Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China.
Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK.
J Affect Disord. 2021 Apr 15;285:69-76. doi: 10.1016/j.jad.2021.02.045. Epub 2021 Feb 17.
Adverse childhood experiences (ACEs) are associated with increased suicidal behaviors in adolescents and most research has been restricted to certain types of or cumulative exposure to ACEs. Few studies have examined the association between patterns of ACEs and suicidal behaviors.
To identify the contributions of type and pattern of exposure to ACEs to suicidal behaviors and their gender differences among middle school students in China.
A school-based health survey was conducted in four provinces in China between 2017 and 2018. 14 500 students aged 10-20 years completed standard questionnaires, to record details of ACEs, suicide ideation, suicide plan, and suicide attempt.
Latent class analysis indicated four distinct patterns of ACEs exposure: high ACEs (6.3%), high abuse and neglect (21.4%), high neglect (45.5%), and low ACEs (26.8%). Logistic analyses showed that, compared with low ACEs, the high ACEs were more likely to report suicidal behaviors. No gender differences were found in the independent effects of ACEs type or pattern on suicidal behaviors, except for the emotional neglect associated with suicidal behaviors in girls than boys.
The study was cross-sectional and used self-reported questionnaires. Thus, it is difficult to establish a causal relationship between patterns of ACEs and suicidal behaviors.
Our findings addressed the need for a comprehensive consideration of ACEs in preventive healthcare work to identify children exposed to the most problematic ACE patterns. The study provided the evidence of targeted intervention to preempt the emergence of suicide behavior in at-risk students in adolescents.
不良童年经历（ACEs）与青少年自杀行为的增加有关，大多数研究仅限于特定类型或累积的 ACEs 暴露。很少有研究探讨 ACEs 模式与自杀行为之间的关系。
确定 ACEs 的类型和模式对中国中学生自杀行为的影响及其性别差异。
2017 年至 2018 年在中国四个省份进行了一项基于学校的健康调查。14500 名 10-20 岁的学生完成了标准问卷，记录 ACEs、自杀意念、自杀计划和自杀企图的详细信息。
潜在类别分析表明 ACEs 暴露有四种不同模式：高 ACEs（6.3%）、高虐待和忽视（21.4%）、高忽视（45.5%）和低 ACEs（26.8%）。逻辑分析表明，与低 ACEs 相比，高 ACEs 更有可能报告自杀行为。除了情感忽视与女孩自杀行为有关外，ACEs 类型或模式对自杀行为的独立影响在性别上没有差异。
该研究是横断面的，使用了自我报告的问卷。因此，很难在 ACEs 模式和自杀行为之间建立因果关系。
我们的研究结果满足了在预防保健工作中全面考虑 ACEs 的需求，以确定暴露于最具问题 ACE 模式的儿童。该研究为针对高危学生的自杀行为提供了有针对性干预的证据。
