Adverse Childhood Experiences and Suicidal Acts in Adolescents: A Systematic Literature Review

Abstract

Background/Objective

This study maps existing empirical evidence on the impact of Adverse Childhood Experiences (ACEs; including, in addition to experiences of violence or acts of omission and neglect directed at the child, dysfunctionality in the family environment), on suicidal acts in adolescents.

Methods

The PRISMA methodology was followed, and three databases were accessed: Medline/PubMed, Embase, and PsycInfo. The data selection process took place in stages. In the first stage, titles and abstracts of the articles resulting from the search were reviewed and, in the second stage, potentially eligible articles were analyzed in full, using the following set of eligibility criteria: scientific papers with peer review; research written in English; studies that empirically and specifically examined suicidal acts (excluding suicidal ideation and non-suicidal self- injurious behaviors); papers that specifically tested the association between ACEs and suicidal acts; research that specifically reported on adolescent populations.

Results

The final pool of analyzed articles numbered 26. Based on this review, included studies provided consistent evidence of an association between ACEs and suicide attempts. Only one study tested the association between ACEs and completed suicide. Further, sexual abuse, physical abuse, parental separation or divorce, and peer bullying were among the types of ACEs most consistently associated with suicide attempts across the reviewed studies. Several studies suggested that non-suicidal self-injurious behavior and exposure to suicidal behavior in friends or family may play a role in explaining the association between ACEs and suicide attempts. Studies examining potential buffering factors also suggested that parental support, family communication, social support, and school connectedness may attenuate this association.

Conclusions

The available evidence indicates a consistent association between ACEs and suicidal acts, particularly suicide attempts. Evidence for specific ACE subtypes, specific populations, mediators, and moderators should be interpreted more cautiously, given it is based on a fewer number of studies.