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Associations of adverse childhood experiences and social support with self-injurious behaviour and suicidality in adolescents

  • Yuhui Wan (a1), Ruoling Chen (a2), Shuangshuang Ma (a3), Danielle McFeeters (a4), Ying Sun (a5), Jiahu Hao (a6) and Fangbiao Tao (a6)...

There is little investigation on the interaction effects of adverse childhood experiences (ACEs) and social support on non-suicidal self-injury (NSSI), suicidal ideation and suicide attempt in community adolescent populations, or gender differences in these effects.


To examine the individual and interaction effects of ACEs and social support on NSSI, suicidal ideation and suicide attempt in adolescents, and explore gender differences.


A school-based health survey was conducted in three provinces in China between 2013–2014. A total of 14 820 students aged 10–20 years completed standard questionnaires, to record details of ACEs, social support, NSSI, suicidal ideation and suicide attempt.


Of included participants, 89.4% reported one or more category of ACEs. The 12-month prevalence of NSSI, suicidal ideation and suicide attempt was 26.1%, 17.5% and 4.4%, respectively; all were significantly associated with increased ACEs and lower social support. The multiple adjusted odds ratio of NSSI in low versus high social support was 2.27 (95% CI 1.85–2.67) for girls and 1.81 (95% CI 1.53–2.14) for boys, and their ratio (Ratio of two odds ratios, ROR) was 1.25 (P = 0.037). Girls with high ACEs scores (5–6) and moderate or low social support also had a higher risk of suicide attempt than boys (RORs: 2.34, 1.84 and 2.02, respectively; all P < 0.05).


ACEs and low social support are associated with increased risk of NSSI and suicidality in Chinese adolescents. Strategies to improve social support, particularly among female adolescents with a high number of ACEs, should be an integral component of targeted mental health interventions.

Declaration of interest


Corresponding author
Correspondence: Fangbiao Tao, Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Shushan District, Hefei, Anhui Province, China. Email:
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Associations of adverse childhood experiences and social support with self-injurious behaviour and suicidality in adolescents

  • Yuhui Wan (a1), Ruoling Chen (a2), Shuangshuang Ma (a3), Danielle McFeeters (a4), Ying Sun (a5), Jiahu Hao (a6) and Fangbiao Tao (a6)...
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