Adverse childhood experiences and suicide attempts in rural China: Case–control study on roles of negative life events and psychological factors

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Abstract

Background: While adverse childhood experiences (ACEs) increase suicide attempt risk, the psychosocial pathways underlying this association remain uncl
Objective: To explore the potential mediating roles of negative life events (NLEs) and multiple psychological factors in the association between ACEs and suicide attempts.
Study design: A 1:1 matched case–control study.
Methods: A total of 442 participants (221 suicide attempters and 221 age- and sex-matched controls) were included from rural areas of Shandong Province, China. Information on ACEs, NLEs, and five psychological variables (resilience, impulsivity, depressive symptoms, anxiety, and loneliness) was collected via face-to-face interviews. Psychological status was identified using latent profile analysis. Conditional logistic regression and exploratory mediation analyses (simple, parallel, and serial mediation models) were used to explore the association of ACEs with suicide attempts and the potential mediating roles of NLEs and psychological factors.
Results: Individuals with ≥ 4 ACEs showed higher suicide attempt risk than those with 0–3 ACEs (odds ratio = 5.24, 95% confidence interval: 1.21–22.75). Simple mediation analyses showed that NLEs and psychological factors significantly contributed to the association between ACEs and suicide attempts, with indirect effects accounting for 19.9%–42.8% of the total effect. In parallel mediation models, resilience, impulsivity, depressive symptoms, and psychological status remained significant mediators after accounting for NLEs. Serial mediation analyses identified potential sequential pathways involving NLEs followed by multiple psychological factors.
Conclusions: ACEs were associated with suicide attempt risk, potentially through NLEs and psychological pathways. These results highlight the importance of considering stress exposure and psychological functioning, while the identified pathways require validation in longitudinal studies.

Keywords

Adverse childhood experiences / Negative life events / Psychological variables / Mediation

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