Violence Exposure and Perpetration in Black and Minoritized Youth - 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.
