Internalization of Multilevel Violence Among Black People Living in Areas of Concentrated Disadvantage in Baltimore, MD, USA

Introduction This study examines longitudinal models of self‐directed violence among 584 Black people (44% female) in a community‐based sample living in areas of concentrated disadvantage. Methods I used data from the Self‐Help in Eliminating Life‐Threatening Diseases study in Baltimore City, Maryland. Multiple groups factor analyses and generalized structural equations evaluated invariance between observed female and male genders across longitudinal mediation models linking perceived neighborhood disorder to self‐directed violence ideations through witnessing and experiencing interpersonal violence. Results Greater perceived neighborhood disorder was significantly associated with witnessing violence, which correlated significantly with experiencing violence. Experiencing violence was significantly associated with greater rates of active and passive self‐directed violence ideations. The model was structurally invariant between genders, but factor loading variance on experiencing violence showed that attacks with weapons loaded significantly more among males, while rape emerged as a distinct form of violence for females. Conclusion The study supported a multilevel violence risk process. Structural violence among Black people living in areas of concentrated disadvantage becomes internalized through perceived neighborhood disorder that contributes to exposure to interpersonal violence and subsequent active and passive self‐directed violent ideations. These results highlight how community‐based approaches to multilevel violence risk as a gendered process can inform public health theory and practice.