Objective: Criminal justice involvement, substance use, and suicide pose significant public health concerns; however, the unique and synergistic effects of these experiences among high-risk individuals remain understudied. We hypothesized positive main effects for alcohol-related severity, drug-related severity, current criminal justice involvement, and thwarted belonging (TB) on suicide ideation history (SIH) and suicide attempt history (SAH) and that TB would moderate these associations.

Method: We report on cross-sectional analyses of self-report assessments completed by 824 adult residential substance use patients.

Results: Multinomial logistic regression analyses indicated that as alcohol- and drug-related severity increases, the probability of SIH and SAH increases; however, TB was only associated with a higher SIH probability. Significant two-way interactions (current criminal justice involvement*TB; alcohol-related severity*TB) indicated that (1) those high in TB with current criminal justice involvement were more likely to report a SIH than those without current criminal justice involvement; and (2) those low in TB and alcohol-related severity had the lowest SAH probability, whereas those low in TB and high in alcohol-related severity had the highest SAH probability.

Conclusion: The unique and combined effects of interpersonal and contextual risk factors may improve suicide risk conceptualization and assessment, and allow for tailored treatments for this high-risk population.

Keywords: criminal justice system; substance use; suicide attempt; suicide ideation; thwarted belonging.

© 2020 American Association of Suicidology.