The Role of Adverse Childhood Experiences in the Suicidal Outcomes of Migrants With a Suicide Attempt in Spain

Abstract

Suicide rates have increased notably in Spain, particularly among the migrant population, where mortality by suicide rose by 25% between 2018 and 2021. Migrants are exposed to cumulative stressors, including socioeconomic adversity, acculturative challenges, and adverse childhood experiences (ACEs) that may heighten the risk of suicidal behavior. This study aimed to examine and compare the risk factors associated with suicide attempts among foreign-born and native-born individuals in Spain, with particular emphasis on the role of ACEs. A sample of 754 patients assessed 15 days after a suicide attempt (73.1% female; M = 40.23, SD = 15.72) from the SURVIVE study was used. Sociodemographic, clinical, and psychological variables, including ACEs, were measured using validated instruments. Group comparisons and multigroup regression analyses were conducted to explore factors associated with suicidal outcomes based on migration status. Foreign-born patients were significantly younger and more likely to report emotional abuse, physical abuse, sexual abuse, and physical neglect during childhood than native-born individuals. They also exhibited higher psychological distress and greater acquired capability for suicide. In multivariate models, different predictors of suicidal ideation and behavior emerged across groups. In multivariate models, different predictors of suicidal ideation and behavior emerged across groups. For native-born individuals, suicidal ideation intensity was associated with greater psychopathology severity, more diagnosed mental disorders, higher acquired capability, and a history of suicide attempts. For migrants, higher acquired capability, lower impulsivity, and a history of suicide attempts were associated with greater ideation intensity. Migrant populations in Spain demonstrate a different profile of suicide risk, marked by increased ACEs and psychological burden. These findings highlight the need for culturally sensitive suicide prevention strategies that incorporate early trauma screening and address structural vulnerabilities. Prevention protocols should prioritize trauma-informed care and social integration to mitigate suicide risk in this vulnerable population.