Mediators between adverse childhood experiences and suicidality

Abstract

We investigated whether psychiatric symptomatology, impulsivity, family and social dysfunction, and alcohol use mediate the relationship between adverse childhood experiences (ACEs) and suicidality. The study population comprised 206 adolescent psychiatric inpatients and 203 age- and gender-matched adolescents from the community. ACEs and suicidality were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime version, the Life Events Checklist, and a structured background data collection sheet. Psychiatric symptomatology was measured using the Symptom Checklist -90. Impulsivity, social dysfunction, and family dysfunction were measured using the Offer Self-Image Questionnaire, and alcohol use was assessed with the Alcohol Use Disorders Identification Test. A simple mediation test and multiple mediation analyses were conducted. A positive direct effect of ACEs on suicidality was observed. Also seen was a positive indirect effect of ACEs on suicidality through psychiatric symptomatology, impulsivity, and family and social dysfunctions. Alcohol misuse did not, however, mediate the relationship between ACEs and suicidality. According to the multiple mediation analyses, psychiatric symptomatology was the most significant mediator, followed by impulsivity. Psychiatric symptoms, impulsivity, and family and social dysfunctions are factors that should be taken into consideration when assessing suicidality in adolescents.

Developmental pathways from child maltreatment to adolescent suicide-related behaviors: The internalizing and externalizing comorbidity hypothesis

“…Internalizing and externalizing behavior problems are two major developmental pathways that underlie the link between child maltreatment and suicidal ideation and behaviors in adolescence (Rytilä-Manninen et al, 2018; Wanner et al, 2012). However, to date, these two mechanisms have largely been modeled as independent processes.…”

“…Despite the robust documentation on the link between child maltreatment and suicidal ideation and behaviors, there is relatively scant knowledge on the developmental mechanisms underlying this association. Several studies have identified internalizing and externalizing psychopathology as two separate mechanisms in the association between child maltreatment and suicidal ideation and behaviors in adolescence (e.g., Miller, Adams, Esposito-Smythers, Thompson, & Proctor, 2014; Rytilä-Manninen, Haravuori, Fröjd, Marttunen, & Lindberg, 2018; Wanner, Vitaro, Tremblay, & Turecki, 2012). However, emerging research suggests that some youth exhibit both internalizing and externalizing symptoms and that these concurrent symptom elevations are stable over time (Willner, Gatzke-Kopp, & Bray, 2016).…”

Adverse adolescence experiences, feeling lonely across life stages and loneliness in adulthood

“…Traumatic experiences before age 18 have been demonstrated to have significant and profound effects on a wide range of mental health measures ( Kim et al, 2019 , Racine et al, 2018 ). For example, most previous studies have shown that early traumatic or adverse experience is strongly related to depression or psychiatric problems (e.g., suicidality) ( Merrick et al, 2017 , Rytila-Manninen et al, 2018 ). Belsky’s developmental hypothesis ( Belsky, 1993 ) provided a theoretical background for this relation and argued that the accumulation of various personal adversities throughout an individual’s life will synergistically create poor health consequences in later years.…”

The mediating role of internalizing and externalizing symptoms in the relationship between childhood trauma and suicidality among adolescents: a structural equation model

“…In fact, whether externalizing symptoms directly affect suicidality in adolescents has been a controversial issue. Some studies have reported that externalizing behaviors such as aggressive behavior and impulsivity could be a link between childhood trauma and suicidality in adolescents [ 64 – 66 ]. A previous study investigating the trajectory of high anxiety and high disruptiveness has reported that both trajectories independently affect the association between childhood trauma and suicide attempts [ 19 ].…”