Self-directed Violence Research Articles

Associations of military sexual harassment and assault with nonsuicidal self-injury: Examining gender and sexual orientation as moderators

Military sexual harassment (MSH) and assault (MSA) are prevalent among service members and are linked to negative psychosocial outcomes, including self-directed violence. Veterans identifying as women or as sexual or gender minorities are at heightened risk for both MSH/MSA and self-directed violence, but their relationship remains understudied in these populations. We examined associations of MSH and MSA with nonsuicidal self-injury (NSSI) and tested whether relations varied by self-identified gender or sexual orientation in two national samples of U.S. veterans. Sample 1 included post-9/11 veterans who had recently discharged from service (n = 1,494); sample 2 included veterans from any service era (n = 1,187). Veterans self-reported MSH, MSA, gender identity and sexual orientation, and lifetime and past-month histories of NSSI. We estimated logistic regressions to examine the associations of MSH and MSA history with NSSI and evaluated gender (man or woman) and sexual orientation as moderators of these relations. Results suggested significant associations of both MSH and MSA with NSSI but largely failed to support moderation of these associations by either gender or sexual orientation identity. Screening for both MSH and MSA in veterans across gender and sexual orientation identities appears indicated in clinical assessment of NSSI.

An Examination of Hate-Motivated Behavior Among Adults in Scotland and Associations with Risk Factors for Self-Directed Violence

An Examination of Hate-Motivated Behavior Among Adults in Scotland and Associations with Risk Factors for Self-Directed Violence

Development and implementation of a self-directed violence prevention training program for correctional behavioral health providers: a clinical trial study protocol

BackgroundSelf-directed violence (SDV) comprises both suicide and self-injury and represents a pressing problem among incarcerated persons. Negative impacts of SDV in correctional settings also extend to behavioral health clinicians (BHCs) (e.g., job turnover). Correctional SDV risk assessment and management standards include staff training as part of the comprehensive approach. The Core Competency Model for Corrections (CCM-C) is a novel, evidence-informed training program for BHCs covering both clinician self-management and clinical care skills.MethodsThis pilot trial is a type 3 hybrid implementation–effectiveness approach. It will employ a wait-list control sequential cross-over design. Participants (N = 50–100) will be BHCs employed by the North Carolina Department of Adult Corrections. Following stratification for years of clinical experience, BHCs will be randomly assigned to (1) a training group that receives CCM-C immediately and (2) a wait-list control receiving CCM-C approximately 6 weeks later. Electronically administrated survey evaluation will occur across baseline and two follow-up (i.e., 2 weeks after each training session) time points.DiscussionThe primary outcome is feasibility assessed through collaboration with a Corrections Advisory Panel and feedback from BHCs. Secondary effectiveness outcomes that will be evaluated over time include SDV-related knowledge, attitudes, stigma, and intent to use training content. We will examine a tertiary outcome, namely compassion fatigue. Clinical trial limitations and impacts are discussed.Trial registrationClinicaltrials.gov, NCT06359574. This study was registered on 04/05/2024.

Youth Perceptions of Juvenile Justice Facility Staff: Associations With Self-Directed Violence Among Juvenile Detainees

Youth in juvenile justice facilities are at high risk of self-directed violence (SDV; suicide attempts and self-harm). Research shows that positive youth perceptions of adults are preventive against SDV among community youth, yet it is unknown whether this extends to detained youth. Using a large national dataset, the present study examines whether, at the facility level, youth perceptions of staff are associated with rates of youth SDV over time. Results from a multilevel mixed-effects negative binomial model suggest that after accounting for various juvenile facility characteristics and practices, youth perceptions of staff are marginally associated with decreased rates of SDV over time. The results from the present study hold implications for research, policy, and practice. Importantly, the results imply a need for facility-wide and evidence-based staff training on SDV among detained youth that emphasizes building positive interpersonal relationships between staff and youth.

Digital Catharsis or Harmful Exposure? A Thematic Analysis of Self-Directed Violence Reddit Posts

Digital Catharsis or Harmful Exposure? A Thematic Analysis of Self-Directed Violence Reddit Posts

A Scoping Review: Associations Between Drugs of Abuse and Toxoplasma Gondii Infection

Toxoplasma gondii (T. gondii) is one of the most common parasites that infect humans. The parasite exists in approximately 40 million people in the United States. Latent infections are frequently associated with tissue cysts of T. gondii in the skeletal muscle and brain tissue that can lead to mental disorders, congenital disorders, and vision dysfunction. Furthermore, self-directed violence, impulsivity, and aggression are associated with T. gondii infection. Dopamine is associated with human behaviors including pleasure, aggression, memory, and substance use disorder; however, the studies on the association of T. gondii infection and drugs of abuse are not well understood. The frequency of substance use may be associated with substance-induced modification of dopamine-receptor densities and basal dopaminergic activity. Likewise, T. gondii can directly or indirectly influence dopaminergic activity in infected cells. The current scoping review aimed to review peer-reviewed literature and identify gaps to evaluate the association between drugs of abuse and T. gondii infection. Articles for review were included if published between the 1st of January 1970 and to the 30th of December 2022. Different key words and phrases were adopted: “T. gondii infection”, “Toxoplasmosis”, “T. gondii and drug use”, “T. gondii infection and dopamine”, “T. gondii infection and drugs of abuse”, “drugs of abuse”, “T. gondii infection and alcohol”, “SUD”, “Toxoplasmosis and SUD” and “Substance abuse and inflammation”. Articles that did not match and/or were published outside of history range were excluded. Databases utilized to generate results included PubMed, Web of Science, and Scopus. One hundred and nine articles or resources were generated and deemed appropriate for reference in this review. Results indicate that individuals infected with T. gondii display increased risky behavior, such as excessive alcohol consumption. T. gondii seropositive subjects had a reduced likelihood of self-reported substance use compared to T. gondii seronegative subjects which confirms that SUD is a potential risk factor for behavioral and psychiatric complications associated with T. gondii infection. Therefore, it is necessary to conduct further research characterizing the mechanisms associated with dopamine metabolism of drug dependence and withdrawal in the context of a T. gondii infection, evaluating the role of inflammation, and identifying potential drug-and-sex specific underpinnings of these associations

Latent profiles and psychosocial correlates of persistent self-injury among incarcerated adults

Self-directed violence (SDV), including both suicide and non-suicidal self-injury, represents a major challenge for carceral systems. Persistent self-injury (PSI) is an understudied SDV subtype, especially within the carceral context. The present study addressed three research questions: (a) do naturally occurring SDV subgroups occur within a carceral population (e.g., PSI versus other classes); (b) how SDV groups may be differentiated by verbal or behavioral SDV; and (c) whether demographic, mental health, and incarceration-related factors are associated with SDV subgroups. We conducted a secondary analysis of existing data from a statewide carceral electronic medical record (N = 3527). Latent class analysis supports two SDV subtypes: episodic and persistent self-injury. The PSI class was characterized by significantly greater verbal expressions and behavioral acts of SDV compared to the episodic group. Correlates of the PSI subtype included older age, male sex, prior SDV, and lower depressive symptoms. Findings are discussed with respect to the proposed Diagnostic and Statistical Manual self-injury focused disorder, influential factors on SDV in carceral settings, and recommendations for future research and practice.

A systematic review of lethal means safety counseling interventions: impacts on safety behaviors and self-directed violence.

For lethal means safety counseling (LMSC) interventions to reduce population-level suicide rates, interventions must be deployed across many settings and populations. We conducted a systematic search in 6 databases to review the current state of LMSC interventions across study designs, settings, intervention providers, populations, and injury prevention levels (eg, universal). Eligibility criteria were as follows: any individual or group receiving an LMSC intervention involving a human-to-human component aiming to influence adult behaviors related to lethal suicide methods, and outcome assessment of storage behaviors and/or suicidal self-directed violence (SDV). Risk of bias was assessed using the Effective Public Health Practice Project quality assessment tool. A descriptive synthesis approach was used for analysis. Twenty-two studies were included that reported medication- and/or firearm-storage behaviors and/or SDV after LMSC. Of the 19 studies assessing behavioral change, 14 reported a significant improvement in safe storage behaviors, and all studies measuring acceptability reported that participants found the interventions favorable. The quality of evidence was limited. No studies were rated low risk of bias, and 77% were rated high risk of bias. There was substantial heterogeneity in the settings, populations, injury prevention levels, delivery methods, and intervention elements. Many included studies focused on caregivers of pediatric populations, and few studies assessed SDV outcomes. Higher-quality trials conducted across a variety of settings, particularly those focusing on adults at risk of suicide, are needed. This review was preregistered with the International Prospective Register of Systematic Reviews (no. CRD42021230668).

A latent class analysis of non-suicidal self-injury and associations with constructs from the interpersonal theory of suicide in a sample of sexual minority young adults

Introduction: Self-directed violence (SDV), comprising both non-suicidal self-injury (NSSI) and suicide, is elevated among sexual minority populations. NSSI age of onset has been shown to impact severity of SDV outcomes. Components of the Interpersonal Theory of Suicide (ITS), which includes perceived burdensomeness (PB), thwarted belongingness (TB), and acquired capability for suicide (ACS), may be useful to understanding NSSI subgroups, especially among under-researched groups such as sexual minority persons. Methods: This study examined subtypes of NSSI and associations with constructs from the ITS. A sample of 473 sexual minority young adults with a history of NSSI completed self-report measures assessing demographics, SDV, and ITS constructs. More than half of the sample (59.7%) reported engaging in NSSI during their lifetime. For suicidal thoughts and behaviors, a majority of the sample reported having thoughts of suicide in their lifetime (87.3%), and one-third reported a lifetime suicide attempt (33.0%). Results: Latent class analysis revealed three classes: (1) lower NSSI, (2) moderate NSSI, and (3) higher NSSI. NSSI age of onset, intensity of suicidal thoughts, suicide plan likelihood, duration of NSSI, and number of NSSI methods differentiated groups. Multivariate Analysis of Variance (MANOVA) revealed that the lower NSSI group reported lower PB and TB than the moderate NSSI group. No differences were found for ACS across NSSI classes. Discussion: Results are discussed in terms of their theoretical implications and application for counseling at-risk sexual minority young adults. This study identifies factors associated with subgroups of self-directed violence among sexual minority young adults. Such findings inform gaps in self-directed violence prevention research and clinical practice for sexual minority persons.

ViolHelp: results of a pilot study to identify potential warning signs and risk factors for self- and hetero-directed violence in the calls received by the Helplines of the Italian National Institute of Health.

Self- and hetero-directed violence (SHDV) is a serious public health problem and a complex phenomenon, influenced by individual and environmental factors. SHDV may occur particularly in moments of personal, economic and/or social crisis. During the COVID-19 pandemic, the ISS-Helplines operators have perceived an increase in psychological distress and self-isolation among callers. The ViolHelp project aimed at identifying potential warning signs and risk factors of SHDV emerging in the activity of the ISS-Helplines (Istituto Superiore di Sanità, ISS, Italian National Institute of Health). A dashboard collecting warning signs and risk factors of SHDV was developed to be used during the ISS-Helplines activity. In one year of data collection, 135 calls were compiled. In 106 calls, callers referred experienced violence: 72 self-directed violence (SDV), 20 hetero-directed violence (HDV), 14 both. The most frequent warning signs and risk factors for SDV were desire to die (68.6%), previous suicide attempts (31.4%) and threat of self-harm (25.6%); for HDV were depressed mood (32.4%), diagnosis of pathology and/or psychiatric disorders, desire to die, use of psychotropic drugs, and alcohol abuse (29.4%). The results of this pilot project show the importance of being able to read the warning signs and to create a network that can improve information, prevention and support activities for people at risk of violence and their families.

A Qualitative Analysis of Perspectives on Self-directed Violence in a Prospective Longitudinal Study of Young Women With and Without Childhood ADHD

Objective: Non-suicidal self-directed violence (NSSDV) is a significant and growing youth public health crisis. Girls with ADHD are at increased risk of engaging in NSSDV, yet qualitative studies with this population—to better understand manifestations, motivations, and developmental course—are lacking. Method: We conducted semi-structured, qualitative interviews with a sub-sample of 57 young women (32 with childhood ADHD, 25 neurotypical comparisons; mean age of 27 years, part of a larger prospective longitudinal study) regarding histories and manifestations of NSSDV. Results: Inductive and deductive analysis revealed several key themes, including self-perceived reasons for engaging in NSSDV (affect regulation, attention seeking, self-punishment, asserting control), impulsivity, secretiveness, and in some cases motivations for desistance. Conclusion: Findings underscore the importance of early education and screening, especially among high-risk clinical populations. Increased resources and supports for professionals, parents, and peers are indicated, along with countering the persistent stigma associated with ADHD and NSSDV.

Patterns of firearm related injury in the elderly: A single institution analysis

BackgroundFirearm-related violence (FRV) is a public health crisis in the United States that impacts individuals across the lifespan. This study sought to investigate patterns of injury and outcomes of firearm-related injury (FRI) in elderly victims and the impact of social determinants of health on this age demographic. MethodsA retrospective review of the trauma registry at a large Level I center was performed from 2016–2021. Patients over age 18 were included and FRI was defined by ICD 9 and 10 codes. Comparisons were then made between elderly (age > 65 years) and non-elderly (age 18–64 years) victims. The primary outcome was mortality. Secondary outcomes included hospital and intensive care unit length of stay, in-hospital complications and the impact of distressed community index (DCI) and insurance status on discharge disposition. Results23,975 patients were admitted for traumatic injury and 4,133 (6 %) were elderly. Of these, 134 had penetrating injuries and 72 (54 %) were FRI. The elderly patients had a median age of 69y and they were predominantly black (50 %) males (85%). Over 75 % had some form of government insurance compared to less than 20% in non-elderly (p<0.001). 33 % of elderly FRIs were self-inflicted compared to only 4 % in the non-elderly cohort and their overall mortality rate was 25 % versus 15 % in non-elderly with FRI (p = 0.038). The median DCI for the non-elderly victims was 72.3 [IQR 53.7–93.1] compared to 63.7 [IQR 33.2–83.6] in the elderly (p < 0.001), however, over 50 % of elderly victims were living in “at risk” or “distressed” communities. ConclusionFRV is a public health crisis across the lifespan and elderly individuals represent a vulnerable subset of patients with unique needs and public health considerations. While many interventions target youth and young adults, it is imperative to not overlook the elderly in injury prevention efforts, particularly self-directed violence. Additionally, given most elderly victims were on government funded insurance and had a higher likelihood of requiring more costly discharge dispositions, new policies should take into consideration the potential financial burden of FRV in the elderly.

Risk of Suicide-Related Outcomes After SARS-COV-2 Infection: Results from a Nationwide Observational Matched Cohort of US Veterans.

Negative mental health-related effects of SARS-COV-2 infection are increasingly evident. However, the impact on suicide-related outcomes is poorly understood, especially among populations at elevated risk. To determine risk of suicide attempts and other self-directed violence (SDV) after SARS-COV-2 infection in a high-risk population. We employed an observational design supported by comprehensive electronic health records from the Veterans Health Administration (VHA) to examine the association of SARS-COV-2 infection with suicide attempts and other SDV within one year of infection. Veterans with SARS-COV-2 infections were matched 1:5 with non-infected comparators each month. Three periods after index were evaluated: days 1-30, days 31-365, and days 1-365. VHA patients infected with SARS-COV-2 between March 1, 2020 and March 31, 2021 and matched non-infected Veteran comparators. Suicide attempt and other SDV events for the COVID-19 and non-infected comparator groups were analyzed using incidence rates per 100,000 person years and hazard ratios from Cox regressions modeling time from matched index date to first event. Subgroups were also examined. 198,938 veterans with SARS-COV-2 (COVID-19 group) and 992,036 comparators were included. Unadjusted one-year incidence per 100,000 for suicide attempt and other SDV was higher among the COVID-19 group: 355 vs 250 and 327 vs 235, respectively. The COVID-19 group had higher risk than comparators for suicide attempts: days 1-30 hazard ratio (HR) = 2.54 (CI:2.05, 3.15), days 31-365 HR = 1.30 (CI:1.19, 1.43) and days 1-365 HR = 1.41 (CI:1.30, 1.54), and for other SDV: days 1-30 HR = 1.94 (CI:1.51, 2.49), days 31-365 HR = 1.32 (CI:1.20, 1.45) and days 1-365 HR = 1.38 (CI:1.26, 1.51). COVID-19 patients had higher risks of both suicide attempts and other forms of SDV compared to uninfected comparators, which persisted for at least one year after infection. Results support suicide risk screening of those infected with SARS-COV-2 to identify opportunities to prevent self-harm.

Pressure, bullying and low social support predict depressive symptoms and self-directed violence

Abstract Background More in-depth evidence about the complex relationships between risk and protective factors and mental health among adolescents has been warranted. Thus, the aim of the study was to examine the direct and indirect effects of experiencing pressure, bullying, and low social support on depressive symptoms and self-directed violence in adolescence. Methods A cross-sectional study was conducted in 2022 among 15 823 Norwegian adolescents, aged 13-19 years. Structural Equation Modelling was used to assess the relationships between socioeconomic status, pressure, bullying, social support, depressive symptoms, self-harm and suicide thoughts. Results Poor family economy and low parental education predicted high pressure, bullying, low parental support and depressive symptoms in males and females. Further, high pressure predicted depressive symptoms among males and females, and self-harm and suicide thoughts among females, but not males. Bullying predicted depressive symptoms, self-harm, and suicide thoughts among males and females. Low parental support predicted bullying, depressive symptoms, self-harm and suicide thoughts among males and females, and high pressure among females, but not males. Low teacher support predicted high pressure, depressive symptoms, whereas low friends support predicted bullying, depressive symptoms and suicide thoughts among males and females, and self-harm among males, but not females. Results also showed that depressive symptoms predicted self-harm and suicide thoughts among males and females. Finally, pressure, bullying and depressive symptoms were the main mediators by which family economy, parental education, friends support, teacher support and parental support predicted self-harm and suicide thoughts. Conclusions Low socioeconomic status, pressure, bullying and low social support were important predictors of depressive symptoms and self-directed violence among Norwegian adolescents through direct and indirect mechanisms. Key messages • These results also provide increased knowledge about how multiple risk and protective factors across domains impact both depressive symptoms, self-harm and suicide thoughts among adolescents. • This study highlights the importance of policies aiming at reducing economic and social inequalities, as they may also improve youth mental health.

Trajectories to Suicide Following Intimate Partner Violence Victimization: Using Structural Equation Modelling to Examine Suicide and PTSD in Female Emergency Department Users

Abstract Purpose Intimate partner violence (IPV) is known to increase the risk of suicidal thoughts and behaviors. Despite the urgent need to increase women’s safety and wellbeing, trajectories to suicide are not well understood and few studies have tested potentially important mediators, such as post-traumatic stress disorder (PTSD), that could help to improve risk stratification and clinical responses. Methods This study used baseline data from a prospective cohort study (2019–2020) to examine differential effects of psychological, physical, sexual, and multiple IPV on suicidal ideation and suicide attempt and test whether pathways are mediated by PTSD. Simple random sampling – online/in-person in Australian emergency departments (EDs) – was used to survey consenting women with a recent suicide-related ED presentation. Structural equation modelling was used to test the pathways between recent and lifetime IPV, PTSD, and suicidal ideation and attempt. Results Of the 1,715 women (M = 30.24, SD = 11.91 years) who participated, 1,012 (59%) reported lifetime IPV exposure, with 608 (35%) reporting recent victimization (&lt; 18 months). Presence of PTSD wholly mediated the effects of psychological, physical, and sexual IPV on ideation (p &lt; .05). Multiple IPV was unique in its direct effects on ideation and attempt and these pathways were most consistent for recent IPV, compared with lifetime exposure (p &lt; .05). Conclusions Pathway analysis identified two high-risk patient-populations: Women with recent multiple IPV and those with a diagnosis of PTSD following lifetime IPV exposure. Findings can be used to improve risk prediction and clinical intervention for patients living with mortality risk from partner- and self-directed violence.

Firearm Safety &amp; Mental Health: A Call to ARMS (Assess and Reduce Means to Suicide)

Firearm violence is a significant public health problem. Public opinion data suggests that most Americans support evidence-based policies that can help reduce firearm violence. Even without national policy changes, nurses can refocus the conversation and make a lasting impact by acting now. Suicide is the leading cause of firearm-related deaths. Unsafe firearm storage is associated with a higher risk for self-directed violence. Nurses are uniquely positioned to promote a safety culture around firearms and safe storage practices. Nurses can assess, screen, and provide education to patients that can help decrease deaths related to firearms. This article explores how the attributes of cultural humility provide an outline and framework that can enable nurses to respond to the risk of firearm violence and take up a call to ARMS – Assess &amp; Reduce Means to Suicide.

Neurocognitive Care to Reverse Solitary Confinement in Prison: Case Report

Inmate populations have been found to have mental health problems and substance abuse much higher than non-incarcerated populations. Caring for incarcerated patients is problematic, given the limitations on access to healthcare services within detention facilities. A case report of a patient with psychomotor agitation and psychoactive substances use, prone to hetero and self-aggression, is presented. The patient was treated for a month in a Mexican state detention center by nursing students, under supervision and pedagogical support. Using the nursing process, focused on psychosocial health needs, six priority diagnoses were identified: anxiety, ineffective health maintenance behaviors, acute confusion, risk of self-directed violence and violence directed at others, as well as discomfort. Based on these diagnoses, care plans using cognitive stimulation was carried out with the goals of decreased anxiety, increased self-care, increased self-responsibility, better anger control, management of hallucination. The cognitive stimulation was a primary intervention that helped with other interventions to achieve holistic goals, such as improving hygiene. Improvements in the patient’s general ability to function led to, among other aspects, the release of solitary confinement and adaptation to social environment of the prison. Patient improvements reflect the importance of professional nursing care in mental health care in correctional healthcare.

Relationship of Maternal Age and Adverse Childhood Experiences (ACEs) with Traumatic Sequelae in Commercially Sexually Exploited Youth

The impact of early maternal age on several outcomes (e.g., mental health issues, delinquency, aggression, impulsivity, victimization, and interpersonal difficulties) has been studied since the late 1980s. Research has demonstrated links between exposure to adverse childhood experiences (ACEs) and trauma-related outcomes such as substance abuse, interpersonal and self-directed violence, and sexual risk-taking, to name a few. The current study analyzed the incidence of ACE exposure and mental health outcomes (e.g., suicidal behaviors or self-harm, psychiatric hospitalizations, and substance use) as related to early maternal age in youth known to have experienced trafficking or sexual abuse. General demographics and incidence of various experiences and clinical presentations (e.g., ACE exposure, age of mother at birth of youth, and age at first birth), and history of self-harm, substance use, and psychiatric hospitalization, were examined in a sample of 225 youth referred for services subsequent to experiences of sex trafficking or exploitation. Relationships between ACE exposure and maternal age related to mental health outcomes were also examined. Trafficked and exploited youth reported rates of ACE exposure and poor mental health outcomes at far greater rates than the general population. Significant findings were related to early maternal age and engaging in self-harm or suicidal behaviors. Previously anticipated mediational analyses were not conducted due to the sample size and lack of correlations. Findings highlight the significant ACE exposure and high needs of exploited, trafficked, and abused youth and related mental health outcomes, emphasizing the need for early and comprehensive preventive and therapeutic interventions.

Love Is Not All You Need: Understanding the Association Between Relationship Status and Relationship Dysfunction With Self-Directed Violence in Veterans

Introduction Research indicates that being married is associated with reduced risk of suicide and self-directed violence (SDV) relative to being divorced. Simultaneously, difficulties within relationships predict poorer health outcomes. However, research on relationship status rarely examines relationship functioning, obfuscating the joint contribution of these variables for SDV risk. Method Veterans (N = 1,049) completed a survey that included assessment of relationship status, relationship functioning, and SDV history. Logistic regression models tested how (a) relationship status, (b) relationship dysfunction, and (c) being divorced compared to being in a low- or high-dysfunction relationship were associated with SDV, controlling for several intrapersonal risk factors. Results Veterans in a relationship did not differ in SDV history compared to divorced/separated veterans. However, more dysfunction within relationships was associated with greater odds of a history of SDV and suicidal cognitions. Finally, SDV histories were more likely among veterans endorsing high-dysfunction relationships compared with (a) low-dysfunction relationships and (b) divorced veterans. Conclusion It may be insufficient to only consider relationship status when evaluating interpersonal risk factors for SDV. A single item assessing relationship dysfunction was associated with enacted SDV and suicidal cognitions over and above intrapersonal risk factors. Integrating such single-item measures into clinical practice could improve identification and subsequent tailored intervention for veterans at greater risk for SDV.

Relationship between Veterans Crisis Line risk rating and subsequent suicidal self-directed violence among veteran callers: A gender comparison.

Disparities in suicide rates by veteran status are particularly striking for women. Veterans Crisis Line (VCL) is a preventive strategy. Examine the relationships and gender differences between VCL risk rating, and subsequent suicidal self-directed violence (SSDV) in the 12-months following VCL index call. Cohort study of VCL callers in 2018. Dichotomized composite SSDV (non-fatal suicide event and/or suicide) in the 12 months following VCL call. Veterans with high/moderate VCL risk had significantly higher odds of SSDV (OR = 4.02, 95% CI: 3.75, 4.30). There were no gender/VCL risk interaction (p = 0.3605). We also examined the association of gender, combination of VCL risk and suicide attempt (SA) history, on SSDV. Differential odds of SSDV for gender and combined VCL risk and SA history combinations were observed (p = 0.0005). Compared to those with lower VCL risk without SA history, those with high/moderate VCL risk with SA history showed higher odds of SSDV. Magnitude was higher for men, than for women veterans. Veterans Crisis Line risk assessment performs relatively stable across the gender binary and highlights potential gender differences when factoring in SA history. Combining risk assessment and attempt history may lead to effective suicide prevention strategies.