Self-directed violence (SDV), defined as anything a person does intentionally that can cause injury to one's
self, including death (i.e., suicide attempt, suicide ideation, non-suicidal self-injury), is a significant public health
issue. A growing number of SDV prevention programs train adults and peers (termed “gatekeeper training”) to
be more active bystanders– to try to help when they see someone who may be at risk for self-injury. Such
programs have demonstrated positive changes in knowledge and attitudes about suicide, but have had less
success in changing behaviors in real world settings. Limited impact may be due to the absence of longitudinal
research on how SDV bystander actions unfold and what attitudes and barriers influence bystanders' behavior.
A recent national survey of 1,031 youth and young adults conducted by this research team to inform the
current proposal revealed that 83.1% have been exposed to SDV in their lifetimes. While this suggests great
opportunity for interventions focused on bystanders, studies also document the mental health impact of those
exposed to SDV (i.e., “bystanders”). Indeed, lifetime exposure to suicidal behavior is associated with past
month trauma symptoms, suicide ideation, and thoughts of self-harm among youth. Also, we have surprisingly
limited information about how these bystanders are impacted by the help they provide. In the interpersonal
violence field, research suggests that the feelings of bystanders about their intervention are influenced by the
way their actions were received by the other person. Given research on the contagion of SDV among young
people, extending this research to SDV bystanders is critical. Further, exposure to SDV may be amplifying
existing mental health disparities experienced by sexual and gender minority (SGM) populations. Youth with
SGM identities experience elevated rates of suicidal behavior and associated risk factors including depression,
substance use, and peer victimization because of discrimination and structural inequalities. The negative
impacts of SDV exposure noted above may amplify these disparities. New and innovative approaches are
clearly needed to help narrow these gaps in SDV risk and exposures among SGM and other minority
populations. To address these gaps, we propose to conduct a national longitudinal study of youth, ages 13-22.
Participants will be recruited via social media to facilitate a national reach and oversampling of SGM youth.
Specific Aims are informed by the research team's prior work, previous research about interpersonal violence
bystander behavior, and guided by the Enhanced Social Cognitive Model for SDV (ESC-SDV). Specifically, we
will: 1) Recruit and survey a cohort of 5,000 adolescents and young adults to identify the pathways through
which attitudinal and contextual components of the ESC-SDV predict: a) opportunity to act, b) intent to act, and
c) actual bystander behavior for SDV; 2) Survey these youth two more times, 12 months apart, to identify the
impact of bystander behavior on the bystanders themselves; and 3) Examine how these trends are different for
important subgroups of youth.
