Co-occurring Physical Fighting and Suicide Attempts Among U.S. High School Students

Examining Patterns of Early Alcohol Use Initiation and Current Binge Drinking

Monica H. Swahn, PhD, MPH; Robert M. Bossarte, PhD; Jane B. Palmier, JD, MPH; Huang Yao, MA


Western J Emerg Med. 2013;14(4):341-346. 

In This Article


The prevalence of involvement in both suicide attempts and physical fighting in this study was similar to reports from earlier studies of youth and suggest that the patterns and prevalence of co-occurrence remain similar over time and across populations of youth in different settings.[8,11,30] Moreover, early alcohol use initiation, prior to age 13, was significantly associated with all levels of the outcome variable. However, the strongest associations were noted between early alcohol use initiation and co-occurring suicide attempt and physical fighting for girls (Adj. OR = 6.50). The associations between early alcohol use initiation and co-occurring suicide attempt and physical fighting and also between early alcohol use initiation and with physical fighting appeared stronger for girls than for boys. This finding is intriguing and warrants further research of potential sex differences in early alcohol use and associated outcomes.

While many of the confounders examined were statistically significant especially for co-occurring suicide attempt and physical fighting, the patterns varied greatly for suicide attempt only. In fact, the fewest statistically significant associations were observed when examining correlates of suicide attempt alone. As has been noted previously and also found in the current study, there is a robust association between reports of sadness and co-occurring suicidal and violent behaviors.[11,25,26] Consistent with earlier reports, we identified a strong association between sadness and cooccurring suicide attempt and physical fighting among both boys and girls. More importantly, while sadness was a significant correlate of all levels of the outcome, sadness had by far the strongest association with co-occurring suicide attempt and fighting. This was particularly noted among boys, where the association between sadness and co-occurring suicide attempt and physical fighting was remarkably high (Adj. OR = 20.99).

Results from previous studies have found a strong link between suicidal behavior and violent behavior. In one study of school shootings in the U.S., for example, it was noted that the majority of perpetrators exhibited suicidal ideation or suicidal behavior prior to or during the violent attack.[31] Perhaps more intriguingly, more than half of the perpetrators in these school shootings had no history of prior violence. It is clear that the link between suicidal and violent behavior is complex. Researchers have suggested that unrecognized or untreated suicidality may be highly prevalent among violent perpetrators.[10] Future research on the predictors and correlates of suicidal behaviors among violent perpetrators is recommended, as is research into the link between suicidal behavior and violence at the population level.