Adverse childhood experiences and suicidal distress

What does the evidence tell us about the link between adverse childhood experiences (ACEs) and suicidal distress?

ACEs are defined in the literature as exposure to childhood abuse (sexual, physical and emotional), neglect (physical and emotional), and household challenges (e.g. parental incarceration, household mental illness, household substance use, parental divorce/separation, intimate partner violence) during the first 18 years of life.¹

Research has shown that ACEs, in particular childhood maltreatment are strongly linked to self-harm and suicidal distress. Within Australia, childhood experiences of maltreatment (abuse and neglect) are the leading risk factor contributing to the number of years of life lost to suicide and have been found to account for 41% of suicide attempts.² They are also shown to be closely linked to other contributors to suicidal distress such as employment problems, limited educational opportunities and financial insecurity.

ACEs can also negatively impact on the development of an individual’s stress response and coping skills, and can be linked to the development of physical, mental and behavioural health conditions.¹ All these factors can accumulate and compound over time and contribute to an increase in suicidal distress and suicide risk, particularly in the absence of protective factors.

Recent research in Australia has shown a strong link between childhood experiences of maltreatment and health risk behaviours later in life including binge drinking, smoking, cannabis dependence, obesity, self-harm and suicide. The research also found that childhood experiences of maltreatment significantly increased the odds of developing a mental disorder over a lifetime, with 48% of those who experience maltreatment developing a mental disorder later in life compared with 21% of those who have not experienced childhood maltreatment.³ The research also demonstrated that people who experience child maltreatment are 4.6 times more likely to have attempted suicide in the past 12 months.⁴

A meta-analysis published in 2024² found that 21% to 41% of common mental health conditions in Australia are caused by childhood maltreatment, with the highest attributable proportion for suicide attempts and self-harm. The study also found that child maltreatment accounted for more than 184,000 years of healthy life lost through mental ill-health in Australia.

With a growing body of evidence showing the strong link between ACEs and suicidal distress, suicide prevention efforts must urgently include cross-sector coordination to prevent ACEs and intervene following exposure to reduce the population prevalence and impact of suicidal distress.

What does this mean for policy and practice?

Addressing issues that contribute to adverse childhood experiences is essential for suicide prevention policy and practice. More than 6 in 10 Australians have experienced ACEs so addressing this number is critical in reducing suicidal distress in Australia.⁴ There are a number of effective interventions that can be implemented at an individual and family level to assist in the prevention of ACEs, however these interventions must be combined with broader strategies and initiatives that address structural and systematic determinants of ACEs in order to prevent suicidal distress self-harm and suicide.

Suicide prevention policy and practice should:

• Include suicide prevention strategies and programs that prevent exposure to ACEs. Some effective interventions to prevent childhood maltreatment include home visitation programs by trained personnel to provide support to parents, parent education programs that improve knowledge and promote warm, consistent and responsive parenting, and support for parents to address their own mental health and substance use concerns.^5,6,7
• Policies to support alleviating stress experienced by families, such as paid parental leave, affordable childcare, or income support. These strategies can better enable families to responsively attend to their children and reduce the risk of child maltreatment.^8,9
• Address ACEs in treatment and interventions for mental health concerns and suicidal distress, including screening for ACEs to refer clients to therapeutic interventions to address these in the broader context of mental health support. Ensuring primary care settings and mental health treatment services are trauma-aware is also critical. See this Practical Guide for Implementing a Trauma-Informed Approach.
• Include early distress approaches to reduce the risks of people reaching a crisis point. These approaches should utilise governments and partnerships with other agencies to develop the workforce and embed services to meet people where they live, work and connect.
• Increase understanding, both professionally and publicly, of ACEs as a significant cause of mental and physical health concerns, and the associated link to suicidal distress and suicide at the population level. This includes improving understanding among policy-makers and the public that ACEs are not inevitable and can be prevented, as well as the pathways for recovery if a child is exposed.
• Cross-sector partnerships that include strategies to strengthen economic support for families, change social norms to support parents, provide quality care/education early in life, enhance parenting skills, and intervene to lessen harm and prevent future risk.¹

Acknowledgements

This page was developed with the support of The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney.