Understanding Bystanders for Self-Directed Violence Prevention: A Prospective National Study Highlighting Marginalized Youth and Young Adults

Self-directed violence (SDV), defined as anything a person does intentionally that can cause injury to one’s self, including death, suicide attempt, suicide ideation, and non-suicidal self-injury,1 is a significant public health issue. Project Lift Up is the only national longitudinal survey of youth and young adults designed to study expo- sure to SDV as well as pathways to engaging in bystander, or helping, behaviors for those at-risk. This study began in 2021 (NIMH 1R01MH128269)4 to examine the attitudinal and contextual components that predict SDV bystander behavior, understand the impact of bystander behavior on the bystanders themselves, and ex- amine how these trends vary for sub-groups of youth facing health disparities (i.e., sexual, gender, racial and ethnic minority youth). Project Lift Up consists of 4,890 teens and young adults, aged 13-22 years, who agreed to participate in this 3-wave longitudinal study. We have an oversample of sexual (58.8%) and gender (37.3%) minority youth, as well as a diversity in terms of race, ethnicity, income and other social and structural determi- nants of health. Data indicate almost universal exposure to SDV: 94.4% of youth report lifetime exposure to SDV and 87.4% reported their own SDV. These high rates of personal SDV in our cohort provide us with a unique opportunity to gather data about bystander/gatekeeper behavior from a different perspective, namely that of the recipient – or the person struggling with SDV. Pilot data from Project Lift Up on SDV help receipt indicates a range of feelings about and responses to those who tried to help them; feelings ranged from being thankful and appreciative to feeling ashamed, sad, scared, guilty and indifferent. Two comments that reflect the opinions of many “I appreciated it but felt as though it was futile or a waste of time” and “I always thanked them, but it never really helped, especially not in the moment.” To effectively measure SDV bystander behavior from this perspective, an in-depth survey focusing on the experiences of those who have engaged in SDV about their disclosure and the help they may have received is needed to supplement our existing survey struc- ture. To collect these data, we need to supplement data collection with the funded cohort with an additional survey that focuses on the recipient’s perspective on being helped. The survey would include items describing disclosure of one’s own SDV, ways people have tried to help them, what actions they felt were most helpful, any negative responses, stigma, and what type of help they hoped for. Specifically, this Revision will: 1a) Re- survey a cohort of 4,890 youth about disclosure of SDV, the range of help they received (if any), and their per- ceptions of that help; 1b) Examine how these trends of disclosure and help receipt for SDV are different for sexual, gender, racial, and ethnic minority youth; 2) Examine how one’s own experiences around SDV disclo- sure, help-seeking and receipt influence pathways for opportunity, intentions, attitudes and behaviors of help- ing others struggling with SDV; and 3) Explore in more depth the context of SDV disclosure, what types of help they expected, and their reactions to different forms of helping through qualitative interviews.