScholarPubMed
Defense and Veterans Brain Injury Center. (2017). DoD worldwide numbers for traumatic brain injury. Retrieved from Google Scholar
Delis, D.C., Kaplan, E., & Kramer, J.H. (2001). Delis-Kaplan Executive Function System (D-KEFS). San Antonio: The Psychological Corporation.Google Scholar
Delis, D.C., Kramer, J.H., Kaplan, E., & Ober, B.A. (2000). The California Verbal Learning Test - Second Edition. San Antonio: The Psychological Corporation.Google Scholar
Department of Veterans Affairs/Department of Defense, Management of Concussion-mTBI Working Group. (2016). VA/DoD Clinical Practice Guideline for Management of Concussion-Mild Traumatic Brain Injury. Retrieved from Google Scholar
Dretsch, M.N., Silverberg, N.D., & Iverson, G.L. (2015). Multiple past concussions are associated with ongoing post-concussive symptoms but not cognitive impairment in active-duty Army soldiers. Journal of Neurotrauma, 32, 13011306. CrossRefGoogle Scholar
Fazel, S., Wolf, A., Pillas, D., Lichtenstein, P., & Långström, N. (2014). Suicide, fatal injuries, and other causes of premature mortality in patients with traumatic brain injury a 41-year Swedish population study. JAMA Psychiatry, 71, 326333. CrossRefGoogle ScholarPubMed
Fehily, B., & Fitzgerald, M. (2017). Repeated mild traumatic brain injury: Potential mechanisms of damage. Cell Transplantation, 26, 11311155. CrossRefGoogle ScholarPubMed
Finley, E.P., Bollinger, M., Noël, P.H., Amuan, M.E., Copeland, L.A., Pugh, J.A., … Pugh, M.J.V. (2015). A national cohort study of the association between the polytrauma clinical triad and suicide-related behavior among US veterans who served in Iraq and Afghanistan. American Journal of Public Health, 105, 380387. CrossRefGoogle ScholarPubMed
Guskiewicz, K.M., Marshall, S.W., Bailes, J., McCrea, M., Harding, H.P., Matthews, A., … Cantu, R.C. (2007). Recurrent concussion and risk of depression in retired professional football players. Medicine and Science in Sports and Exercise, 39, 903909.CrossRefGoogle ScholarPubMed
Guskiewicz, K.M., McCrea, M., Marshall, S.W., Cantu, R.C., Randolph, C., Barr, W., … Kelly, J.P. (2003). Cumulative effects associated with recurrent concussion in collegiate football players: The NCAA Concussion Study. JAMA, 19, 25492555.CrossRefGoogle Scholar
Haller, M., Angkaw, A.C., Hendricks, B.A., & Norman, S.B. (2016). Does reintegration stress contribute to suicidal ideation among returning veterans seeking PTSD treatment? Suicide and Life-Threatening Behavior, 46, 160171. doi:10.1111/sltb.12181 CrossRefGoogle ScholarPubMed
Hayes, A.F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: The Guilford Press.Google Scholar
Hellmuth, J.C., Stappenbeck, C.A., Hoerster, K.D., & Jakupcak, M. (2012). Modeling PTSD symptom clusters, alcohol misuse, anger, and depression as they relate to aggression and suicidality in returning US veterans. Journal of Traumatic Stress, 25, 527534. doi:10.1002/jts.21732 CrossRefGoogle Scholar
Hoge, C.W., McGurk, D., Thomas, J.L., Cox, A.L., Engel, C.C., & Castro, C.A. (2008). Mild traumatic brain injury in U.S. soldiers returning from Iraq. The New England Journal of Medicine, 358, 453463. CrossRefGoogle ScholarPubMed
Homaifar, B.Y., Brenner, L.A., Forster, J.E., & Nagamoto, H. (2012). Traumatic brain injury, executive functioning, and suicidal behavior: A brief report. Rehabilitation Psychology, 57, 337341. CrossRefGoogle ScholarPubMed
Ilgen, M.A., Bohnert, A.S.B., Ignacio, R.V., McCarthy, J.F., Valenstein, M.M., Kim, H.M., & Blow, F.C. (2010). Psychiatric diagnoses and risk of suicide in veterans. Archives of General Psychiatry, 67, 11521158. CrossRefGoogle ScholarPubMed
Iverson, G.L., Brooks, B.L., Lovell, M.R., & Collins, M.W. (2006). No cumulative effects for one or two previous concussions. British Journal of Sports Medicine, 40, 7275. CrossRefGoogle ScholarPubMed
Iverson, G.L., Echemendia, R.J., LaMarre, A.K., Brooks, B.L., & Gaetz, M.B. (2012). Possible lingering effects of multiple past concussions. Rehabilitation Research and Practice, 2012, 17. Google ScholarPubMed
Iverson, G.L., Gaetz, M., Lovell, M.R., & Collins, M.W. (2004). Cumulative effects of concussion in amateur athletes. Brain Injury, 18, 433443. CrossRefGoogle ScholarPubMed
Jollant, F., Bellivier, F., Leboyer, M., Astruc, B., Torres, S., Verdier, R., … Courtet, P. (2005). Impaired decision making in suicide attempters. American Journal of Psychiatry, 162, 304310. CrossRefGoogle ScholarPubMed
Jakupcak, M., Cook, J., Imel, Z., Fontana, A., Rosenheck, R., & McFall, M. (2009). Posttraumatic stress disorder as a risk factor for suicidal ideation in Iraq and Afghanistan war veterans. Journal of Traumatic Stress, 22, 303306. CrossRefGoogle ScholarPubMed
Jurick, S.M., Crocker, L.D., Sanderson-Cimino, M., Keller, A.V., Trenova, L.S., Boyd, B.L., … Jak, A.J. (2018). Contributions to executive dysfunction in Operation Enduring Freedom/Operation Iraqi Freedom veterans with posttraumatic stress disorder and history of mild traumatic brain injury. Journal of Head Trauma Rehabilitation. 33, E41E52. Google ScholarPubMed
Kang, H.K., & Bullman, T.A. (2008). Risk of suicide among US veterans after returning from the Iraq and Afghanistan War Zones. Journal of the American Medical Association, 300, 652653.Google ScholarPubMed
Kang, H.K., Bullman, T.A., Smolenski, D.J., Skopp, N.A., Gahm, G.A., & Reger, M.A. (2015). Suicide risk among 1.3 million veterans who were on active duty during the Iraq and Afghanistan wars. Annals of Epidemiology, 25, 96100. CrossRefGoogle ScholarPubMed
Keilp, J.G., Beers, S.R., Burke, A.K., Melhem, N.M., Oquendo, M.A., Brent, D.A., & Mann, J.J. (2014). Neuropsychological deficits in past suicide attempters with varying levels of depression severity. Psychological Medicine, 44, 29652974. CrossRefGoogle ScholarPubMed
Keilp, J.G., Gorlyn, M., Russell, M., Oquendo, M.A., Burke, A.K., Harkavy-Friedman, J., & Mann, J.J. (2013). Neuropsychological function and suicidal behavior: Attention control, memory and executive dysfunction in suicide attempt. Psychological Medicine, 43, 539551. CrossRefGoogle ScholarPubMed
Keilp, J.G., Sackeim, H.A., Brodsky, B.S., Oquendo, M.A., Malone, K.M., & Mann, J.J. (2001). Neuropsychological dysfunction in depressed suicide attempters. American Journal of Psychiatry, 158, 735741. CrossRefGoogle ScholarPubMed
Kerr, Z.Y., Thomas, L.C., Simon, J.E., McCrea, M., & Guskiewicz, K.M. (2018). Association between history of multiple concussions and health outcomes among former college football players: 15-year follow-up from the NCAA Concussion Study (1999-2001). The American Journal of Sports Medicine, 46, 17331741. doi:10.1177/0363546518765121 CrossRefGoogle Scholar
Kongs, S.K., Thompson, L.L., Iverson, G.L., & Heaton, R.K. (2000). Wisconsin Card Sorting Test-64 Card Version (WCST-64). Odessa, FL: Psychological Assessment Resources.Google Scholar
Lippa, S.M., Fonda, J.R., Fortier, C.B., Amick, M.A., Kenna, A., Milberg, W.P., & Mcglinchey, R.E. (2015). Deployment-related psychiatric and behavioral conditions and their association with functional disability in OEF/OIF/OND veterans. Journal of Traumatic Stress, 28, 2533. CrossRefGoogle ScholarPubMed
Mackelprang, J.L., Bombardier, C.H., Fann, J.R., Temkin, N.R., Barber, J.K., & Dikmen, S.S. (2014). Rates and predictors of suicidal ideation during the first year after traumatic brain injury. American Journal of Public Health, 104, e100e107. doi:10.2105/AJPH.2013.301794 CrossRefGoogle ScholarPubMed
Madigan, N.K., DeLuca, J., Diamond, B.J., Tramontano, G., & Averill, A. (2000). Speed of information processing in traumatic brain injury: Modality‐specific factors. The Journal of Head Trauma Rehabilitation, 15, 943956.CrossRefGoogle ScholarPubMed
Mann, J.J., Ellis, S.P., Waternaux, C.M., Liu, X., Oquendo, M.A., Malone, K.M., … Currier, D. (2008). Classification trees distinguish suicide attempters in major psychiatric disorders: A model of clinical decision making. The Journal of Clinical Psychiatry, 69, 2331. CrossRefGoogle ScholarPubMed
Meyers, J., & Meyers, K. (1995). Rey Complex Figure Test and Recognition Trial (RCFT). Odessa, FL: Psychological Assessment Resources.Google Scholar
Mouzon, B., Chaytow, H., Crynen, G., Bachmeier, C., Stewart, J., Mullan, M., … Crawford, F. (2012). Repetitive mild traumatic brain injury in a mouse model produces learning and memory deficits accompanied by histological changes. Journal of Neurotrauma, 29, 27612773. CrossRefGoogle Scholar
Multani, N., Goswami, R., Khodadadi, M., Ebraheem, A., Davis, K.D., Tator, C.H., … Tartaglia, M.C. (2016). The association between white-matter tract abnormalities, and neuropsychiatric and cognitive symptoms in retired professional football players with multiple concussions. Journal of Neurology, 263, 13321341. CrossRefGoogle ScholarPubMed
Nelson, L.A., Yoash-Gantz, R.E., Pickett, T.C., & Campbell, T.A. (2009). Relationship between processing speed and executive functioning performance among OEF/OIF veterans: Implications for postdeployment rehabilitation. Journal of Head Trauma Rehabilitation, 24, 3240. CrossRefGoogle ScholarPubMed
Niogi, S.N., Mukherjee, P., Ghajar, J., Johnson, C., Kolster, R.A., Sarkar, R., … McCandliss, B.D. (2008). Extent of microstructural white matter injury in postconcussive syndrome correlates with impaired cognitive reaction time: A 3T diffusion tensor imaging study of mild traumatic brain injury. American Journal of Neuroradiology, 29, 967973. CrossRefGoogle ScholarPubMed
Office of Suicide Prevention, Department of Veterans Affairs (2016). Suicide among veterans and other Americans. Retrieved from Google Scholar
Oquendo, M.A., Friedman, J.H., Grunebaum, M.F., Burke, A., Silver, J.M., & Mann, J.J. (2004). Suicidal behavior and mild traumatic brain injury in major depression. Journal of Nervous and Mental Disease, 192, 430434. CrossRefGoogle ScholarPubMed
Pietrzak, R.H., Goldstein, M.B., Malley, J.C., Rivers, A.J., Johnson, D.C., & Southwick, S.M. (2010). Risk and protective factors associated with suicidal ideation in veterans of Operations Enduring Freedom and Iraqi Freedom. Journal of Affective Disorders, 123, 102107. CrossRefGoogle ScholarPubMed
Pompili, M., Sher, L., Serafini, G., Forte, A., Innamorati, M., Dominici, G., … Girardi, P. (2013). Posttraumatic stress disorder and suicide risk among veterans: A literature review. Journal of Nervous and Mental Disease, 201, 802812. CrossRefGoogle ScholarPubMed
Pu, S., Setoyama, S., & Noda, T. (2017). Association between cognitive deficits and suicidal ideation in patients with major depressive disorder. Scientific Reports, 7, 16. CrossRefGoogle ScholarPubMed
Richard-Devantoy, S., Berlim, M.T., & Jollant, F. (2014). A meta-analysis of neuropsychological markers of vulnerability to suicidal behavior in mood disorders. Psychological Medicine, 44, 16631673. CrossRefGoogle ScholarPubMed
Richard-Devantoy, S., Berlim, M.T., & Jollant, F. (2015). Suicidal behaviour and memory: A systematic review and meta-analysis. World Journal of Biological Psychiatry, 16, 544566. CrossRefGoogle ScholarPubMed
Richard-Devantoy, S., Gorwood, P., Annweiler, C., Olié, J.-P., Le Gall, D., & Beauchet, O. (2012). Suicidal behaviours in affective disorders: A deficit of cognitive inhibition? The Canadian Journal of Psychiatry, 57, 254262. CrossRefGoogle ScholarPubMed
Silver, J.M., Kramer, R., Greenwald, S., & Weissman, M. (2001). The association between head injuries and psychiatric disorders: Findings from the New Haven NIMH Epidemiologic Catchment Area Study. Brain Injury, 15, 935945. CrossRefGoogle ScholarPubMed
Simpson, G., & Tate, R. (2002). Suicidality after traumatic brain injury: Demographic, injury and clinical correlates. Psychological Medicine, 32, 687697. CrossRefGoogle ScholarPubMed
Simpson, G., & Tate, R. (2005). Clinical features of suicide attempts after traumatic brain injury. Journal of Nervous and Mental Disease, 193, 680685. CrossRefGoogle ScholarPubMed
Simpson, G., & Tate, R. (2007). Suicidality in people surviving a traumatic brain injury: Prevalence, risk factors and implications for clinical management. Brain Injury, 21, 13351351. CrossRefGoogle ScholarPubMed
Slemmer, J.E., Matser, E.J.T., De Zeeuw, C.I., & Weber, J.T. (2002). Repeated mild injury causes cumulative damage to hippocampal cells. Brain, 125, 26992709. CrossRefGoogle ScholarPubMed
Spira, J.L., Lathan, C.E., Bleiberg, J., & Tsao, J.W. (2014). The impact of multiple concussions on emotional distress, post-concussive symptoms, and neurocognitive functioning in active duty United States Marines independent of combat exposure or emotional distress. Journal of Neurotrauma, 31, 18231834. CrossRefGoogle ScholarPubMed
Stack, S. (2000). Suicide: A 15-year review of the sociological literature. Part I: Cultural and economic factors. Suicide and Life-Threatening Behavior, 30, 145162. Google ScholarPubMed
Tanielian, T., & Jaycox, L.H. (Eds.) (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences and services to assist recovery. Santa Monica, CA: RAND Corporation. Google Scholar
Teasdale, T.W., & Engberg, A.W. (2001). Suicide after traumatic brain injury: A population study. Journal of Neurology, Neurosurgery, & Psychiatry, 71, 436440. CrossRefGoogle ScholarPubMed
Tombaugh, T.N. (1996). Test of memory malingering. New York: Multi Health Systems.Google Scholar
Weathers, F., Litz, B., Herman, D., Huska, J., & Keane, T. (1993, October). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TX.Google Scholar
Wilkinson, G.S., & Robertson, G.J. (2006). Wide Range Achievement Test 4. Torrance, CA: Western Psychological Services.Google Scholar
Wisco, B.E., Marx, B.P., Holowka, D.W., Vasterling, J.J., Han, S.C., Chen, M.S., … Keane, T.M. (2014). Traumatic brain injury, PTSD, and current suicidal ideation among Iraq and Afghanistan U.S. veterans. Journal of Traumatic Stress, 27, 244248. CrossRefGoogle ScholarPubMed
Zimmerman, L., Villatte, J.L., Kerbrat, A.H., Atkins, D.C., Flaster, A., & Comtois, K.A. (2015). Current suicidal ideation among treatment-engaged active-duty soldiers and marines. Military Behavioral Health, 3, 296305. CrossRefGoogle ScholarPubMed