Patterns of adverse childhood experiences and suicidal behaviors in adolescents: A four-province study in China

Background: : Adverse childhood experiences (ACEs) are associated with increased suicidal behaviors in adolescents and most research has been restricted to certain types of or cumulative exposure to ACEs. Few studies have examined the association between patterns of ACEs and suicidal behaviors. Objective: : To identify the contributions of type and pattern of exposure to ACEs to suicidal behaviors and their gender differences among middle school students in China. Methods: : A school-based health survey was conducted in four provinces in China between 2017 and 2018. 14 500 students aged 10?20 years completed standard questionnaires, to record details of ACEs, suicide ideation, suicide plan, and suicide attempt. Results: : Latent class analysis indicated four distinct patterns of ACEs exposure: high ACEs (6.3%), high abuse and neglect (21.4%), high neglect (45.5%), and low ACEs (26.8%). Logistic analyses showed that, compared with low ACEs, the high ACEs were more likely to report suicidal behaviors. No gender differences were found in the independent effects of ACEs type or pattern on suicidal behaviors, except for the emotional neglect associated with suicidal behaviors in girls than boys. Limitations: : The study was cross-sectional and used self-reported questionnaires. Thus, it is difficult to establish a causal relationship between patterns of ACEs and suicidal behaviors. Conclusion: : Our findings addressed the need for a comprehensive consideration of ACEs in preventive healthcare work to identify children exposed to the most problematic ACE patterns. The study provided the evidence of targeted intervention to preempt the emergence of suicide behavior in at-risk students in adolescents.