The association between adverse childhood experiences (ACEs) and suicide attempts in a population-based study.
To further our understanding of the relationship between Adverse Childhood Experiences (ACEs) and suicidal behaviour, this study investigates the association between three types of ACEs and lifetime suicide attempts, while considering potential gender-specific and mediating effects.



Data were obtained from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH), a cross-sectional, population-based survey comprised of respondents aged 18 or older who provided self-reported data on past experiences of suicide attempts, as well as childhood sexual abuse (CSA), childhood physical abuse (CPA) and parental domestic violence (PDV) (n = 22 559). After testing for ACE by gender interactions, we estimated the odds of lifetime suicide attempts for each ACE and then investigated whether depression, anxiety, substance abuse and chronic pain acted as mediators of the relationship.



The odds of suicide attempts are significantly higher among those with a history of CPA (OR = 3.29; 99.9% CI 2.33-4.64), CSA (OR = 4.42; 99.9% CI 3.14-6.23) or PDV (OR = 2.52; 99.9% CI 1.69-3.76), when ACEs are mutually adjusted. There is little evidence that gender acts as a moderator; however, depression, anxiety, substance abuse and chronic pain appear to partially mediate the associations. Depression alone accounts for about a quarter of the associations with CSA and CPA.



Mental health factors and chronic pain appear only to partially mediate relationships between ACEs and lifetime suicide attempts. Future research should look at other pathways with the goal of developing multi-level interventions.
Department of Family and Community Medicine, Factor-Inwentash Faculty of Social Work, and Institute for Life Course & Aging, University of Toronto, Toronto, Canada.
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Fuller-Thomson
Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
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Baird
Student Life, Outreach and Equity Advisor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
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Dhrodia
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
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Brennenstuhl
D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D002170:Canada / Q000453:epidemiology; D002648:Child; D002649:Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D059350:Chronic Pain / Q000453:epidemiology / Q000523:psychology; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D017579:Domestic Violence / Q000523:psychology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
abuse; child sexual abuse; risk factors; suicide attempts; violence