(PS9-A22) History of Exposure to Violence and Suicide Attempt Method in an Intensive Longitudinal Study of Suicidal Behaviors

Exposure to violence can have both direct and indirect impacts on loss of life. Beyond the direct possibility of death at the hands of another, exposure to violence has been identified as a risk factor for suicide (e.g., Castellvi et al., 2016; MacIsaac et al., 2016).  Recent research has increasingly highlighted the importance of differentiating those risk factors that are associated with suicidal ideation (SI) versus those that predict suicide attempt (SA) given the presence of SI (e.g., Nock, Kessler, & Franklin, 2016; Nock et al., 2018). It is unclear whether exposure to violence is independently associated with SAs, or specifically with lethality of SA. The interpersonal theory of suicide suggests that repeated exposure to violence and other painful or provocative experiences (PPEs) should be associated with higher risk of lethal and nearly lethal SAs specifically (Joiner, 2005) because it increases acquired capability for suicide. To address these gaps in existing research on exposure to violence and suicide risk, we aimed to test whether exposure to violence was associated with SAs even among individuals with SI, and whether it was associated with likelihood of medical intervention after an SA or with method selection among those who made a SA.

         In the current study, we tested whether exposure to violence was associated with a history of SA, medical intervention after an SA, and method used for most severe SA in a sample of n=252 adults presenting to an emergency department and n=300 adolescents treated on a psychiatric inpatient unit. All participants had SI as a presenting problem for treatment. All analyses included age, gender, and racial identity as covariates.

Nearly 55% of the adults (n=141) and 65% of the adolescents (n=190) reported a history of one or more SAs. Among adults, 67% (n=168) reported a history of exposure to violence, and 25% (n=76) among adolescents.  Among adults but not adolescents, exposure to violence was significantly associated with history of SA (β =.70, p =.011), and likelihood of needing medical treatment following an SA (β =1.53, p = .001). Older age (β = 1.44, p = .002) was associated with higher likelihood of exposure to violence, while identifying as a woman (β = -1.01, p = .029) was associated with less likelihood, also only among adults. Exposure to violence was not associated with method choice among those who made an SA in either population. Future work will use participants’ electronic health records to study detailed descriptions of additional SAs.

         Overall, our findings suggest that exposure to violence is associated with SAs even among individuals with SI, and among SAs, is associated with more lethal SAs that require medical intervention. Across many of the nation’s largest cities, violence has been on the rise over the past decade, including an overall convergence of community violence, police violence and contact with the criminal system (Sharkey & Marsteller, 2022). If we can better understand the association between exposure to violence and suicide risk, this may inform risk assessment and targeted intervention for suicide prevention.