Exposure to adverse childhood experiences is common among youth. Numerous studies have identified cumulative exposures to adversity during childhood as a serious public health issue. Studies have found a significant dose-response association between cumulative adversities and risk for negative behavioral and mental health outcomes in adults, and developmental delays and internalizing and externalizing disorders in children. Efforts to expand existing knowledge about childhood adversities and the factors that are protective has been a focus of recent efforts.

In this dissertation, two studies were conducted to assess the relationship of adverse childhood experiences and social integration on risk for adolescent suicidal ideation. Study 1 focused on assessing the predictability of a 20-item childhood adversity assessment versus a 9-item assessment for risk of suicidal ideation. Results from this study found that additional items in the expanded assessment were predictive of suicidal ideation and increasing exposures significantly increased risk for suicidal ideation. However, the 20-item assessment was only slightly more predictive of suicidal ideation compared to the 9-item assessment.

Study 2 examined the protective effect of family, school, religious/spiritual, peer and teacher integration as a protective factor of the relationship of cumulative childhood adversity and adolescent suicidal ideation. Results indicate family, school and religious/spiritual integration reduce risk for suicidal ideation for adolescents reporting 1-3 adversities. Only family integration significantly reduced risk for suicidal ideation for youth reporting 4-6 adversities. None of the five social integration factors reduced suicidal ideation risk for youth reporting 7 or more adversities. Further, peer and teacher integration were not found to be a protective influence across any of the adverse childhood experiences risk groups.

Future public health research must focus on identifying those childhood experiences that may increase risk for poor behavioral and mental health outcomes. Current priorities should also focus on youth who have experienced higher levels of adversity so that more appropriate prevention and intervention programs and policies can be developed. Finally, given the impact of childhood adversities on health and wellbeing over the life-course, more efforts are needed to reduce or eliminate childhood adversities.