Childhood Adversities and Suicidal Ideation Among Young Adults with Serious Mental Illnesses: The Mediating Roles of Perceived Stress, Dispositional Hope, and Mental Health Hope

Background and Purpose: Rates of suicidality are high among young people and minoritized groups are disproportionately affected. Despite evidence that adverse childhood experiences (ACEs) may increase suicide-related risk, the mechanisms through which ACEs may impact suicidal ideation (SI) are not well known, especially among minoritized and low-income young adults with serious mental illnesses (SMI). This study examines whether ACEs influence SI during young adulthood, and whether they do so through mediators of perceived stress, dispositional hope, and mental health hope.

Methods: The sample includes 114 young adults diagnosed with SMI (schizophrenia spectrum, major depressive, and bipolar disorders) who participated in a larger NIMH-funded randomized trial. We used prior validated scales (e.g., Cohen’s Perceived Stress Scale, ACE-IQ) and measures unique to the study (e.g., mental health hope); all demonstrated strong psychometric properties. After exploring preliminary bivariate relationships among variables, a structural equation model (SEM) was evaluated. Analyses were conducted in Mplus using robust maximum likelihood estimation and missing data were treated using full information maximum likelihood. Sociodemographic factors (age, sex, race and ethnicity) were treated as covariates. Confidence intervals (CI) are presented in the form of margins of error (MOEs), which are the half-width of the 95% CI.

Results: The sample is 66% male and 42% identify as Black, 38% Latinx, and 19% Multiracial; the mean age was 26.7 (SD=3.9). The SEM was statistically just-identified, so indices of global fit are moot. Young adults with more ACEs reported higher perceived stress (b=0.97, MOE=0.78, p=0.01), which in turn, was associated with more frequent SI (b=0.28, MOE=0.16, p=0.001). Higher perceived stress was associated with less dispositional hope (b=-0.53, MOE=0.22, p<0.001) and mental health hope (b=-0.24, MOE=0.11, p<0.001). Although dispositional hope was negatively associated with SI on a bivariate level (r=-0.28, p<0.01), neither dispositional nor mental health hope were significantly associated with SI in the SEM. Additionally, we found no two-way interactions between (1) ACEs and hope (dispositional or mental health hope) and (2) perceived stress and hope in relation to SI. This suggests that over and above perceived stress, dispositional hope may not have a significant protective effect against SI.

Conclusions and Implications: Young adults with more ACEs reported increased perceived stress, which in turn, was associated with more SI. This suggests that the association between ACEs and SI may be explained by the mechanism of higher perceived stress, further advancing a ‘science of how.’ This is consistent with facets of the ‘Stress-Sensitization’ framework (McLaughlin et al., 2010), which posits that exposure to ACEs may increase negative responses to subsequent life stressors and impact one’s capacity to cope with stress, heightening the risk of SI. Thus, addressing stress-related processes may be one important target for suicide prevention efforts in the context of ACEs. Policy interventions focused on changing environments that are stress and trauma-inducing are needed to reduce the occurrence of ACEs and their negative sequelae. This involves confronting structural racism and poverty as mechanisms that produce and exacerbate adverse conditions, which contribute to inequities in risk factors and resources to mitigate risk.