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Mental Disorders Mediate the Relationship Between Adverse Childhood Experiences and Suicidal Behavior in a High-risk Population: A Counterfactual Analysis From Jeju Island

Year: 2025

Type: article

Abstract: OBJECTIVES: Jeju Island, Korea, is characterized by a significantly higher prevalence of adverse childhood experiences (ACE, 32.4%), elevated rates of mental disorders (34.6 vs. 22.9%), and lifetime suicidal thoughts (20.6 vs. 10.7%) compared to national averages. We investigated the mediating role of mental disorders in the pathway from ACE to suicidal behavior in Jeju. METHODS: Data from the Jeju Special Self-Governing Province Mental Health Survey 2023 (n=703) were analyzed. Exposure was defined as experiencing at least one ACE from the 10-item Adverse Childhood Experience International Questionnaire. Depressive disorder, anxiety disorder, and alcohol use disorder were diagnosed using the Korean-Composite International Diagnostic Interview. Suicidal behavior was defined as experiencing suicidal ideation, planning, or attempts. A counterfactual mediation model was used to evaluate the natural direct effect and natural indirect effect (NIE) of mental disorders. RESULTS: The total effect of ACE on suicidal behavior showed a risk difference of 35.3 percntage points (%p). When considering all three mental disorders simultaneously, the NIE was 27.6%p, accounting for 78.1% of the total effect. Stratification analyses revealed stronger total effects in women and older adults, while the proportion mediated was higher in women and younger adults. CONCLUSIONS: In this ACE-prevalent population, mental disorders collectively mediated approximately three-quarters of the pathway from ACE to suicidal behavior. These findings, derived through robust counterfactual analysis, suggest that strengthening screening and management protocols for mental disorders among adults with a history of ACE may effectively prevent suicide in populations with high ACE prevalence.

Source: Journal of Preventive Medicine and Public Health

DOI: 10.3961/jpmph.25.120

Authors: Yeon Woo Oh, Dongkyu Lee, Young-Eun Jung, Sun Jae Jung

Institutions: Yonsei University, Yonsei University Health System, Jeju National University

Language: English

Topic: Suicide and Self-Harm Studies

Subfield: Clinical Psychology

Field: Psychology

Domain: Social Sciences

SDGs: Good health and well-being, Peace, justice, and strong institutions

Open Access status: gold

Estimated APC paid: $214