Minoritized communities have the highest rates of violence exposure. However, those affected remain
underdiagnosed and untreated for resulting trauma symptoms as severe as suicidal thoughts and behaviors
(STBs) and as consequential as reactive aggression and violence perpetration. 1,2 Importantly, Black and
minoritized youth are more likely to experience traumatic events and be diagnosed with disruptive behavior
disorders,3-5 which perpetuates past criminal stereotypes that persist in the public psyche such as the
Superpredator myth 6,7 and leads to further violence exposure through over-surveillance and incarceration.8,9
Rather than effective mental healthcare access, minoritized youth are being exposed and re-exposed to cycles
of violence.
The leading intervention for aggression and violence perpetration among youth in the US has been
incarceration. 8 There persists a perverse logic that incapacitation, which removes “would-be offenders” from
classrooms and neighborhoods, leads to safer communities; yet increased incarceration rates have not
lowered crime rates nationwide as violent crimes have actually increased. 7,8 Related, the past 50 years of
randomized control trials (RCTs) testing interventions for STBs revealed that efficacy has not improved,
treatment effect sizes are small, and there is no difference in efficacy among interventions.12 In short,
interventions aimed at suicide prevention and violence reduction have fallen short. A major factor for why these
interventions don’t show widespread success may be that violence reduction efforts have largely been limited
to the study of aggression and STBs as phenomena present in discrete groups, yet these behaviors often
co-occur to yield more severe clinical presentations. Although critical for diagnosis and treatment planning, little
is known about potential cognitive mechanisms that can help describe the function of self/other-directed
violence. The current proposal is focused on systematically describing the function of self-directed
suicidal and other-direct violent aggression using behavioral models of choice behavior and qualitative
interviews. An understanding of the constraints and preferences of individuals directly impacts treatment
engagement and effectiveness—clinical decision-making is therefore critical.14 Focus on people from
minoritized communities and their developmental risk factors may help mitigate race-based stress disparities in
healthcare and help identify systemic needs for social services that reduce barriers to accessing treatment.22-25
This study has three main objectives: (1) to test the link between violence exposure and decision
making (2) to test the link between decision-making and self/other-directed violence among violence-exposed
youth; (3) to conduct a detailed diagnostic assessment with qualitative interviews exploring beliefs about the
function of STBs and violence perpetration among youth identified through algorithms applied to electronic
health records.