Childhoods marked by neglect, abuse or upheaval leave marks that can last well beyond the years they happened. A large new review of research confirms just how far those marks can reach. It links adverse childhood experiences to some of the most serious outcomes a young person can face, including death by suicide. Substance use sits close to the centre of this picture. One factor stands out as offering real protection: a stable and consistent family life.
What the Evidence Shows About Adverse Childhood Experiences
Published in JAMA Network Open, the review pulled together findings from 68 studies and 90 reports. It covered young people aged 24 and under, comparing those who died by suicide with peers who did not. Dr Geoffroy at McGill University in Canada led the analysis, which the authors describe as the most comprehensive of its kind to date.
The findings were stark. Young people who had experienced maltreatment faced roughly four times the odds of dying by suicide compared with those who had not. Youths removed from their family home carried similarly elevated risk. So did those who had been through the youth justice system, or whose parents had faced justice system involvement themselves. Lower educational attainment carried nearly three times the odds of suicide.
Taken together, the researchers describe childhood adversity as one half of a picture. The other half is psychiatric vulnerability, and the two are often closely intertwined.
How Adverse Childhood Experiences Fuel Substance Use
Among the clearest threads running through the research is substance use. Young people with a history of substance use faced more than seven times the odds of dying by suicide. Alcohol misuse carried around five times the odds. Drug use carried around six times the odds, figures the authors note were remarkably consistent across the studies reviewed.
Prior self-harm carried some of the highest odds of any single factor in the review, at fourteen times higher. Serious mental illness, including schizophrenia and mood disorders, followed close behind. Substance use rarely sits alone in a young person’s life. It tends to follow, or run alongside, the same childhood adversity that raises the risk of suicide in the first place. Early exposure to alcohol and drugs is a marker worth taking seriously, not a separate or later stage problem.
This is why prevention matters so much. Delaying and reducing early substance use, rather than managing it once established, remains one of the clearest levers available to protect young people. Waiting until use has become a fixed pattern narrows the options for changing course.
Family Stability as the Strongest Protection
Protective factors were studied far less often than risk factors. Where they were, one signal came through clearly. Young people living with both parents had close to half the odds of dying by suicide compared with those who did not. Having married parents carried a similar protective association.
The authors are careful to note that living arrangement and marital status are imperfect measures. What they most likely capture is something harder to quantify: consistency, presence and a sense of belonging. For prevention efforts, the message is nonetheless clear. Strengthening family bonds and supporting parents through difficulty is not a peripheral concern. It sits at the heart of protecting young people from some of the worst outcomes linked to adverse childhood experiences.
Turning the Evidence Into Prevention
Suicide remains among the leading causes of death for people aged 10 to 24 worldwide. The researchers behind this review are clear that reversing that trend means acting earlier. Reducing exposure to maltreatment and instability sits upstream of the crises this research documents. So does supporting families under strain, and treating early substance use as an urgent warning sign rather than a private matter.
Adverse childhood experiences do not determine a young person’s future on their own. But where they combine with early substance use and an absence of family stability, the risks compound. Recognising that pattern, and acting on it early, gives young people the best chance of a different outcome.
(Source: jamanetwork)