Childhood Adversity and Suicide

What Childhood Events Are Especially Problematic?

Suicidal patients often report adverse childhood events (O’Connor, 2021; Thompson & Kingree, 2022). Consequently, psychotherapists working with suicidal patients need to consider how these experiences impact their current functioning and how they contribute to their suicidality. 

Adverse childhood events could involve a wide range of serious and upsetting stressors or events, including being the victim of child abuse, witnessing violence in the household or community, having a parent who has a serious mental illness or who has been incarcerated, being the subject of bullying, or experiencing parents’ divorce. Approximately two-thirds of American adults reported experiencing at least one adverse childhood event, and 17% reported having four or more such events (Swedo et al., 2023). The risk of psychological harm increases as the number of adverse childhood events increases (Tang et al., 2025). Notably, individuals who identify with a sexual and/or gender minority status reported higher rates of adverse childhood events (Solberg, 2024). Additionally, individuals who experience adverse childhood events demonstrate an increased risk for poor physical and mental health as adults, increasing their risk for depression, substance misuse, non-suicidal self-injury, and suicidal behavior (Tang et al., 2025).

Experiencing maltreatment from a caregiver is one of the most disruptive events a child can experience. Even after controlling for other environmental conditions, child maltreatment is associated with an increased likelihood of developing psychiatric disorders and making suicide attempts (Grummitt et al., 2024). In addition to experiencing child abuse, several other factors are associated with an increased risk for suicide, including younger maternal age at birth, low parental education, low birth weight, the death of a parent in childhood (Vidal-Ribas et al., 2024), or a traumatic brain injury in childhood (Dougall et al., 2024). Some of these factors are associated with living in poverty, such as food or housing insecurity, and others are related to a minoritized status, such as discrimination or social exclusion.

Circumstances, such as the duration or context of the stressors, may exacerbate or mitigate their impact (Liu et al., 2025). The harm from adverse events is greater when children have an inconsistent or unsupportive social network. The harm is reduced when children have a supportive social network (Srivastav et al., 2022).

Why Do Adverse Childhood Events Matter?

The mechanisms by which adverse childhood events make someone vulnerable to suicide are not well understood. Nonetheless, evidence suggests that adverse experiences in early life may alter brain structure, thereby increasing difficulties with emotion regulation. The prenatal and early childhood periods are characterized by heightened plasticity and exposure to stressors, which can have consequences that last into adulthood. These stressors may alter the hypothalamic-pituitary-adrenal axis, a neuroendocrine system, and reduce its threshold for a stress response (Giotakos, 2020).

Additionally, adverse childhood events may increase the risk that an individual will develop maladaptive responses to life circumstances, such as poor executive functioning (Rogerson et al., 2023), a limited ability to regulate emotions (Wong et al., 2024), and a lack of trust in social relationships (Flechsenhar et al., 2024). These maladaptive responses may influence an individual’s dissatisfaction with their life and contribute to their desire to die.

Finally, adverse childhood events may increase an individual’s capability to kill themselves, although the research on this remains inconsistent (Serebriakova et al., 2025). According to ideation-to-actiontheories of suicide, a suicide attempt occurs when an individual has the desire to die and has also acquired the capability to kill themselves (Joiner, 2010). A person acquires the capability for suicide when they have overcome the natural urge for self-protection and the general desire to avoid harm to oneself. The capability for suicide is hypothesized to be multidetermined. It involves dispositional factors, such as one’s genetic endowment, access to lethal means to kill oneself, and life experiences that habituate an individual to pain and suffering and reduce their fear of death. These life events include experiences that provoke pain or fear, such as exposure to violence as either a victim, perpetrator, or witness (O’Connor, 2021).

How Should Psychotherapists Address Adverse Childhood Events?

Psychotherapists should ask patients about adverse childhood experiences as part of the social history component of an initial intake or clinical interview. However, psychotherapists should go beyond counting the number of stressors or traumas and instead ask about the circumstances and context of these events to better understand their impact on the patient. For example, the effect of an assault on a child may vary according to whether the assault caused temporary pain or a long-term disability, if the physical assault was a one-time event or part of abuse, and the degree of support the child received from the family and community following the assault.

Psychotherapists should be curious from the beginning about their patients’ childhood experiences. The following questions should be considered when initially starting this conversation:

• Can you describe your home life growing up?
• Did you have any experiences in childhood that were especially upsetting?
• Did you have any experiences in childhood that appear linked to the reason you are seeking therapy?
• Did any experiences in childhood appear especially important in making you the person you are today?

If patients describe salient adverse events or experiences, psychotherapists may proceed by asking open-ended questions as follows:

• How did you feel about it at the time?
• How do you feel about it now?
• How does it impact you today?
• How did it impact you in the past?
• Is it linked to behaviors that keep you from reaching your goals?
• Does it impair your relationships with your family?
• Have these experiences changed how you interact with others?

If patients report suicidal thoughts, psychotherapists should consider whether the patient has developed an acquired capability for suicide. If a patient with suicidal thoughts has an increased habituation to pain and suffering and a decreased fear of death, psychotherapists need to be especially alert to suicidal plans (i.e., time, location, means), past attempts, backup plans (i.e., plans to fall back on if the primary plan is not feasible), partial plans (i.e., plans that have not been created thoroughly), and any dormant plans (i.e., plans made in the past that are not currently considered). This information is important when developing a plan to restrict easy access to lethal means of suicide (Knapp, 2023).

The discussion of childhood events can focus on how they affect patients’ day-to-day functioning, including their ability to regulate their emotions and to develop trusting relationships with others. For example, adults who were maltreated as children were more likely to use unproductive emotional regulation strategies, like emotional suppression, and less likely to use productive emotional regulation strategies, like cognitive reappraisal (Ion et al., 2023). In addition, the experience of maltreatment may lead to a general pattern of distrust that makes it more difficult to develop close and meaningful relationships with others. This information can guide the treatment plan for suicidal patients because of some emotions or beliefs, such as a sense of entrapment (i.e., my life is intolerable and there is no way for the pain to end), perceived burdensomeness (i.e., people would be better off if I were dead), and thwarted belongingness (i.e., no important social group values me) are linked to an increased risk of suicide (O’Connor, 2021).        

Practice Pointers

Adverse childhood events may lead to the development of maladaptive responses to life circumstances, increase a patient’s capability of suicide by reducing their fear of death by habituating them to pain and suffering, contribute to ineffective emotion regulation strategies, and increase distrust of others. Psychotherapists should ask about adverse childhood events as part of their routine social history. These events increase the risk of later psychological problems, including a heightened risk of suicide. Psychotherapists should also explore the nature of the event, the circumstances in which it occurred, and the patients’ perception of how it has influenced their later lives. This information may influence how psychotherapists perceive their patients’ capability for self-harm and their approach to psychotherapy, to the extent that these events started a chain of events or a pattern of thinking that diminished the patients’ ability to fulfill their life goals.