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Cited by 2,296Suicide and Self-Harm StudiesChild Abuse and TraumaHomicide, Infanticide, and Child Abuse

Childhood Abuse, Household Dysfunction, and the Risk of Attempted Suicide Throughout the Life Span: Findings From the Adverse Childhood Experiences Study

Dube, Shanta R., Anda, Robert F., Felitti, Vincent J., Chapman, Daniel P., Williamson, David F., Giles, Wayne H.·2001·JAMA
DOI 10.1001/jama.286.24.3089
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Abstract

CONTEXT: Suicide is a leading cause of death in the United States, but identifying persons at risk is difficult. Thus, the US surgeon general has made suicide prevention a national priority. An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including attempted suicide among adolescents and adults. OBJECTIVE: To examine the relationship between the risk of suicide attempts and adverse childhood experiences and the number of such experiences (adverse childhood experiences [ACE] score). DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of 17 337 adult health maintenance organization members (54% female; mean [SD] age, 57 [15.3] years) who attended a primary care clinic in San Diego, Calif, within a 3-year period (1995-1997) and completed a survey about childhood abuse and household dysfunction, suicide attempts (including age at first attempt), and multiple other health-related issues. MAIN OUTCOME MEASURE: Self-reported suicide attempts, compared by number of adverse childhood experiences, including emotional, physical, and sexual abuse; household substance abuse, mental illness, and incarceration; and parental domestic violence, separation, or divorce. RESULTS: The lifetime prevalence of having at least 1 suicide attempt was 3.8%. Adverse childhood experiences in any category increased the risk of attempted suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted suicide during childhood/adolescence and adulthood (P<.001). Compared with persons with no such experiences (prevalence of attempted suicide, 1.1%), the adjusted odds ratio of ever attempting suicide among persons with 7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6-47.1). Adjustment for illicit drug use, depressed affect, and self-reported alcoholism reduced the strength of the relationship between the ACE score and suicide attempts, suggesting partial mediation of the adverse childhood experience-suicide attempt relationship by these factors. The population-attributable risk fractions for 1 or more experiences were 67%, 64%, and 80% for lifetime, adult, and childhood/adolescent suicide attempts, respectively. CONCLUSIONS: A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide throughout the life span. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship. Because estimates of the attributable risk fraction caused by these experiences were large, prevention of these experiences and the treatment of persons affected by them may lead to progress in suicide prevention.

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Authors
Dube, S. R., Anda, R. F., Felitti, V. J., Chapman, D. P., Williamson, D. F., & Giles, W. H.
Affiliations
Centers for Disease Control and Prevention (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2001-12-26
Volume
286
Issue
24
Pages
3089
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.286.24.3089
OpenAlex
W2154515843
Cited by
2,296
References
8
Citations by year
2026: 81 · 2025: 98 · 2024: 127 · 2023: 112 · 2022: 143 · 2021: 203 · 2020: 155 · 2019: 150 · 2018: 134 · 2017: 125 · 2016: 103 · 2015: 103 · 2014: 96 · 2013: 82 · 2012: 94
FWCI
35.69
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
Keywords
suicide attempts, adverse childhood experiences, ACE score, childhood abuse, household dysfunction, suicide prevention, alcoholism, illicit drug use, depressive affect, household mental illness, mediation, population attributable risk, health maintenance organization members, San Diego, United States
MeSH terms
Adolescent, Adult, Child, Child Abuse, Family Characteristics, Family Relations, Female, Humans, Male, Middle Aged, Psychology, Social, Retrospective Studies, Risk Factors, Suicide, Attempted, Domestic Violence, Substance-Related Disorders

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