Erin McGlade ^1,2,3* James R Yancey ^1,2,3 Keenan E Roberts ^1,2,3 Audrey Elias ^1,2 Chelsea Carson ^1,2,3 Jiyoung Ma ^1,2 Margaret R Legarreta ^3,4 Deborah Yurgelun-Todd ^1,2,3

• ¹ Diagnostic Neuroimaging Lab, University of Utah, Salt Lake City, United States
• ² Department of Psychiatry, Huntsman Mental Health Institute, Salt Lake City, United States
• ³ Rocky Mountain MIRECC, Department of Veterans Affairs, Salt Lake City, United States
• ⁴ Sheridan VA Health Care System, Sheridan, United States

Attention has emerged as a possible predictor of suicide behavior (SB), yet associated neural correlates remain understudied, particularly in Veterans. The current study examines sustained and selective attention and anterior cingulate cortex (ACC) volume as they relate to SB in Veterans. Veterans completed clinical interviews, questionnaires, and the Ruff 2&7 Selective Attention Test. A subset of these Veterans also completed a structural magnetic resonance imaging (MRI) protocol on a 3T magnet. Participants were grouped on history of suicidal ideation (SI), suicide attempt (SA), and no SB (HC). Veterans with a history of SA performed more slowly on Ruff 2 & 7 Automatic Detection Speed (ADS) and Controlled Search Speed (CSS) compared to Veterans with SI and HC. SI and SA group differences on ADS and CSS remained after Bonferroni correction, and CSS differences remained after controlling for depressive/anxious symptoms. There were no between-group differences on Ruff 2 & 7 Accuracy measures. When analyses were divided by sex, males with a history of SA performed more slowly than SI and HC on ADS. Males with a history of SA also performed more slowly on CSS and Total Speed than males with a history of SI. Males with a history of SA performed more slowly on ADS, CSS, and Total Speed compared to males with a history of SI after including depressive/anxious symptoms and Bonferroni corrections. Female Veterans with a history of SA performed more slowly than female HC on CSS; however, these findings were not significant after controlling for depressive/anxious symptoms. No significant differences were found for females with SI, SA, and HC on ADS or Total Speed. Left rostral ACC gray matter (GM) volume for the female and male Veteran sample was positively correlated with ADS and CSS scores in HC but not SA. Right rostral ACC GM volume negatively correlated with ADS and CSS scores in the SA group but not HC. These findings highlight associations between attention speed, ACC volume, and SB after controlling for acute mood symptoms, and emphasize the importance of examining SI and SA as distinct groups, in addition to including sex in analyses.