Exploring the Role of Protective Factors In the Relationship between Early Childhood Adversity and Suicidal Behavior In Youth: A Scoping Review

Background and Purpose: Suicide is one of the leading causes of death among youths worldwide and the second-leading cause in the United States, with a steady rise among adolescents aged 10-19, resulting in more than 2,700 reported deaths annually. Consequently, several bodies of research have revealed an association between adverse childhood experiences (ACEs) and suicidal behaviors, reporting that individuals with high ACEs have a significantly higher likelihood of suicidal ideation. However, no comprehensive study synthesizes this association and identifies the most effective protective factors that buffer youth against suicide. To this end, this scoping review explores the association between ACEs, suicidal behaviors, and the role of protective factors in youth by mapping existing research, identifying key gaps, and highlighting directions for future research and practice.

Methods: This study employed the scoping review methodology developed by Arksey and O’Malley. Six databases were searched: APA PsycINFO (EBSCOhost), CINAHL (EBSCOhost), MEDLINE (EBSCO), Academic Search Complete (EBSCOhost), Social Services Abstracts (ProQuest), and Social Work Abstracts. The study included English-language, peer-reviewed articles focusing on youth (children and adolescents aged 6-19), as well as studies that included children and young adults within the age range of 6-24. Eligible studies were required to measure all three key variables: adverse childhood experiences (ACEs), suicidal behaviors, and protective factors.

Results: The total number of articles from the database search was 2502; 7 articles were marked as ineligible, leaving 2495. 34 articles were identified after screening by two independent reviewers. Findings confirmed that exposure to adverse childhood experiences (ACEs) significantly increases the risk of suicidal ideation, attempts, or self-harming behaviors among youths, and that social support, family communication, and school/family connectedness emerged as protective factors that either mediated or moderated these relationships. However, resilience, supportive relationships (family/social support), and connectedness were the most consistent moderators between early childhood adversity and the suicidal pathway.

Conclusions and Implications: While the review identified several protective factors that can buffer against youth exposure to ACEs leading to suicidal behaviors, future studies should explicitly test the relative potency of different protective factors, especially in the context of chronic or dimensional ACEs, to better inform targeted intervention strategies. In addition, future studies should investigate early interventions such as home visitation, parent support groups, and family education. For policy implications, community-integrated prevention systems should invest in a secured and strong neighborhood network and resources.

Keywords: Adverse childhood experiences, Suicidal behaviors, Protective factors, Youth