Background: Individual-level adverse childhood experiences (ACE) and contextual-level adversities (CA) are associated with suicide and related outcomes. Since impact of ACE may be worse in areas with CA, possibly due to inadequate community support, we examined whether associations between ACE and suicidality were moderated by CA, using several CA measures to expand our previous work.
Methods: We used baseline and 1-year follow-up Adolescent Brain Cognitive Development (ABCD) study data, collapsed into a single timepoint as ACE are from both. We included all youth with complete data for variables of interest (n=5,593). We used 22 ACE categories from previous research and 11 CA measures from geocoded residential history: Area Deprivation Index quintiles, Social Vulnerability Index quintiles (overall & 4 subdomains: household composition, race/ethnicity/language, housing/transportation, socioeconomic status), Childhood Opportunity Levels (COL; overall & 3 subdomains: education, health/environment, social/economic), and child-reported neighborhood safety. We defined suicidality as any child-reported suicidal thoughts/behaviors through 1-year follow-up. We fit 1 generalized linear mixed model for each CA measure (11 total), accounting for familial/study site variations and adjusting for demographic/socioeconomic factors, to examine associations among ACE, CA, and suicidality. We included an interaction term to investigate potential moderation of ACE-suicidality relationship by CA.
Results: In all adjusted models, ACE was positively associated with suicidality (all p?0.030). Two CA measures were associated with suicidality. Youth with more educational opportunities and perceived neighborhood safety had lower suicidality odds (all significant comparisons: p?0.032). We found no strong evidence of moderation of ACE-suicidality relationship by any CA except potentially neighborhood safety. The increase in suicidality odds with more ACE was greater in neighborhoods with highest vs. lowest perceived safety (p=0.047).
Conclusions: Among preadolescents, ACE often have stronger associations with suicidality than CA and are positively associated with suicidality regardless of most CA. Future work should further explore neighborhood safety impact and evaluate longitudinal associations and pathways between childhood adversity and suicidality. Identifying youth at high suicidality risk can inform targeted action, including comprehensive ACE prevention/intervention.