Physical Violence Exposure, Violence Involvement, and Incarceration As Cumulative Risk for Suicidal Ideation

Background and Purpose: Suicide is a public health crisis with over 49,300 Americans dying by suicide each year. While suicidal ideation (SI) is commonly thought to be an outcome of individual psychopathology, it can be exacerbated by both violence exposure and justice involvement. Individuals involved in the criminal-legal system are disproportionately exposed to lifetime violence, suggesting that incarceration and violence exposure may be interrelated structural determinants of suicide risk. Limited population-based research has examined violence exposure and incarceration as independent and combined contributors to suicide risk. To address this gap, the present study examines whether cumulative exposure to past-year physical violence, involvement in physical violence, and lifetime incarceration is associated with past-year SI in a statewide sample of adults in California. We hypothesized that SI would increase in a graded manner as the number of types of exposures increases.

Methods: Secondary data were drawn from the 2023 California Violence Experiences Survey, a general population-based survey of adults aged 18 and older (N = 3,560). Analyses were conducted on a complete-case sample (n = 3,484). The outcome was past-year SI (yes/no). Exposures included binary indicators of past-year physical violence victimization and past-year involvement in physical violence (each defined as physical or weapon-related violence), as well as lifetime incarceration (yes/no). A cumulative exposure variable was created by summing these three indicators (range: 0–3 exposures). Logistic regression models were used to estimate the association between cumulative exposure and SI. Both unadjusted and adjusted models were estimated, with adjusted models controlling for gender and race/ethnicity.

Results: Most participants (83.4%) reported no exposures, whereas 12.8% reported one exposure, 2.5% reported two exposures, and 1.3% reported all three exposure types. The prevalence of SI increased significantly across exposure levels, from 6.0% among those with no exposures to 16.6% (one exposure), 37.9% (two exposures), and 63.8% (three exposures). In unadjusted models, compared to individuals with no exposures, those with one exposure had over three times higher odds of SI (OR = 3.14, 95% CI [2.33, 4.19]), those with two exposures had nearly ten times higher odds (OR = 9.65, 95% CI [6.05, 15.20]), and those with three exposures had nearly 28 times higher odds (OR = 27.86, 95% CI [15.24, 52.53]). These associations remained strong after adjusting for gender and race/ethnicity (ORs = 3.11, 9.56, and 32.54, respectively).

Conclusions and Implications: Findings demonstrate a strong, graded relationship between SI and cumulative exposure to physical violence, involvement in physical violence, and incarceration. Rather than operating independently, these exposures appear to co-occur and together shape suicide risk, with individuals experiencing multiple types of exposures resulting in elevated odds of SI. These results illustrate the importance of moving beyond individual psychopathology frameworks to consider how overlapping interpersonal and structural exposures contribute to mental health disparities. Implications include the need for integrated, trauma and justice-informed suicide prevention efforts that address the cumulative impact of violence and criminal-legal system involvement.