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Article

Suicidal Ideation in U.S. Adolescents Exposed to Neighborhood Violence

by
Silviya Nikolova
1,*,
Eusebius Small
2 and
Benjamin Sesay
2
1
Department of Social Medicine and Healthcare Organization, Medical University of Varna, 9000 Varna, Bulgaria
2
School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA
*
Author to whom correspondence should be addressed.
Adolescents 2025, 5(3), 31; https://doi.org/10.3390/adolescents5030031
Submission received: 15 May 2025 / Revised: 25 June 2025 / Accepted: 2 July 2025 / Published: 7 July 2025
Versions Notes

Abstract

Background: Suicidal ideation among adolescents remains a major public health challenge. Exposure to neighborhood violence is associated with increased risk of mental health distress and school-related vulnerabilities. This study investigates the predictors of suicidal ideation among U.S. adolescents who have witnessed neighborhood violence. Methods: Data were drawn from the 2023 Youth Risk Behavior Survey (YRBS), a nationally representative survey of high school students in the United States. A subsample of 3495 adolescents who reported witnessing neighborhood violence was analyzed. Key variables included sociodemographic characteristics, mental health symptoms, perceived school safety, and experiences of victimization. Multivariable logistic regression was used to identify factors associated with suicidal ideation, defined as seriously considering suicide in the past year. Analyses were conducted using Jamovi (version 2.6), with statistical significance set at p < 0.05. Results: The prevalence of suicidal ideation in the sample was 34.2%. Bisexual adolescents had significantly higher odds of suicidal ideation compared to heterosexual peers (OR = 2.34, p < 0.001). Depressive symptoms were the strongest predictor (OR = 7.51, p < 0.001). Both perceived lack of safety at school and differences in ethnic and population backgrounds were significant. Black and Hispanic/Latino adolescents had lower odds compared to White peers. Conclusions: Findings highlight sexual identity, depressive symptoms, school safety concerns, and ethnic and population background differences as key correlates of suicidal ideation. Culturally responsive, trauma-informed interventions are urgently needed for youth exposed to community violence.

1. Introduction

Adolescent suicidal behaviors, including suicidal ideation and nonfatal suicide attempts, represent a significant public health concern in the United States. Suicide is the second leading cause of death among individuals aged 10 to 24, with the rate increasing by 48% between 2011 and 2021 [1]. While suicide deaths are of major concern, the prevalence of suicidal ideation and nonfatal attempts remains a critical issue. This underscores the need for early identification and comprehensive prevention strategies. Recent research indicates that youth suicides typically result from a combination of biological, psychological, socio-cultural, and family factors, rather than a single cause [2,3]. Understanding the complex factors that contribute to suicidal ideation, especially in the context of community violence, can help dispel misconceptions about the isolated nature of suicidal behaviors [3]. Common risk factors include previous suicide attempts, depression, substance abuse, behavioral disorders, family instability, relationship conflicts, social and cultural influences, difficulties in coping with adversity, psychiatric illnesses, access to lethal means, and other contributing factors [2,3,4].
Among the various social and environmental factors influencing suicidality, exposure to neighborhood violence (NV)—a form of community violence that occurs in public spaces and involves individuals who are generally unrelated—has been shown to significantly increase psychological distress. According to the Centers for Disease Control and Prevention [5], community violence includes incidents such as assaults, shootings, and gang activity that typically happen in neighborhoods, schools, and on the streets. Adolescents exposed to such violence face 1.38 times greater odds of attempting suicide [6], with long-term risks persisting over time [7]. They often experience heightened stress, depression, and trauma-related symptoms, all of which elevate suicidality risk [8]. Identifying the factors associated with suicidal ideation among adolescents exposed to neighborhood violence is crucial for developing targeted interventions.
Building on the complex interplay of environmental and individual risk factors, this study examines how exposure to neighborhood violence correlates with adolescent suicidal ideation and attempts. It also examines associations between suicidal ideation and demographic characteristics, mental health, school environments, and personal experiences among youth exposed to neighborhood violence. A deeper understanding of these relationships can guide the development of targeted interventions to mitigate risk and strengthen protective factors for vulnerable youth.

1.1. Literature Review

1.1.1. Ethnicity and Population Disparities in Suicidal Ideation

Neighborhood violence constitutes a significant environmental factor influencing suicidal ideation among adolescents from ethnically diverse and socioeconomically marginalized populations [9]. Research consistently shows that Black and Hispanic youth experience disproportionately high levels of neighborhood violence, largely due to their residence in neighborhoods marked by elevated crime rates, social instability, and limited protective resources [6,10,11]. This heightened exposure is closely linked to an increased risk of suicidal thoughts and attempts compared to peers living in less violent communities [12].
Distinct patterns emerge when considering gender differences in responses to neighborhood violence. Female adolescents exposed to such violence tend to report more internalizing symptoms, including depression and suicidal ideation, while male adolescents are more likely to exhibit externalizing behaviors such as aggression and delinquency [13,14]. Within population groups, variations in suicidality reflect differing levels of neighborhood violence exposure alongside broader social determinants. Black female adolescents show higher rates of suicidal ideation and attempts compared to their White and Hispanic peers, a disparity that appears linked to chronic neighborhood violence exposure compounded by socioeconomic hardship and limited access to mental healthcare [15,16]. Although Black male adolescents report lower rates of suicidal ideation, their risk of suicide attempts rises substantially under conditions of severe or repeated neighborhood violence exposure [17]. Among Hispanic adolescents, neighborhood violence remains a salient influence on mental health outcomes. Hispanic females report elevated psychological distress and suicidal ideation in contexts where persistent neighborhood violence intersects with culturally specific stressors such as acculturation and family expectations [18]. While Hispanic males generally show lower rates of suicidal ideation, increased exposure to neighborhood violence, combined with untreated mental health conditions and systemic barriers to care, correlates with higher incidences of suicidal behaviors.

1.1.2. Sexual Minority and Suicidal Ideation

Sexual minority youth, including LGBTQ+ adolescents, face unique stressors due to their minority status, which significantly impact their mental health [19,20]. The minority stress model posits that these individuals experience chronic stress from discrimination, stigma, prejudice, microaggressions, and internalized negative beliefs about their sexual orientation or gender identity [21,22]. This persistent stress contributes to higher rates of anxiety, depression, and suicidal ideation compared to their non-LGBTQ+ peers [23]. Research shows that LGBTQ+ teens are four times more likely to attempt suicide than their heterosexual counterparts [19,24,25]. The Trevor Project’s 2024 survey revealed that 39% of LGBTQ+ young people considered suicide in the past year, with 66% experiencing symptoms of anxiety and 53% experiencing symptoms of depression [19].
The minority stress theory identifies both distal stressors (external events like discrimination and violence) and proximal stressors (internal processes such as expectations of rejection and concealment of identity) [22,26]. These stressors are interrelated and can have long-lasting impacts on mental health, potentially disrupting developmental tasks and contributing to negative outcomes later in life [22,26]. It is important to note that LGBTQ+ youth are not inherently prone to mental health issues because of their identity, but rather due to the societal challenges they face [23,27]. Supportive environments, LGBTQ-affirmative social support, and embracing one’s identity with pride can help mitigate the impact of minority stress [20,28].

1.1.3. Grade Level and Suicidal Ideation

Suicidal ideation among adolescents varies across grade levels, with distinct developmental, social, and familial influences shaping mental health at different ages. Wei and Liu found that mental health challenges fluctuate as students progress through middle school, affecting the prevalence of suicidal thoughts [29]. For middle school students, gender, family atmosphere, and interpersonal stress were identified as significant predictors of suicidal ideation. Specifically, female students and those from unstable or negative family environments were more prone to psychological health issues [29]. Among older adolescents (ages 14–18), suicide remains a leading cause of death, with a 2021 rate of 9.0 per 100,000 population reported by the CDC, and Gaylor et al. identified academic pressure, social dynamics, and mental health challenges as key contributors to suicidal ideation in high school students [30]. The Youth Risk Behavior Survey further corroborates these findings, indicating significant variations in serious suicidal thoughts across different grade levels [31]. Additionally, negative parenting styles have been linked to increased suicidal ideation among adolescents, with negative emotions mediating this relationship [32]. These results underscore the need for targeted, age-appropriate interventions and mental health education strategies in schools to address the complex factors influencing suicidal ideation.

1.1.4. School and Home Environment and Suicidal Ideation

Beyond individual and family-level influences, school environments and community resources play a crucial role in shaping adolescent responses to NV. Research in JAMA highlights that adolescents who perceive their schools as safe and supportive report lower rates of suicidal ideation, even when exposed to high levels of neighborhood violence [33]. Similarly, access to mentorship programs and trauma-informed care within schools has been associated with improved emotional regulation and reduced suicide risk [7]. This evidence underscores the need for a comprehensive, multi-level approach to understanding how NV influences suicidal behaviors. Future research should further explore the cumulative effects of violence exposure over time and the effectiveness of community-based interventions in mitigating these risks.

1.1.5. School Connectedness and Suicidal Ideation

School connectedness has been consistently identified as a protective factor against suicidal thoughts and behaviors among adolescents. A meta-analysis by Marraccini and Brier found that higher school connectedness was associated with reduced reports of suicidal thoughts and behaviors across general (odds ratio [OR] = 0.536), high-risk (OR = 0.603), and sexual minority (OR = 0.608) adolescents [34]. These findings remained consistent when analyzed separately for suicidal ideation (OR = 0.529) and suicide attempts (OR = 0.589) [34].
Several studies have demonstrated the protective role of school connectedness. Eugene et al. found that perceived school connectedness protected adolescents who reported suicidal ideation from engaging in a suicide attempt [35]. Foster et al. observed that adolescents aged 12–15 who felt more connected with their schools experienced a decrease in suicidal ideation compared to their less connected peers [36]. Eugene et al. reported that adolescents with a stronger sense of school connectedness experienced fewer depressive symptoms, including suicidal ideations [35]. The protective effect of school connectedness is believed to stem from the sense of belonging it fosters. This sense of connection, experienced through feelings of belonging to the school, active engagement, and perceived support from others, may continue to buffer the effects of mental health symptoms on suicidal behaviors well into young adulthood [35,37]. This aligns with the Interpersonal Theory of Suicide, which suggests that belongingness and burdensomeness are linked to passive suicidal ideation [38].

1.1.6. Sexual Violence and Suicidal Ideation

Sexual violence is a significant risk factor for suicidal ideation and behavior among adolescents, with studies consistently showing that those who have experienced sexual abuse are more likely to contemplate or attempt suicide compared to their non-abused peers [39]. The relationship between sexual violence and suicidal behavior is influenced by several factors, including the severity and duration of abuse, gender differences, co-occurring mental health issues, and family context [40]. Early childhood sexual abuse, more severe forms of abuse, and longer duration are associated with higher rates of suicidal ideation and attempts [41]. Additionally, adolescent girls generally report higher rates of suicidal ideation than boys after experiencing sexual abuse, although both genders in LGBTQ+ youth show significantly higher odds of attempting suicide following sexual violence [40,42]. Understanding this complex association is crucial for identifying high-risk populations and developing effective interventions to reduce suicide risk among vulnerable adolescents [41,43].

1.1.7. Mental Health and Suicidal Ideation

Adolescent mental health and its association with suicidal ideation remain critical public health concerns. Research consistently highlights the strong link between various mental health disorders and an increased risk of suicidal thoughts and behaviors in this vulnerable population. Depression emerges as the strongest predictor of suicidal ideation in adolescents. Psychological autopsy studies have shown that up to 60% of adolescent suicide victims had a depressive disorder at the time of death, and between 40 and 80% of adolescents met the diagnostic criteria for depression at the time of a suicide attempt [44]. Depression is the main predictor of suicidal ideation, with up to 85% of clinically referred adolescents with major depressive disorder or dysthymia experiencing suicidal ideation [44].
Beyond depression, other mental health issues contribute to suicidal ideation. Anxiety disorders, bipolar disorders, psychotic disorders, conduct disorders, and substance use disorders are also associated with increased suicide risk in adolescents [45]. Marijuana use and depression are also associated with suicidal ideation and a greater likelihood of suicide attempts among adolescents [45]. The relationship between mental health and suicidal ideation is complex, often mediated by cognitive distortions and emotional dysregulation. Automatic negative thoughts, which focus on issues of loss and failure, can influence the emergence of suicidal ideas [46]. These thoughts are typically evaluative, brief, and not usually the result of reasoning [46].
Environmental factors, such as exposure to violence or stressful events, can compound mental health challenges and suicidal risk. Childhood trauma, being in the child welfare system, being a victim or perpetrator of bullying, and experiencing stressful events are all risk factors for suicidal behavior in youth [47]. Recent data from the Centers for Disease Control and Prevention (CDC) shows an increase in suicidal thoughts and behaviors among high school students from 2011 to 2021. Overall, 22% of high school students reported seriously considering suicide within the past year, up from 16% in 2011 [48]. Certain groups face greater risk, including female students, Black students, American Indian and Alaskan native students, and LGBQ+ teens [47]. Addressing adolescent suicidal ideation requires early identification and treatment of mental health disorders. The American Academy of Pediatrics recommends screening everyone ages 12 and older for suicide risk at least once a year [47].

1.1.8. Health and Sleep Factor

Sleep is a critical factor influencing cognitive functioning in adolescents, with particular relevance for those exposed to trauma such as neighborhood violence. Exposure to neighborhood violence generates chronic stress responses that disrupt sleep patterns, contributing to deficits in working memory, learning, and academic achievement [48]. While research on high-functioning autism spectrum disorder (HFASD) has documented the links between sleep disruption and cognitive challenges, similar pathways are likely present in adolescents experiencing trauma from neighborhood violence, though further empirical validation is warranted [48]. Socioeconomic disadvantages and disparities related to population background compound the effects of neighborhood violence by intensifying sleep disturbances and their cognitive consequences as factors such as discrimination and economic hardship negatively influence sleep quality and neurodevelopment [49]. Longitudinal studies reveal that persistent sleep problems originating in early childhood—particularly in violent and unstable neighborhoods—predict impaired cognitive control and heightened risk-taking during adolescence, emphasizing sleep’s role in regulating behavior and decision-making under environmental stress [50].
Neighborhood violence, therefore, operates as a central environmental determinant by heightening stress-induced sleep disturbances that diminish cognitive resilience and behavioral regulation in affected youth [51]. These sleep disruptions constitute a pathway through which the adverse effects of neighborhood violence translate into cognitive and emotional vulnerabilities. Addressing sleep quality among adolescents living in violence-affected neighborhoods emerges as a vital consideration for mitigating the cognitive and behavioral sequelae of such exposure.
The purpose of the current study is to examine the risk and protective factors associated with suicidal ideation among U.S. high school students who have been exposed to neighborhood violence. Specifically, the study aims to identify which factors—across demographic characteristics, mental health status, school environment, and personal experiences—are associated with higher or lower likelihood of suicidal ideation within this group.
This research addresses a critical public health concern: the rising prevalence of suicidal ideation and behavior among adolescents, particularly in the context of environmental stressors such as neighborhood violence. By exploring the complex interplay between individual vulnerabilities (e.g., mental health challenges and adverse personal experiences) and protective factors (e.g., school connectedness), the study aims to provide a more nuanced understanding of the mechanisms contributing to adolescent suicidality in high-risk environments.
The findings have the potential to inform the design of targeted prevention and intervention strategies aimed at reducing suicide risk among vulnerable youth populations. Furthermore, by examining how demographic variables such as ethic and population background, sex/gender, and grade level influence these associations, the study seeks to identify subgroups at elevated risk and support the development of tailored, equity-informed approaches. Finally, the research will contribute to a broader understanding of the roles that school and family environments may play in mitigating or exacerbating suicidal ideation in adolescents.
The study is guided by two key research questions: (1) What are the risk and protective factors associated with suicidal ideation among U.S. high school students exposed to neighborhood violence? (2) To what extent do specific domains—such as demographics, mental health status, school environment, and personal experiences—explain variability in suicidal ideation within this group?

2. Materials and Methods

2.1. Participants and Procedures

The study analyzed data from the 2023 Youth Risk Behavior Survey (YRBS), a nationally representative survey conducted biennially by the CDC to monitor adolescent health-risk behaviors linked to morbidity and mortality, including violence exposure, mental health concerns, and substance use [52]. The 2023 YRBS sampled 20,103 high school students (grades 9–12) from U.S. public and private schools using a two-stage cluster sampling design. Counties or groups of counties were selected first, followed by schools and classrooms. Trained school staff and CDC personnel administered the anonymous, self-reported questionnaire, ensuring confidentiality. The response rate was 70.1%, and data were weighted to adjust for nonresponse and demographic factors.
This study focused on a subsample of students who reported witnessing neighborhood violence (N = 3495 [24%]), determined by their response to the question: “Have you ever seen someone get physically attacked, beaten, stabbed, or shot in your neighborhood?” (Yes/No). This item was used to approximate exposure to neighborhood violence; however, it did not capture information on the severity or outcome of the violence.

2.2. Measures

We examined various factors as potential predictors of suicide consideration among adolescents. Demographic variables included ethnic and population background (with White as the reference group), sex (female as reference), sexual identity (heterosexual as reference), and grade level (10th grade as reference). We also assessed school-related and mental health factors, including safety concerns at school during the past 30 days (with 0 days feeling unsafe as the reference), whether participants felt sad or hopeless for two consecutive weeks, frequency of parental conflict, considered suicide in the last 12 months (No/Never as reference), and school connectedness (Agree as reference). Health-related factors were also considered, such as difficulty concentrating due to poor health (No as reference), sleep duration (8 h as reference), experiences of forced sexual intercourse (No as reference), and frequency of sexual violence experiences (0 times as reference). Each factor was categorized with specific reference groups to facilitate comparison in the analysis. This comprehensive approach allowed us to explore a wide range of potential influences on adolescent suicide consideration, spanning personal characteristics, school environment, family dynamics, mental health, and experiences of violence or trauma.

2.3. Data Analysis

Data analysis was conducted using Jamovi software (version 2.6). Descriptive statistics, including frequencies and percentages, were employed to summarize categorical variables such as sex, ethnic, and population background, grade level, and suicidal ideation. To investigate factors associated with suicidal ideation, we applied a binary logistic regression model, with suicidal ideation (yes/no) as the outcome variable. The analysis focused on identifying independent predictors of suicidal ideation; interaction effects were not tested. The model incorporated a diverse set of predictors, including demographic characteristics (sex, ethnic, and population background, sexual identity, grade level), school-related factors (school connectedness, feelings of safety), experiences of victimization (sexual violence), mental health indicators (depressive symptoms, forced sexual intercourse), and health factors (concentration difficulties, sleep duration). To assess potential multicollinearity among predictors, we calculated Variance Inflation Factor (VIF) values. All VIFs were below 3, indicating no concerns regarding multicollinearity. The logistic regression results are presented as odds ratios (OR) with corresponding 95% confidence intervals (CI), and statistical significance was determined using p-values, with p < 0.05 considered significant. Participants with missing data on variables included in the analysis were excluded from the regression analyses using listwise deletion. Given that the proportion of missing data was less than 10%, this approach was chosen to maintain a consistent analytic sample across all variables.

3. Results

3.1. Sample Characteristics

The study sample comprised 3495 adolescents who reported witnessing neighborhood violence. The sample consisted of 53.5% males (n = 1855) and 46.5% females (n = 1611). Participants represented diverse ethnic backgrounds, with the largest groups identifying as White (36.6%), multiple Hispanic/Latino (20.3%), Black or African American (12.2%), and multiple Non-Hispanic/Latino (12.4%). Smaller proportions identified as American Indian/Alaskan native (7.9%), Hispanic/Latino (7.5%), Asian (2.7%), and native Hawaiian/Pacific Islander (0.4%).
The distribution across grade levels was as follows: 27.6% in 9th grade, 27.4% in 10th grade, 24.5% in 11th grade, and 20.2% in 12th grade. A small percentage (0.4%) reported being in the “other” grade category. Notably, 34.2% (n = 1165) of the sample reported experiencing suicidal ideation (Table 1).

3.2. Model of Suicidal Ideation

The binomial logistic regression model predicting the likelihood of considering suicide demonstrated a significant overall fit, χ2(42) = 994, p < 0.001, with a McFadden’s R2 of 0.322. This suggests that the included predictors explain 32.2% of the variance in suicidal ideation. The model’s deviance was 2089, and both the AIC (2175) and BIC (2424) values provide comparative measures for evaluating model complexity (Table 2).

3.2.1. Demographic Factors

Ethnic and population background showed significant associations with suicidal ideation. Compared to White adolescents, Black or African American youth had significantly lower odds of considering suicide (OR = 0.616, p = 0.006), as did Hispanic/Latino adolescents (OR = 0.478, p = 0.006) and those identifying as multiple Hispanic/Latino (OR = 0.676, p = 0.010). Other ethnic and population groups, including American Indian/Alaskan native (OR = 0.866, p = 0.496), Asian (OR = 0.687, p = 0.294), native Hawaiian/Pacific Islander (OR = 0.822, p = 0.795), and multiple non-Hispanic/Latino youth (OR = 0.852, p = 0.359), did not show statistically significant differences in suicidal ideation compared to White adolescents.
Sex identity (male vs. female) was not significantly associated with considering suicide (OR = 1.233, p = 0.092), suggesting that the risk of suicidal ideation did not differ meaningfully between male and female adolescents in this sample. However, sexual identity was a strong predictor. Compared to heterosexual adolescents, bisexual youth had significantly higher odds of considering suicide (OR = 2.338, p < 0.001), as did those identifying as some other identity (OR = 1.658, p = 0.036) and those questioning their identity (OR = 1.775, p = 0.015). While the odds ratio for gay or lesbian adolescents (OR = 1.573, p = 0.076) was elevated, it did not reach statistical significance. Adolescents who reported not understanding their sexual identity did not have significantly different odds compared to heterosexual youth (OR = 1.151, p = 0.683).
Grade level showed limited association with suicidal ideation. Compared to 10th graders, 9th graders had significantly higher odds of considering suicide (OR = 1.361, p = 0.042). However, no significant differences were observed for 11th (OR = 0.939, p = 0.679) or 12th graders (OR = 1.004, p = 0.980), nor for students in the “other” grade category (OR = 0.819, p = 0.871).

3.2.2. School and Home Environment Factors

Safety concerns at school emerged as a significant predictor. Adolescents who reported feeling unsafe at school for two or three days in the past 30 days had significantly higher odds of considering suicide (OR = 1.574, p = 0.017), as did those who felt unsafe for four or five days (OR = 2.349, p = 0.024). Those who felt unsafe for five or more days also had elevated odds (OR = 1.721, p = 0.080), though this association did not reach conventional significance.
Parental conflict was also a significant predictor. Compared to adolescents who reported their parents never fought, those reporting frequent parental conflict had significantly greater odds of considering suicide. Specifically, the odds were 1.500 times higher for those experiencing moderate conflict (p = 0.004) and 2.300 times higher for those who reported that their parents “always” fought (p = 0.033).
Adolescents who felt less close to people at school were more likely to consider suicide. Compared to those who responded with level 2 on a school connectedness scale, those who selected level 3 had significantly higher odds (OR = 1.751, p < 0.001), as did those at level 4 (OR = 1.401, p = 0.042) and level 5 (OR = 1.686, p = 0.003). These findings suggest a dose–response relationship, where lower school connectedness is associated with increased suicidal ideation.

3.2.3. Mental Health and Victimization

Depressive symptoms were the strongest predictor of suicidal ideation. Adolescents who reported feeling sad or hopeless for at least two consecutive weeks had more than seven times the odds of considering suicide (OR = 7.508, p < 0.001), highlighting the strong link between depressive symptoms and suicidal thoughts.
Experiences of victimization were also predictive. Adolescents who reported experiencing forced sexual intercourse had significantly higher odds of suicidal ideation (OR = 1.542, p = 0.004). Exposure to repeated incidents of sexual violence showed a dose–response effect, with higher frequencies associated with greater odds of suicidal ideation (e.g., OR = 3.075, p < 0.001 for five or more incidents).

3.2.4. Health and Sleep Factors

Difficulty concentrating due to poor health was a significant predictor, with affected adolescents having more than twice the odds of considering suicide (OR = 2.607, p < 0.001). Sleep duration, however, showed inconsistent associations. While those sleeping four or fewer hours had slightly elevated odds (OR = 1.486, p = 0.087), the effect was not statistically significant. Similarly, those sleeping five (OR = 1.353, p = 0.172), six (OR = 1.120, p = 0.596), seven (OR = 1.433, p = 0.101), or nine hours (OR = 1.094, p = 0.817) did not significantly differ from those who slept eight hours. Notably, adolescents sleeping ten or more hours exhibited a non-significant but elevated odds ratio (OR = 2.186, p = 0.099), which warrants further research.

4. Discussion

The findings of this study elucidate the intricate interplay of factors influencing suicidal ideation among adolescents exposed to neighborhood violence, revealing significant disparities across ethnic and population background groups. Black, Hispanic/Latino, and multiple Hispanic/Latino adolescents demonstrated lower rates of reported suicidal ideation compared to their White counterparts, potentially due to culturally specific protective factors such as strong community ties and familial support crises [53,54]. These results align with previous research, suggesting that cultural elements like family bonds and community cohesion can buffer against mental health crises. However, the absence of universally protective patterns across all ethnicities underscores the need for a nuanced understanding and further exploration of heterogeneous protective mechanisms within subgroups.
Sexual minority youth, particularly bisexual and questioning adolescents in our study, reported disproportionately higher risks of suicidal ideation compared to their heterosexual peers, which is consistent with what others have reported [55,56]. This elevated risk can be attributed to experiences of stigma, discrimination, and social exclusion, as outlined by the Minority Stress Theory. The unique vulnerabilities faced by bisexual youth, who often experience rejection from both heterosexual and LGBTQ+ communities, highlight the urgent need for targeted, culturally sensitive interventions that address the mental health risks associated with social marginalization and foster resilience in sexual minority youth.
School connectedness and safety emerged as critical factors in predicting suicidal ideation among adolescents exposed to neighborhood violence in our study. Students reporting feelings of insecurity or a lack of belonging at school demonstrated a higher risk of suicidal thoughts, emphasizing the importance of cultivating safe and inclusive school environments [57]. Implementing initiatives to reduce bullying, enhance peer support, and promote inclusivity could effectively mitigate mental health risks associated with negative school climates.
Parental conflict significantly impacts adolescent suicidality, with those reporting frequent conflicts showing a markedly higher likelihood of experiencing suicidal thoughts [58]. This finding underscores the crucial role of family dynamics in adolescent mental health, particularly in the context of neighborhood violence exposure. Interventions aimed at improving family communication, addressing conflicts, and providing family therapy could be effective in reducing suicidal risk among adolescents.
The strong association between mental health issues, particularly depression, and suicidal ideation among adolescents exposed to neighborhood violence reinforces the critical need for early mental health screenings. Depression, particularly persistent feelings of sadness and hopelessness, emerged as a significant predictor of suicidality, consistent with established research linking depressive symptoms to suicidal thoughts in adolescents [59,60]. The integration of mental health services within schools and communities should be paramount for identifying at-risk youth and providing timely interventions [61].
Victimization experiences, especially sexual violence, demonstrated a strong association with suicidal ideation among adolescents. Those who had endured forced sexual intercourse or repeated sexual violence showed a significantly higher risk of contemplating suicide, emphasizing the need for trauma-informed care in interventions addressing adolescent suicidality. This finding aligns with established research linking sexual victimization to suicidality [41,62,63]. These results emphasize the critical need for trauma-informed care in interventions addressing adolescent suicidality, specifically tailored to address the psychological consequences of abuse and victimization [64].
The study also highlights the complex interplay between physical health and adolescent suicidality. Adolescents reporting difficulty concentrating due to physical health issues showed a higher likelihood of suicidal ideation, underscoring the need for integrated healthcare approaches that address both physical and mental health concerns [45,47]. This finding emphasizes the need for integrated healthcare approaches that address both physical and mental health concerns, particularly given that chronic physical conditions can exacerbate psychological distress.
Sleep duration emerged as a potentially modifiable risk factor, with very short sleep durations (four or fewer hours per night) associated with increased suicidality risk [14,50,51]. While the relationship between sleep and suicidality in our study was not entirely consistent, it aligns with growing evidence linking sleep disturbances to mood disorders and suicidal thoughts. This suggests that addressing sleep problems could be a valuable component of suicide prevention strategies [65].
The findings of this study are subject to several limitations, some of which are inherent to the study design and data collection methods. First, due to the cross-sectional nature of the data, it is not possible to infer causality or the directionality of the associations between the identified risk factors and suicidal ideation. While variables are referred to as “protective factors” or “risk factors” based on the existing literature, the temporality of these factors cannot be established from the data. As such, it is possible that some of the factors may not precede the outcome of suicidal ideation but rather occur as a result of it. Second, the study relies on self-reported data, which is subject to recall bias. The recall periods for individual behaviors, mental health indicators, and experiences such as victimization or family conflict vary. This inconsistency in time reference points may affect the validity of the responses, leading to potential discrepancies in the interpretation of constructs. Furthermore, varying recall periods across items could impact the comparability of different variables. Additionally, while the measure of neighborhood violence used in this study captured whether adolescents had witnessed violent events (e.g., assaults, shootings), it did not include information about the severity or outcomes of these incidents, such as whether they resulted in fatalities. This limits our ability to assess how varying degrees of violence severity may differently affect suicidal ideation. Third, the interrelated nature of the protective and risk factors examined in this study presents another limitation. Because the data do not allow for the disentangling of these interconnected variables, the independent contributions of each factor to suicidal ideation could not be assessed. The complex associations between these factors may play a crucial role in understanding their collective impact on adolescent mental health, but such influence could not be fully explored with the current data. Additionally, although socioeconomic status (SES) is known to shape the relationship between mental health and risk factors [66], it was not included in the present survey, which limits the scope of the analysis. Previous research has demonstrated that SES can modify the impact of both protective and risk factors on mental health outcomes, including suicidality [67,68]. Therefore, the exclusion of SES from the analysis limits our ability to account for its potential confounding effects. Future studies should aim to incorporate socioeconomic data to better understand how these factors interact with mental health outcomes in diverse adolescent populations. Lastly, the study focused solely on adolescents exposed to violence; future work could compare this group to unexposed peers or test interaction effects to clarify how violence exposure modifies risk pathways.

5. Conclusions

This study highlights the association between exposure to neighborhood violence and elevated suicidal ideation among adolescents, with sexual minority youth experiencing disproportionately greater vulnerability. To advance understanding, future research should adopt longitudinal methodologies to clarify causal pathways and examine the long-term psychological impacts of violence exposure, using more nuanced measures of violence severity and context [69]. Comprehensive suicide prevention strategies must incorporate trauma-informed, school-based interventions that buffer the psychological effects of violence by fostering emotionally safe, supportive, and resilient educational environments. In parallel, family-centered approaches can enhance protective factors within the home by strengthening parent–adolescent communication and emotional regulation skills [70,71]. Given the unique stressors confronting sexual minority adolescents, targeted interventions addressing minority stress and stigma are essential for reducing suicide risk, with mechanisms such as affirmation of identity and increased access to culturally competent mental health services playing a central role [49,72]. Collectively, these multi-level, culturally informed strategies offer a robust framework for mitigating suicidality linked to neighborhood violence and promoting mental health equity among vulnerable youth.

Author Contributions

Conceptualization, S.N.; methodology, S.N.; formal analysis, S.N.; investigation, S.N. and B.S.; literature search and background of study, B.S.; writing—original draft preparation, E.S.; writing—review and editing, S.N. and B.S.; discussion, S.N.; supervision, S.N.; project administration, S.N. and E.S. All authors have read and agreed to the published version of the manuscript.

Funding

This study was financed by the European Union-NextGenerationEU, through the National Recovery and Resilience Plan of the Republic of Bulgaria, project No. BG-RRP-2.004-0009-C02.

Institutional Review Board Statement

The YRBS study protocol was approved by the CDC Institutional Review Board (IRB) (Protocol #1969.0, Approval Date: 16 October 2023). Because the current study performed secondary data analyses without personal identifiers, IRB approval was not required.

Informed Consent Statement

Patient consent was waived due to the secondary nature of the YRBSS data which was anonymized and did not involve direct interaction with participants.

Data Availability Statement

The data presented in this study are openly available in the CDC Youth Risk Behavior Surveillance System (YRBSS) repository at https://www.cdc.gov/yrbs/data/index.html (accessed on 18 June 2025).

Conflicts of Interest

The authors declare no conflicts of interest.

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Table 1. Demographic characteristics of the sample.
Table 1. Demographic characteristics of the sample.
Variablen (%)
Sex
Female1611 (46.5)
Male1855 (53.5)
Ethnic and Population Background
White1259 (36.6)
Multiple Hispanic/Latino699 (20.3)
Black/African American419 (12.2)
Multiple Non-Hispanic/Latino426 (12.4)
American Indian/Alaskan Native272 (7.9)
Hispanic/Latino259 (7.5)
Asian94 (2.7)
Native Hawaiian/Pacific Islander13 (0.4)
Grade Level
9th Grade960 (27.6)
10th Grade952 (27.4)
11th Grade853 (24.5)
12th Grade702 (20.2)
Other Grade13 (0.4)
Considered Suicide
Yes1165 (34.2)
No2244 (65.8)
Table 2. Binomial logistic regression model predicting suicidal ideation.
Table 2. Binomial logistic regression model predicting suicidal ideation.
PredictorEstimate (B)SEZpOR95% CI (Lower–Upper)
Intercept−3.9480.290−13.600.0010.0190.011–0.034
Ethnic and Population Background
American Indian/Alaskan Native (Ref: White)−0.1440.212−0.680.4960.8660.572–1.311
Asian (Ref: White)−0.3750.357−1.050.2940.6870.341–1.384
Black or African American (Ref: White)−0.4850.177−2.740.0060.6160.436–0.871
Native Hawaiian/Pacific Islander (Ref: White)−0.1960.754−0.260.7950.8220.188–3.600
Hispanic/Latino (Ref: White)−0.7390.268−2.760.0060.4780.283–0.807
Multiple Hispanic/Latino (Ref: White)−0.3910.152−2.570.0100.6760.502–0.912
Multiple Non-Hispanic/Latino (Ref: White)−0.1600.174−0.920.3590.8520.606–1.199
Sex Identity
Male (Ref: Female)0.2100.1251.680.0921.2330.966–1.574
Sexual Identity
Gay or Lesbian (Ref: Heterosexual)0.4530.2551.780.0761.5730.955–2.591
Bisexual (Ref: Heterosexual)0.8490.1585.360.0012.3381.714–3.189
Other Identity (Ref: Heterosexual)0.5060.2412.100.0361.6581.034–2.660
Questioning Identity (Ref: Heterosexual)0.5740.2362.430.0151.7751.117–2.820
Not Understanding (Ref: Heterosexual)0.1400.3430.410.6831.1510.587–2.255
Grade Level
9th Grade (Ref: 10th Grade)0.3080.1512.030.0421.3611.011–1.830
11th Grade (Ref: 10th Grade)−0.0630.153−0.410.6790.9390.696–1.266
12th Grade (Ref: 10th Grade)0.0040.1560.030.9801.0040.739–1.364
Other Grade (Ref: 10th Grade)−0.2001.227−0.160.8710.8190.074–9.064
School and Home Environment
Feeling Unsafe (2–3 days) (Ref: 0 days)0.4540.1912.380.0171.5741.083–2.288
Feeling Unsafe (4–5 days) (Ref: 0 days)0.8540.3782.260.0242.3491.119–4.929
Feeling Unsafe (≥5 days) (Ref: 0 days)0.5430.3101.750.0801.7210.938–3.157
School Connectedness (1 = Agree, 5 = Disagree)
Level 3 (Ref: Level 2)0.5600.1483.800.0011.7511.311–2.339
Level 4 (Ref: Level 2)0.3370.1662.030.0421.4011.012–1.940
Level 5 (Ref: Level 2)0.5230.1782.940.0031.6861.190–2.389
Sexual Violence
1 time (Ref: 0 times)0.3530.2001.760.0781.4230.961–2.107
2–3 times (Ref: 0 times)0.7750.2033.810.0012.1701.457–3.231
4–5 times (Ref: 0 times)0.7090.3741.900.0582.0330.977–4.231
5+ times (Ref: 0 times)1.1230.3383.330.0013.0751.587–5.958
Mental Health and Victimization
Depressive Symptoms (Yes vs. No)2.0160.14813.630.0017.5085.619–10.032
Forced Sexual Intercourse (Yes vs. No)0.4330.1502.880.0041.5421.149–2.070
Health and Sleep Factors
Difficulty Concentrating Due to Poor Health (Yes vs. No)0.9580.1377.010.0012.6071.994–3.409
Sleeping 4 or Fewer Hours (Ref: 8 h)0.3960.2321.710.0871.4860.944–2.340
Sleeping 10 or More Hours (Ref: 8 h)0.7820.4731.650.0992.1860.864–5.529
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Nikolova, S.; Small, E.; Sesay, B. Suicidal Ideation in U.S. Adolescents Exposed to Neighborhood Violence. Adolescents 2025, 5, 31. https://doi.org/10.3390/adolescents5030031

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Nikolova S, Small E, Sesay B. Suicidal Ideation in U.S. Adolescents Exposed to Neighborhood Violence. Adolescents. 2025; 5(3):31. https://doi.org/10.3390/adolescents5030031

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Nikolova, Silviya, Eusebius Small, and Benjamin Sesay. 2025. "Suicidal Ideation in U.S. Adolescents Exposed to Neighborhood Violence" Adolescents 5, no. 3: 31. https://doi.org/10.3390/adolescents5030031

APA Style

Nikolova, S., Small, E., & Sesay, B. (2025). Suicidal Ideation in U.S. Adolescents Exposed to Neighborhood Violence. Adolescents, 5(3), 31. https://doi.org/10.3390/adolescents5030031

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