Can Social Support Buffer the Association between Adverse Childhood Experiences and Depressive Symptoms, Non-suicidal Self-injury, and Suicide Behaviors in Early Adulthood?

Adults with a history of adverse childhood experiences (ACE) are at increased risk for long-term mental health issues including depression and suicide behaviors. However, the relationship between ACE, perceived social support, and mental health has not been well researched among young adult college students. This study examined associations between ACE and depressive symptoms, non-suicidal self-injury (NSSI), suicide ideation (SI), and suicide attempt (SA) and the role of perceived social support in these relationships among a diverse sample of college students. Data are from students ages 18-27 who participated in the 2018 National College Health Assessment (NCHA) at a large public university in southern California (n=3,384). Multivariable regression models examined the association between accumulated ACE (range: 0-9) and the number of past-year depressive symptoms (range: 0-8) and the odds of past-year NSSI, SI, and SA. All models were adjusted for age, gender, ethnicity, and poverty status. This project also explored whether perceived social support from peers or significant others moderated the ACE-depressive symptoms, NSSI, suicide ideation, and suicide attempt associations. The average age of students was 21.7 years; 41.5% reported one or more ACE; and 72.0% of the sample was female. Approximately 5% of students reported past-year NSSI, 9% acknowledged past-year suicide ideation, and 2% lifetime suicide attempt. Results of multivariable models indicate that every additional ACE was associated with a significant increase in depressive symptoms [B=0.35 (CI: 0.29, 0.41)] and higher odds of NSSI [OR=1.28 (CI: 1.18, 1.38)], suicide ideation [OR=1.33 (CI: 1.24, 1.42)], and suicide attempt [OR=1.33 (CI: 1.17, 1.51)]. The strong association between ACE and mental health, and the strong inverse relationship between perceived social support and compromised mental health, have important implications for college and university prevention efforts. Investing in campus-wide efforts to increase perceived social support, including mentorship programs, counseling services, residence staff, and awareness campaigns, may be promising prevention approaches to reduce risk of depression and suicide behaviors, one of the leading causes of death and injury in early adulthood.