Adverse Childhood Experiences,Race/Ethnicity,and Suicidality Among Florida High School Students

Abstract

Previous studies have well-documented that adverse childhood experiences (ACEs) are associated with negative health outcomes, including suicidal thoughts and behaviors. As historically marginalized groups have long experienced poorer socio-emotional outcomes due to systemic and institutional racism, racial stress, and related factors, surprisingly little is known about how ACEs matter across racial/ethnic adolescent groups. This study aims to fill this gap by analyzing data from the 2022 Florida Youth Substance Abuse Survey (FYSAS). Utilizing logistic regression models, we investigate how ACEs influence adolescent suicidal thoughts and behaviors. Results reveal a significant link between ACEs and these outcomes, indicating that higher ACE scores correlate with increased risk of suicidal thoughts and attempts. Racial/ethnic variations in ACE effects on suicidality are observed among non-Hispanic Black and Hispanic/Latinx youth. We also find that despite generally experiencing fewer ACEs, Asian American youth were nearly 30% more likely to have suicidal thoughts than non-Hispanic White youth.

Keywords

adverse childhood experiences suicidal thoughts suicidal behaviors race/ethnicity adolescence

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References

Afifi

T. O.

Taillieu

Salmon

Davila

I. G.

Stewart-Tufescu

Fortier

Struck

Asmundson

G. J. G.

Sareen

MacMillan

H. L.

(2020). Adverse childhood experiences (ACEs), peer victimization, and substance use among adolescents. Child Abuse & Neglect, 106, Article 104504. https://doi.org/10.1016/j.chiabu.2020.104504

Alvarez

Polanco-Roman

Samuel Breslow

Molock

(2022). Structural racism and suicide prevention for ethnoracially minoritized youth: A conceptual framework and illustration across systems. American Journal of Psychiatry, 179(6), 422–433.

Anderson

K. N.

Swedo

E. A.

Trinh

Ray

C. M.

Krause

K. H.

Verlenden

J. V.

Clayton

H. B.

Villaveces

Massetti

G. M.

Niolon

P. H.

(2022). Adverse childhood experiences during the COVID-19 pandemic and associations with poor mental health and suicidal behaviors among high school students—Adolescent behaviors and experiences survey, United States, January–June 2021. Morbidity and Mortality Weekly Report, 71(41), Article 1301.

Assini-Meytin

L. C.

Fix

R. L.

Green

K. M.

Nair

Letourneau

E. J.

(2022). Adverse childhood experiences, mental health, and risk behaviors in adulthood: Exploring sex, racial, and ethnic group differences in a nationally representative sample. Journal of Child & Adolescent Trauma, 15(3), 833–845.

Barajas-Gonzalez Ayon

Brabeck

Rojas-Flores

Valdez

C. R

. (2021). An ecological expansion of the adverse childhood experiences (ACEs) framework to include threat and deprivation. Social Science & Medicine, 282(2021), 1–9.

Bernard

D. L.

Calhoun

C. D.

Banks

D. E.

Halliday

C. A.

Hughes-Halbert

Danielson

C. K.

(2021). Making the “C-ACE” for a culturally-informed adverse childhood experiences framework to understand the pervasive mental health impact of racism on Black youth. Journal of Child & Adolescent Trauma, 14, 233–247.

Bridge

J. A.

Ruch

D. A.

Sheftall

A. H.

Hahm

H. C.

O’Keefe

V. M.

Fontanella

C. A.

Brock

Campo

J. V.

Horowitz

L. M.

(2023). Youth suicide during the first year of the COVID-19 pandemic. Pediatrics, 151(3), Article e2022058375.

Centers for Disease Control and Prevention. (2015). Web-based injury statistics query and reporting system (WISQARS). http://webappa.cdc.gov/sasweb/ncipc/mortrate10_us.html

Centers for Disease Control and Prevention. (2019). Adverse childhood experiences (ACEs) prevention resource for action: A compilation of the best available evidence. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/pdf/ACEs-Prevention-Resource_508.pdf

10.

Centers for Disease Control and Prevention. (2023). Disparities in suicide. https://www.cdc.gov/suicide/facts/disparities-in-suicide.html

11.

Cheng

J. K.

Fancher

T. L.

Ratanasen

Conner

K. R.

Duberstein

P. R.

Sue

Takeuchi

(2010). Lifetime suicidal ideation and suicide attempts in Asian Americans. Asian American Journal of Psychology, 1(1), 18–30. https://doi.org/10.1037/a0018799

12.

Choi

Chang

J. E.

(2024). Suicide ideation and behavior disparities among high school students: Examining Asian and multiracial race/ethnicity groups. PLOS Mental Health, 1(2), Article e0000052. https://doi.org/10.1371/journal.pmen.0000052

13.

Clements-Nolle

Lensch

Baxa

Gay

Larson

Yang

(2018). Sexual identity, adverse childhood experiences, and suicidal behaviors. Journal of Adolescent Health, 62(2), 198–204.

14.

Cluver

Orkin

Boyes

M. E.

Sherr

(2015). Child and adolescent suicide attempts, suicidal behavior, and adverse childhood experiences in south Africa: A prospective study. Journal of Adolescent Health, 57(1), 52–59.

15.

Crouch

Probst

J. C.

Radcliff

Bennett

K. J.

McKinney

S. H.

(2019). Prevalence of adverse childhood experiences (ACEs) among US children. Child Abuse & Neglect, 92, 209–218.

16.

Curtin

S. C.

Garnett

M. F.

(2023). Suicide and homicide death rates among youth and young adults aged 10–24: United States, 2001–2021. NCHS Data Brief, no 471. National Center for Health Statistics. https://doi.org/10.15620/cdc:128423

17.

Damian

A. J.

Bryant

Gallo

J. J.

(2021). Evaluating the association of adverse childhood experiences, mood and anxiety disorders, and suicidal ideation among behavioral health patients at a large federally qualified health center. PLOS ONE, 16(7), Article e0254385.

18.

Eigel-Miller

Vaughn

L. M.

Topmiller

Semanova

Prideaux

Bouvay

Hilvert

Page

(2022). Evaluating school profiles to determine risk for teen suicide. Health Behavior and Policy Review, 9(2), 738–750.

19.

Elkins

Briggs

H. E.

Miller

K. M.

Kim

Orellana

Mowbray

(2019). Racial/ethnic differences in the impact of adverse childhood experiences on posttraumatic stress disorder in a nationally representative sample of adolescents. Child and Adolescent Social Work Journal, 36, 449–457.

20.

Fedina

Moss

Rousson

A. N.

Smith

M. E.

Bright

Herrenkohl

T. I.

DeVylder

(2023). Effects of neighborhood disconnection on psychological distress and suicide risk associated with interpersonal violence within racial groups. Journal of Child & Adolescent Trauma, 16(3), 681–697.

21.

Felitti

V. J.

Anda

R. F.

Nordenberg

Williamson

D. F.

Spitz

A. M.

Edwards

Marks

J. S.

(1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245–258.

22.

Flores

M. W.

Sharp

Carson

N. J.

Cook

B. L.

(2023). Estimates of major depressive disorder and treatment among adolescents by race and ethnicity. JAMA Pediatrics, 177(11), 1215–1223.

23.

Fox

B. H.

Perez

Cass

Baglivio

M. T.

Epps

(2015). Trauma changes everything: Examining the relationship between adverse childhood experiences and serious, violent and chronic juvenile offenders. Child Abuse & Neglect, 46, 163–173.

24.

Garnett

M. F.

Curtin

S. C

. (2024). Suicide mortality in the United States, 2002–2022. NCHS Data Brief no 509. Hyattsville, MD: National Center of Health Statistics. https://dx.doi.org/10.15620/cdc/160504

25.

Gaylor

E. M.

Krause

K. H.

Welder

L. E.

Cooper

A. C.

Ashley

Mack

K. A.

Crosby

A. E.

Trinh

Ivey-Stephenson

A. Z.

Whittle

(2023). Suicidal thoughts and behaviors among high school students—Youth risk behavior survey, united states, 2021. MMWR Supplements, 72(1), 45–54.

26.

Goldstein

Topitzes

Miller-Cribbs

Brown

R. L.

(2021). Influence of race/ethnicity and income on the link between adverse childhood experiences and child flourishing. Pediatric Research, 89(7), 1861–1869.

27.

Graham

J. W.

Olchowski

A. E.

Gilreath

T. D.

(2007). How many imputations are really needed? some practical clarifications of multiple imputation theory. Prevention Science, 8, 206–213.

28.

Grest

C. V.

Finno-Velasquez

Cederbaum

J. A.

Unger

J. B.

(2021). Adverse childhood experiences among 3 generations of latinx youth. American Journal of Preventive Medicine, 60(1), 20–28. https://doi.org/10.1016/j.amepre.2020.07.007

29.

Hamed

Bradby

Ahlberg

B. M.

Thapar-Björkert

(2022). Racism in healthcare: A scoping review. BMC Public Health, 22(1), Article 988.

30.

Han

C. S.

Oliffe

J. L.

Ogrodniczuk

J. S.

(2013). Suicide among East Asians in North America: A scoping review. Journal of Mental Health, 22(4), 361–371. https://doi.org/10.3109/09638237.2012.734651

31.

Helton

J. J.

Davis

J. P.

Lee

D. S.

Pakdaman

(2022). Expanding adverse child experiences to inequality and racial discrimination. Preventive Medicine, 157, Article 107016.

32.

Holcombe

E. A.

Jones

M. S.

Lehmann

P. S.

Meldrum

R. C.

(2023). Differential exposure to adverse childhood experiences among florida high school students: The intersection of race, ethnicity, and gender. Journal of Adolescent Health, 72(4), 553–559.

33.

Ivey-Stephenson

A. Z.

Demissie

Crosby

A. E.

Stone

D. M.

Gaylor

Wilkins

Lowry

Brown

(2020). Suicidal ideation and behaviors among high school students—Youth risk behavior survey, united states, 2019. MMWR Supplements, 69(1), 47–55.

34.

Jones

S. E.

Ethier

K. A.

Hertz

DeGue

V. D.

Thornton

Lim

Dittus

P. J.

Geda

(2022). Mental health, suicidality, and connectedness among high school students during the COVID-19 pandemic—Adolescent behaviors and experiences survey, united states, January–June 2021. MMWR Supplements, 71(3), 16–21.

35.

Jones

M. S.

Kevorkian

S. S.

Lehmann

P. S.

Chouhy

Meldrum

R. C.

(2024). Adverse childhood experiences, gender, and suicidality among Florida high school students: Examining intervening mechanisms. Child Abuse & Neglect, 153, Article 106834.

36.

Jones

M. S.

Pierce

(2021). Early exposure to adverse childhood experiences and youth delinquent behavior in fragile families. Youth & Society, 53(5), 841–867.

37.

Jones

M. S.

Shurtliff

T. M.

Gerlinger

(2022). Racial differences in the effects of early adverse childhood experiences on adolescent delinquency: The role of middle childhood mechanisms. Journal of Criminal Justice, 82, Article 101977. https://doi.org/10.1016/j.jcrimjus.2022.101977

38.

Kernan

A. R.

Jones

M. S.

Lehmann

P. S.

Meldrum

R. C.

(2023). The intersection of race, ethnicity, and gender and the prevalence of suicidal thoughts and behaviors. Preventive Medicine Reports, 36, Article 102426.

39.

Keum

B. T.

Wong

M. J.

Salim-Eissa

(2023) Gendered racial microaggressions, internalized racism, and suicidal ideation among emerging adult Asian American women. International Journal of Social Psychiatry, 69(2), 342–350. https://doi.org/10.1177/00207640221089536

40.

Kidd

Henrich

C. C.

Brookmeyer

K. A.

Davidson

King

R. A.

Shahar

(2006). The social context of adolescent suicide attempts: Interactive effects of parent, peer, and school social relations. Suicide and Life-Threatening Behavior, 36(4), 386–395.

41.

Kisch

Leino

E. V.

Silverman

M. M.

(2005). Aspects of suicidal behavior, depression, and treatment in college students: Results from the spring 2000 National College Health Assessment Survey. Suicide and Life-Threatening Behavior, 35, 3–13. https://doi.org/10.1521/suli.35.1.3.59263

42.

LaBrenz

C. A.

Panisch

L. S.

Lawson

Borcyk

A. L.

Gerlach

Tennant

P. S.

Nulu

Faulkner

. (2020). Adverse childhood experiences and outcomes among at-risk Spanish-speaking latino families. Journal of Child and Family Studies, 29, 1221–1235

43.

Lee

H. Y.

Kim

Nam

Jeong

(2020). Adverse childhood experiences and the associations with depression and anxiety in adolescents. Children and Youth Services Review, 111, Article 104850.

44.

Lee

C. S.

Wong

Y. J.

(2020). Racial/ethnic and gender differences in the antecedents of youth suicide. Cultural Diversity and Ethnic Minority Psychology, 26(4), 532–543.

45.

Lensch

Clements-Nolle

Oman

R. F.

Evans

W. P.

Yang

(2021). Adverse childhood experiences and suicidal behaviors among youth: The buffering influence of family communication and school connectedness. Journal of Adolescent Health, 68(5), 945–952.

46.

Lindsey

M. A.

Banks

Cota

C. F.

Lawrence Scott

Joe

(2018). A review of treatments for young black males experiencing depression. Research on Social Work Practice, 28(3), 320–329.

47.

Lindsey

M. A.

Sheftall

A. H.

Xiao

Joe

(2019). Trends of suicidal behaviors among high school students in the united states: 1991–2017. Pediatrics, 144(5), Article e20191187.

48.

Long

J. S.

Mustillo

S. A.

(2021). Using predictions and marginal effects to compare groups in regression models for binary outcomes. Sociological Methods & Research, 50(3), 1284–1320.

49.

Lorenzo-Luaces

Phillips

J. A.

(2014). Racial and ethnic differences in risk factors associated with suicidal behavior among young adults in the USA. Ethnicity & Health, 19(4), 458–477.

50.

Maguire-Jack

Lanier

Lombardi

(2020). Investigating racial differences in clusters of adverse childhood experiences. American Journal of Orthopsychiatry, 90(1), 106–114.

51.

McEwen

C. A.

McEwen

B. S.

(2017). Social structure, adversity, toxic stress, and intergenerational poverty: An early childhood model. Annual Review of Sociology, 43, 445–472.

52.

Nock

M. K.

Borges

Bromet

E. J.

Cha

C. B.

Kessler

R. C.

Lee

(2008). Suicide and suicidal behavior. Epidemiologic Reviews, 30(1), 133–154.

53.

D. L.

Jerman

Silvério Marques

Koita

Puewal Boparai

S. K.

Burke Harris

Bucci

(2018). Systematic review of pediatric health outcomes associated with childhood adversity. BMC Pediatrics, 18, Article 83.

54.

Paradies

Ben

Denson

Elias

Priest

Pieterse

Gupta

Kelaher

Gee

(2015). Racism as a determinant of health: A systematic review and meta-analysis. PLoS ONE, 10(9), Article e0138511.

55.

Park

S. Y.

Park

S. Y

. (2020). Immigration and Language Factors Related to Depressive Symptoms and Suicidal Ideation in Asian American Adolescents and Young Adults. Community Mental Health Journal, 56, 139–148. https://doi.org/10.1007/s10597-019-00463-z

56.

Ramirez

Harland

Frederick

Shepherd

Wong

Cavanaugh

J. E.

(2013). Listen protect connect for traumatized schoolchildren: A pilot study of psychological first aid. BMC Psychology, 1, Article 26.

57.

Rosado

J. I.

Ramirez

Montgomery

Reyes

Wang

(2021). Adverse childhood experiences and its association with emotional and behavioral problems in U.S. children of latino immigrants. Child Abuse & Neglect, 112, Article 104887. https://doi.org/10.1016/j.chiabu.2020.104887

58.

Sacks

Murphey

(2018). The prevalence of adverse childhood experiences, nationally, by state, and by race or ethnicity. [Reserach Brief]. Child Trends. https://www.childtrends.org/publications/prevalence-adverse-childhood-experiences-nationally-state-race-ethnicity

59.

Sieben

Lust

Crose

Renner

L. M.

Nguyen

R. H.

(2021). Race and sex differences in adverse childhood experiences among asian/pacific islander college students. Journal of American College Health, 69(4), 353–360.

60.

Stone

D. M.

Mack

K. A.

Qualters

(2021). Notes from the Field: Recent changes in suicide rates, by race and ethnicity and age group—United States. Morbidity and Mortality Weekly Report, 72, 160–162. https://doi.org/10.15585/mmwr.mm7206a4

61.

U.S. Census. (2024). State Population by Characteristics: 2020–2024. Retrieved December 12, 2024, from https://www.census.gov/library/stories/state-by-state/florida-population-change-between-census-decade.html

62.

Winsper

Lereya

Zanarini

Wolke

(2012). Involvement in bullying and suicide-related behavior at 11 years: A prospective birth cohort study. Journal of the American Academy of Child & Adolescent Psychiatry, 51(3), 271–282. e3.

63.

Wong

Y. J.

Brownson

Schwing

A. E.

(2011). Risk and protective factors associated with Asian American students’ suicidal ideation: A multicampus, national study. Journal of College Student Development, 52(4), 396–408. https://doi.org/10.1353/csd.2011.0057

64.

Wyatt

L. C.

Ung

Park

Kwon

S. C.

Trinh-Shevrin

(2015). Risk factors of suicide and depression among Asian American, Native Hawaiian, and Pacific Islander Youth: A systematic literature review. Journal of Health Care for the Poor and Underserved, 26(2), 191–237. https://doi.org/10.1353/hpu.2015.0059

65.

Xiao

Cerel

Mann

J. J.

(2021). Temporal trends in suicidal ideation and attempts among US adolescents by sex and race/ethnicity, 1991–2019. JAMA Network Open, 4(6), Article e2113513.

66.

Xiao

(2021). Temporal trends and disparities in suicidal behaviors by sex and sexual identity among Asian American adolescents. JAMA Network Open, 4(4), Article e214498. https://doi.org/10.1001/jamanetworkopen.2021.4498

67.

Zhang

Monnat

S. M.

(2022). Racial/ethnic differences in clusters of adverse childhood experiences and associations with adolescent mental health. SSM-Population Health, 17, Article 100997.