Trajectories to Suicide Following Intimate Partner Violence Victimization: Using Structural Equation Modelling to Examine Suicide and PTSD in Female Emergency Department Users

Abstract Purpose Intimate partner violence (IPV) is known to increase the risk of suicidal thoughts and behaviors. Despite the urgent need to increase women’s safety and wellbeing, trajectories to suicide are not well understood and few studies have tested potentially important mediators, such as post-traumatic stress disorder (PTSD), that could help to improve risk stratification and clinical responses. Methods This study used baseline data from a prospective cohort study (2019–2020) to examine differential effects of psychological, physical, sexual, and multiple IPV on suicidal ideation and suicide attempt and test whether pathways are mediated by PTSD. Simple random sampling – online/in-person in Australian emergency departments (EDs) – was used to survey consenting women with a recent suicide-related ED presentation. Structural equation modelling was used to test the pathways between recent and lifetime IPV, PTSD, and suicidal ideation and attempt. Results Of the 1,715 women ( M = 30.24, SD = 11.91 years) who participated, 1,012 (59%) reported lifetime IPV exposure, with 608 (35%) reporting recent victimization (< 18 months). Presence of PTSD wholly mediated the effects of psychological, physical, and sexual IPV on ideation ( p < .05). Multiple IPV was unique in its direct effects on ideation and attempt and these pathways were most consistent for recent IPV, compared with lifetime exposure ( p < .05). Conclusions Pathway analysis identified two high-risk patient-populations: Women with recent multiple IPV and those with a diagnosis of PTSD following lifetime IPV exposure. Findings can be used to improve risk prediction and clinical intervention for patients living with mortality risk from partner- and self-directed violence.