To investigate the associations of childhood adversities (CAs) with lifetime onset and transitions across suicidal thoughts and behaviors (STB) among incoming college students.
Web-based self-report surveys administered to 20,842 incoming college students from nine countries (response rate 45.6%) assessed lifetime suicidal ideation, plans and attempts along with seven CAs: parental psychopathology, three types of abuse (emotional, physical, sexual), neglect, bully victimization, and dating violence. Logistic regression estimated individual- and population-level associations using CA operationalizations for type, number, severity, and frequency.
Associations of CAs with lifetime ideation and the transition from ideation to plan were best explained by the exact number of CA types (OR range 1.32–52.30 for exactly two to seven CAs). Associations of CAs with a transition to attempts were best explained by the frequency of specific CA types (scaled 0–4). Attempts among ideators with a plan were significantly associated with all seven CAs (OR range 1.16–1.59) and associations remained significant in adjusted analyses with the frequency of sexual abuse (OR = 1.42), dating violence (OR = 1.29), physical abuse (OR = 1.17) and bully victimization (OR = 1.17). Attempts among ideators without plan were significantly associated with frequency of emotional abuse (OR = 1.29) and bully victimization (OR = 1.36), in both unadjusted and adjusted analyses. Population attributable risk simulations found 63% of ideation and 30–47% of STB transitions associated with CAs.
Early-life adversities represent a potentially important driver in explaining lifetime STB among incoming college students. Comprehensive intervention strategies that prevent or reduce the negative effects of CAs may reduce subsequent onset of STB.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
World Bank EdStats (2020) Gross enrollment ratio in tertiary education (1970–2014). https://data.worldbank.org/data-catalog/ed-stats. Accessed 25 Apr 2021
OECD (2019) Education at a Glance 2019. OECD
Mortier P, Auerbach RP, Alonso J et al (2018) Suicidal thoughts and behaviors among first-year college students: results from the WMH-ICS project. J Am Acad Child Adolesc Psychiatry 57:263-273.e1. https://doi.org/10.1016/j.jaac.2018.01.018
Mortier P, Cuijpers P, Kiekens G et al (2018) The prevalence of suicidal thoughts and behaviours among college students: a meta-analysis. Psychol Med 48:554–565. https://doi.org/10.1017/S0033291717002215
Nock MK, Borges G, Bromet EJ et al (2008) Suicide and suicidal behavior. Epidemiol Rev 30:133–154. https://doi.org/10.1093/epirev/mxn002
De Luca SM, Franklin C, Yueqi Y et al (2016) The relationship between suicide ideation, behavioral health, and college academic performance. Community Ment Health J 52:534–540. https://doi.org/10.1007/s10597-016-9987-4
Mortier P, Auerbach RP, Alonso J et al (2018) Suicidal thoughts and behaviors among college students and same-aged peers: results from the World Health Organization World Mental Health Surveys. Soc Psychiatry Psychiatr Epidemiol 53:279–288. https://doi.org/10.1007/s00127-018-1481-6
Goldman-Mellor SJ, Caspi A, Harrington H et al (2014) Suicide attempt in young people: a signal for long-term health care and social needs. JAMA Psychiat 71:119–127. https://doi.org/10.1001/jamapsychiatry.2013.2803
Angelakis I, Gillespie EL, Panagioti M (2019) Childhood maltreatment and adult suicidality: a comprehensive systematic review with meta-analysis. Psychol Med 49:1057–1078. https://doi.org/10.1017/S0033291718003823
Angelakis I, Austin JL, Gooding P (2020) Association of childhood maltreatment with suicide behaviors among young people. JAMA Netw Open 3:e2012563. https://doi.org/10.1001/jamanetworkopen.2020.12563
Hughes K, Bellis MA, Hardcastle KA et al (2017) The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health 2:e356–e366. https://doi.org/10.1016/S2468-2667(17)30118-4
Bruffaerts R, Demyttenaere K, Borges G et al (2010) Childhood adversities as risk factors for onset and persistence of suicidal behaviour. Br J Psychiatry 197:20–27. https://doi.org/10.1192/bjp.bp.109.074716
Lacey RE, Minnis H (2020) Practitioner review: twenty years of research with adverse childhood experience scores—advantages, disadvantages and applications to practice. J Child Psychol Psychiatry 61:116–130. https://doi.org/10.1111/jcpp.13135
de Araújo RMF, Lara DR (2016) More than words: the association of childhood emotional abuse and suicidal behavior. Eur Psychiatry 37:14–21. https://doi.org/10.1016/j.eurpsy.2016.04.002
Spokas M, Wenzel A, Brown GK, Beck AT (2012) Characteristics of individuals who make impulsive suicide attempts. J Affect Disord 136:1121–1125. https://doi.org/10.1016/j.jad.2011.10.034
Burke TA, Ammerman BA, Jacobucci R (2019) The use of machine learning in the study of suicidal and non-suicidal self-injurious thoughts and behaviors: a systematic review. J Affect Disord 245:869–884. https://doi.org/10.1016/j.jad.2018.11.073
Wiens K, Gillis J, Nicolau I, Wade TJ (2020) Capturing risk associated with childhood adversity: independent, cumulative, and multiplicative effects of physical abuse, sexual abuse, and family violence on mental disorders and suicidality. Perm J 24:1–7. https://doi.org/10.7812/TPP/19.079
Serafini G, Muzio C, Piccinini G et al (2015) Life adversities and suicidal behavior in young individuals: a systematic review. Eur Child Adolesc Psychiatry 24:1423–1446. https://doi.org/10.1007/s00787-015-0760-y
Mathews B, Pacella R, Dunne MP, et al (2020) Improving measurement of child abuse and neglect : A systematic review and analysis of national prevalence studies. PLoS One 1–22
Castellví P, Miranda-Mendizábal A, Parés-Badell O et al (2017) Exposure to violence, a risk for suicide in youths and young adults. A meta-analysis of longitudinal studies. Acta Psychiatr Scand 135:195–211. https://doi.org/10.1111/acps.12679
Van Geel M, Vedder P, Tanilon J (2014) Relationship between peer victimization, cyberbullying, and suicide in children and adolescents ameta-analysis. JAMA Pediatr 168:435–442. https://doi.org/10.1001/jamapediatrics.2013.4143
Decker MR, Wilcox HC, Holliday CN, Webster DW (2018) An integrated public health approach to interpersonal violence and suicide prevention and response. Public Health Rep 133:65S-79S. https://doi.org/10.1177/0033354918800019
Goodday SM, Shuldiner J, Bondy S, Rhodes AE (2019) Exposure to parental psychopathology and offspring’s risk of suicide-related thoughts and behaviours: a systematic review. Epidemiol Psychiatr Sci 28:179–190. https://doi.org/10.1017/S2045796017000397
Finkelhor D, Shattuck A, Turner H, Hamby S (2013) Improving the adverse childhood experiences study scale. JAMA Pediatr 167:70–75. https://doi.org/10.1001/jamapediatrics.2013.420
Nock MK, Borges G, Ono Y (2015) Suicide. Global perspectives from the WHO World Mental Health Surveys. Cambridge University Press, Cambridge
Dube SR, Anda RF, Felitti VJ et al (2001) Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span. JAMA 286:3089. https://doi.org/10.1001/jama.286.24.3089
Springe L, Pulmanis T, Velika B et al (2016) Self-reported suicide attempts and exposure to different types of violence and neglect during childhood: Findings from a young adult population survey in Latvia. Scand J Public Health 44:411–417. https://doi.org/10.1177/1403494816631394
Cuijpers P, Auerbach RP, Benjet C et al (2019) The World Health Organization world mental health international college student initiative: an overview. Int J Methods Psychiatr Res 28:e1761. https://doi.org/10.1002/mpr.1761
WHO WHO World Mental Health International College Student (WMH-ICS) Initiative Consortium (2020) Ethics approval for the WHO World Mental Health International College Student (WMH-ICS) Initiative. https://www.hcp.med.harvard.edu/wmh/ftpdir/IRB_EthicsApproval_WMH-ICS.pdf. Accessed 18 Oct 2020
Posner K, Brown GK, Stanley B et al (2011) The columbia-suicide severity rating scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry 168:1266–1277. https://doi.org/10.1176/appi.ajp.2011.10111704
Kessler RC, Üstün TB (2004) The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) composite international diagnostic interview (CIDI). Int J Methods Psychiatr Res 13:93–121. https://doi.org/10.1002/mpr.168
Felitti VJ, Anda RF, Nordenberg D et al (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. Am J Prev Med 14:245–258. https://doi.org/10.1016/S0749-3797(98)00017-8
Swearer SM, Cary PT (2003) Perceptions and attitudes toward bullying in middle school youth. J Appl Sch Psychol 19:63–79. https://doi.org/10.1300/J008v19n02_05
Allison PD (2012) Logistic regression using SAS: theory and application. SAS Institute Inc., NC
Dummy Coding. In: Encyclopedia of Research Design. SAGE Publications, Inc., 2455 Teller Road, Thousand Oaks California 91320 United States. http://methods.sagepub.com/reference/encyc-of-research-design/n123.xml Accessed 25 Apr 2021
Krysinska K, Martin G (2009) The struggle to prevent and evaluate: application of population attributable risk and preventive fraction to suicide prevention research. Suicide Life Threat Behav 39:548–557. https://doi.org/10.1521/suli.2009.39.5.548
Wang Y-R, Sun J-W, Lin P-Z et al (2019) Suicidality among young adults: unique and cumulative roles of 14 different adverse childhood experiences. Child Abuse Negl 98:104183. https://doi.org/10.1016/j.chiabu.2019.104183
Shonkoff JP, Garner AS, Siegel BS et al (2012) The lifelong effects of early childhood adversity and toxic stress. Pediatrics 129:e232–e246. https://doi.org/10.1542/peds.2011-2663
Nelson CA, Bhutta ZA, Burke Harris N et al (2020) Adversity in childhood is linked to mental and physical health throughout life. BMJ 371:m3048. https://doi.org/10.1136/bmj.m3048
Bronfenbrenner U (1979) The ecology of human development. Harvard University Press
Khan A, McCormack HC, Bolger EA et al (2015) Childhood maltreatment, depression, and suicidal ideation: critical importance of parental and peer emotional abuse during developmental sensitive periods in males and females. Front Psychiatry. https://doi.org/10.3389/fpsyt.2015.00042
Van Orden KA, Witte TK, Cukrowicz KC et al (2010) The interpersonal theory of suicide. Psychol Rev 117:575–600. https://doi.org/10.1037/a0018697
Herbert JL, Bromfield L (2019) Better together? A review of evidence for multi-disciplinary teams responding to physical and sexual child abuse. Trauma Violence Abuse 20:214–228. https://doi.org/10.1177/1524838017697268
Bunting L, Montgomery L, Mooney S et al (2019) Trauma informed child welfare systems—a rapid evidence review. Int J Environ Res Public Health 16:2365. https://doi.org/10.3390/ijerph16132365
Rivara F, Le Menestrel S (2016) Preventing bullying through science, policy, and practice. National Academies Press, Washington, D.C.
Vivolo-Kantor AM, Niolon PH, Estefan LF et al (2019) Middle school effects of the dating Matters® comprehensive teen dating violence prevention model on physical violence, bullying, and cyberbullying: a cluster-randomized controlled trial. Prev Sci. https://doi.org/10.1007/s11121-019-01071-9
Singer M, Bulled N, Ostrach B, Mendenhall E (2017) Syndemics and the biosocial conception of health. Lancet 389:941–950. https://doi.org/10.1016/S0140-6736(17)30003-X
Rod NH, Bengtsson J, Budtz-Jørgensen E et al (2020) Trajectories of childhood adversity and mortality in early adulthood: a population-based cohort study. Lancet 396:489–497. https://doi.org/10.1016/S0140-6736(20)30621-8
Cammack AL, Hogue CJ (2017) Retrospectively self-reported age of childhood abuse onset in a United States nationally representative sample. Inj Epidemiol 4:7. https://doi.org/10.1186/s40621-017-0103-1
U.S. Department of Health and Human Services (2019) Facts about bullying. https://www.stopbullying.gov/resources/facts. Accessed 18 Oct 2020
Shorey RC, Cohen JR, Lu Y et al (2017) Age of onset for physical and sexual teen dating violence perpetration: a longitudinal investigation. Prev Med (Baltim) 105:275–279. https://doi.org/10.1016/j.ypmed.2017.10.008
Baldwin JR, Reuben A, Newbury JB, Danese A (2019) Agreement between prospective and retrospective measures of childhood maltreatment. JAMA Psychiat 76:584. https://doi.org/10.1001/jamapsychiatry.2019.0097
Viguera AC, Milano N, Laurel R et al (2015) Comparison of electronic screening for suicidal risk with the patient health questionnaire item 9 and the columbia suicide severity rating scale in an outpatient psychiatric clinic. Psychosomatics 56:460–469. https://doi.org/10.1016/j.psym.2015.04.005
Amaya A, Presser S (2016) Nonresponse bias for univariate and multivariate estimates of social activities and roles. Public Opin 81:37. https://doi.org/10.1093/poq/nfw037
Angelakis I, Austin JL, Gooding P (2020) Childhood maltreatment and suicide attempts in prisoners: a systematic meta-analytic review. Psychol Med 50:1–10
Riley RD, Lambert PC, Abo-Zaid G (2010) Meta-analysis of individual participant data: rationale, conduct, and reporting. BMJ 340:c221–c221
Funding to support this project was received from the National Institute of Mental Health (NIMH) R56MH109566 (RPA), and the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or NIMH; the Belgian Fund for Scientific Research (11N0514N/11N0516N/1114717N) (PM), the King Baudouin Foundation (2014-J2140150-102905) (RB), and Eli Lilly (IIT-H6U-BX-I002) (RB, PM); BARMER, a health care insurance company, for project StudiCare (DDE); ZonMw (Netherlands Organisation for Health Research and Development; grant number 636110005) and the PFGV (PFGV; Protestants Fonds voor de Geestelijke Volksgezondheid) in support of the student survey project (PC); South African Medical Research Council (Mid-Career Scientist Programme awarded to Jason Bantjes); Consejo Nacional de Ciencia y Tecnología (CONACyT: CB-2016–01-28554) (BC); Fondo de Investigación Sanitaria, Instituto de Salud Carlos III—FEDER (PI13/00343), ISCIII (Río Hortega, CM14/00125), ISCIII (Sara Borrell, CD12/00440); European Union Regional Development Fund (ERDF) EU Sustainable Competitiveness Programme for Northern Ireland, Northern Ireland Public Health Agency (HSC R&D), and Ulster University (TB); Ministerio de Sanidad, Servicios Sociales e Igualdad, PNSD (Exp. 2015I015); DIUE Generalitat de Catalunya (2014 SGR 748), FPU (FPU15/05728) (JA). In Australia, the World Mental Health International College Student project is supported by Suicide Prevention Australia. Philippe Mortier has a Sara Borrell research contract awarded by the Instituto de Salud Carlos IIII (SCIII—CD18/00049). The World Mental Health International College Student project is carried out as part of the WHO World Mental Health (WMH) Survey Initiative. The WMH survey is supported by the National Institute of Mental Health NIMH R01MH070884, the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline, and Bristol-Myers Squibb.
Conflict of interest
Dr. Auerbach serves on the scientific advisory board for Ksana Health. Dr. Ebert reports to have received consultancy fees/served on the scientific advisory board for Sanofi, Novartis, Minddistrict, Lantern, Schoen Kliniken, and two German health insurance companies (BARMER, Techniker Krankenkasse). He is also a stakeholder in the Institute for health training online (GET.ON), which aims to implement scientific findings related to digital health interventions into routine care. Dr. Wilks receives consultation fees from Mindstrong Health and Click Therapeutics. In the past 3 years, Dr. Kessler was a consultant for Datastat, Inc., Holmusk, RallyPoint Networks, Inc., and Sage Pharmaceuticals. He has stock options in Mirah, PYM, and Roga Sciences.
Details about ethics approval for the WHO WMH‐ICS Initiative countries is available online .
Consent to participate
Informed consent was obtained before administering the web-based self-report questionnaires and after explaining study procedures in all countries.
Consent for publication
Availability of data and material
The participant data and statistical analysis plan used for this study are available upon reasonable request from the corresponding author (PM) as long as the main objective of the data sharing request is replicating the analysis and findings as reported in this paper.
The statistical code (SAS) used for this study are available upon reasonable request from the corresponding author (PM) as long as the main objective of the statistical code sharing request is replicating the analysis and findings as reported in this paper.
The members of the group "WHO WMH-ICS Collaborators" are listed in Acknowledgements section.
About this article
Cite this article
Mortier, P., Alonso, J., Auerbach, R.P. et al. Childhood adversities and suicidal thoughts and behaviors among first-year college students: results from the WMH-ICS initiative. Soc Psychiatry Psychiatr Epidemiol (2021). https://doi.org/10.1007/s00127-021-02151-4
- Childhood adversity
- Suicidal ideation
- Suicide attempt
- College students
- Multivariate models
- Population-attributable risk