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Rocky Mountain MIRECC for VA Suicide Prevention - Erin C. McGlade PhD

Rocky Mountain MIRECC for Veteran Suicide Prevention

Updated: 5 February 2018


Erin C. McGladeErin C. McGlade, PhD
Co-director of the VA Advanced Fellowship Program in Mental Illness in the Salt Lake City MIRECC
MIRECC Investigator
Dr. Erin McGlade received her PhD in Clinical Psychology from Idaho State University and completed a pre-doctoral internship and a post-doctoral residency at the University of Utah Neuropsychiatric Institute. Her clinical training was with adolescents and adults diagnosed with serious psychiatric disorders and suicidal ideation, areas of clinical interest she has carried forward in her work at the VA.
Dr. McGlade is a licensed clinical psychologist and a MIRECC investigator. She is interested in studying neural mechanisms of symptoms in co-morbid disorders, particularly the relationship between depressive symptoms and co-morbid PTSD and TBI. Her current studies focus on veterans with suicide risk with and without a history of depression. Dr. McGlade is Co-Director of the Advanced Fellowship in Mental Illness Research and Treatment at the Salt Lake City MIRECC and has been instrumental in developing curriculum for the new fellowship program.

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Recent Publications

Legarreta M, Bueler E, DiMuzio J, McGlade E, Yurgelun-Todd D. Suicide Behavior and Chronic Pain: An Exploration of Pain-Related Catastrophic Thinking, Disability, and Descriptions of the Pain Experience. J Nerv Ment Dis. 2018 Feb 2. doi: 10.1097/NMD.0000000000000799. [Epub ahead of print] PubMed PMID: 29394193
This study examined differences in suicidal ideation (SI) and suicide attempts (SAs) among veterans with chronic pain. Pain-specific variables, including catastrophic thinking, disability, and sensory, affective, and evaluative pain descriptors, were a focus. Structured diagnostic and clinical interviews were conducted to examine SI/SA and mental health. Veterans completed the Structured Clinical Interview for DSM-IV and the Columbia-Suicide Severity Rating Scale to assess Axis I symptoms and suicidal behavior(s). Self-report questionnaires were used to evaluate the participants' subjective experience of chronic pain, which included the McGill Pain Questionnaire, Pain Catastrophizing Scale, and Pain Disability Index. The findings add to previous literature by suggesting pain-related catastrophic thinking specifically is related to elevated risk for SA, whereas affective and sensory pain are associated with SI. The study results support the need to assess pain from a multifaceted perspective and to examine the different experiences of pain, such as sensory and affective constructs, when discussing suicide risk in veterans.
McGlade E, Rogowska J, Yurgelun-Todd D. (2015). Sex differences in orbitofrontal connectivity in male and female veterans with TBI. Brain Imaging Behav. 9(3):535-49.
More female soldiers are now serving in combat theaters than at any other time. However, little is known about possible sex differences underlying the neuropathology and manifestation of one of modern war's signature injuries, traumatic brain injury (TBI). The paucity of information regarding sex differences in TBI is particularly evident when examining changes in executive function and emotion regulation associated with post concussive events. The current study objective was to observe whether patterns of orbitofrontal (OFC) functional connectivity would differ between female veterans with TBI and their male counterparts. The study further sought to determine whether OFC connectivity might be differentially associated with clinical measures of aggression and hostility. Seventeen female veterans and 24 male veterans, age 18 to 25, who met criteria for TBI completed resting state magnetic resonance imaging (MRI) and clinical assessment measures. Imaging data were analyzed using left and right seed regions of the OFC, and regression analyses were conducted to observe the relationship between resting state connectivity and self-reported aggression. Females and males in this study differed in OFC connectivity, with females demonstrating greater connectivity between left and right OFC and parietal and occipital regions and males demonstrating greater connectivity between left and right OFC and frontal and temporal regions. Significant associations between resting state connectivity and clinical measures were found only in male veterans. These findings suggest that TBI may interact with sex-specific patterns of brain connectivity in male and female veterans and exert divergent effects on clinical profiles of aggression post-injury.
Keywords: aggression, functional connectivity, orbitofrontal, traumatic brain injury
Graham J, Legarreta M, North L, DiMuzio J, McGlade E, Yurgelun-Todd D. (2016). A Preliminary Study of DSM-5 PTSD symptom Patterns in Veterans by Trauma Type. Mil Psychol, 28(2),115-122.
Posttraumatic stress disorder (PTSD) has a primary etiology in experiencing psychological trauma and the subsequent psychological sequelae (American Psychiatric Association, 2013). There are multiple trauma types that may serve as the index trauma in PTSD. This exploratory study compared DSM–5 PTSD symptoms for 3 types of trauma in veterans: combat trauma (n 36), sexual trauma (n 21), and civilian trauma (n 21). Results indicated that veterans with combat trauma were likely to experience diminished interest and detachment and estrangement from others. Veterans with sexual trauma were likely to experience detachment and estrangement from others, sleep disturbances, and problems with concentration. Veterans with civilian traumas were less likely to meet criteria for PTSD and were less likely to experience a number of PTSD symptoms. Results of this preliminary study suggest that PTSD is not a unitary disorder, but a disorder characterized by different subtypes based on the precipitating trauma.
Keywords: PTSD, veterans, trauma type, symptom profile, DSM–5
Epstein DJ, Legarreta M, Bueler E, King J, McGlade E, Yurgelun-Todd D (2016). Orbitofrontal cortical thinning and aggression in mild traumatic brain injury patients. Brain Behav, 6(12): e00581
INTRODUCTION: Although mild traumatic brain injury (mTBI) comprises 80% of all TBI, the morphological examination of the orbitofrontal cortex (OFC) in relation to clinical symptoms such as aggression, anxiety and depression in a strictly mTBI sample has never before been performed. OBJECTIVES: The primary objective of the study was to determine if mTBI patients would show morphological differences in the OFC and if the morphology of this region would relate to clinical symptoms. METHODS: Using structural images acquired in a 3T MRI machine, the cortical thickness and cortical volume (corrected for total brain volume) of the OFC was collected for healthy control (N = 27) subjects and chronic mTBI (N = 55) patients at least one year post injury. Also, during clinical interviews, measures quantifying the severity of clinical symptoms, including aggression, anxiety, and depression, were collected. RESULTS: MTBI subjects displayed increased aggression, anxiety, and depression, and anxiety and depression measures showed a relationship with the number of mTBI in which the subject lost consciousness. The cortical thickness of the right lateral OFC displayed evidence of thinning in the mTBI group; however, after correction for multiple comparisons, this difference was no longer significant. Clinical measures were not significantly related with OFC morphometry. CONCLUSION: This study found increased aggression, anxiety, and depression, in the mTBI group as well as evidence of cortical thinning in the right lateral OFC. The association between clinical symptoms and the number of mTBI with loss of consciousness suggests the number and severity of mTBI may influence clinical symptoms long after injury. Future studies examining other brain regions involved in the production and regulation of affective processes and inclusion of subjects with well-characterized mood disorders could further elucidate the relationship between mTBI, brain morphology, and clinical symptoms.
Keywords: aggression; mild traumatic brain injury; morphometry; orbitofrontal cortex
McGlade E, Bakian A, Coon H, Yurgelun-Todd D, Callor WB, Byrd J, Gray D. Male suspected suicide decedents in Utah: A comparison of Veterans and nonveterans. Compr Psychiatry. 2016 Aug;69:1-10. doi: 10.1016/j.comppsych.2016.04.014. Epub 2016 Apr 28.
There has been significant debate regarding suicide risk in Veterans compared to nonveterans. However, few studies have examined similarities and differences between Veteran and nonveteran suicide decedents using a combination of next of kin psychological autopsy and data from a state Office of the Medical Examiner (OME). For the current study, next of kin of a one-year cohort of male suspected suicide decedents in Utah completed psychological autopsy interviews with trained research staff. Next of kin of 70 Veterans and 356 nonveterans completed the interviews, which included demographic, behavioral, psychosocial, and clinical variables. The psychological autopsy data then were combined with OME data for the presented analyses. Results showed that Veteran and nonveteran suicide decedents differed on multiple factors, including age at death. Specifically, male nonveteran suicide decedents were younger at age of death compared to Utah Veterans and to a national sample. Veteran decedents also were more likely to have a history of suicide attempts and more likely to have access to firearms compared to nonveterans. Other between-group differences, including Veterans being more likely to have lived alone and method of death (e.g., gunshot, hanging, etc.), were no longer statistically significant after adjustment for age at death. CONCLUSIONS: these findings have significant clinical and practical importance, as they highlight the risk for suicide in younger nonveterans and older Veterans in Utah.
Keywords: Suicide Prevention
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Lopez-Larson, M. P., Bogorodzki, P., Rogowska, J., McGlade, E., King, J. B., Terry, J., & Yurgelun-Todd, D. (2011). Altered prefrontal and insular cortical thickness in adolescent marijuana users. Behavioral Brain Research, 220(1), 164-172.
INTRODUCTION: There are limited data regarding the impact of marijuana (MJ) on cortical development during adolescence. Adolescence is a period of substantial brain maturation and cortical thickness abnormalities may be indicative of disruptions of normal cortical development. This investigation applied cortical-surface based techniques to compare cortical thickness measures in MJ using adolescents compared to non-using controls. METHODS: Eighteen adolescents with heavy MJ use and 18 non-using controls similar in age received MRI scans using a 3T Siemens scanner. Cortical reconstruction and volumetric segmentation was performed with FreeSurfer. Group differences in cortical thickness were assessed using statistical difference maps covarying for age and gender. RESULTS: Compared to non-users, MJ users had decreased cortical thickness in right caudal middle frontal, bilateral insula and bilateral superior frontal cortices. Marijuana users had increased cortical thickness in the bilateral lingual, right superior temporal, right inferior parietal and left paracentral regions. In the MJ users, negative correlations were found between frontal and lingual regions for urinary cannabinoid levels and between age of onset of use and the right superior frontal gyrus. CONCLUSION: This is one of the first studies to evaluate cortical thickness in a group of adolescents with heavy MJ use compared to non-users. Our findings are consistent with prior studies that documented abnormalities in prefrontal and insular regions. Our results suggest that age of regular use may be associated with altered prefrontal cortical gray matter development in adolescents. Furthermore, reduced insular cortical thickness may be a biological marker for increased risk of substance dependence.
Keywords: Brain & Biology, Substance Use Disorders (SUD)
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Yurgelun-Todd, D.A., Bueler, C. E., McGlade, E., Churchwell, J., Brenner, L.A., & Lopez-Larson, M. (2011). Neuroimaging correlates of traumatic brain injury and suicidal behavior. Journal of Head Trauma Rehabilitation, 26(4), 276-289.
INTRODUCTION: There is an urgent need to define the neurobiological and cognitive underpinnings of suicidal ideation and behavior in veterans with traumatic brain injury (TBI). Separate studies implicate frontal white matter systems in the pathophysiology of TBI, suicidality, and impulsivity. We examined the relationship between the integrity of major frontal white matter (WM) systems on measures of impulsivity and suicidality in veterans with TBI. METHODS: Fifteen male veterans with TBI and 17 matched healthy controls (HC) received clinical ratings, measures of impulsivity and MRI scans on a 3T magnet. Diffusion tensor imaging (DTI) data for the genu and cingulum were analyzed using Freesurfer and FSL. Correlations were performed for fractional anisotropy (FA) (DTI) values and measures of suicidality and impulsivity for veterans with TBI. RESULTS: Significantly decreased in FA values in the left cingulum (P = 0.02), and left (P = 0.02) and total genu (P = 0.01) were observed in the TBI group relative to controls. Measures of impulsivity were significantly greater for the TBI group and total and right cingulum FA positively correlated with current suicidal ideation and measures of impulsivity (P <0.03). CONCLUSION: These data demonstrate a significant reduction in FA in frontal WM tracts in veterans with mild TBI that was associated with both impulsivity and suicidality. These findings may reflect a neurobiological vulnerability to suicidal risk related to white matter microstructure.
Keywords: Brain & Biology, Suicide Prevention, Traumatic Brain Injury (TBI)
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