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

Abstract

Introduction: This study examines associations between externalizing behaviors/violence exposure and suicidal behavior among U.S. high school students from 1991 to 2021.

Methods: Data 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.

Results: The prevalence of externalizing behaviors/violence exposure increased among youth with an injurious suicide attempt (ISA). Logistic regression models indicated statistically significant associations across suicidal behaviors with a higher magnitude of association observed among those with an ISA. For instance, compared to those who did not carry a gun, those who carried a gun had 6.32 (95% confidence interval: 4.78, 8.36) times the odds of ISA versus no attempt and 2.66 (95% confidence interval: 2.00, 3.53) times the odds of non-ISA versus no attempt. Stronger associations arose among male individuals. Among those with an ISA in 2021, state-level differences in weapon access emerged.

Conclusions: Adolescents with externalizing behaviors/violence exposure are at an increased risk of an ISA. 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.