Polyvictimization and Suicidal Thoughts and Behaviors Among Adolescents: Findings from the 2017-2021 National Youth Risk Behavior Survey

Background: Suicide is a major public health issue in the United States. and ranks as the second leading cause of death among adolescents. Identifying factors that increase the risk of suicidal thoughts and behaviors (STBs; i.e., suicidal ideation, suicide planning, and suicide attempts) among adolescents is crucial and could help prevent future STBs, including death by suicide. Several studies have documented the association between single forms of victimization, such as bullying (school and cyber), sexual violence, and STBs among adolescents. Although studies have investigated the association between victimization and STBs, few studies have examined the association between polyvictimization and STBs among adolescents using nationally representative samples. The objectives of this study were to examine trends in polyvictimization and STBs among adolescents and the cross-sectional association between polyvictimization and STBs among adolescents.

Methods: Data for this study came from the 2017-2021 Youth Risk Behavior Survey. A sample of 45,423 adolescents aged 14-18 (50.1% female) was analyzed. The outcome variables investigated in this study included STBs during the past 12 months, and each was measured as a binary variable. The primary explanatory variable examined was polyvictimization (victim of school bullying, cyberbullying, SV, and being threatened with or injured with a weapon on school property) within the past 12 months. The main analysis involves using complementary log-log models to estimate the association between polyvictimization and STBs while simultaneously controlling for the effects of symptoms of depression, substance use, and demographic characteristics.

Results: Of the 45,423 adolescents, 19.8% experienced suicidal ideation, 16% made a suicide plan, and 9.8% attempted suicide at least once during the past 12 months. About 5% of adolescents experienced three or more forms of victimization. There was a statistically significant upward trend in the proportion of adolescents who experienced each STBs from 2017 to 2021 (suicidal ideation: from 17.6% in 2017 to 21.2% in 2021; suicide planning: from 13.9% in 2017 to 17.2% in 2021; and suicide attempts: from 7.8% in 2017 to 11.2% in 2021). The proportion of adolescents who experienced two or more forms of victimization was consistent from 2017 to 2021. Controlling for other factors, adolescents who experienced three or more forms of victimization had 2.73 times higher odds of experiencing suicidal ideation (AOR=2.73, 95% CI=2.42-3.09), 2.86 times higher odds of making a suicide plan (AOR=2.86, 95% CI=2.51-3.25), and 4.7 times higher odds of making a suicide attempt (AOR=4.70, 95% CI=4.00-5.11) when compared to adolescents who did not experience victimization. Self-identifying as a lesbian/gay, bisexual, or “other/questioning, symptoms of depression, cigarette smoking, alcohol, and marijuana use were significantly associated with higher odds of suicidal ideation, suicide plan, and suicide attempts.

Implications: We found a dose-response association between polyvictimization and STBs with adolescents who experienced three or more forms of victimization having the greatest likelihood of experiencing suicidal ideation, making a suicide plan, or attempting suicide during the past year. The findings of this study indicate the importance of examining multiple forms of victimization. Clinicians may consider including suicide screening when working with clients who experience polyvictimization.