Early childhood adversity, stress, and developmental pathways of suicide risk

In the US, suicide is the second leading cause of death among youth between the ages of 10 and 24. Suicide and suicidal behavior are rare in childhood, and their prevalence increases sharply in early adolescence. While suicide ideation and attempts peak in middle-to-late adolescence, suicide rates continue to increase until late adulthood. Exposure to childhood adversities is an important suicide risk factor. Experiences of maltreatment, including sexual, physical, and emotional abuse, and neglect, are among the most frequently studied adversities in the suicide field. However, the mechanisms through which maltreatment increases suicide risk remain poorly understood. In this chapter, we first provide the prevalence rates of suicide and suicidal behavior for children, adolescents, and young adults and their distribution by suicide methods, sex, race/ethnicity, and sexual orientation. Then, we propose three frameworks that can be used to study the experiences of maltreatment and suicide risk, including the Adverse Childhood Experiences Model, the Dimensional Model of Adversity and Psychopathology, and the Interpersonal Theory of Suicide. Then, we describe several cognitive and biological factors that may serve as mechanisms that explain the association between maltreatment experiences and suicidal behavior, including epigenetics, executive functioning, stress reactivity, and emotion regulation. Finally, we focus on how timing of pubertal changes may be related to suicide risk and maltreatment, and we provide a summary of the limited literature on the menstrual cycle and its implications for suicide risk.