BACKGROUND

Although the association between adverse childhood experiences (ACEs) and non-suicidal self-injury (NSSI) is well established, the influence of minority stress related to sexual orientation and gender expression on the mental health burden of ACEs, as well as the role of social support in these associations, remain unclear.

OBJECTIVE

This study aimed to examine the prevalence of ACEs and NSSI, as well as their associations, considering sexual orientation, gender expression, and the role of social support.

PARTICIPANTS AND SETTING

A national survey was conducted with 84,181 adolescents from 288 high schools across China.

METHODS

Data on ACEs, sexual orientation, gender nonconformity (GNC), and NSSI (categorized as non, sub-clinical, and clinical) were collected. Weighted multinomial logistic regression models, including joint, interaction, and sex-stratified analyses, were performed.

RESULTS

Compared with their heterosexual peers, homosexual and bisexual adolescents were found to have higher odds of reporting both sub-clinical and clinical NSSI (e.g., homosexual: aOR = 2.47, 95 % CI: 2.15-2.83). Adolescents with moderate or high GNC were more likely to report both sub-clinical and clinical NSSI. Social support was negatively associated with NSSI. Joint analyses revealed that ACEs when combined with sexual orientation or gender expression, increased the risk of NSSI. Significant multiplicative interactions between ACEs and social support were observed in the association with NSSI across different sexual orientation and gender expression groups. These results were consistent across both male and female participants.

CONCLUSIONS

These findings suggest that preventing ACEs and providing social support may reduce NSSI risk, especially for non-heterosexual and gender-nonconforming adolescents.