Expanding What Counts as Suicide Prevention: A Q&A With Andrea Cimino

Andrea N. Cimino, PhD, LMSW, is a social scientist at the Johns Hopkins Center for Suicide Prevention. Her work sits where suicide prevention and violence prevention meet. We asked her about her path to this work and what her research shows.

This interview has been condensed.

Q: How did you come to this work?

"I am a social science researcher and social worker by training. My work focuses on gender-based violence, fatal violence, and how systems respond to survivors, particularly people involved in the criminal legal system.

"Before becoming a researcher, my practice experience was in domestic violence and crisis response, including work in a domestic violence shelter, on a sexual assault and suicide hotline, and with a mobile crisis unit.

"My social work training pushes me to look beyond the individual and ask what is happening around a person: their relationships, environment, resources, risks, and supports. This is what I mean by expanding what counts as suicide prevention: looking not only at the moment of acute crisis, but also at the earlier conditions and contact points that shape whether people have a way to survive."

Q: What did your study Fatal Peril reveal?

Fatal Peril: Unheard Stories from the IPV-to-Prison Pipeline, a 2024 report from the Stanford Criminal Justice Center co-authored by Cimino, surveyed people incarcerated for murder or manslaughter in California's two women's prisons. Of the 625 respondents who had been in a relationship, 74.2% had experienced intimate partner violence in the year before the offense. Among those, 66.4% were in extreme danger of being killed by their partner, as measured by the Danger Assessment.

"One of the most striking findings was how often suicide appeared in respondents' narratives, not as a separate issue, but as deeply intertwined with violence, coercive control, child safety fears, and survival. Another pattern involved abusive partners threatening to kill themselves, the respondent, and/or their children — a coercive control tactic that can make the survivor feel responsible for keeping them alive, prevent the survivor from leaving, or punish them for setting boundaries.

"This matters for suicide prevention because intimate partner violence can create conditions that are deeply relevant to suicide risk: fear, shame, isolation, entrapment, hopelessness, loss of autonomy, and the belief that there is no safe way out."

Q: How does this connect to your work at the Center?

"At the Center, I am interested in using psychological autopsy methods to better understand the overlap between suicide, homicide, and violence. Psychological autopsy allows researchers to reconstruct the circumstances leading up to a death through interviews with people who knew the decedent.

"I am also interested in bystander interventions that address both suicide prevention and sexual assault prevention. Most recently, I worked in collaboration with the U.S. Air Force and the Air Force Research Laboratory on bystander intervention approaches for sexual assault prevention."

Q: What is the main takeaway?

"Suicide prevention and violence prevention are deeply connected. If we want to prevent suicide, we need to better understand the conditions that make people feel there is no way out. The more clearly we see those connections, the more opportunities we have to intervene before a crisis becomes fatal."