Association between adverse childhood experiences and suicidal behavior in schizophrenia spectrum disorders: A systematic review and meta-analysis
Open accessAbstract
Assessing and managing suicide behaviors is highly relevant to individuals with schizophrenia spectrum disorders. Our study aims to assess the association between adverse childhood experiences and suicidal behaviors in individuals with schizophrenia spectrum disorders. We included observational studies comparing the probability of suicide behaviors in adults with schizophrenia spectrum disorders exposed and unexposed to adverse childhood experiences. Odds ratio estimates were obtained by pooling data using a random-effects pairwise meta-analysis. Standardized criteria were used to assess the strength of the association of the pooled estimate. We found 21 eligible studies reporting outcomes for 6257 individuals from 11 countries. The primary outcome revealed an association between any suicidal behavior and adverse childhood experiences, which resulted "highly suggestive" according to validated Umbrella Criteria. Similarly, a positive association was confirmed for suicidal ideation and suicide attempt and for any subtype of adverse childhood experience. This meta-analysis showed that exposure to adverse childhood experiences strongly increases the probability of suicide behaviors in people with schizophrenia spectrum disorders.
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ACEs are associated with an increased risk of suicidal behaviors in schizophrenia.
“a clear association has been demonstrated between ACEs and an increased risk of suicidal behaviors in schizophrenia [15].”
From Association between adverse childhood experiences and suicidal behavior in affective disorders: A systematic review and meta-analysis (2025) · cites this paper as [15]
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“The presence of childhood adversity ("AdverseExperience4") and aggression-related variables ("HxPhysicalObject," "HxPhysicalSelf") align with research linking early-life stressors and aggressive behavior to more complex illness courses 37-38 .”
Factors of suicidal behavior formation in adolescents
Berezantsev, A. Y., & Konstantinova, M. M. (2025) · Vestnik nevrologii psihiatrii i nejrohirurgii (Bulletin of Neurology Psychiatry and Neurosurgery) · doi:10.33920/med-01-2503-12
Goldstein, A., Shachar‐Lavie, I., Krispin, O., Rom, R., Gur, E., Horesh, N., & Gvion, Y. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1564384
The Role of Gut Microbiota in Suicidality: Mechanisms, Evidence, and Future Directions
Baldini, V., Gnazzo, M., Santangelo, G., Varallo, G., Ronchi, D. D., & Carotenuto, M. (2025) · Psychiatry International · doi:10.3390/psychiatryint6030084
Self-citationYang, F., Fang, J., Liu, J., Mu, G.-X., Tan, L., Ma, R., & Wang, Y. (2025) · Scientific Reports · doi:10.1038/s41598-025-20933-7
“It has undergone cross-cultural validation in samples of adolescents from mainland China and has demonstrated acceptable validity and reliability, with Kuder-Richardson 20 and Guttman split-half reliability being 0.830 and 0.750, respectively 40 .”
InfluentialAdverse childhood experiences, emotion regulation and subjective happiness among young adults
Asawa, P., Pandey, S., & Srivastava, A. (2025) · Discover Public Health · doi:10.1186/s12982-025-01126-z
“Exposure to adverse childhood experiences significantly increases the likelihood of suicidal behaviors across both affective and schizophrenia spectrum disorders, nearly doubling the risk in affected individuals [4, 5].”
Hou, H., Yu, Y., Kang, L., Wang, F., Zhang, W., Ma, S., Yang, C., Zou, H., Wang, X. Q., Luo, D., et al. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07579-5
“Consistent with previous studies, childhood emotional abuse shows a strong association with mental disorders [63, 64] and RDE [6, 65].”
Coşkun, A. B., Elmaoğlu, E., Alsaç, S. Y., Bektaş, M., & Şahiner, N. C. (2025) · Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri ve Araştırmaları Dergisi · doi:10.46413/boneyusbad.1644265
Bennett, S., Robb, K. A., Zortea, T. C., & O’Connor, R. C. (2026) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2026.108024 · Cited by 1 · see citing works
“…demonstrated in clinical populations, with meta-analytic evidence showing that adverse childhood experiences are associated with an increased risk of suicidal ideation and suicide attempts among individuals with affective disorders and schizophrenia spectrum disorders (Baldini et al., 2023, 2025).”
Adverse childhood experiences and their impact on suicidal ideation among medical students in Iran
Qezelgachi, A., Jafari, E., Goli, A. G., & Oveisi, S. (2026) · Discover Public Health · doi:10.1186/s12982-026-01589-8
Wang, Y., Liang, Q., Zhou, W., Wang, Y., Tian, S., Hu, X., Tian, J., Liu, Y., Fang, H., & Wang, W. (2026) · Behavioral and Brain Functions · doi:10.1186/s12993-026-00332-2
“These studies highlight that early-life trauma exerts a cumulative deleterious impact on mental well-being [50, 51].”
Du, Y., Wan, X., Xu, J., & Feng, H. (2026) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-026-03061-z
Sandrin, V. C., da Silva, M. R., Missano, S. D. M., Andrade, M. N., Nascimento, J. B. T., de Oliveira, G. G., Nunes, B. M., & Santana, L. V. S. (2026) · Revista Multidisciplinar do Nordeste Mineiro · doi:10.66104/hy0q2p41
Postpartum Suicidality beyond Depression: a Systematic Review of Risk Profiles and Prevention Gaps
Baldini, V., Gnazzo, M., Varallo, G., Ronchi, D. D., Carotenuto, M., & Fiorillo, A. (2026) · Current Psychiatry Reports · doi:10.1007/s11920-026-01706-z
“Intimate partner violence emerged as one of the most recurrent and potent social predictors, highlighting the critical intersection between interpersonal trauma and mental health [ 5 ].”
Self-citationGhorbannejad, F., Moghadam, N. K., & Hedayati, A. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1525688
“These may also involve the loss of meaningful relationships or struggles encountered in school or the workplace (7, 8).”
Agudelo‐Hernández, F., & Cadavid-Jimenez, S. (2026) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2026.108316
Ashworth, E., Alatrany, S. S. J., George, A., Flaiyah, A. M., ALdrraji, . A. S., Alatrany, A. S., Aldhaibani, O. A., Jaafar, T. N., Nadeem, S., & Saini, P. (2026) · Adolescents · doi:10.3390/adolescents6050087
Anghel, C. E., Bacila, C. I., Vintilă, B. I., Cornea, M., Grama, A. M., Lomnășan, A., Roman-Filip, I., Ștef, L., Ioana, B. (. C., & Roman-Filip, C. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15197628
“Beyond its psychiatric manifestations, schizophrenia is associated with increased premature mortality [5,10,11], a heightened risk of suicide [5,11–14], a substantial burden of somatic comorbidities [5,15,16], and considerable socioeconomic costs [17,18].”
- Authors
- Baldini, V., Stefano, R. D., Rindi, L. V., Ahmed, A. O., Koola, M. M., Solmi, M., Papola, D., De Ronchi, D., Barbui, C., & Ostuzzi, G.
- Affiliations
- University of Modena and Reggio Emilia (IT)
- University of L'Aquila (IT)
- University of Rome Tor Vergata (IT)
- Weill Cornell Medicine (US)
- Cooper Medical School of Rowan University (US)
- University of Ottawa (CA)
- University of Verona (IT)
- Corresponding author
- Baldini, Valentina
- ORCID
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2023-11
- Volume
- 329
- Pages
- 115488
- ISSN
- 0165-1781 (ISSN-L)
- OpenAlex
- W4386840287
- Cited by
- 46
- References
- 61
- Citations by year
- 2026: 16 · 2025: 24 · 2024: 6
- FWCI
- 2.35
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Psychiatry Research (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion, cc-by-sa)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by-nc-nd)
- Funders
- University of Belgrade
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- adverse childhood experiences, suicidal behavior, schizophrenia spectrum disorders, suicidal ideation, suicide attempts, childhood trauma, suicide risk
- MeSH terms
- Adverse Childhood Experiences, Adult, Humans, Probability, Schizophrenia, Suicide, Attempted, Suicidal Ideation
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