Adverse childhood experiences, lifestyle-related risks, and suicidal ideation and suicide attempts among Chinese college students: joint associations and exploratory network analysis
5 affiliations
- 1School of General Medicine Xi’an Medical University
- 2Shaanxi Provincial Health Industry Association Service Center
- 3Shaanxi Medical Association
- 4Department of Psychiatry, Xijing Hospital, Air Force Medical University
- 5Department of Maternal and Child Health, Xiangya School of Public Health, Central South University
Abstract
Background: Adverse childhood experiences (ACEs) are established correlates of suicidality, but their joint associations with cumulative lifestyle-related risks during emerging adulthood and the conditional connections among specific indicators remain insufficiently characterized.
Methods: A cross-sectional survey was conducted among 18,723 college students selected through multistage cluster sampling from six colleges in Shaanxi Province, China. Thirteen ACE domains were assessed using the Adverse Childhood Experiences International Questionnaire. A cumulative lifestyle-related risk score included smoking, drinking, inadequate physical activity, unhealthy body mass index, and unhealthy diet. Suicidal ideation (SI) and suicide attempt (SA) during the past 12 months were self-reported. Modified Poisson regression was used to estimate adjusted prevalence ratios ( aPRs ). Departure from additivity on the prevalence-ratio scale was evaluated using the relative excess risk due to interaction ( RERI ) and attributable proportion ( AP ). Exploratory network models were used to characterize conditional associations and cross-community connectivity.
Results: The prevalence of SI and SA was 3.3 and 1.9% during the past 12 months, respectively. Greater ACE exposure and higher cumulative lifestyle-related risk score were associated with a higher prevalence of both outcomes. Compared with participants reporting 0–3 ACEs and 0–1 lifestyle-related risk factors, those reporting ≥4 ACEs and ≥2 lifestyle-related risks had the highest adjusted prevalence ratios of SI ( aPR , 8.37; 95% CI , 5.64–11.10) and SA ( aPR , 10.30; 95% CI, 5.76–14.85). Positive departure from additivity was observed for SI ( RERI , 3.35; 95% CI , 1.03–5.97; AP , 0.40; 95% CI , 0.13–0.62) and SA ( RERI , 5.18; 95% CI , 1.92–9.78; AP , 0.50; 95% CI , 0.19–0.75). In the exploratory networks, poor sleep showed high cross-community connectivity, while emotional abuse, bullying, inadequate physical activity, and drinking also showed prominent bridge expected influence.
Conclusion: Greater ACE exposure and cumulative lifestyle-related risks were separately and jointly associated with a higher prevalence of SI and SA. Participants reporting both ≥ 4 ACEs and ≥2 lifestyle-related risk profiles had the highest prevalence for SI and SA with evidence of additive interactions. The network results describe cross-sectional conditional associations and should be regarded as hypothesis-generating rather than as evidence of causal or mediating pathways.
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BibTeX
@article{wang2026adverse,
title = {{Adverse childhood experiences, lifestyle-related risks, and suicidal ideation and suicide attempts among Chinese college students: joint associations and exploratory network analysis}},
author = {Xue Wang and Lei Zhang and Zhe Wang and Xiaoxiao Yuan and Huaning Wang and Mingyang Wu and Wenhua Wang},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1978715},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1978715/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Adverse childhood experiences, lifestyle-related risks, and suicidal ideation and suicide attempts among Chinese college students: joint associations and exploratory network analysis
AU - Xue Wang
AU - Lei Zhang
AU - Zhe Wang
AU - Xiaoxiao Yuan
AU - Huaning Wang
AU - Mingyang Wu
AU - Wenhua Wang
PY - 2026
DA - 2026/10/23
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1978715
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1978715/full
AB - Background: Adverse childhood experiences (ACEs) are established correlates of suicidality, but their joint associations with cumulative lifestyle-related risks during emerging adulthood and the conditional connections among specific indicators remain insufficiently characterized. Methods: A cross-sectional survey was conducted among 18,723 college students selected through multistage cluster sampling from six colleges in Shaanxi Province, China. Thirteen ACE domains were assessed using the Adverse Childhood Experiences International Questionnaire. A cumulative lifestyle-related risk score included smoking, drinking, inadequate physical activity, unhealthy body mass index, and unhealthy diet. Suicidal ideation (SI) and suicide attempt (SA) during the past 12 months were self-reported. Modified Poisson regression was used to estimate adjusted prevalence ratios ( aPRs ). Departure from additivity on the prevalence-ratio scale was evaluated using the relative excess risk due to interaction ( RERI ) and attributable proportion ( AP ). Exploratory network models were used to characterize conditional associations and cross-community connectivity. Results: The prevalence of SI and SA was 3.3 and 1.9% during the past 12 months, respectively. Greater ACE exposure and higher cumulative lifestyle-related risk score were associated with a higher prevalence of both outcomes. Compared with participants reporting 0–3 ACEs and 0–1 lifestyle-related risk factors, those reporting ≥4 ACEs and ≥2 lifestyle-related risks had the highest adjusted prevalence ratios of SI ( aPR , 8.37; 95% CI , 5.64–11.10) and SA ( aPR , 10.30; 95% CI, 5.76–14.85). Positive departure from additivity was observed for SI ( RERI , 3.35; 95% CI , 1.03–5.97; AP , 0.40; 95% CI , 0.13–0.62) and SA ( RERI , 5.18; 95% CI , 1.92–9.78; AP , 0.50; 95% CI , 0.19–0.75). In the exploratory networks, poor sleep showed high cross-community connectivity, while emotional abuse, bullying, inadequate physical activity, and drinking also showed prominent bridge expected influence. Conclusion: Greater ACE exposure and cumulative lifestyle-related risks were separately and jointly associated with a higher prevalence of SI and SA. Participants reporting both ≥ 4 ACEs and ≥2 lifestyle-related risk profiles had the highest prevalence for SI and SA with evidence of additive interactions. The network results describe cross-sectional conditional associations and should be regarded as hypothesis-generating rather than as evidence of causal or mediating pathways.
SN - 2296-2565
ER -