Key Facts:
Children who experience sustained trauma across their early lives are more likely to present with suicidal ideation or self-harm as teenagers, according to a new study led by UNSW researchers.
A recent study followed more than 73,000 NSW children from their prenatal period through to adulthood to reveal how adverse childhood experiences (ACEs) are linked to risks of teen self-harm or suicide. Those with the highest risk of self-harm or suicide in adolescence sustained cumulative ACEs throughout their early and middle childhood.
"We investigated the relationship between adverse childhood experiences and subsequent suicidal ideation and self-harm in adolescence using data from the NSW Child Development Study," says lead author Dr Oliver Watkeys, a UNSW Sydney Postdoctoral Research Fellow.
Rather than treating childhood adversity as a single experience, the researchers used data from multiple sources across key periods of child and adolescent development to map six distinct trajectories of exposure to ACEs in the general population.
"Research in this area mostly looks at single types of adverse childhood experiences. Not many studies have looked at trajectories of multiple adversities, or the accumulation of ACE exposure over time," Dr Watkeys says.
"We asked, 'are there different kinds of patterns of ACE exposure among kids in terms of how many ACEs they experience over time?' and 'how does that relate to subsequent suicidal ideation and self-harm?'"
He and the team found while most children had limited exposure to ACEs throughout their development, others experienced spikes of adversity at different stages – or, in the highest-risk group, at persistently high levels across their entire childhood, from the prenatal period through to middle childhood.
"The kids that had an accumulation of ACEs throughout both early and middle childhood faced the greatest danger," Dr Watkeys says.
"These children were more than 10 times as likely as those in the low-adversity group to experience suicidal ideation or self-harm."
What are ACEs?
The researchers found around 73% of adolescents with a record of self-harm or suicidal ideation had experienced a high level of adversity in at least one developmental stage.
The study broadened the definition of ACEs beyond traditional measures such as abuse, neglect and household dysfunction – which often reflect intergenerational, or parental, risk factors – to include the child's own adverse experiences of contact with police, involvement with child protection services, parental death, poverty and time spent in out-of-home care.
"Maternal and paternal death is obviously very traumatising for a child," Dr Watkeys says.
He says police contact emerged as one of the strongest indicators of later risk in childhood, even when it did not involve criminal conviction or incarceration.
"Contact with police could be as a victim, a witness or a person of interest," he says.
"Simply being in contact with police, for all different kinds of reasons, can be a source of distress.
"It can be an othering experience. It can make people feel like a burden. It can make them lose hope.
"And that's why it's a really important aspect to look at in the context of suicide and suicide risk."
Key signals
The study drew on linked administrative records spanning health, welfare, education, child protection and police systems, which highlights how signs of risk are spread across government agencies – often long before a young person presents to mental health services.
"The multi-agency data holds early warning signs that point towards increased risk of self-harm and suicide among the kids who experience multiple adversities," Dr Watkeys says.
He says the study's findings further echo and support calls made in the latest National Suicide Prevention Strategy for a whole of government approach, though there is still room for improvement.
"The latest strategy covers supporting people who are transitioning into and out of detention," he says. "But it doesn't really talk about children who are in contact with police generally and what can be done to help support them."
He also says suicide prevention efforts need to start earlier in life.
"This means looking at all the different touch points where kids are coming into contact with different government services and asking, 'how can we be picking these kids up and bringing them in to get the support they need?'"
Informing prevention
"While intervention at any stage is important, the earlier we can get in there the better," Dr Watkeys says.
"The kids whose outcomes weren't as bad only had high ACEs in one developmental period, which suggests that if we can do something to arrest that trajectory from being persistently high, we can alter outcomes."
He says the prenatal period also provides a key opportunity for prevention, when parents are already engaged with health services.
"We could be doing things to increase screening for parents who might have children with a higher risk of these outcomes down the track," he says. "This includes putting things in place that go beyond just looking at the child – such as offering parenting support and family-based interventions."
Co-author UNSW Professor Melissa Green is the Scientific Director of the NSW Child Development Study. She says suicide risk cannot be understood – or addressed – solely as an individual mental health issue.
"It's not just a mental health issue, it's a social issue," Prof. Green says.
"The whole family's living in adversity, not just the child," she says.
"So how can we pull the whole family out of the intergenerational cycle of adversity?
"We need a considered and coordinated prevention approach across a range of human service agencies."
