Substance use and suicidal thoughts and behaviors in a pretrial diversion program: What are the roles of aggression, substance use-related problems, and depression?

Suicide is a public health issue in the U.S. criminal legal system, including pretrial diversion programs. Consistent with ideation-to-action frameworks, substance use may co-occur with conflict, reactive aggression, depression, and suicide-related outcomes. However, integrated models of these factors and suicidal behaviors remain untested in pretrial diversion samples. Using Associational Variable Analysis in a pretrial diversion sample ( N = 225), we examined indirect associations of alcohol and drug use with lifetime suicide ideation and suicide attempt history through reactive aggression, substance use-related consequences, and depressive symptoms. Fully adjusted models identified indirect associations of alcohol and drug use with suicide ideation and suicide attempt history. Although indirect associations through reactive aggression were unsupported, alcohol and drug use were associated with suicide ideation and suicide attempt history through substance use-related consequences and depressive symptoms. Findings highlight substance-related impairment and depressive symptoms as clinical correlates of suicide risk among individuals in pretrial diversion programs.