(PS11-60) History of Exposure to Violence and Suicide Attempt During 6 Months Following ED Visit for Suicidal Ideation

Exposure to violence (EV) can have both direct and indirect impacts on loss of life. Beyond the direct possibility of death at the hands of another, EV 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 EV is independently associated with risk for SAs. Additionally, prior research has not addressed whether EV is a useful predictor of future SA risk when controlling for past SA. The interpersonal theory of suicide suggests that repeated EV and other painful or provocative experiences 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 EV and suicide risk, we aimed to test whether EV was associated with both history of SAs and prediction of future SAs, even among individuals with SI, or with method selection among those who made a SA. A sample of n=252 adults presenting to an emergency department and n=300 adolescents treated on a psychiatric inpatient unit completed a baseline assessment including SA and EV history. After hospital discharge, participants’ SAs were documented over the following 6 months through a combination of electronic health records data, daily surveys, and interaction with study staff. 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 EV, and 25% (n=76) among adolescents.  Among adults but not adolescents, EV was significantly associated with history of SA (p =.011). EV was also a strong predictor of SA over the 6-month period following hospitalization when controlling for age, gender, and race, (p =.002) but not when also controlling for history of attempt. EV was not associated with method choice among those who made an SA in those 6 months.

Overall, our findings suggest that exposure to violence is associated with both a history of SAs and future SAs, even among individuals with SI, but may not be a useful predictor of future SAs if prior SA history is known. Our findings did not support a unique association with use of more lethal methods. 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 risk of suicide attempt, this may inform risk assessment and targeted intervention for suicide prevention, advancing behavior health and community resilience.