Adverse Childhood Experiences and Suicidal Behaviors Among Adults in South Korea: The Mediating Role of Depressive Symptoms

Background and Purpose:

Suicide has been the leading cause of death for young adult since 2007 in South Korea. Several studies found that the accumulation of adverse childhood experiences (ACEs) increases the risk not only for depression, but also for suicide. Emerging studies suggest that multiple aspects of ACEs are interrelated. However, few studies have considered the relationship between ACEs and suicide while including depression as an intervening variable to be a risk factor for suicidal behaviors. Therefore, the objectives of this study were to (1) identify ACEs patterns and (2) to examine the direct and indirect effects of ACEs on suicidal behaviors (suicidal thoughts and suicide plans or attempts) through depressive symptoms.

Methods: The current study analyzed data from the 2012 Korean General Social Survey (KGSS). Of 1,396 samples who participated in 2012 survey, we selected 1,048 final analytic sample. The dependent variables included two suicidal behaviors: suicidal thoughts and a suicide plan or attempt. The independent variable is ACEs. This variable was identified by ten binary variables indicating each of the following adversities in early childhood: (1) physical abuse, (2) emotional abuse, (3) neglect, (4) sexual abuse, (5) parent died or got sick, (6) brothers/sisters died or injured, (7) divorce/separation, (8) victim of or witness to family violence, (9) mental illness, or (10) substance abuse. Mediating variable was depressive symptoms measured using the Korean version of Patient Health Questionnaire-9 (PHQ-9). Covariates were included to control for sociodemographic characteristics: age, gender, education, and household income. We conducted latent class analysis (LCA) to classify different patterns of ACEs. Then, we employed path analysis to examine mediating effects of depression in the relationship between ACEs and suicidal behaviors using Mplus.

Results: LCA classified three latent classes of ACEs – the “child maltreatment” class (20.86%), the “child maltreatment and family violence” class (19.17%), and the “low ACE” class (59.97%). Exposure to ACEs significantly increased depressive symptoms among adults. The “child maltreatment” class (β = 0.19, p < .001) and the “child maltreatment and family violence” class (β = 0.30, p < .001) had significantly higher depressive symptoms compared to those in the “low ACEs” class. Those who had higher depressive symptoms were more likely to experience suicidal thoughts (β = 0.45, p < .001) and plan or attempt a suicide (β = 0.23, p < .001). In turn, the findings showed significant indirect pathways from ACEs exposure to suicidal behaviors through depression. Exposure to ACEs was also significantly and directly associated with suicidal behaviors.

Discussion and Implications:

This study contributes to better understandings of the relationship between ACEs and suicidal behaviors through depression in South Korea. It is important to note that child maltreatment and family violence appear to result in worse effects on depression and suicidal behaviors.