Skip to main content
×
×
Home

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)...
Abstract
Background

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.

Aims

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.

Method

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.

Results

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).

Conclusions

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

None.

Copyright
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: taofangbiao@126.com
References
Hide All
1Hawton, K, Saunders, KE, O'Connor, RC. Self-harm and suicide in adolescents. Lancet 2012; 379: 2373–82.
2Tang, J, Li, G, Chen, B, Huang, Z, Zhang, Y, Chang, H, et al. Prevalence of and risk factors for non-suicidal self-injury in rural China: results from a nationwide survey in China. J Affect Disord 2018; 226: 188–95.
3Borowsky, IW, Ireland, M, Resnick, MD. Adolescent suicide attempts: risks and protectors. Pediatrics 2001; 107: 485–93.
4Liu, RT, Scopelliti, KM, Pittman, SK, Zamora, AS. Childhood maltreatment and non-suicidal self-injury: a systematic review and meta-analysis. Lancet Psychiatry 2018; 5: 5164.
5Miller, AB, Esposito-Smythers, C, Leichtweis, RN. Role of social support in adolescent suicidal ideation and suicide attempts. J Adolesc Health 2015; 56: 286–92.
6Wan, Y, Chen, J, Sun, Y, Tao, F. Impact of childhood abuse on the risk of non-suicidal self-injury in mainland Chinese adolescents. PLoS ONE 2015; 10: e0131239.
7Christoffersen, MN, Møhl, B, DePanfilis, D, Vammen, KS. Non-Suicidal Self-Injury—Does social support make a difference? An epidemiological investigation of a Danish national sample. Child Abuse Negl 2015; 44: 106–16.
8Felitti, VJ, Anda, RF, Nordenberg, D, Williamson, DF, Spitz, AM, Edwards, V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study. Am J Prev Med 1998; 14: 245–58.
9Rueger, SY, Malecki, CK, Demaray, MK. Relationship between multiple sources of perceived social support and psychological and academic adjustment in early adolescence: comparisons across gender. J Youth Adolesc 2010; 39: 4761.
10Hesketh, T, Xing, ZW. Abnormal sex ratios in human populations: causes and consequences. Proc Natl Acad Sci USA 2006; 103: 13271–5.
11Zheng, Y, Zheng, X. Current state and recent developments of child psychiatry in China. Child Adolesc Psychiatry Ment Health 2015; 9: 10.
12Tao, F, Hu, CL, Sun, Y, Hao, JH. The development and application of Multidimensional Sub-health Questionnaire of Adolescents (MSQA). Chin J Dis Control Prev 2008; 12: 309–14.
13Bernstein, DP, Ahluvalia, T, Pogge, D, Handelsman, L. Validity of the Childhood Trauma Questionnaire in an adolescent psychiatric population. J Am Acad Child Adolesc Psychiatry 1997; 36: 340–8.
14Zhao, X, Zhang, Y, Li, L, Zhou, Y, Li, H, Yang, S. Reliability and validity of the Chinese version of childhood trauma questionnaire. Chin J Clin Rehabil 2005; 9: 105–7.
15Ye, Y, Dai, X. Development of social support scale for university students. Chin J Clin Psychol 2008; 16: 456–8.
16Centers for Disease Control and Prevention (CDC). Adolescent and School Health: YRBSS Questionnaire 2013. CDC, 2013 (https://www.cdc.gov/healthyyouth/data/yrbs/questionnaires.htm).
17Altman, DG, Bland, JM. Interaction revisited: the difference between two estimates. BMJ 2003; 326: 219.
18Martin, J, Bureau, J-F, Yurkowski, K, Fournier, TR, Lafontaine, M-F, Cloutier, P. Family-based risk factors for non-suicidal self-injury: considering influences of maltreatment, adverse family-life experiences, and parent–child relational risk. J Adolesc 2016; 49: 170–80.
19Hadland, SE, Wood, E, Dong, H, Marshall, BD, Kerr, T, Montaner, JS, et al. Suicide attempts and childhood maltreatment among street youth: a prospective cohort study. Pediatrics 2015; 136: 440–9.
20Armiento, J, Hamza, CA, Stewart, SL, Leschied, A. Direct and indirect forms of childhood maltreatment and nonsuicidal self-injury among clinically-referred children and youth. J Affect Disord 2016; 200: 212–7.
21Johnstone, JM, Carter, JD, Luty, SE, Mulder, RT, Frampton, CM, Joyce, PR. Childhood predictors of lifetime suicide attempts and non-suicidal self-injury in depressed adults. Aust N Z J Psychiatry 2016; 50: 135–44.
22Hou, Z, Jia, H, Guo, J. A cross-sectional investigation of mental health level of 1397 middle school students. Med J Chin People's Health 2006; 18: 788–9.
23Isohookana, R, Riala, K, Hakko, H, Räsänen, P. Adverse childhood experiences and suicidal behavior of adolescent psychiatric inpatients. Eur Child Adolesc Psychiatry 2013; 22: 1322.
24Garcia, M, Montalvo, I, Creus, M, CabezasÁ, SM, Algora, MJ, et al. Sex differences in the effect of childhood trauma on the clinical expression of early psychosis. Compr Psychiatry 2016; 68: 8696.
25Baiden, P, Stewart, SL, Fallon, B. The role of adverse childhood experiences as determinants of non-suicidal self-injury among children and adolescents referred to community and inpatient mental health settings. Child Abuse Negl 2017; 69: 163–76.
26Ayub, N. Predicting suicide ideation through intrapersonal and interpersonal factors: the interplay of Big-Five personality traits and social support. Personal Ment Health 2015; 9: 308–18.
27Zhang, Y, Deng, G, Zhang, Z, Zhou, Q, Gao, X, Di, L, et al. A cross sectional study between the prevalence of chronic pain and academic pressure in adolescents in China (Shanghai). BMC Musculoskelet Disord 2015; 16: 219.
28Adrian, M, Miller, AB, McCauley, E, Vander Stoep, A. Suicidal ideation in early to middle adolescence: sex-specific trajectories and predictors. J Child Psychol Psychiatry 2016; 57: 645–53.
29Šedivy, NZ, Podlogar, T, Kerr, DC, De Leo, D. Community social support as a protective factor against suicide: a gender-specific ecological study of 75 regions of 23 European countries. Health Place 2017; 48: 40–6.
30Kaslow, NJ, Thompson, MP, Meadows, LA, Jacobs, D, Chance, S, Gibb, B, et al. Factors that mediate and moderate the link between partner abuse and suicidal behavior in African American women. J Consult Clin Psychol 1998; 66: 533.
31Kessler, RC, Berglund, P, Borges, G, Nock, M, Wang, PS. Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. JAMA 2005; 293: 2487–95.
32Zalsman, G, Hawton, K, Wasserman, D, van Heeringen, K, Arensman, E, Sarchiapone, M, et al. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry 2016; 3: 646–59.
33Ougrin, D, Tranah, T, Leigh, E, Taylor, L, Asarnow, JR. Practitioner review: self-harm in adolescents. J Child Psychol Psychiatry 2012; 53: 337–50.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Type Description Title
WORD
Supplementary materials

Wan et al. supplementary material
Wan et al. supplementary material 1

 Word (232 KB)
232 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

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)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *