Original article
Adverse Childhood Experiences and Suicidal Behaviors Among Youth: The Buffering Influence of Family Communication and School Connectedness

https://doi.org/10.1016/j.jadohealth.2020.08.024Get rights and content

Abstract

Purpose

The main objectives of this study were to determine (1) whether family communication and school connectedness offer protection against suicidal behaviors in the presence of adverse childhood experiences (ACEs; direct protective effect) and (2) whether family communication or school connectedness buffer the association between ACEs and suicidal behaviors (interacting protective effect) on the multiplicative and additive scales.

Methods

Data were obtained from a western state's 2019 Youth Risk Behavior Survey that included 5,341 middle school and 4,980 high school participants. Generalized linear models were used to estimate whether family communication and school connectedness offered direct protection against suicidal behaviors or buffered the association between ACEs and suicidal behaviors using adjusted prevalence ratios and corresponding 95% confidence intervals.

Results

Family communication and school connectedness offered direct protection against suicidal behaviors in the presence of ACEs (a 1-unit higher score was associated with a 32%–42% lower prevalence of suicidal behaviors for middle school youth and a 27%–39% lower prevalence of suicidal behaviors for high school youth). There was evidence that family communication and school connectedness buffered the association between ACEs and suicidal behaviors on the multiplicative scale.

Conclusions

The findings provide support for the development and implementation of interventions that build family communication and school connectedness to reduce suicidal behaviors. Furthermore, screening for trauma and suicidal behaviors is warranted.

Section snippets

Objectives

Using samples of 5,341 middle school and 4,980 high school youth drawn from all schools in western state, we aimed to determine (1) whether family communication and school connectedness offer protection against suicidal behaviors in the presence of ACEs (direct protective effect) and (2) whether family communication and school connectedness buffer the association between ACEs and suicidal behaviors (interacting protective effect) on the multiplicative and additive scales.

Participants and procedures

The Youth Risk Behavior Survey (YRBS) is a national, school-based surveillance system established by the Centers for Disease Control and Prevention (CDC) in 1991 to monitor the prevalence of risk behaviors among high school youth. A small number of states also choose to conduct the YRBS in middle schools [20]. Data for the present study were obtained from a 2019 middle school and high school YRBS conducted in a western state. A strata (region)/cluster (classroom) sampling design was used to

Results

Table 1 shows the characteristics of middle school and high school participants. Just more than half of both samples were male, and the most common racial/ethnic group was Hispanic (45% middle school and 43% high school). Most students lived in urban settings, about 42% qualified for free or reduced-price lunch, and 8% of middle school students and 5% of high school students lived in a military household. Approximately 15% of middle school youth and 21% of high school youth self-reported 3+

Discussion

The main objectives of this study were to determine (1) whether family communication and school connectedness offer protection against suicidal behaviors in the presence of ACEs (direct protective effect) and (2) whether family communication and school connectedness buffer the association between ACEs and suicidal behaviors (interacting protective effect). Our findings suggest that both family communication and school connectedness had a direct protective effect on suicidal behaviors, as they

Conclusions

In summary, the findings suggest family communication and school connectedness may buffer the association between ACEs and suicidal behaviors, particularly among middle school youth. Strength-based approaches to suicide prevention that focus on the family and school setting are warranted. For example, a large randomized trial demonstrated that a school-based intervention designed to help youth deal with stress, adverse life events, and suicidal thoughts by improving coping skills and school

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    Conflicts of interest: The authors have no conflicts of interest to disclose.

    Disclaimer: The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

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