Violence and substance use in adolescents with increasing severity of suicidal behavior

A theoretical pathway of progression of suicidal behavior, from ideation to communicating suicidal intent to suicide attempt was examined by investigating whether adolescents at each stage of the pathway could be differentiated from those at the previous stage by their risk behaviors. Cluster sampling produced a sample of 7,340 high-school students who completed a self-administered questionnaire. Bivariate analyses and multivariate logistic regression models were used to investigate the relationships between stage of severity of suicidal behavior and selected risk behaviors. For females, the more severe the suicidal behaviors exhibited, the more likely that the adolescent had been both a perpetrator and victim of violence. For males, attempting suicide was associated with being a victim and perpetrator of violence. Our findings lend partial support to the continuum of severity hypothesis of suicidal behaviors and suggest that clinicians should be alerted to escalating violent behavior as a potential precursor to suicide attempt.