Adverse Childhood Experiences and Suicide Attempts Among Those with Mental and Substance Use Disorders

Abstract

Background and Purpose: Reducing suicide is a major public health challenge. Using data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions, we examined the associations of ten types of adverse childhood experiences (ACEs) with (1) lifetime suicide attempts and (2) number and age of attempts among U.S. adults aged 18+. Methods: Using a case-control design, we matched suicide attempters (5.14% of the full sample) with never attempters (matched sample N=3,912) on nine mental and substance use disorders, and we conducted multivariable logistic regression analyses. Results: ACE rates were higher among attempters (3.30 [SE=0.07]) than their matched controls (2.19 [SE=0.06]). Results from multivariable logistic regression analyses showed that sexual abuse and parental/other family member’s mental illness were associated with increased odds of having attempted suicide among both genders, and emotional neglect was also a factor for men. Population attributable risk fractions for sexual abuse were 25.75% for women and 8.56% for men. Sexual abuse and a higher number of ACEs were also related to repeated suicide attempts. A higher number of ACEs was associated with a younger first attempt age. Gay/bisexual orientation in men and the lack of college education in both genders were significant covariates. Conclusions and Implications: This study underscores that ACEs are significantly associated with lifetime suicide attempts even when mental and substance use disorders are controlled. It also indicates that ACEs may have affects throughout the life course, further emphasizing the need for prevention and early detection of ACEs. In particular, victims of childhood sexual abuse need interventions to prevent repeated suicidal behaviors. Accepting environments and support services may also reduce suicidal behaviors among gay/bisexual adolescents and young adults. Helping children who experience adversities do well in K-12 education and pursue higher education may also be powerful antidotes to suicidal behavior.