Exposure to Violence Linked to Suicidal Behavior
Shatel Francis, PH.D.
Crisis Mental Health Advocate, Safe Families Office
Every nine seconds a woman is beaten in the United States. Every 40 seconds a person dies by suicide worldwide. Although both domestic violence and suicide are public health concerns, each are often discussed in isolation. While national reports explore the relationship between intimate partner violence (IPV) and death at the hands of the abuser, increased risk for suicidal behavior is often overlooked as it pertains to victims.
While an exaggerated reaction and not the leading factor of completed suicide, research has shown that exposure to violence leads to an increased risk for suicidal behavior in women and children. Suicidal behavior includes any behavior that puts a person at risk for death such as a drug overdose, initiating a car crash or shooting oneself.
Researchers, practitioners and advocates have made great strides in understanding suicidal behaviors and exploring risk factors. Research has consistently shown that “women who are sexually abused show a 12- to 20-fold increase in suicide attempts. Child sexual abuse confers a 150 percent increased risk of later suicidal behavior (MacIsaac, Bugeja, & Jelinek, 2017). Therefore, a systematic examination of the intersection of suicide and IPV must be explored more closely.
Youth and Young Adults
Childhood and adolescence are sensitive developmental periods associated with increased susceptibility to long-term or modeling behavior, including power and control dynamics and suicidality. Children and youth are also the populations with the greatest risk of being victims of IPV. In developed and developing countries, suicide has been deemed the second leading cause of death among youth (WHO, 2014). Furthermore, Catellvi et al. (2017) asserted that children and youth exposed to any type of IPV (neglect, sexual abuse, physical abuse or emotional abuse) were consistently twice as likely as their non-exposed peers to have at least one suicide attempt and a greater risk of dying by suicide by the age of 20.
Studies regarding the association between IPV and suicide has been more varied regarding women. Variations have largely been attributed to the frequency and severity of violence exposure, type of relationship (dating vs. marriage) and culturally-accepted practices. For example, MacIsaac, Bugeja, and Jelinek (2017) reflected that exposure to violence increased suicide risk up to 17-fold in Swedish women, whereas abuse or oppression by a husband contributed to almost 50 percent of suicides in a small area of Bangladesh. Therefore, the public must be cautious when reading the literature on the association between suicide and IPV among women.
What is alarming however is that suicide rates among girls and women increased by 50% between 2000 and 2016 (NPR, 2018). Because this information has been so newly released, only now are researchers beginning to examine the contributing factors to the increase. Preliminary data revealed by Cerulli and Cross (2015) indicate that almost one-third of women seeking protection orders have experienced suicidal thoughts or behaviors.
A search for scholarly, peer-reviewed research examining the relationship between suicide in men and its relationship to IPV yielded only two results. The first article examined suicide among young, sexual minority men but made no association or causal claims related to IPV - rather shifting the focus to societal and systemic oppression. The second article focused on adolescent aggression and suicidal history as a predictor of adult negative relationships. Thus, there is insufficient information to make general claims about suicide and IPV as it relates to men as the victim.
Currently, the American Foundation for Suicide Prevention estimates that men die by suicide more than three times than women. Most theorists believe that men and women attempt suicide at approximately the same rate, however men use more lethal means, resulting in more deaths. Other theorists believe that Western cultures tend to socialize men toward suicide, often deterring men from expressing emotion, thus leading to depression and ultimately suicidal behavior.
Mental Illness as a Mediating Factor
What has been consistent in literature is the mediating factor of mental illness. While IPV and suicidal behavior are associated, the relationship is not always casual or direct. Instead, IPV may cause disturbances in psychological functioning, and these disturbances then lead to suicidal behavior. Multiple psychological disorders have been explored as a direct result of IPV including, but not limited to, posttraumatic stress disorder (PTSD), depression, bipolar disorder and schizophrenia (Wolford-Clevenger & Smith, 2016). More importantly, coercive control as a form of abuse has been implicated as the highest predictor of suicidal behavior in a survivor of IPV.
Coercive control can be defined as the assertion of power through the use of demands based on credible threats (Dutton & Goodman, 2005). Preliminary data has supported that above other forms of abuse, coercive control creates the feeling of hopelessness in the survivor. Once hope has been removed from the survivor’s field of vision, a fast end to the abuse is often sought. Hopefulness serves as a protective factor and bolsters one’s ability to cope with stress. Therefore, therapeutic services associated with IPV often includes components of hope installation.
Best practices suggest that when treating clients exposed to IPV, it is important to assess both the violence suffered and the person’s thoughts about hurting oneself. Many clients will state that they have never thought about harming themselves and those who have may not be actively suicidal. However, for those who are actively considering suicide, having an open conversation about their intentions and access to means give advocates the ability to create a safety plan and provide the necessary referrals. Conducting a thorough assessment does not make clients start to think about harming themselves if they never had that intention.
If you or someone you know has been experiencing suicidal thoughts, please call the National Suicide Line at 1 (800) 273-TALK (8255).