The Impact of Adverse Childhood Experiences on Suicide Attempt, Suicidal Ideation, and Non-suicidal Self-injury: the Mediating Roles of Post-Traumatic Stress Symptoms and Psychological Distress

Date of Award

8-23-2024

Degree Type

Thesis

Degree Name

Master of Arts (MA)

Department

Marriage and Family Therapy

Advisor(s)

Deborah Coolhart

Keywords

Adverse Childhood Experiences;Non-suicidal Self-injury;Post-Traumatic Stress Symptoms;Psychological Distress;Suicidal Ideation;Suicide Attempt

Subject Categories

Psychology | Social and Behavioral Sciences

Abstract

Objective: Although a lot of prior studies have investigated the impact of adverse childhood experiences (ACEs) on self-injurious behaviors among adolescents, few studies have examined the pathways of ACEs to self-injurious behaviors in a community sample of adults. The overall purpose of this study was to investigate the effect of cumulative ACEs on current non-suicidal self-injury (NSSI), current suicidal ideation (SI), and suicide attempt (SA) history. The present study examined the mediating roles of post-traumatic stress symptoms (PTSS) and psychological distress (PD) on the association of cumulative ACEs and different self-injurious behaviors among adults by using structural equation modeling (SEM), and a bootstrap analysis was used to measure the mediation effects. Method: The study is cross-sectional and the data were collected by self-report measures in a couple and family therapy clinic that provides free individual, couple, and family therapy for the community. 1051 adults were recruited to participate. The present study used standardized measures including PTSD Checklist-Civilian Version (PCL-C), Brief Symptom Inventory (BSI-18), and a modified Behavioral Risk Factor Surveillance Systems Questionnaire to assess post-traumatic stress symptoms, psychological distress, and ACEs, respectively. Results: Of the 1051 adults who sought mental health services participated in this study 186 (17.7%) of them reported SA history, 54 (5.1%) reported current SI, and 19 (1.8%) reported current NSSI. 573 (55%) of the participants identified as female, 784 (75%) as Caucasian, and 788 (75%) as heterosexual. Additionally, 383 participants (36%) reported an annual household income greater than $70,000, and 663 participants (63%) were aged between 18 and 40 years. After controlling income, race, gender, and sexual orientation, SEM results revealed that cumulative ACEs had a direct effect on SA history and an indirect effect on current SI or current NSSI. Post-traumatic stress symptoms and psychological distress played chain-mediating roles in the relationships between cumulative ACEs and current SI or NSSI. Models that were mediated by re-experiencing had a better fit indices when compare to other post-traumatic stress symptoms. In SA history models, chain mediation aroused only when the mediating variables were re-experiences and psychological distress (β = 0.030, 95% CI [0.002, 0.063]). Simple mediating effects were not present in any of the models except that when hyperarousal mediated the association of cumulative ACEs and current SI (β = –0.159, 95% CI [–0.379, –0.060]). Conclusions: By examining the effect of ACEs on NSSI, SI, and SA, this study provides clinicians and scientists with an understanding of the functions and mechanisms of NSSI, SI, and SA. The impacts of ACEs on people can persist throughout adulthood, and have indirect impact on current NSSI and SI. Despite NSSI, SA, and SI are essentially distinct from one another, they have many commonalities.

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