What Emergency Department Healthcare Providers Can Do To Prevent a Trajectory of Violence

• Olivia Rivera, Nursing, University of Delaware

• Kathleen Brewer-Smyth, , University of Delaware

Aims: Due to growing threats of suicidal females committing homicide and other violence, this
study identifies risk factors for these behaviors in order to inform evidence-based prevention
interventions.
Methods: Secondary analyses were conducted of data from private interviews and examinations
of female prison inmates.
Results: Analyses compared females who have (n = 41) and have not (n = 92) attempted suicide;
and those who committed a violent crime and/ or attempted suicide (n = 84) to those who did not
attempt suicide or commit a violent crime (n = 71).
Bivariate logistic regressions revealed that females who committed a violent crime and/ or
attempted suicide experienced greater childhood physical abuse (CPA) (OR=1.088;
95%CI=1.015-1.166), childhood sexual abuse (CSA) (OR=1.128; 95%CI=1.020-1.247), total
childhood abuse (OR=1.075; 95%CI=1.022-1.130), and greater healthcare access for abuse-
related injuries (OR=1.316; 95%CI= 1.035-1.672) compared to those who did not attempt
suicide or commit violent crimes. Abuse resulting in access to healthcare was the only significant
variable when adjusting for other associated variables. The mean number of suicide attempts of
those convicted of homicide and other violent crimes was almost 3 times greater than the others.
CSA predicted more suicide attempts per person.
Conclusions: Both childhood physical and sexual abuse are risk factors for attempting suicide
and/ or committing violent crimes. This is especially true for those with abuse-related injuries
resulting in access to healthcare. Women were released by health care providers because their
injuries were not life-threatening; yet they were life-threatening for victims of their subsequent
violent crimes including homicide. Females accessing health care for abuse-related injuries and/
or suicide attempts present a critical opportunity to prevent further violence perpetrated by
victims.