Serial mediation of the association between adverse childhood experiences, suicidality and self-harm by sexual orientation discrimination and anhedonia in adolescents

Abstract

Background The rate of suicidality and non-suicidal self-injury (NSSI) among youth has been rising. Previous studies have shown adverse childhood experiences (ACEs) are risk factors for psychological issues and children exposed to ACEs are more sensitive to discrimination. This study investigates the relationship between adverse childhood experiences (ACEs) and suicidality and NSSI in adolescents, with a specific focus on the sequential mediating roles of perceived sexual orientation discrimination and anhedonia. Methods We included 11,880 children aged 9 to 10 years in the Adolescent Brain and Cognitive Development (ABCD) cohort. Data collection for one baseline and two follow-up surveys were completed from 2016 to 2018. Logistic regression and longitudinal mediation analyses were conducted to assess the association between exposures and outcomes and to investigate whether perceived discrimination and anhedonia sequentially mediate the impact of ACEs on adolescent suicidality and NSSI. Results The findings show ACEs were associated with increased risk of perceived discrimination against gay/lesbian/bisexual (OR = 1.28, 95% CI = 1.16, 1.41), and anhedonia (OR = 1.13, 95% CI = 1.06, 1.21), suicidality (OR = 1.17, 95% CI = 1.08, 1.26) and NSSI (OR = 1.14, 95% CI = 1.03, 1.26). In addition, perceived discrimination against gay/lesbian/bisexual was associated with an elevated risk of anhedonia (OR = 1.53, 95% CI = 1.02, 231), suicidality (OR = 2.22, 95% CI = 1.46, 3.35) and NSSI (OR = 2.99, 95% CI = 1.86, 4.81). Also, anhedonia was associated with an increased risk for suicidality (OR = 3.25, 95% CI = 2.54, 4.15) and NSSI (OR = 3.31, 95% CI = 2.44, 4.50). The associations between ACEs and suicidality and NSSI were sequentially mediated by perceived discrimination against gay/lesbian/bisexual and anhedonia. Conclusions Our study underscored the significant predictive roles of ACEs, perceived discrimination, and anhedonia in adolescent suicidality and NSSI. Findings may support the idea that eliminating specific discrimination and addressing anhedonia may help reduce suicidality and NSSI risk in adolescents who have experienced ACEs.