Objective: Role of depression, PTSD, and cognitive effort on combat-related PTSD male veteran's neuropsychological performance Authors: Ryan Holliday, Matthew A. Clem, Elizabeth Anderson, Andrea Zartman, PhD, & Alina Surís, PhD Objective: Neuropsychological assessment within Veteran Affairs Medical Centers remains a high-priority medical service. However, the extant research regarding how comorbid mental health presentations affect neuropsychological scores is limited. In particular, posttraumatic stress disorder (PTSD) and depressive symptomatology tends to be highly comorbid within veteran populations. Moreover, current research indicates that these mental health disorders may result in impaired cognitive performance. Despite this, knowledge is scant regarding the extent to which PTSD and depression symptomatology is explained by an individual's overall cognitive effort. Method: In order to assess this, our study enrolled 57 male veterans (mean age = 43.00 ± 14.98, mean education = 13.84 ± 1.56) with combat-related posttraumatic stress disorder (PTSD). To assess psychiatric symptomatology, veterans were administered the PTSD Checklist to assess PTSD symptom severity and the Quick Inventory of Depressive Symptomatology to assess depression symptom severity. Additionally, the Repeated Battery for the Assessment of Neuropsychological Status (RBANS) to assess for neuropsychological functioning. Additionally, a measure of overall cognitive effort was calculated utilizing a validated algorithm. Results: Eight veterans (14.04%) put forth insufficient cognitive effort in contrast to forty-nine veterans (85.96%) who put forth sufficient cognitive effort. Those with insufficient effort had significantly lower performance on several RBANS indices as well as significantly greater PTSD and depression symptom severity (p < .05). When cognitive effort was controlled for, PTSD symptom severity was significantly predictive of the RBANS language index (p < .05). Moreover, PTSD symptom severity trended towards predicting the RBANS visuospatial/constructional ability index as well as the total RBANS score (p < .10). Conclusion: Cognitive effort and PTSD are tied to several aspects of poorer neuropsychological performance. Caution may be necessary when interpreting neuropsychological performance in the presence of comorbid PTSD and low cognitive effort. Future research should focus on replicating our study within a sample of veterans with comorbid traumatic brain injury in addition to examining aspects of cognitive effort, PTSD, and depression.