Self-directed violence (SDV), defined as anything a person does intentionally that can cause injury to one's self, including death (i.e., suicide attempt, suicide ideation, non-suicidal self-injury), is a significant public health issue. A growing number of SDV prevention programs train adults and peers (termed “gatekeeper training”) to be more active bystanders– to try to help when they see someone who may be at risk for self-injury. Such programs have demonstrated positive changes in knowledge and attitudes about suicide, but have had less success in changing behaviors in real world settings. Limited impact may be due to the absence of longitudinal research on how SDV bystander actions unfold and what attitudes and barriers influence bystanders' behavior. A recent national survey of 1,031 youth and young adults conducted by this research team to inform the current proposal revealed that 83.1% have been exposed to SDV in their lifetimes. While this suggests great opportunity for interventions focused on bystanders, studies also document the mental health impact of those exposed to SDV (i.e., “bystanders”). Indeed, lifetime exposure to suicidal behavior is associated with past month trauma symptoms, suicide ideation, and thoughts of self-harm among youth. Also, we have surprisingly limited information about how these bystanders are impacted by the help they provide. In the interpersonal violence field, research suggests that the feelings of bystanders about their intervention are influenced by the way their actions were received by the other person. Given research on the contagion of SDV among young people, extending this research to SDV bystanders is critical. Further, exposure to SDV may be amplifying existing mental health disparities experienced by sexual and gender minority (SGM) populations. Youth with SGM identities experience elevated rates of suicidal behavior and associated risk factors including depression, substance use, and peer victimization because of discrimination and structural inequalities. The negative impacts of SDV exposure noted above may amplify these disparities. New and innovative approaches are clearly needed to help narrow these gaps in SDV risk and exposures among SGM and other minority populations. To address these gaps, we propose to conduct a national longitudinal study of youth, ages 13-22. Participants will be recruited via social media to facilitate a national reach and oversampling of SGM youth. Specific Aims are informed by the research team's prior work, previous research about interpersonal violence bystander behavior, and guided by the Enhanced Social Cognitive Model for SDV (ESC-SDV). Specifically, we will: 1) Recruit and survey a cohort of 5,000 adolescents and young adults to identify the pathways through which attitudinal and contextual components of the ESC-SDV predict: a) opportunity to act, b) intent to act, and c) actual bystander behavior for SDV; 2) Survey these youth two more times, 12 months apart, to identify the impact of bystander behavior on the bystanders themselves; and 3) Examine how these trends are different for important subgroups of youth.

PROJECT NARRATIVE The proposed research is highly relevant to public health because it will provide critical data on the pathways to intent to act and leverage points for influencing actual bystander behavior among those who report knowing someone at risk for self-directed violence (SDV), including how youth perceive the outcomes of their actions. Importantly, this study will also identify how exposure to SDV may be differentially impacting the helping behaviors and the impact of such behaviors over time for sexual and gender minority as well as racial/ethnic minority populations, information key to designing more helpful suicide prevention strategies. As a result, we would expect decreased morbidity from SDV, improved quality of life for SDV youth and their friends and families, and a widespread reduction in medical costs associated with SDV.