Skip to main content

Childhood adversities and suicidal thoughts and behaviors among first-year college students: results from the WMH-ICS initiative



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.


  1. 1.

    World Bank EdStats (2020) Gross enrollment ratio in tertiary education (1970–2014). Accessed 25 Apr 2021

  2. 2.

    OECD (2019) Education at a Glance 2019. OECD

  3. 3.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    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.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Nock MK, Borges G, Bromet EJ et al (2008) Suicide and suicidal behavior. Epidemiol Rev 30:133–154.

    Article  PubMed  Google Scholar 

  6. 6.

    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.

    Article  PubMed  Google Scholar 

  7. 7.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    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.

    Article  Google Scholar 

  9. 9.

    Angelakis I, Gillespie EL, Panagioti M (2019) Childhood maltreatment and adult suicidality: a comprehensive systematic review with meta-analysis. Psychol Med 49:1057–1078.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Angelakis I, Austin JL, Gooding P (2020) Association of childhood maltreatment with suicide behaviors among young people. JAMA Netw Open 3:e2012563.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    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.

    Article  PubMed  Google Scholar 

  12. 12.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    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.

    Article  PubMed  Google Scholar 

  14. 14.

    de Araújo RMF, Lara DR (2016) More than words: the association of childhood emotional abuse and suicidal behavior. Eur Psychiatry 37:14–21.

    Article  PubMed  Google Scholar 

  15. 15.

    Spokas M, Wenzel A, Brown GK, Beck AT (2012) Characteristics of individuals who make impulsive suicide attempts. J Affect Disord 136:1121–1125.

    Article  PubMed  Google Scholar 

  16. 16.

    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.

    Article  PubMed  Google Scholar 

  17. 17.

    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.

    Article  Google Scholar 

  18. 18.

    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.

    Article  PubMed  Google Scholar 

  19. 19.

    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

  20. 20.

    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.

    Article  PubMed  Google Scholar 

  21. 21.

    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.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    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.

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Finkelhor D, Shattuck A, Turner H, Hamby S (2013) Improving the adverse childhood experiences study scale. JAMA Pediatr 167:70–75.

    Article  PubMed  Google Scholar 

  25. 25.

    Nock MK, Borges G, Ono Y (2015) Suicide. Global perspectives from the WHO World Mental Health Surveys. Cambridge University Press, Cambridge

    Google Scholar 

  26. 26.

    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.

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    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.

    Article  PubMed  Google Scholar 

  28. 28.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    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. Accessed 18 Oct 2020

  30. 30.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    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.

    Article  PubMed  Google Scholar 

  32. 32.

    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.

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    Swearer SM, Cary PT (2003) Perceptions and attitudes toward bullying in middle school youth. J Appl Sch Psychol 19:63–79.

    Article  Google Scholar 

  34. 34.

    Allison PD (2012) Logistic regression using SAS: theory and application. SAS Institute Inc., NC

    Google Scholar 

  35. 35.

    Dummy Coding. In: Encyclopedia of Research Design. SAGE Publications, Inc., 2455 Teller Road, Thousand Oaks California 91320 United States. Accessed 25 Apr 2021

  36. 36.

    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.

    Article  PubMed  Google Scholar 

  37. 37.

    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.

    Article  PubMed  Google Scholar 

  38. 38.

    Shonkoff JP, Garner AS, Siegel BS et al (2012) The lifelong effects of early childhood adversity and toxic stress. Pediatrics 129:e232–e246.

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  40. 40.

    Bronfenbrenner U (1979) The ecology of human development. Harvard University Press

    Google Scholar 

  41. 41.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Van Orden KA, Witte TK, Cukrowicz KC et al (2010) The interpersonal theory of suicide. Psychol Rev 117:575–600.

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    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.

    Article  PubMed  Google Scholar 

  44. 44.

    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.

    Article  PubMed Central  Google Scholar 

  45. 45.

    Rivara F, Le Menestrel S (2016) Preventing bullying through science, policy, and practice. National Academies Press, Washington, D.C.

    Book  Google Scholar 

  46. 46.

    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.

    Article  PubMed Central  Google Scholar 

  47. 47.

    Singer M, Bulled N, Ostrach B, Mendenhall E (2017) Syndemics and the biosocial conception of health. Lancet 389:941–950.

    Article  PubMed  Google Scholar 

  48. 48.

    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.

    Article  PubMed  Google Scholar 

  49. 49.

    Cammack AL, Hogue CJ (2017) Retrospectively self-reported age of childhood abuse onset in a United States nationally representative sample. Inj Epidemiol 4:7.

    Article  PubMed  PubMed Central  Google Scholar 

  50. 50.

    U.S. Department of Health and Human Services (2019) Facts about bullying. Accessed 18 Oct 2020

  51. 51.

    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.

    Article  Google Scholar 

  52. 52.

    Baldwin JR, Reuben A, Newbury JB, Danese A (2019) Agreement between prospective and retrospective measures of childhood maltreatment. JAMA Psychiat 76:584.

    Article  Google Scholar 

  53. 53.

    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.

    Article  PubMed  Google Scholar 

  54. 54.

    Amaya A, Presser S (2016) Nonresponse bias for univariate and multivariate estimates of social activities and roles. Public Opin 81:37.

    Article  Google Scholar 

  55. 55.

    Angelakis I, Austin JL, Gooding P (2020) Childhood maltreatment and suicide attempts in prisoners: a systematic meta-analytic review. Psychol Med 50:1–10

    Article  Google Scholar 

  56. 56.

    Riley RD, Lambert PC, Abo-Zaid G (2010) Meta-analysis of individual participant data: rationale, conduct, and reporting. BMJ 340:c221–c221

    Article  Google Scholar 

Download references


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.

Author information





All authors made substantial contributions to the conception or design of the manuscript, or the acquisition, analysis, or interpretation of data; drafted the work or revised it critically for important intellectual content; approved the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Data analysis was performed by PM, AMZ, and RCK. The first draft of the manuscript was written by PM and all authors commented on previous versions of the manuscript.

WHO WMH-ICS Collaborators. Australia: Mark Boyes, David Preece, (School of Population Health, Curtin University); Belgium: Erik Bootsma, Koen Demyttenaere (KU Leuven); Germany: Matthias Berking, Marvin Franke, Fanny Kählke (Friedrich-Alexander University Erlangen Nuremberg); Harald Baumeister, Ann-Marie Küchler (University of Ulm); Hong Kong: Siu Oi-ling, Lingnan University; Mexico: Yesica Albor, Guilherme Borges, Maria Elena Medina-Mora (Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz); Raúl Alejandro Gutierrez-García (Universidad la Salle Bajío); Ma. Socorro Durán, Gustavo Pérez Tarango, María Alicia Zavala Berbena (Universidad la Salle Bajío); Rogaciano González González, Maria Abigail Paz-Peréz (Universidad la Salle Salamanca); Alicia Edith Hermosillo de la Torre, Kalina Isela Martínez Martínez (Universidad Autonoma de Aguascalientes); Anabell Covarrubias Díaz (Universidad La Salle Noroeste); Sinead Martínez Ruiz (Universidad la Salle Pachuca); Ana María Martínez Jérez (Universidad Autonoma de Tamaulipas); Rebeca Guzmán (Universidad Autonoma del Estado de Hidalgo); Adrián Abrego Ramírez (Universidad Cuauhtémoc); Northern Ireland: Tony Bjourson, Margaret McLafferty, Elaine Murray, (Ulster University); South Africa: Christine Lochner, Janine Roos, Lian Taljaard, (MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University); Wylene Saal, (Department of Psychology, Stellenbosch University); Spain: The UNIVERSAL study Group (Universidad y Salud Mental) includes: Itxaso Alayo, Laura Ballester, Gabriela Barbaglia, Maria Jesús Blasco, Pere Castellví, Ana Isabel Cebrià, Carlos García-Forero, Andrea Miranda-Mendizábal, Oleguer Parès-Badell (Pompeu Fabra University); José Almenara, Carolina Lagares (Cadiz University), Enrique Echeburúa, Andrea Gabilondo, Álvaro Iruin (Basque Country University); María Teresa Pérez-Vázquez, José Antonio Piqueras, Victoria Soto-Sanz, Jesús Rodríguez-Marín (Miguel Hernández University); and Miquel Roca, Margarida Gili, Margarida Vives (Illes Balears University).

Corresponding author

Correspondence to Philippe Mortier.

Ethics declarations

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.

Ethics approval

Details about ethics approval for the WHO WMH‐ICS Initiative countries is available online [29].

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

Not applicable.

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.

Code availability

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.

Additional information

The members of the group "WHO WMH-ICS Collaborators" are listed in Acknowledgements section.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 22 KB)

Supplementary file2 (DOCX 93 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

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).

Download citation


  • Childhood adversity
  • Suicidal ideation
  • Suicide attempt
  • College students
  • Multivariate models
  • Population-attributable risk