The associations of childhood adversities and mental disorders with suicidal thoughts and behaviors - Results from the World Mental Health International College Student Initiative

WHO WMH-ICS Collaborators; Philippe MORTIER; Xue YANG; Yasmin A. ALTWAIJRI; Jacob A. HOLDCRAFT; Sue LEE; Nancy A SAMPSON; Yesica ALBOR; Ahmad N. ALHADI; Jordi ALONSO; Nouf K. AL-SAUD; Claes ANDERSSON; Lukoye ATWOLI; Randy P. AUERBACH; Caroline AYUYA MUAKA; Patricia M. BÁEZ-MANSUR; Laura BALLESTER; Jason BANTJES; Harald BAUMEISTER; Marcus BENDTSEN; Corina BENJET; Anne H. BERMAN; Ronny BRUFFAERTS; Paula CARRASCO; Silver C.N. CHAN; Irina COHUT; María Anabell Covarrubias Díaz COUDER; Marcelo A. CROCKETT; Pim CUIJPERS; Oana A. DAVID; Dong DONG; David D. EBERT; Jorge GAETE; Mireia FELEZ-NOBREGA; Carlos GARCÍA FORERO; Margalida GILI; Raúl A. GUTIÉRREZ-GARCÍA; Josep Maria HARO; Penelope HASKING; Xanthe HUNT; Mathilde M. HUSKY; Florence JAGUGA; Leontien JANSEN; Álvaro I. LANGER; Yan LIU; Scarlett MAC-GINTY; Vania MARTÍNEZ; Andre MASON; Muthoni MATHAI; Margaret MCLAFFERTY; Andrea Miranda-Mendizabal; Elaine K. MURRAY; Catherine M. MUSYOKA; Siobhan M. O'NEILL; Claudiu C. PAPASTERI; José A. PIQUERAS; Codruta A. POPESCU; Charlene RAPSEY; Kealagh ROBINSON; Tiscar RODRIGUEZ-JIMENEZ; Damian SCARF; Oi-Ling SIU; Dan J. STEIN; Sascha Y. STRUIJS; Cristina T. TOMOIAGA; Karla Patricia VALDÉS-GARCÍA; Shelby VEREECKE; Daniel V. VIGO; Angel Y. WANG; Samuel Y.S. WONG; Ronald C. KESSLER

doi:10.1016/j.psychres.2025.116555

The associations of childhood adversities and mental disorders with suicidal thoughts and behaviors - Results from the World Mental Health International College Student Initiative

WHO WMH-ICS Collaborators
, Philippe MORTIER
, Xue YANG
, Yasmin A. ALTWAIJRI
, Jacob A. HOLDCRAFT
, Sue LEE
, Nancy A SAMPSON
, Yesica ALBOR
, Ahmad N. ALHADI
, Jordi ALONSO
, Nouf K. AL-SAUD
, Claes ANDERSSON
, Lukoye ATWOLI
, Randy P. AUERBACH
, Caroline AYUYA MUAKA
, Patricia M. BÁEZ-MANSUR
, Laura BALLESTER
, Jason BANTJES
, Harald BAUMEISTER
, Marcus BENDTSEN

Corina BENJET, Anne H. BERMAN, Ronny BRUFFAERTS, Paula CARRASCO, Silver C.N. CHAN, Irina COHUT, María Anabell Covarrubias Díaz COUDER, Marcelo A. CROCKETT, Pim CUIJPERS, Oana A. DAVID, Dong DONG, David D. EBERT, Jorge GAETE, Mireia FELEZ-NOBREGA, Carlos GARCÍA FORERO, Margalida GILI, Raúl A. GUTIÉRREZ-GARCÍA, Josep Maria HARO, Penelope HASKING, Xanthe HUNT, Mathilde M. HUSKY, Florence JAGUGA, Leontien JANSEN, Álvaro I. LANGER, Yan LIU, Scarlett MAC-GINTY, Vania MARTÍNEZ, Andre MASON, Muthoni MATHAI, Margaret MCLAFFERTY, Andrea Miranda-Mendizabal, Elaine K. MURRAY, Catherine M. MUSYOKA, Siobhan M. O'NEILL, Claudiu C. PAPASTERI, José A. PIQUERAS, Codruta A. POPESCU, Charlene RAPSEY, Kealagh ROBINSON, Tiscar RODRIGUEZ-JIMENEZ, Damian SCARF, Oi-Ling SIU, Dan J. STEIN, Sascha Y. STRUIJS, Cristina T. TOMOIAGA, Karla Patricia VALDÉS-GARCÍA, Shelby VEREECKE, Daniel V. VIGO, Angel Y. WANG, Samuel Y.S. WONG, Ronald C. KESSLER

Department of Psychology

Research output: Journal Publications › Journal Article (refereed) › peer-review

3 Citations (Scopus)

Abstract

Objective
To investigate the associations of demographic variables, childhood adversities (CAs), and mental disorders (MDx) with onset, transition, and persistence of suicidal thoughts and behaviors (STB) among first-year university students.
Method
Poisson regression models within a discrete-time survival framework were constructed using web-based self-report survey data from 72,288 incoming university students across 18 countries (response rate=20.9%; median age=19 years, 57.9% female, 1.4% transgender, 21.0% non-heterosexual). These models examined the associations of four demographic variables, five CAs, and eight MDx with STB outcomes.
Results
Lifetime prevalence of suicidal ideation, plans, and attempts was 47.0%, 26.0%, and 9.6%, respectively; 12-month estimates were 30.6%, 14.0%, and 2.3%. In unadjusted analyses, associations were strongest between lifetime onset of suicidal ideation and CAs (RR range 4.4-7.0), particularly parental psychopathology (relative risk [RR]=7.0 [95% CI 6.5–7.7]), followed by MDx (RR range 1.3-3.0). Of the demographic subgroups, transgender students had highest risk of STB (lifetime ideation onset RR=2.4 [2.3–2.6]; ideation-to-attempt transition RR=1.4 [1.3–1.5]). In fully adjusted models, strongest predictors of lifetime ideation onset were emotional abuse (RR=2.1 [1.9–2.2]), major depressive disorder (RR=2.0 [1.9–2.1]), and bipolar disorder (RR=1.8 [1.6–2.0]). Ideation-to-attempt transition remained most strongly associated with panic disorder (RR=1.5 [1.3–1.7]), bipolar disorder (RR=1.4 [1.2–1.7]), and sexual abuse (RR=1.4 [1.2–1.7]). Most predictors were significantly but weakly associated with persistence of ideation and plan, while only physical abuse remained associated with repeated suicide attempts (RR=1.3 [1.0-1.8]).
Conclusion
CAs and MDx are strong predictors of both onset of and transition within the STB spectrum, underscoring the importance of implementing early-life prevention interventions.

Original language	English
Article number	116555
Journal	Psychiatry Research
Volume	350
Early online date	22 May 2025
DOIs	https://doi.org/10.1016/j.psychres.2025.116555 https://doi.org/10.1016/j.psychres.2025.116555
Publication status	Published - Aug 2025

Bibliographical note

Publisher Copyright:
© 2025 The Author(s)

Funding

Funding to support this initiative was received from the National Institute of Mental Health (NIMH) R56MH109566 (RPA), and the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or NIMH. Philippe Mortier received funding from grant Miguel Servet CP21/00078 funded by the Instituto de Salud Carlos III (ISCIII) and co-funded by the European Union; project grant AC22/00006, supported by Instituto de Salud Carlos III (ISCIII), and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia (MRR), under the frame of ERA PerMed; project grant PI22/00107, funded by Instituto de Salud Carlos III (ISCIII) and co-funded by the European Union; and project grant 202220–30 from the Fundació la Marató de TV3. Local funding for surveys in each country is listed below: Australia: pH has received funding for this work from Suicide Prevention Australia, the Feilman Foundation, and the National Health and Medical Research Council (ID 2032058). Belgium: The Belgian Fund for Scientific Research (11N0514N/11N0516N/1114717N), the King Baudouin Foundation (2014-J2140150–102905; RB), the Ministry of Education, Flanders - Grant# EDC-E3738, institutional payment, awarded to RB. Canada: Health Canada - Substance Use and Addictions Program. Grant for the Mental Health Systems and Services Laboratory at the University of British Columbia. Chile: MAC, VM, JG, and ÁIL received funding from ANID/Millennium Science Initiative Program-NCS2021_081 and ANID/FONDECYT REGULAR-N°1221230. SM-G received funding from ANID/Millennium Science Initiative Program-NCS2021_081 and ANID/PFCHA/DOCTORADO EN EL EXTRANJERO BECAS CHILE/2019–72200092. China: Shandong Taishan Scholar Young Expert Project (tsqn201909145), awarded to Yan Liu. France: Institut Universitaire de France. Germany: BARMER, a health care insurance company, for project StudiCare. Mexico: Consejo Nacional de Ciencia y Tecnología (Mexican National Council of Science and Technology). Grant CONACYT 285548 awarded to institution (National Institute of Psychiatry Ramon de la Fuente Muñiz) with CB as PI. The Netherlands: ZonMw (Netherlands Organisation for Health Research and Development; grant number 636110005) and the PFGV (PFGV; Protestants Fonds voor de Geestelijke Volksgezondheid) in support of the student survey project. New Zealand: The WMH-ICS NZ surveys were supported by a Rutherford Discovery Fellowship and a James Hume Bequest Grant. Northern Ireland: The Student Psychological Intervention Trial (SPIT) was supported by Clinical Healthcare Intervention Trials in Ireland Network (CHITIN). CHITIN has received €10.6 million funding from the European Union’s INTERREG VA programme managed by the Special EU Programmes Body (SEUPB) with match funding from the Departments of Health in NI and ROI (CHI/5433/18) Romania: This work was supported by a grant of the Ministry of Research, Innovation and Digitization, CNCS - UEFISCDI, project number PN-IV-P1-PCE-2023–1854, within PNCDI IV. Saudi Arabia: The Saudi University Mental Health Survey is conducted by the King Salman Center for Disability Research; funded by Saudi Basic Industries Corporation, King Abdulaziz City for Science and Technology, Ministry of Health (Saudi Arabia) and King Saud University. Funding in-kind was provided by King Faisal Specialist Hospital & Research Center, and Ministry of Economy & Planning, General Authority for Statistics, Riyadh. South Africa: The work reported herein was made possible through funding by the South African Medical Research Council (SAMRC) through its Division of Research Capacity Development under the MCSP (awarded to JB and XH). Spain: The PROMES-U study is supported by Instituto de Salud Carlos III (ISCIII) and cofunded by the European Union, grant number PI20/00006; the Departament de Recerca i Universitats of the Generalitat de Catalunya (AGAUR 2021 SGR 00624); and CIBER -Consorcio Centro de Investigación Biomédica en Red- (CB06/02/0046), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea. For surveys directed by Parc Sanitari Sant Joan de Déu, funding was provided by Fundació Sant Joan de Déu. AMM received funding from Sara Borrell grant (CD23/00010) ISC-III. Sweden: CA, MB and AHB received funding for this work from the Swedish Research Council (ID 2019–01127) as well as from a Public Health Agency in Sweden (ID 04252–2021–2.3.2). Both grants were awarded to AHB. The World Mental Health International College Student (WMH-ICS) initiative is carried out as part of the World Mental Health (WMH) Survey Initiative. The WMH survey is supported by the National Institute of Mental Health NIMH R01MH070884, the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline, and Bristol-Myers Squibb (RCK).

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Adverse childhood experiences
Mental health
Prevalence
Risk factors
Self-injurious behavior
Students
Suicide

Access to Document

https://linkinghub.elsevier.com/retrieve/pii/S0165178125002033

Cite this

WHO WMH-ICS Collaborators, MORTIER, P., YANG, X., ALTWAIJRI, Y. A., HOLDCRAFT, J. A., LEE, S., SAMPSON, N. A., ALBOR, Y., ALHADI, A. N., ALONSO, J., AL-SAUD, N. K., ANDERSSON, C., ATWOLI, L., AUERBACH, R. P., AYUYA MUAKA, C., BÁEZ-MANSUR, P. M., BALLESTER, L., BANTJES, J., BAUMEISTER, H., ... KESSLER, R. C. (2025). The associations of childhood adversities and mental disorders with suicidal thoughts and behaviors - Results from the World Mental Health International College Student Initiative. Psychiatry Research, 350, Article 116555. https://doi.org/10.1016/j.psychres.2025.116555, https://doi.org/10.1016/j.psychres.2025.116555

@article{00419da2910e4ca7acf9959efae6081f,

title = "The associations of childhood adversities and mental disorders with suicidal thoughts and behaviors - Results from the World Mental Health International College Student Initiative",

abstract = "Objective To investigate the associations of demographic variables, childhood adversities (CAs), and mental disorders (MDx) with onset, transition, and persistence of suicidal thoughts and behaviors (STB) among first-year university students. Method Poisson regression models within a discrete-time survival framework were constructed using web-based self-report survey data from 72,288 incoming university students across 18 countries (response rate=20.9\%; median age=19 years, 57.9\% female, 1.4\% transgender, 21.0\% non-heterosexual). These models examined the associations of four demographic variables, five CAs, and eight MDx with STB outcomes. Results Lifetime prevalence of suicidal ideation, plans, and attempts was 47.0\%, 26.0\%, and 9.6\%, respectively; 12-month estimates were 30.6\%, 14.0\%, and 2.3\%. In unadjusted analyses, associations were strongest between lifetime onset of suicidal ideation and CAs (RR range 4.4-7.0), particularly parental psychopathology (relative risk [RR]=7.0 [95\% CI 6.5–7.7]), followed by MDx (RR range 1.3-3.0). Of the demographic subgroups, transgender students had highest risk of STB (lifetime ideation onset RR=2.4 [2.3–2.6]; ideation-to-attempt transition RR=1.4 [1.3–1.5]). In fully adjusted models, strongest predictors of lifetime ideation onset were emotional abuse (RR=2.1 [1.9–2.2]), major depressive disorder (RR=2.0 [1.9–2.1]), and bipolar disorder (RR=1.8 [1.6–2.0]). Ideation-to-attempt transition remained most strongly associated with panic disorder (RR=1.5 [1.3–1.7]), bipolar disorder (RR=1.4 [1.2–1.7]), and sexual abuse (RR=1.4 [1.2–1.7]). Most predictors were significantly but weakly associated with persistence of ideation and plan, while only physical abuse remained associated with repeated suicide attempts (RR=1.3 [1.0-1.8]). Conclusion CAs and MDx are strong predictors of both onset of and transition within the STB spectrum, underscoring the importance of implementing early-life prevention interventions.",

keywords = "Adverse childhood experiences, Mental health, Prevalence, Risk factors, Self-injurious behavior, Students, Suicide",

author = "\{WHO WMH-ICS Collaborators\} and Philippe MORTIER and Xue YANG and ALTWAIJRI, \{Yasmin A.\} and HOLDCRAFT, \{Jacob A.\} and Sue LEE and SAMPSON, \{Nancy A\} and Yesica ALBOR and ALHADI, \{Ahmad N.\} and Jordi ALONSO and AL-SAUD, \{Nouf K.\} and Claes ANDERSSON and Lukoye ATWOLI and AUERBACH, \{Randy P.\} and \{AYUYA MUAKA\}, Caroline and B{\'A}EZ-MANSUR, \{Patricia M.\} and Laura BALLESTER and Jason BANTJES and Harald BAUMEISTER and Marcus BENDTSEN and Corina BENJET and BERMAN, \{Anne H.\} and Ronny BRUFFAERTS and Paula CARRASCO and CHAN, \{Silver C.N.\} and Irina COHUT and COUDER, \{Mar{\'i}a Anabell Covarrubias D{\'i}az\} and CROCKETT, \{Marcelo A.\} and Pim CUIJPERS and DAVID, \{Oana A.\} and Dong DONG and EBERT, \{David D.\} and Jorge GAETE and Mireia FELEZ-NOBREGA and \{GARC{\'I}A FORERO\}, Carlos and Margalida GILI and GUTI{\'E}RREZ-GARC{\'I}A, \{Ra{\'u}l A.\} and HARO, \{Josep Maria\} and Penelope HASKING and Xanthe HUNT and HUSKY, \{Mathilde M.\} and Florence JAGUGA and Leontien JANSEN and LANGER, \{{\'A}lvaro I.\} and Yan LIU and Scarlett MAC-GINTY and Vania MART{\'I}NEZ and Andre MASON and Muthoni MATHAI and Margaret MCLAFFERTY and Andrea Miranda-Mendizabal and MURRAY, \{Elaine K.\} and MUSYOKA, \{Catherine M.\} and O'NEILL, \{Siobhan M.\} and PAPASTERI, \{Claudiu C.\} and PIQUERAS, \{Jos{\'e} A.\} and POPESCU, \{Codruta A.\} and Charlene RAPSEY and Kealagh ROBINSON and Tiscar RODRIGUEZ-JIMENEZ and Damian SCARF and Oi-Ling SIU and STEIN, \{Dan J.\} and STRUIJS, \{Sascha Y.\} and TOMOIAGA, \{Cristina T.\} and VALD{\'E}S-GARC{\'I}A, \{Karla Patricia\} and Shelby VEREECKE and VIGO, \{Daniel V.\} and WANG, \{Angel Y.\} and WONG, \{Samuel Y.S.\} and KESSLER, \{Ronald C.\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s)",

year = "2025",

month = aug,

doi = "10.1016/j.psychres.2025.116555",

language = "English",

volume = "350",

journal = "Psychiatry Research",

issn = "0165-1781",

publisher = "Elsevier Ireland Ltd",

}

WHO WMH-ICS Collaborators, MORTIER, P, YANG, X, ALTWAIJRI, YA, HOLDCRAFT, JA, LEE, S, SAMPSON, NA, ALBOR, Y, ALHADI, AN, ALONSO, J, AL-SAUD, NK, ANDERSSON, C, ATWOLI, L, AUERBACH, RP, AYUYA MUAKA, C, BÁEZ-MANSUR, PM, BALLESTER, L, BANTJES, J, BAUMEISTER, H, BENDTSEN, M, BENJET, C, BERMAN, AH, BRUFFAERTS, R, CARRASCO, P, CHAN, SCN, COHUT, I, COUDER, MACD, CROCKETT, MA, CUIJPERS, P, DAVID, OA, DONG, D, EBERT, DD, GAETE, J, FELEZ-NOBREGA, M, GARCÍA FORERO, C, GILI, M, GUTIÉRREZ-GARCÍA, RA, HARO, JM, HASKING, P, HUNT, X, HUSKY, MM, JAGUGA, F, JANSEN, L, LANGER, ÁI, LIU, Y, MAC-GINTY, S, MARTÍNEZ, V, MASON, A, MATHAI, M, MCLAFFERTY, M, Miranda-Mendizabal, A, MURRAY, EK, MUSYOKA, CM, O'NEILL, SM, PAPASTERI, CC, PIQUERAS, JA, POPESCU, CA, RAPSEY, C, ROBINSON, K, RODRIGUEZ-JIMENEZ, T, SCARF, D, SIU, O-L, STEIN, DJ, STRUIJS, SY, TOMOIAGA, CT, VALDÉS-GARCÍA, KP, VEREECKE, S, VIGO, DV, WANG, AY, WONG, SYS & KESSLER, RC 2025, 'The associations of childhood adversities and mental disorders with suicidal thoughts and behaviors - Results from the World Mental Health International College Student Initiative', Psychiatry Research, vol. 350, 116555. https://doi.org/10.1016/j.psychres.2025.116555, https://doi.org/10.1016/j.psychres.2025.116555

The associations of childhood adversities and mental disorders with suicidal thoughts and behaviors - Results from the World Mental Health International College Student Initiative. / WHO WMH-ICS Collaborators; MORTIER, Philippe; YANG, Xue et al.
In: Psychiatry Research, Vol. 350, 116555, 08.2025.

Research output: Journal Publications › Journal Article (refereed) › peer-review

TY - JOUR

T1 - The associations of childhood adversities and mental disorders with suicidal thoughts and behaviors - Results from the World Mental Health International College Student Initiative

AU - WHO WMH-ICS Collaborators

AU - MORTIER, Philippe

AU - YANG, Xue

AU - ALTWAIJRI, Yasmin A.

AU - HOLDCRAFT, Jacob A.

AU - LEE, Sue

AU - SAMPSON, Nancy A

AU - ALBOR, Yesica

AU - ALHADI, Ahmad N.

AU - ALONSO, Jordi

AU - AL-SAUD, Nouf K.

AU - ANDERSSON, Claes

AU - ATWOLI, Lukoye

AU - AUERBACH, Randy P.

AU - AYUYA MUAKA, Caroline

AU - BÁEZ-MANSUR, Patricia M.

AU - BALLESTER, Laura

AU - BANTJES, Jason

AU - BAUMEISTER, Harald

AU - BENDTSEN, Marcus

AU - BENJET, Corina

AU - BERMAN, Anne H.

AU - BRUFFAERTS, Ronny

AU - CARRASCO, Paula

AU - CHAN, Silver C.N.

AU - COHUT, Irina

AU - COUDER, María Anabell Covarrubias Díaz

AU - CROCKETT, Marcelo A.

AU - CUIJPERS, Pim

AU - DAVID, Oana A.

AU - DONG, Dong

AU - EBERT, David D.

AU - GAETE, Jorge

AU - FELEZ-NOBREGA, Mireia

AU - GARCÍA FORERO, Carlos

AU - GILI, Margalida

AU - GUTIÉRREZ-GARCÍA, Raúl A.

AU - HARO, Josep Maria

AU - HASKING, Penelope

AU - HUNT, Xanthe

AU - HUSKY, Mathilde M.

AU - JAGUGA, Florence

AU - JANSEN, Leontien

AU - LANGER, Álvaro I.

AU - LIU, Yan

AU - MAC-GINTY, Scarlett

AU - MARTÍNEZ, Vania

AU - MASON, Andre

AU - MATHAI, Muthoni

AU - MCLAFFERTY, Margaret

AU - Miranda-Mendizabal, Andrea

AU - MURRAY, Elaine K.

AU - MUSYOKA, Catherine M.

AU - O'NEILL, Siobhan M.

AU - PAPASTERI, Claudiu C.

AU - PIQUERAS, José A.

AU - POPESCU, Codruta A.

AU - RAPSEY, Charlene

AU - ROBINSON, Kealagh

AU - RODRIGUEZ-JIMENEZ, Tiscar

AU - SCARF, Damian

AU - SIU, Oi-Ling

AU - STEIN, Dan J.

AU - STRUIJS, Sascha Y.

AU - TOMOIAGA, Cristina T.

AU - VALDÉS-GARCÍA, Karla Patricia

AU - VEREECKE, Shelby

AU - VIGO, Daniel V.

AU - WANG, Angel Y.

AU - WONG, Samuel Y.S.

AU - KESSLER, Ronald C.

PY - 2025/8

Y1 - 2025/8

N2 - Objective To investigate the associations of demographic variables, childhood adversities (CAs), and mental disorders (MDx) with onset, transition, and persistence of suicidal thoughts and behaviors (STB) among first-year university students. Method Poisson regression models within a discrete-time survival framework were constructed using web-based self-report survey data from 72,288 incoming university students across 18 countries (response rate=20.9%; median age=19 years, 57.9% female, 1.4% transgender, 21.0% non-heterosexual). These models examined the associations of four demographic variables, five CAs, and eight MDx with STB outcomes. Results Lifetime prevalence of suicidal ideation, plans, and attempts was 47.0%, 26.0%, and 9.6%, respectively; 12-month estimates were 30.6%, 14.0%, and 2.3%. In unadjusted analyses, associations were strongest between lifetime onset of suicidal ideation and CAs (RR range 4.4-7.0), particularly parental psychopathology (relative risk [RR]=7.0 [95% CI 6.5–7.7]), followed by MDx (RR range 1.3-3.0). Of the demographic subgroups, transgender students had highest risk of STB (lifetime ideation onset RR=2.4 [2.3–2.6]; ideation-to-attempt transition RR=1.4 [1.3–1.5]). In fully adjusted models, strongest predictors of lifetime ideation onset were emotional abuse (RR=2.1 [1.9–2.2]), major depressive disorder (RR=2.0 [1.9–2.1]), and bipolar disorder (RR=1.8 [1.6–2.0]). Ideation-to-attempt transition remained most strongly associated with panic disorder (RR=1.5 [1.3–1.7]), bipolar disorder (RR=1.4 [1.2–1.7]), and sexual abuse (RR=1.4 [1.2–1.7]). Most predictors were significantly but weakly associated with persistence of ideation and plan, while only physical abuse remained associated with repeated suicide attempts (RR=1.3 [1.0-1.8]). Conclusion CAs and MDx are strong predictors of both onset of and transition within the STB spectrum, underscoring the importance of implementing early-life prevention interventions.

AB - Objective To investigate the associations of demographic variables, childhood adversities (CAs), and mental disorders (MDx) with onset, transition, and persistence of suicidal thoughts and behaviors (STB) among first-year university students. Method Poisson regression models within a discrete-time survival framework were constructed using web-based self-report survey data from 72,288 incoming university students across 18 countries (response rate=20.9%; median age=19 years, 57.9% female, 1.4% transgender, 21.0% non-heterosexual). These models examined the associations of four demographic variables, five CAs, and eight MDx with STB outcomes. Results Lifetime prevalence of suicidal ideation, plans, and attempts was 47.0%, 26.0%, and 9.6%, respectively; 12-month estimates were 30.6%, 14.0%, and 2.3%. In unadjusted analyses, associations were strongest between lifetime onset of suicidal ideation and CAs (RR range 4.4-7.0), particularly parental psychopathology (relative risk [RR]=7.0 [95% CI 6.5–7.7]), followed by MDx (RR range 1.3-3.0). Of the demographic subgroups, transgender students had highest risk of STB (lifetime ideation onset RR=2.4 [2.3–2.6]; ideation-to-attempt transition RR=1.4 [1.3–1.5]). In fully adjusted models, strongest predictors of lifetime ideation onset were emotional abuse (RR=2.1 [1.9–2.2]), major depressive disorder (RR=2.0 [1.9–2.1]), and bipolar disorder (RR=1.8 [1.6–2.0]). Ideation-to-attempt transition remained most strongly associated with panic disorder (RR=1.5 [1.3–1.7]), bipolar disorder (RR=1.4 [1.2–1.7]), and sexual abuse (RR=1.4 [1.2–1.7]). Most predictors were significantly but weakly associated with persistence of ideation and plan, while only physical abuse remained associated with repeated suicide attempts (RR=1.3 [1.0-1.8]). Conclusion CAs and MDx are strong predictors of both onset of and transition within the STB spectrum, underscoring the importance of implementing early-life prevention interventions.

KW - Adverse childhood experiences

KW - Mental health

KW - Prevalence

KW - Risk factors

KW - Self-injurious behavior

KW - Students

KW - Suicide

UR - https://www.scopus.com/pages/publications/105007048617

U2 - 10.1016/j.psychres.2025.116555

DO - 10.1016/j.psychres.2025.116555

M3 - Journal Article (refereed)

C2 - 40450963

SN - 0165-1781

VL - 350

JO - Psychiatry Research

JF - Psychiatry Research

M1 - 116555

ER -

WHO WMH-ICS Collaborators, MORTIER P, YANG X, ALTWAIJRI YA, HOLDCRAFT JA, LEE S et al. The associations of childhood adversities and mental disorders with suicidal thoughts and behaviors - Results from the World Mental Health International College Student Initiative. Psychiatry Research. 2025 Aug;350:116555. Epub 2025 May 22. doi: 10.1016/j.psychres.2025.116555, 10.1016/j.psychres.2025.116555

The associations of childhood adversities and mental disorders with suicidal thoughts and behaviors - Results from the World Mental Health International College Student Initiative

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

Access to Document

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