Externalizing Behaviors/Violence Exposure and Suicide Among U.S. Adolescents

Abstract

IntroductionThis study examines associations between externalizing behaviors/violence exposure and suicidal behavior among US high school students from 1991-2021 MethodsData for this cross-sectional study were drawn from the Youth Risk Behavior Survey and the total sample contained data on 234,588 adolescents. Logistic regression models were used to assess the relationship between externalizing behaviors/violence exposure and suicidal behavior. To assess trends over time, models were then assessed for multiplicative interactions between externalizing behaviors/violence exposure and time by sex. State-level trends were also assessed. All analyses were conducted in 2024 ResultsThe prevalence of externalizing behaviors/violence exposure increased among youth with an injurious suicide attempt. Logistic regression models indicated statistically significant associations across suicidal behaviors with a higher magnitude of association observed among those with an injurious suicide attempt. For instance, compared to those who did not carry a gun, those who carried a gun had 6.32 (95% CI: 4.78, 8.36) times the odds of injurious suicide attempt vs. no attempt and 2.66 (95% CI: 2.00, 3.53) times the odds of non-injurious suicide attempt vs. no attempt. Stronger associations arose among male individuals. Among those with an injurious suicide attempt in 2021, state-level differences in weapon access emerged ConclusionsAdolescents with externalizing behaviors/violence exposure are at an increased risk of an injurious suicide attempt. The relationship varies over time and by sex. Culturally adaptive and structurally competent approaches to mental health and mechanisms to identify at-risk youth are imperative.