PURPOSE:The Veteran Affairs (VA) New Jersey Parkinson's Disease (PD) Telepsychotherapy Hub (PD Telepsych Hub) delivers virtual mental health treatments to underserved rural Veterans in partnership with VA Parkinson's Disease Research, Education, and Clinical Centers (PADRECCs). This manuscript outlines the PD Telepsych Hub's hybrid type 2 implementation-effectiveness framework then presents the clinical and demographic characteristics of Enrolled Veterans along with mental health outcomes for Treatment Engagers receiving individual Cognitive Behavioral Therapy (CBT-PD) or group Mindfulness-Based Cognitive Therapy (MBCT-PD) over the first 5 years of operation (10/2020 to 09/2025). METHODS:Underserved rural Veterans with PD were primarily directly outreached by the PD Telepsych Hub (64%) or referred by VA clinicians. Veterans who met screening criteria and completed a psychiatric consult were enrolled and offered CBT-PD or MBCT-PD via telehealth according to preferences and needs. Enrolled Veterans completed baseline questionnaires assessing demographics and health characteristics. Treatment Engagers completed pre-and-post measures of mood, anxiety, loneliness, functional change, and treatment satisfaction. RESULTS:Enrolled Veterans (N = 522 across 31 states) were rural (72%), 6% Hispanic, 8% people of color, and on average 71-years-old. They reported an average of 7 years since PD diagnosis. Although most met criteria for a mood disorder (86%) and 43% had psychiatric comorbidities, only 9% were receiving psychotherapy at time of program enrollment. CBT-PD (n = 202) significantly reduced depression and anxiety, while MCBT-PD (n = 38) reduced depression. Treatment Engagers (n = 240) overall reported high treatment satisfaction (94%). CONCLUSION:At baseline, the mismatch between care access and clinical need was striking. Results highlight a growing foundation for real-world effectiveness in delivering empirically supported, PD-adapted interventions via telehealth to the highest-need, lowest-access populations.

Motor impulsivity is implicated in the transition from suicidal ideation to suicidal behavior. A prior study used a Go/No-go (GNG) task to show increased motor impulsivity in those with recent suicide attempt; additionally, computational modeling to extract latent cognitive variables from GNG has shown decreased decisional efficiency in those with an upcoming attempt. The current study aimed to examine a simpler version of GNG in a small sample of Veterans with prior history of suicidal behavior. Participants completed multiple GNG sessions over a one-year period. Each session was coded according to whether the participant had (1) an actual suicide attempt (ASA) in the 90 days following that session; (2) another suicide-related event (OtherSE) but not an ASA; or (3) neither (noSE) in the next 90 days. Although miss rates were low across all groups, results showed that, relative to noSE, an upcoming ASA was associated with 1) reduced false alarms in the behavioral data; 2) increased drift efficiency for foils in the computational modeling. These results complement the prior results which showed increased miss rate and increased drift efficiency for foils were associated with upcoming ASA. Importantly, in both studies, these variables were not associated with upcoming OtherSE, suggesting different cognitive processes associated with upcoming ASA, compared to other suicide-related events that fall short of an actual attempt. These two studies suggest the neurocognitive markers may represent both a cognitive risk factor and a behavioral marker of short-term risk for suicide attempt.

Negative automatic thoughts feature centrally in psychiatric disorder but are rarely studied in the prediction of suicide attempts. This study tested whether negative automatic thoughts could prospectively predict suicide attempt or other suicide event (aborted or self-interrupted attempt, preparatory behavior or suicidal ideation resulting in hospitalization) within a 90-day window among high suicide risk patients. Sixty Veterans at high risk of suicide completed assessments of negative automatic thoughts at multiple timepoints over a 1-year period. Each assessment session was then coded according to whether the participant made a suicide attempt or had an other suicide event in the following 90 days. Generalized Estimating Equations (GEE) were used to evaluate the incremental utility of (1) negative automatic thoughts and (2) acquired capability for suicide on predicting 90-day suicide attempt or other suicide event over established suicide risk factors, including lifetime number of suicide attempts, concurrent suicidal ideation, depressive symptom severity and hopelessness. The odds of a 90-day suicide attempt were significantly greater with more frequent negative automatic thoughts (OR = 1.06 [95% CI 1.03-1.09], p < .001); however, negative automatic thoughts did not significantly predict a near-term other suicide event (excluding an actual attempt). Acquired capability did not add to the near-term prediction of either suicide attempt or other suicide event. The study was a secondary analysis of data collected from a small sample, and thus, findings require replication. Near-term suicide attempts were rare even in this high-risk sample. Nevertheless, findings provide preliminary evidence for depressionogenic thought content in suicide attempt risk, and suggest a more direct link between negative automatic thoughts and suicide attempt than posited in contemporary theories.

Data were collected prospectively from 60 Veterans at risk for suicide at multiple time points over a one year period to identify predictors of suicidal events in the next 90 days. This outcome included suicide attempts, interrupted/aborted attempts, preparatory behaviors, or suicide-related hospitalizations. Entry criteria included prior year suicidal behavior or prior week severe suicidal ideation. At each time point, participants completed neurocognitive testing and self-report measures of suicidality, and reported suicide-related events since the previous time point. Available data include suicide-related outcomes, question-level data for clinical interviews and self-report measures (including assessments of suicidal thoughts and behaviors, suicidal ideation severity, as well as the Beck Depression Inventory-II (BDI-II), Beck Hopelessness Scale (BHS), Holmes-Rahe Stress Inventory, Automatic Thoughts Questionnaire (ATQ-30), and Acquired Capacity for Suicide Scale (ACSS)), and trial-level data for neurocognitive testing (including go-no/go task, a reward- and punishment-based learning task, death/suicide version of the Implicit Association Task, a memory recognition test), as well as latent cognitive variables extracted from computational modeling of the neurocognitive tests. This data may be used in secondary analyses for identification of predictors of multiple suicide-related outcomes over different time frames.

Individuals with chronic pain have increased risk of suicide, however, few receive suicide prevention interventions. Problem-solving therapy is an evidence-based treatment for chronic pain that seeks to improve problem-solving ability, an executive function associated with suicide risk and related outcomes. The goal of this pilot randomized controlled trial was to estimate if problem-solving therapy improves problem-solving ability and other outcomes for Veterans with chronic pain and moderate suicide risk (n = 44). Veterans were randomized to receive 12-weeks of video delivered problem-solving therapy or supportive psychotherapy. At post-treatment, problem-solving therapy was estimated to result in a greater increase in problem-solving ability (Cohen's d = 0.33, small effect) and a greater reduction in perceived burdensomeness (Cohen's d = 0.60, large effect), compared to supportive psychotherapy. These between-group differences were estimated to be maintained for problem-solving ability (Cohen's d = 0.94, large effect) and perceived burdensomeness (Cohen's d = 0.45, medium effect) at 6-month follow-up. It was estimated that problem-solving therapy did not have a differential effect on thwarted belongingness compared to supportive psychotherapy. In exploratory analysis, problem-solving therapy was estimated to reduce suicide ideation intensity, suicide ideation frequency, and suicide coping at post-treatment, however, in between-group analysis, only suicide ideation frequency was estimated to be reduced as compared to supportive psychotherapy. Results for the exploratory pain outcomes were mixed. This study suggests problem-solving therapy may improve problem-solving ability and reduce feelings of perceived burdensomeness. A fully powered clinical trial is needed to confirm these results and to determine if problem-solving therapy reduces suicide risk and improves pain outcomes.

BackgroundAnxiety is poorly recognized and inadequately treated in persons with Parkinson's disease (PD).ObjectiveThe present study aimed to develop and validate a new clinical screening and research outcome measure to identify triggers and manifestations of anxiety specific to PD, the Parkinson's disease Specific Anxiety Inventory (PDSAI).MethodData from PDSAI derived from 172 people with PD across Australia and the United States was used to assess the reliability and validity of the inventory. Construct validity was assessed.ResultsFrequency analyses revealed low rates of missing data across the 40 items. The inventory demonstrated high reliability (Cronbach's a = 0.93, split-half = 0.68) and mid to high concurrent validity between the PDSAI and (i) Hamilton Anxiety Scale (r = 0.51), (ii) Liebowitz Social Anxiety Scale (r = 0.697) and Parkinson's Anxiety Scale (r = 0.747).ConclusionsThe PDSAI is a valid and reliable tool designed to capture PD specific triggers and manifestations of anxiety in people with PD.

Objective There has been a proliferation of psychosocial interventions to prevent suicide over the past several decades with varying levels of benefit. We conducted a comprehensive scoping review to synthesize our knowledge of the effectiveness, strengths, and limitations of these interventions among adults. We focused on important aspects of randomized controlled trials (RCTs), including internal and external validity, outcome measurement, and exclusion criteria. We examined predictors, mediators, and moderators associated with suicide outcomes. Methods A systematic search was conducted for RCTs of psychosocial suicide prevention interventions with adults, following PRISMA-ScR guidelines. Results We identified 141 publications and 131 were unique RCTs. Publications had some concerns with risk of bias (internal validity); publications had moderate or high external validity. A quarter of RCTs excluded older adults (60 years or older) and individuals with psychotic symptoms/features and bipolar disorder/symptoms despite the fact that these groups are at elevated risk for suicide death. Forty-one publications (29.1 % of total publications) examined predictors, mediators, and moderators of suicide outcomes. Sixteen (11.3 % of total publications) publications included predictors, two (1.4 %) included mediators, 11 (7.8 %) included posttreatment mediators, and 16 (11.3 %) included moderators. Participant gender/sex, marital status, and race did not moderate treatment effects. Mixed results may be due to insufficient statistical power to test predictor, mediator, and moderator hypotheses. Conclusion This review highlighted RCT aspects (e.g., exclusion of older adults and individuals with serious mental illness, improving suicide outcome measurement) that may be beneficial to consider in future RCTs. Additional research on predictors, mediators, and moderators is needed.

With recent studies citing that as many as 44 Veterans die by suicide daily, Veteran suicide is a pressing public health concern (America's Warrior Partnership. (2022). Operation deep dive summary of interim report. https://e55c5558-502f-457d-8a07-a49806f5ff14.usrfiles.com/ugd/e55c55_086099607d86 49aa8b5227f106f24865.pdf). Despite this alarming statistic, few evidence-based psychotherapies specifically target suicide prevention. Mindfulness-based cognitive therapy for suicide prevention (MBCT-S) is a nine-week, manualized group intervention that integrates mindfulness-based cognitive therapy (MBCT) with the safety planning intervention to address suicidality. A randomized controlled trial (n = 140) found that MBCT-S significantly reduced suicide attempts, suicidal behaviors, and psychiatric hospitalizations among participating Veterans. To illustrate the application of this intervention and maintain participant anonymity, this paper presents a case composite highlighting the intervention's rationale and the facilitator's role in teaching Veterans the skill of staying present with intensely painful, harmful, and self-alienating experiences without resorting to suicidal behavior. The embodied presence of the MBCT-S facilitator emerges as a critical agent of change, fostering curiosity, compassion, and openness when addressing complex and isolating suicidal thoughts. This presence creates a foundation for connectedness within the group, which is essential for Veterans at risk of suicide. By illustrating these processes, the paper highlights the potential of MBCT-S to transform clinicians' capacity to support individuals in building equanimity and life-saving resilience.

Background Head injuries are a major health care concern that can produce many long lasting cognitive, mental, and physical problems. An emerging literature indicates increased impulsivity in patients with a history of traumatic brain injury (TBI). In a recent study, Veterans with clinically-assessed history of mild TBI had increased cognitive, but not motor, impulsivity. Cognitive impulsivity refers to a preference for smaller immediate rewards (i.e., less willing to wait for larger rewards) while motor impulsivity refers to difficulty inhibiting a motor response. This study extended this work to investigating cognitive and motor impulsivity in a non-clinical sample of putatively healthy undergraduates self-reporting a history of head injury. Methods One hundred and sixteen undergraduates, fifty reporting a history of head injury (HI+) and sixty-six reporting no head injury (HI-), participated in an online study via Qualtrics. They completed a series of demographic questionnaires, the UPPS Impulsive Behavior Scale, a computer-based Go/No-go task to assess motor impulsivity, and a computer-based version of the Monetary Choice Questionnaire (MCQ) to assess cognitive impulsivity. Results HI+ individuals exhibited cognitive impulsivity, measured as a reduced willingness to wait for a larger delayed reward in the MCQ, as compared to HI- individuals. There were no significant differences in performance on the Go/No-go task between the HI+ and HI- groups. Overall, these findings that a self-reported history of head injury in a non-clinical sample are related to cognitive impulsivity, but not motor impulsivity, are consistent with findings from Veterans with clinically-assessed mild TBI. Future work should assess more details on head injuries to further explore how a head injury relates to cognitive impulsivity.

OBJECTIVES:Parkinson's disease (PD) is associated with significant impairments in health-related quality of life (HRQoL). Little is known about the impact of psychotherapy on HRQoL in PD. This study aimed to assess the effects of virtual cognitive-behavioral therapy on HRQoL among veterans with PD, and to identify possible mediators for change. METHODS:Veterans with both PD and primary depressive disorders (n = 90) were recruited nationwide and randomized to PD-informed cognitive-behavioral therapy (CBT) or treatment as usual (TAU). The 10-session telehealth CBT intervention focused on behavioral activation, cognitive restructuring, and stress management, with strategies for problem-solving PD-related challenges highlighted throughout. The TAU group received routine VA care with clinical monitoring by study staff. HRQoL was measured with the SF-36, which included summary scores for physical and mental quality of life, along with eight health domain subscales. Depression (HAM-D), behavioral activation (BADS), and automatic negative thoughts (ATQ) were assessed as mediators of CBT and HRQoL in parallel and parallel-serial mediation models.n. RESULTS:There were significant group-by-time effects for physical (p = 0.007) and mental quality of life (p = 0.04) such that the CBT group improved in both by end-of-treatment, while the control group did not. Depression mediated the relationship between CBT and physical quality of life in both parallel (B = 1.90, 95% CI [0.06, 3.94]) and parallel-serial (B = 1.35, 95% CI [0.01, 3.13]) models. CONCLUSIONS:Cognitive-behavioral therapy holistically improves both the physical and mental challenges that Parkinson's disease places on everyday life. The routine assessment and management of depression in PD is a key component of evidence-based interdisciplinary care.

The 90-day period after a suicide attempt or hospitalization for suicidal behavior is a period of increased risk for psychiatric patients. However, predicting who among patients at suicide risk will engage in suicidal behavior in this window remains an elusive task. Neurocognitive task performance, such as performance on the Death/ Suicide Implicit Association Task (D/S IAT), shows some promise for aiding in the prediction of suicidal behavior beyond risk factors routinely assessed in clinical practice, such as self-reported suicidal ideation. This study considered whether performance on the D/S IAT could prospectively predict suicidal behavior within a 90-day window. Sixty Veterans at high risk for suicide completed the D/S IAT at multiple timepoints over a one-year period. Each testing session was then coded according to whether the participant displayed suicidal behavior within 90 days following that testing session. As a secondary aim, drift diffusion modeling (DDM) was used to estimate latent cognitive processes mediating D/S IAT performance, including decisional efficiency. Two applications of the Generalized Estimating Equations (GEE) method were used to evaluate the incremental utility of (1) D/S IAT performance and (2) DDM-derived latent variables on predicting 90-day suicidal behavior over standard suicide risk factors including suicide attempt history, major depressive or bipolar disorder, and suicidal ideation at the time of testing. Age was also included in the models given the impact of age on reaction times and thus D/S IAT performance. The odds of 90-day suicidal behavior were significantly increased as implicit bias linking the self-concept to the concept of life as opposed to death weakened. The latent cognitive process of reduced decisional efficiency towards categorizing the concept of life relative to death as "like me" predicted 90day suicidal behavior. D/S IAT performance may add to near-term suicidal behavior prediction. Reduced decisional efficiency is emerging as a general cognitive factor implicated in suicidal behavior.

BACKGROUND:The suicide rate for United States military veterans is 1.5× higher than that of non-veterans. To meaningfully advance suicide prevention efforts, research is needed to delineate factors that differentiate veterans with suicide attempt/s, particularly in high-risk groups, e.g., major depressive disorder (MDD), from those with suicidal ideation (no history of attempt/s). The current study aimed to identify clinical, neurocognitive, and neuroimaging variables that differentiate suicide-severity groups in veterans with MDD. METHODS:Sixty-eight veterans with a DSM-5 diagnosis of MDD, including those with no ideation or suicide attempt (N = 21; MDD-SI/SA), ideation-only (N = 17; MDD + SI), and one-or-more suicide attempts (N = 30; MDD + SA; aborted, interrupted, actual attempts), participated in this study. Participants underwent a structured diagnostic interview, neurocognitive assessment, and 3 T-structural/diffusion tensor magnetic-resonance-imaging (MRI). Multinomial logistic regression models were conducted to identify variables that differentiated groups with respect to the severity of suicidal behavior. RESULTS:Relative to veterans with MDD-SI/SA, those with MDD + SA had significantly higher left cingulum fractional anisotropy, decreased attentional control on emotional-Stroop, and faster response time with intact accuracy on Go/No-Go. Relative to MDD + SI, MDD + SA had higher left cingulum fractional anisotropy and faster response time with intact accuracy on Go/No-Go. LIMITATIONS:Findings are based on retrospective, cross-sectional data and cannot identify causal relationships. Also, a healthy control group was not included given the study's focus on differentiating suicide profiles in MDD. CONCLUSIONS:This study suggests that MRI and neurocognition differentiate veterans with MDD along the suicide-risk spectrum and could inform suicide-risk stratification and prevention efforts in veterans and other vulnerable populations.

BackgroundLearning from feedback – adapting behavior based on reinforcing and punishing outcomes – has been implicated in numerous psychiatric disorders, including substance misuse, post-traumatic stress disorder, and depression; an emerging literature suggests it may also play a role in suicidality. This study examined whether a feedback-based learning task with rewarding, punishing and ambiguous outcomes, followed by computational modeling, could improve near-term prospective prediction of suicide attempt in a high-risk sample.MethodVeterans (N=60) at high-risk for suicide were tested on a task of reward- and punishment-based learning, at multiple sessions across a one-year period. Each session was coded according to whether the participant had (1) an actual suicide attempt (ASA); (2) another suicide-related event (OtherSE) such as suicidal behavior or suicidal ideation-related hospital admission (but not an ASA); or (3) neither (noSE) in the next 90 days. Computational modeling was used to estimate latent cognitive variables including learning rates from positive and negative outcomes, and the subjective value of ambiguous feedback.ResultsOptimal responding on the reward-based trials was positively associated with upcoming ASA, and remained predictive even after controlling for other standard clinical variables such as current suicidal ideation severity and prior suicide attempts. Computational modeling revealed that patients with upcoming ASA tended to view ambiguous outcomes as similar to weak punishment, while OtherSE and noSE both tended to view the ambiguous outcome as similar to weak reward. Differences in the reinforcement value of the neutral outcome remained predictive for ASA even after controlling for current suicidal ideation and prior suicide attempts.ConclusionA reinforcement learning task with ambiguous neutral outcomes may provide a useful tool to help predict near-term risk of ASA in at-risk patients. While most individuals interpret ambiguous feedback as mildly reinforcing (a “glass half full” interpretation), those with upcoming ASA tend to view it as mildly punishing (a “glass half empty” interpretation). While the current results are based on a very small sample with relatively few ASA events, and require replication in a larger sample, they provide support for the role of negative biases in feedback-based learning in the cognitive profile of suicide risk.

Traumatic brain injuries (TBI) frequently occur and can lead to lasting negative cognitive, physical, and mental health outcomes. The biological response to even mild TBIs (mTBI) includes well-characterized inflammatory sequelae that start immediately post-injury, remain for weeks, and can develop into long-term systemic inflammation. Studies have shown that TBI influences multiple physiological systems, including the gastrointestinal tract, through bidirectional communication modulated, in part, by the gut microbiome. Brainstem functioning post-TBI, as measured by acoustic startle sensorimotor processing, might play a role in this feedback loop. The current study investigated pre- to post-TBI (lateral fluid percussion injury model) changes in microbial communities and acoustic startle response in male and female rats. That is, the influence of mTBI on gut microbiome and sensorimotor processing was explored to examine: 1) overall and sex-specific differences in the gut microbiome and taxa in response to mTBI; 2) overall and sex-specific differences in sensorimotor processing following mTBI; and 3) associations between the gut microbiome and sensorimotor processing. Results showed mTBI had a limited effect on microbial diversity overall, and the same was observed in males and females independently. Yet, mTBI was associated with differences in 13 genus-level taxa. Further evaluation highlighted that 11 of the 13 genus-level taxa were sex-specific, with several being known to have short-chain fatty acid-producing capabilities. Alterations in sensorimotor processing were identified following mTBI; however, no sex-specific differences were evident. In addition, no associations were observed between sensorimotor processing and the gut microbiome. This study contributes longitudinal and sex-specific findings to the growing body of research examining the diverse effects of mTBI on the brain and gut microbial communities.

Background: Suicide rates among veterans are substantially higher than non-veterans and continue to rise according to the most recent data. However, specific mechanisms underlying suicide risk are poorly understood and understudied in this population. We investigated the role of impulsivity and aggression in the suicide process in veterans. Method: A total of 93 veterans (26 with no history of suicidal ideation or attempt, 38 with a history of suicidal ideation but no attempt, and 29 with a history of suicide attempt) were assessed for impulsivity and aggression traits, depression, and suicide status. Multivariate logistic regressions examined the domains of impulsivity and aggression that were associated with suicidal ideation and attempt. Results: Higher odds of suicidal ideation (vs. no suicidal ideation) were associated with greater hostility, odds ratio (OR)=1.23, 95 % confidence interval (CI)=1.03-1.47, p=.025. Negative urgency (OR [95 % CI]=5.40 [1.18-24.78], p=.030) and physical aggression (OR [95 %CI]=1.27 [1.09-1.49], p=.002) were risk factors for suicide attempt (vs ideation only) while greater verbal aggression (OR [95 % CI]=0.78 [0.63-0.98], p=.035) and positive urgency (OR [95 % CI]=0.017[0.04-0.77], p=.021) were associated with lower odds of suicide attempt. Attempters with higher verbal aggression had less lethal suicide attempts. Depression was associated with suicide attempts only among those with low negative or positive urgency but not in those high in these traits. Conclusion: Results suggest that specific domains of impulsivity and aggression, and their interaction with depression, play a role in the suicide process. These findings offer insight into strategies to enhance suicide detection and targeted intervention efforts.

Traumatic brain injury is associated with increased risk for suicide, but the underlying mechanisms remain poorly understood. One candidate mechanism is impulsivity, which includes both choice impulsivity (e.g., preference for smaller, immediate rewards) and motor impulsivity (inability to inhibit prepotent motor responding). We evaluated these facets of impulsivity in Veterans classified according to their history of mild TBI (mTBI) and/or prior suicide attempt. 99 Veterans were classified as having no mTBI or suicide attempt (control, n=35), mTBI but no suicide attempt (mTBI, n=42), or mTBI and prior attempt (mTBI+SA, n=22). A computerized temporal discounting task (Monetary Choice Questionnaire) assessed choice impulsivity and a Go/No-go task assessed motor impulsivity. On temporal discounting, the control group showed less choice impulsivity than the mTBI group. Temporal discounting was not associated with suicide attempt history. However, among the mTBI+SA group, those with high-lethality suicide attempts showed less choice impulsivity than those with low-lethality attempts. No group differences emerged on the Go/No-go task. The findings are consistent with choice impulsivity as a potential pathway by which mTBI affects risk for suicide. The finding that high-lethality attempts were associated with greater willingness to wait for reward supports the emerging view of heterogeneous underlying pathways to suicide risk, with distinct phenotypes that implicate different therapeutic options.

Introduction: Prior work has implicated several neurocognitive domains, including memory, in patients with a history of prior suicide attempt. The current study evaluated whether a delayed recognition test could enhance prospective prediction of near-term suicide outcomes in a sample of patients at high-risk for suicide. Methods: 132 Veterans at high-risk for suicide completed a computer-based recognition memory test including semantically-related and -unrelated words. Outcomes were coded as actual suicide attempt (ASA), other suiciderelated event (OtherSE) such as aborted/interrupted attempt or preparatory behavior, or neither (noSE), within 90 days after testing. Results: Reduced performance was a significant predictor of upcoming ASA, but not OtherSE, after controlling for standard clinical variables such as current suicidal ideation and history of prior suicide attempt. However, compared to the noSE reference group, the OtherSE group showed a reduction in the expected benefit of semantic relatedness in recognizing familiar words. A computational model, the drift diffusion model (DDM), to explore latent cognitive processes, revealed the OtherSE group had decreased decisional efficiency for semanticallyrelated compared to semantically-unrelated familiar words. Limitations: This study was a secondary analysis of an existing dataset, involving participants in a treatment trial, and requires replication; similar to 10 % of the sample was excluded from analysis due to failure to master the practice tasks and/or apparent noncompliance. Conclusion: Impairments in recognition memory may be associated with near-term risk for suicide attempt, and may provide a tool to improve prediction of when at-risk individuals may be transitioning into a period of heightened risk for suicide attempt.