Suicide is the third leading cause of death for adolescents globally (World Health Organization, 2025). Having 4 or more adverse childhood experiences (ACEs) were found to predict suicidal behavior. In a recent representative sample in the U.S. 76.1% of 14- to 18-year-olds reported having experienced at least 1 ACE. Further, those who reported 2-3 ACEs were 5 times more likely to have seriously considered suicide than peers without any reported childhood adversity (Swedo et al., 2024). The buffering impact of positive childhood experiences (PCEs) or "counter-ACEs" shows promise for fostering young people's resilience and preventing problematic mental health outcomes (Bethell et al., 2019).
Over 22,000 adolescents, age 14 to 18, completed questionnaires in Florida in early 2024, via state-based stratified sampling within schools by county. Participants self-reported on depression, suicidal thoughts, plans, and attempts, with 8 school- and family-related positive childhood experiences (PCEs) items, and 10 ACEs. Emotional self-regulation and parent education were covariates in the analyses.
Binary logistic regression models with interactions were tested, explaining 28% of the variance in depression and 20 to 24% of the variance in suicidal thoughts and behaviors, respectively. ACEs and PCEs were significantly associated with suicidal thoughts (AOR=7.59 for 4+ ACEs compared to 0 ACEs, p<.000; AOR=1.88 for 0-7 PCEs vs. 9 PCEs, p<.000) and suicide attempts (AOR=7.31 for 4+ACEs vs. 0 ACEs, p<.000; AOR=2.47 for 0-7 PCEs vs. 9 PCEs, p<.000). There were significantly greater suicidality risks for: females, younger adolescents (age 13-15), and those with military parents/guardians.
Findings indicated PCEs significantly interacted with (moderated) ACEs for depression and suicidality outcomes. Protective effects included positive interactions with family and teachers and faith-based community influences. PCEs hold potential for promoting mental health resilience amid traumatic experiences. Effective suicide prevention hinges on trauma-informed approaches, proceeding along evidenced developmental pathways for well-being across the lifespan.