Greater exposure to adverse childhood experiences (ACEs) may increase the risk of suicide ideation (SI) in young women and increase the risk of suicide attempts (SA) in both young men and women, according to a study published in JAMA Psychiatry.

Using questions from the World Health Organization Composite International Diagnostic Interview (CIDI), the researchers assessed the lifetime and past-year SI and suicide attempts (SA) in young adults at wave 4 of the Boricua Youth Study. The longitudinal cohort study compared individuals from San Juan and Caguas, Puerto Rico, and the South Bronx, New York. The cohort included 2,004 Puerto Rican young adults (80% of the original cohort, mean age of 22.9 years (standard deviation (SD): 2.8 years), 1,109 males).

The young adults were aged 15 to 29 years at wave 4 of the study. They had participated in 3 previous annual waves that occurred a mean of at least 11 years prior that evaluated their exposure to ACES, including child maltreatment, exposure to violence, parental maladjustment, and parental loss.

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Women had statistically significantly higher rates of lifetime SA (9.5% vs. 3.6%, P =.001) and lifetime SI (16.4% vs 11.5%, P =.01) than men. Women were at lower risk of experiencing cumulative ACEs in childhood and early adolescence (odds ratio (OR), 0.73; 95% CI, 0.61-0.87), with lower risk of experiencing physical abuse (OR, 0.63; 95% CI, 0.50-0.79), neglect (OR, 0.69; 95% CI, 0.53- 0.89), and exposure to violence (OR, 0.46; 95% CI, 0.37-0.56).

When the researchers adjusted for demographics and lifetime psychiatric disorders, they found that young women but not young men with more adverse childhood experiences had higher odds of suicide ideation (lifetime; odds ratio [OR], 2.44; 95% CI, 1.54-3.87; past year: OR, 2.56; 95% CI, 1.18-5.55).

Young adults overall with at least 4, although not 2 to 3, ACEs had higher odds of lifetime SA (OR, 1.92; 95% CI, 1.15-3.18) compared with those with 0 to 1 ACE.

Young adults with high factor scores in the youth domain (OR, 1.28; 95% CI, 1.10-1.49) or parental domain (OR, 1.21; 95% CI, 1.07-1.36) had higher odds of lifetime SI. Young adults with higher factor scores in the parental but not youth domain ACEs had higher odds of lifetime SA (OR, 1.31; 95% CI, 1.10-1.57).

In 1 sensitivity analysis, researchers included the young adults with missing ACE information at waves 2 or 3 who had been excluded from the main analysis and found that those young adults were at greater risk for lifetime SA (OR, 2.32; 95% CI, 1.13- 4.75) and SI (OR, 1.74; 95% CI, 1.02-2.97), but not past-year SI (OR, 1.62; 95% CI, 0.51-5.17).

In a second sensitivity analysis, they excluded young adults who reported any SI or SA in childhood or early adolescence and found that those with 4 or more ACEs had higher odds of lifetime SA (OR, 1.92; 95% CI, 1.12-3.30) and lifetime SI (OR, 1.74; 95% CI, 1.18-2.58), although not past-year SI (OR, 1.42; 95% CI, 0.68- 2.96).

Limitations of the study included that the researchers did not examine factors for suicide-related risk that may have increased suicide-related risk more so in men.

“If these findings are replicated, practitioners working with ethnic minority youths from disadvantaged backgrounds who present with 4 or more ACEs should screen for SI and SA risk,” the study authors said. “The prevention of cumulative ACEs in childhood and early adolescence could reduce risk later in life for SA and SI, particularly among young women of ethnic minority groups living in underserved contexts.”


Polanco-Roman L, Alvarez K, Corbeil T, et al. Association of childhood adversities with suicide ideation and attempts in Puerto Rican young adults. JAMA Psychiatry. Published online May 5, 2021. doi: 10.1001/jamapsychiatry.2021.0480