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Original Investigation
May 5, 2021

Association of Childhood Adversities With Suicide Ideation and Attempts in Puerto Rican Young Adults

Author Affiliations
  • 1Department of Psychology, The New School, New York, New York
  • 2Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York
  • 3Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
  • 4Department of Biostatistics, Columbia University, Mailman School of Public Health, New York, New York
  • 5Department of Obstetrics and Gynecology, Columbia University, New York, New York
  • 6Behavioral Science Research Institute, University of Puerto Rico, San Juan
JAMA Psychiatry. 2021;78(8):896-902. doi:10.1001/jamapsychiatry.2021.0480
Key Points

Question  Does greater exposure to childhood adversities help explain higher rates of suicide ideation and attempts among Puerto Rican young women than men?

Findings  In this cohort study of 2004 Puerto Rican young adults, greater exposure to childhood adversities was significantly associated with suicide ideation in young women and suicide attempts irrespective of sex.

Meaning  These findings suggest that childhood adversities are relevant to understanding the risk of suicide attempt in ethnic minority youths from disadvantaged contexts and the risk of suicide ideation among young women.


Importance  Racial/ethnic and sex disparities in suicide ideation and attempts are well established, with higher risk of suicide ideation and attempt among US racial/ethnic minority school-aged youths (than their White peers) and girls and women (than boys and men). The suicide-related risk of racial/ethnic minority young adults, especially young women, may be strongly influenced by adverse childhood experiences, known early determinants of suicide ideation and attempts.

Objectives  To assess lifetime and past-year prevalence estimates of suicide ideation and suicide attempt and to examine sex differences in the role of adverse childhood experiences as a prospective risk factor for Puerto Rican young adults from 2 sociocultural contexts.

Design, Setting, and Participants  Data in this longitudinal cohort study are from 4 waves of the Boricua Youth Study, a population-based cohort study of Puerto Rican children from San Juan and Caguas, Puerto Rico, and the South Bronx, New York, 5 to 17 years of age (N = 2491; waves 1-3: 2000-2004) and 15 to 29 years of age (wave 4: 2013-2017). Data analysis was performed from February 26, 2019, to October 16, 2020.

Exposures  Adverse childhood experiences were assessed by interview in childhood and early adolescence (waves 1-3) and included child maltreatment (physical, sexual, and emotional abuse and neglect), exposure to violence, parental loss (separation, divorce, and death), and parental maladjustment (mental health problems, substance or alcohol abuse, intimate partner violence, and incarceration).

Main Outcomes and Measures  Lifetime and past-year suicide ideation and attempt were assessed in young adulthood (wave 4) using the World Health Organization Composite International Diagnostic Interview.

Results  Among 2004 Puerto Rican young adults (80.4% of the original cohort; mean [SD] age, 22.9 [2.8] years; 1019 [50.8%] male), young women compared with young men had a higher prevalence of lifetime suicide attempt (9.5% vs 3.6%) and lifetime suicide ideation (16.4% vs 11.5%), whereas past-year suicide ideation (4.4% vs 2.4%) was not statistically different. Logistic regression models, adjusting for demographics and lifetime psychiatric disorders, found that young women but not young men with more adverse childhood experiences had higher odds of suicide ideation (lifetime; odds ratio [OR], 2.44; 95% CI, 1.54-3.87; past year: OR, 2.56; 95% CI, 1.18-5.55). More adverse childhood experiences were also prospectively associated with lifetime suicide attempt (OR, 1.16; 95% CI, 1.04-1.29), irrespective of sex.

Conclusions and Relevance  The findings of this cohort study suggest that, among Puerto Rican young adults from 2 different sociocultural contexts, adverse childhood experiences were relevant to understanding suicide attempt and suicide ideation, the latter specifically among young women. The prevention of cumulative adverse childhood experiences could reduce later risk of suicide attempts and, among young women, for suicide ideation.

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