







































64

Adverse Childhood Experiences and Familial Factors in 
Adolescent Suicidality

Byoungwook D. Park1, Pauline Goger 2, & Christine B. Cha3, 4, 5

1Icahn School of Medicine at Mount Sinai, Mount Sinai Behavioral Health Center, New York, NY
2Department of Psychological and Brain Sciences, Fairfield University, Fairfield, CT

3Center for Brain and Mind Health, Yale School of Medicine, New Haven, CT
4Child Study Center, Yale School of Medicine, New Haven, CT

5Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, NY

 Suicide is a major public health concern across the lifes-
pan (Centers for Disease Control and Prevention [CDC], 
2023). In particular, adolescents between the ages of 10 and 
19 are especially vulnerable, with suicide ranking as the sec-
ond leading cause of death in this age group in the United 
States (American Academy of Child and Adolescent Psychi-
atry [AACAP], 2019). In this developmental stage, parents 
or primary caregivers have a unique psychosocial influence, 
as children are legally, emotionally, and developmentally de-
pendent on them (Armsden & Greenberg, 1987; Delgado et 
al., 2022; Moretti & Peled, 2004). For this reason, when exam-
ining adolescent suicidal thoughts and behaviors (STBs; e.g., 
suicide attempts, suicidal ideation, and suicide plan), familial 
factors are often considered (Cha et al., 2018; Shain et al., 2016; 
Wang et al., 2022). Furthermore, efforts are often made to in-
clude parents and families in treating depressed and suicidal 
youth, and parents can play a key role in connecting youth 
with mental healthcare services (Adrian et al., 2023; Cur-
ry, 2001; Diamond et al., 2003; Sander & McCarty, 2005). 
 Suicide is a multifaceted phenomenon shaped by the 
interplay of diverse risk and protective factors (De Berardis 
et al., 2018). Among various risk and protective factors, 
the current study focuses on the following: suicidal ide-
ation (SI), adverse childhood experiences (ACEs), family 
functioning (FF), and perceived parental criticism (PPC). 

Suicidal Ideation      
 Suicidal ideation (SI) refers to the contemplation of 
suicide with or without the intent, or hope for death by 
self-inflicted means (De Leo et al., 2021). Individuals ex-
periencing SI may have varying degrees of intensity and 
frequency in these thoughts, ranging from fleeting wishes 
to die without the intention of engaging in corresponding 
behaviors (i.e., passive SI) to current, persistent, suicidal 
thoughts with detailed plans (i.e., active SI; Harmer et al., 
2024). This construct is a well-established risk factor for 
suicide and is prevalent among youth (Buitron et al., 2016; 
Chu et al., 2015; Saffer et al., 2015). Specifically, approxi-
mately 22% of female and 12% of male high school students 
in the United States have contemplated suicide (Kann et al., 
2018). While some research suggests that SI alone (i.e., SI 
without specific plans, intent, actual preparatory behaviors, 
or access to lethal means) may not indicate high suicide risk 
(Joiner et al., 2003), it remains a significant risk factor as indi-
viduals who have expressed thoughts of killing oneself has a 
higher risk of completing suicide than people who had not 
(Hubers et al., 2018). Thus, the severity of SI plays a crucial 
role in risk formulation for both adolescents and adults.
Adverse Childhood Experiences      
 Adverse childhood experiences (ACEs) refer to po-
tentially traumatic and stressful life events or circumstances 

Purpose: Adverse childhood experiences (ACEs) are risk factors for adolescent suicidal ideation (SI), but the influ-
ence of immediate family factors on this association remains understudied. This study examines how family func-
tioning (FF) and perceived parental criticism (PPC) moderate the relationship between ACEs and SI. Methods: 46 
community-based adolescents between the ages of 15 and 19 (Mage = 17.43 years, 69.57% female) participated in a 
study examining cognitive risk factors for SI. Several self-report measures were administered: the Suicidal Ideation 
Questionnaire to assess SI severity, the Adverse Childhood Experiences Questionnaire to measure ACEs, the McMas-
ter Family Assessment Device – General Functioning Scale to evaluate FF, and the Perceived Criticism Measure to 
determine PPC. Results: Neither the presence (ß = .26, p = .09) nor the count of ACEs (ß = .24, p = .12) significantly 
predicted SI severity. SI severity was significantly associated with specific ACEs such as emotional abuse, emotional 
neglect, and mental illness or suicide attempts in the household (ß = .39-.65, p = .00-.04), but not with others (ß = 
-.21-.40, p = .08-.99). Furthermore, FF (ß = .28, p < .01) and PPC (ß = .19, p =.04) independently moderated the 
association between ACEs and SI severity, while their combined interaction was not significant (ß = -.03, p = .74). 
Conclusion: Specific ACEs predicted SI severity. Moreover, lower FF and higher PPC independently amplified the 
impact of ACEs on SI severity in adolescents, highlighting the need for interventions that enhance FF and address 
PPC to mitigate adolescent suicide risk.
 Keywords: Suicide, Adolescent, Adverse Childhood Experiences, Family Functioning, Perceived Parental 
Criticism

Graduate Student Journal of Psychology
Spring 2025 - Vol. 24

Copyright 2025 by the Department of Counseling and Clinical Psychology
Teachers College, Columbia University



65

that occur during childhood or adolescence, which can have 
lasting negative effects on an individual's well-being (Sahle 
et al., 2022). These adverse experiences typically encompass 
various events that can be classified into three categories: 
abuse (i.e., physical, emotional, or sexual), neglect (i.e., phys-
ical or emotional), and household dysfunction (i.e., sub-
stance abuse or mental health issues in the family, domestic 
violence, incarceration, or parental separation; Sahle et al., 
2022). The association between ACEs and the severity of 
SI and suicide attempts has been consistently demonstrat-
ed in both community and high-risk adolescent samples 
(Dunn et al., 2013; Miller et al., 2013; Sahle et al., 2017). 
 In a nationally representative sample of 10,914 partic-
ipants, the cumulative lifetime counts of ACEs influenced 
the prevalence of SI and suicide attempts in adulthood 
(Thompson & Kingree, 2022). Specifically, one ACE in-
creased the odds of endorsing active SI by 1.5 times, two 
ACEs increased the odds of SI by 2 times and a suicide at-
tempt by 3 times, and three ACEs increased the odds of 
SI by 3 times and a suicide attempt by 5 times. Notably, 
interventions such as parenting education, mental health 
counseling, social service referrals, and social support are 
shown to effectively reduce behavioral and mental health 
problems in children who have experienced such potential-
ly traumatic events (Marie-Mitchell & Kostolansky, 2019).
Family Functioning      
 Various family-related variables have been recognized 
as both protective and risk factors in adolescent suicidality 
(Wang et al., 2022). Family cohesion and the adolescent-par-
ent connection were identified as protective factors against 
the current SI turning into later suicide attempts (Shain et 
al., 2016; Sun et al., 2020). In a study involving 852 Chi-
nese outpatient adolescents and adults, parental emotional 
warmth and less punitive mothers were recognized to be pro-
tective against the development of STBs (Wang et al., 2022). 
 On the contrary, negative family functioning (FF), im-
paired parent-child relationships, family breakdown, low 
paternal attachment, apathetic and severe child-rearing style, 
adolescents not talking to family adults about concerns, do-
mestic violence, arguing at home, low familial adaptability 
and cohesion, and low parental care have been identified as 
significant risk factors (Ohtaki et al., 2019; Saffer et al., 2015; 
Shain et al., 2016; Sheftall et al., 2013; Wang et al., 2022;; 
Weissinger et al., 2023). Among 5,557 adolescents in Hong 
Kong aged 11 to 18, lower levels of family functioning and 
parent–adolescent communication were significantly associ-
ated with depression and suicidal ideation (Kwok & Shek, 
2011). Notably, the improvement of interpersonal relation-

ships with family members has been identified as a help-
ful recovery factor following SI (Grimmond et al., 2019).
Perceived Parental Criticism      
 Perceived parental criticism (PPC) is a construct in ex-
pressed emotion literature (i.e., critical or hostile attitudes 
expressed by family members or caregivers toward a person 
with a psychiatric disorder) that has a crucial role in family 
relationships (Hooley & Miklowitz, 2017). In adolescents, 
PPC captures how much parental criticism is perceived, in-
ternalized, and affects the individual. It is hypothesized that 
PPC has an impact on SI and suicide attempts through its 
connection to constructs in the interpersonal theory of 
suicide (Chu et al., 2017), such as thwarted belongingness 
or perceived burdensomeness (Hagan & Joiner, 2017).      
 Adolescence, a developmental stage from ages 10 to 19, 
is characterized by the emergence of independence, the de-
velopment of sexuality, the formation of new meaningful re-
lationships, and accompanying vulnerabilities (Berenbaum 
et al., 2015; Remschmidt, 1994; World Health Organization 
[WHO], 2025). During this crucial and delicate period, 
adolescents’ sensitivity to parental criticism may intensi-
fy their feelings of loneliness or distort their perception of 
their worth to others. For instance, when parental criticism 
is interpreted as rejection or disapproval of their inherent 
value, it can undermine their sense of belonging within the 
family. Moreover, if adolescents begin to view themselves as 
a burden as a result of PPC, this perception may reinforce 
feelings of burdensomeness, increasing the risk of suicidal 
ideation or self-destructive behaviors. Thus, the importance 
of protective social networks and trusted adults during this 
period has been highlighted by many (Pringle et al., 2018).  
 However, there are conflicting findings on the associa-
tion between PPC and suicidality. Some studies report PPC 
as a significant indicator of depression, SI, and suicide attempt 
(Hagan & Joiner, 2017; Muyan & Chang, 2015; Rapp et 
al., 2021; Wang et al., 2017), while others suggest that PPC 
only has an indirect effect on non-suicidal self-injury (NSSI) 
through self-criticism (Baetens et al., 2015), or find no signif-
icant association between NSSI and PPC altogether (Daly & 
Willoughby, 2019). Further investigation is warranted to clar-
ify the association between PPC and adolescent suicidality.
Aims and Hypotheses
 Previous research has established that SI, ACEs, FF, and 
PPC individually contribute to adolescent suicidality. Al-
though the predictive relationship between ACEs and SI is 
well established, the moderating influence of FF and PPC on 
this association remains largely unexplored. By delving into 
the moderating effects of FF and PPC, we aim to identify 

PARK, GOGER, & CHA



6666

ADVERSE EXPERIENCES, FAMILY, AND ADOLESCENT SUICIDALITY

participation in the study were used as grounds for exclusion. 
 Out of 176 community-based adolescents who en-
rolled in the study, 46 completed the Adverse Childhood 
Experience Questionnaire (ACE-Q). Relatively few ado-
lescents completed the ACE-Q because its administration 
was discontinued mid-study in an effort to shorten the 
baseline protocol. Thus, only this subgroup of adolescents 
(n = 46) between the ages of 15 and 19 (Mage = 17.43 years, 
69.6% female; Table 1) was analyzed. The participants were 
racially diverse, with 45.7% identifying as white, 23.9% 
identifying as Black or African American, 21.7% identify-
ing as Asian, and 4.3% identifying as multiracial or other. 
Additionally, 17.4% of the adolescents identified as Hispan-
ic. The majority (67.4%) of the adolescents reported het-
erosexual sexual orientation, followed by bisexual (19.6%), 
homosexual (8.7%), questioning (2.2%), and other (2.2%).
Measures
Suicidal Ideation Questionnaire (SIQ)      
 The severity of both passive and active suicidal ideation 
in adolescents over the past month was assessed using the SIQ 
(Reynolds, 1987), a 30-item self-report measure rated on a 
seven-point Likert scale (0 = “I never had this thought,” 6 = 
“Almost every day”). An elevated score on the SIQ suggests 
a frequent and pervasive presence of SI (Boege et al., 2014). 
The SIQ is scored by summing responses to each question, 
and a score of 41 or higher is considered clinically signifi-
cant. The SIQ was validated among 226 adolescents aged 13 
to 18 years, with a Cronbach’s α = .98 (Pinto et al., 1997).
Adverse Childhood Experiences Questionnaire 
(ACE-Q)      
 The ACE-Q (Felitti et al., 1998) was administered to 
assess and quantify adverse or traumatic experiences encoun-
tered throughout the participants’ lifetime. The ACE-Q con-
sists of 10 yes-no items and addresses the following domains: 
emotional, physical, and sexual abuse, emotional and physi-
cal neglect, parental separation, domestic violence, household 
substance abuse, mental illness or suicide attempts in the 
household, and incarceration of family members. Moreover, 
scores of four or higher (i.e., the presence of four or more dis-
tinct ACEs) are deemed clinically significant. A high ACE-Q 
score has been associated with an increased risk for depres-
sion, suicide attempts, smoking, drug abuse, adolescent preg-
nancy, and impaired work performance in adulthood (Anda 
et al., 2004; Dube et al., 2003; Edwards et al., 2007; Felitti 
et al., 1998; Hillis et al., 2004). This questionnaire has been 
validated among 79 adolescents, with intraclass correlation 
coefficient values exceeding or being equal to .65 (i.e., good 
to excellent agreement) across all 10 items (Pinto et al., 2014).

nuanced pathways through which ACEs may or may not 
translate into SI later in adolescence. Since the family envi-
ronment plays a pivotal role in adolescents’ emotional and 
psychological development, investigating these interactions 
can offer insights into how familial factors exacerbate or miti-
gate the risk of adolescent suicidality in the presence of ACEs.
 Thus, the current study examines how ACEs predict the 
severity of SI in adolescents, and to what extent this association 
is moderated by FF and PPC. Understanding this intricate re-
lationship may offer valuable insights into protective and risk 
factors of adolescent suicidality, contributing to the design of 
targeted interventions and support systems for at-risk youth. 
 First, this study will investigate the association be-
tween ACEs and the severity of SI in adolescents, positing 
the following hypotheses: Hypothesis 1a: Adolescents 
with at least one ACE will endorse a higher severity of SI 
than those without ACEs. Hypothesis 1b: Subcategories 
of ACEs will correspond with SI severity in adolescents, 
such that those adolescents with a history of each type 
of ACE report more severe SI than their respective non-
ACE comparison group. Hypothesis 1c: A higher count 
of ACEs will predict a higher severity of SI in adolescents.
 Second, the moderating effects of FF and PPC on 
the association between ACEs and the severity of SI in 
adolescents will be examined. The following hypotheses 
are posited:  Hypothesis 2a: ACEs will be more strongly 
associated with SI severity among adolescents with lower 
FF. Hypothesis 2b: ACEs will be more strongly associ-
ated with SI among adolescents with higher PPC. Hy-
pothesis 2c: ACEs will be more strongly associated with 
SI among adolescents with higher PPC and lower FF.

Methods
Sample
 Participants were recruited from the urban communi-
ty in the greater New York metropolitan area via in-person 
(e.g., street fairs and flyers) and online (e.g., social media 
advertisement and ResearchMatch) recruitment efforts 
for a study examining cognitive risk factors associated with 
SI. Post-baccalaureate- and masters-level research assistants 
conducted screenings via phone to determine eligibility. 
Eligibility was determined based on the presence of STBs 
in adolescence, while (1) challenges in the adolescent’s and 
parent/guardian’s understanding of informed consent and 
study procedure, (2) self-disclosure of immediate suicidal in-
tent, (3) the occurrence of violent and agitated behaviors, (4) 
limited proficiency in the English language, and (5) psychiat-
ric symptoms of adolescents which would hinder consent or 



67

PARK, GOGER, & CHA

McMaster Family Assessment Device – General Func-
tioning Scale (FAD-GF)      
 The McMaster Family Assessment Device (FAD; Ep-
stein et al., 1983) is a 60-item self-report questionnaire that 
assesses an individual’s perception of their family across do-
mains of problem-solving, communication, roles, affective 
responsiveness, affective involvement, behavior control, and 
general functioning. Each item is scored on a four-point 
Likert scale ranging from “Strongly Agree” to “Strongly 
Disagree.” In the current study, only 12 questions from 
the general functioning domain were utilized to gauge ad-
olescents' perceptions of how their families work together 
on essential tasks (Byles et al., 1988). Lower scores on the 
FAD-GF indicate better general FF, and it has been validated 
for standalone use in 1,869 families with children between 
4 to 16 years of age (Cronbach’s α = .86; Byles et al., 1988).
Perceived Criticism Measure (PCM)      
 Two items from the Perceived Criticism Measure 
(PCM; Hooley & Teasdale et al., 1989) were employed to 
assess adolescent’s PPC (i.e., “How critical do you think your 
parent or guardian is of you?” and “When your parent or 
guardian criticizes you, how upset do you get?”). Each item 
is scored on a 10-point Likert scale ranging from “not at 
all critical” to “very critical.” Responses to these two items 
were summed to derive the total PCM score for analysis. 
The PCM has robust test-retest reliability (r = .75) over a 
five-month period (Hooley & Teasdale et al., 1989). Some 
argue that the construct and assessment of the PCM merely 
reflect negatively biased perceptions influenced by individu-
als’ moods. However, it was observed that the PCM scores 
did not change significantly after successful positive and 
negative mood inductions in 150 undergraduate students 
(r = -.12 and r = -.09, respectively; Gerlsma et al., 2014).
Procedure
 Adolescents and their families who met the eligibility 
criteria participated in assessments during an initial labora-
tory visit and subsequent follow-up evaluations conducted 
online via email at 3 and 6 months. Compensation included 
a $35 gift card for baseline assessments, with opportunities 
to win $50 and $100 gift cards in raffles for completing the 
3- and 6-month follow-ups, respectively. Notably, the final 
18.75% of the total 176 participants (n = 33) completed 
baseline visits virtually due to the impact of the COVID-19 
pandemic. Furthermore, suicidal participants who were 
recruited during the pandemic indicated elevated levels of 
SI severity when contrasted to suicidal participants recruit-
ed before the onset of the pandemic (R2 = .04; p = .04). 
However, data collection for the 46 participants under 

examination in this study occurred before the pandemic, 
with the last participant completing the baseline visit on 
December 8th, 2018. Thus, this difference in the severity of 
SI in suicidal adolescents did not impact current analyses. 
All study procedures were approved by the Institutional 
Review Board at Teachers College, Columbia University.
Statistical Analyses
 All analyses were conducted with Statistical Package for 
the Social Sciences (SPSS; version 29; IBM SPSS Inc., Chica-
go, Illinois).
Linear Regression      
 To examine whether adolescents with at least one ACE 
will endorse a higher severity of SI than those without ACEs 
(Hypothesis 1a), linear regression was utilized. Given the 
slightly right-skewed distribution of both SI and ACEs, 
linear regression was chosen for analysis due to its robust-
ness against mild violations of assumptions (Ernst & Al-
bers, 2017). Adolescents with a score of one or more on the 
ACE-Q were assigned to the ACEs group, while those with a 
score of zero on the ACE-Q were assigned to the non-ACES 
group. Subsequently, the analysis was completed while exam-
ining this dichotomous classification of ACEs as an indepen-
dent variable and the severity of SI as a dependent variable.
 Furthermore, linear regression was employed to examine 
whether subcategories of ACEs corresponded with SI severi-
ty in adolescents, such that adolescents with a history of each 
type of ACE reported more severe SI than their respective 
non-ACE comparison group (Hypothesis 1b). 10 discrete 
linear regressions were conducted between individual items 
in ACE-Q and the severity of SI. Linear regression was em-
ployed once more to assess whether a higher count of ACEs 
predicted a higher severity of SI in adolescents (Hypothe-
sis 1c). This potential predictive relationship was assessed 
by examining the total score of ACE-Q as an independent 
variable and the total score of SIQ as a dependent variable.
Moderation Analysis     
 PROCESS Macro version 4.2 (Hayes, 2022) was used 
to conduct moderation analysis while examining ACEs 
as an independent variable, severity of SI as a dependent 
variable, and FF and PPC as discrete and composite mod-
erators. PROCESS is an observed variable, Ordinary Least 
Squares (OLS), and logistic regression path analysis mod-
eling tool, often used in the fields of social, business, and 
health sciences. It supports both mediation and modera-
tion analyses by generating 5000 bootstrapped samples, 
automatically mean-centering continuous variables, estab-
lishing product terms, and presenting confidence intervals.



68

Results
Demographic Characteristics
 Participants with at least one ACE accounted for ap-
proximately 67% (n = 31) of the sample. Furthermore, 
around 13% (n = 6) of the sample indicated experienc-
ing four or more ACEs (i.e., clinically significant levels) 
in their lifetime. In terms of ACEs, this sample was rep-
resentative of the population as approximately 64% of 
U.S adults report having at least one ACE, and 17% re-
port having four or more ACEs (Swedo et al., 2023). 
Hypothesis 1a: Adolescents with at least one ACE will 
endorse a higher severity of SI than those without ACEs.
 There was no significant association between 
the history of ACE (i.e., presence of at least one 
ACE vs. no ACE) and SI severity (ß = 0.26, p = .09). 
Hypothesis 1b: Subcategories of ACEs will correspond 
with SI severity in adolescents, such that those adolescents 
with a history of each type of ACE report more severe 
SI than their respective non-ACE comparison group.
 Out of 10 subcategories of ACEs measured by ACE-Q, 
a significant regression was found in emotional abuse (ß = 
0.49, p = .01; Table 2), emotional neglect (ß = 0.65, p <  .001), 
and mental illness or suicide attempt in the household (ß = 
0.39, p = .04) with severity of SI. For emotional abuse, R2 = 
0.24, indicating that emotional abuse explained approximate-
ly 24% of the variance in SI severity. In the case of emotional 
neglect, R2 = 0.43, signifying that approximately 43% of the 
variability in SI severity can be accounted for by emotional ne-
glect. For mental illness or suicide attempt in the household, 
R2 = 0.15, indicating that being in a household with a family 
member who has a mental illness or who has made a suicide 
attempt explained 15% of the variance in SI severity. On the 
contrary, no significant regression was observed for physical 
abuse (ß = 0.37, p  = .08), sexual abuse (ß = 0.40, p = .09), phys-
ical neglect (ß = 0.22, p = .40), parental separation (ß = -0.02, 
p > .99), witnessing domestic violence (ß = 0.29, p = .20), 
household substance and alcohol abuse (ß = -0.21, p = .40), 
and incarceration of household members (ß = 0.39, p = .10).
Hypothesis 1c: A higher count of ACEs will 
predict a higher severity of SI in adolescents.
 There was no significant association between the count 
of ACEs and the severity of SI in adolescents (ß = 0.24, p = .12).
Hypothesis 2a: ACEs will be more strongly associat-
ed with SI severity among adolescents with lower FF.
 The moderation analysis revealed that approximate-
ly 68% of the variability in SI severity in adolescents was 
predicted by ACEs and FF (R2 = 0.68, F(3, 20) = 13.90, p 
< .001; Table 3). Additionally, the results indicated that 

ACEs (ß = 0.21, p = .04) had a significant positive effect on 
SI severity. While FF did not have significant effects on SI 
severity independently (ß = 0.19, p = .12), it was revealed 
that there was a significant interaction between ACEs and 
FF (ß = 0.28, p < .01). This significant interaction indi-
cated that FF moderated the effect of ACEs on SI severity. 
 This moderating effect is displayed in Figure 1. The 
graph demonstrates that the association between ACEs 
and SI severity is stronger for adolescents with lower FF (ß = 
0.49, p < .01; Table 4), and weaker for adolescents who have 
moderate FF (ß = 0.20, p = .04). Furthermore, the graph 
suggested that ACEs had a negative impact on the severity 
of SI for adolescents with high FF. Specifically, adolescents in 
the high ACEs group within the high FF category endorsed 
lower SI than those in the low ACEs group. However, this 
decline in SI within the high FF group was not found to be 
statistically significant upon further investigation (ß = -0.08, 
p = .46). In interpreting this result, it should be noted that 
a significant correlation was found between ACEs and FF 
(r(25) = .48, p = .02). Upon further investigation, it was re-
vealed that only one subcategory of ACEs was correlated to 
FF (i.e., emotional abuse; r(23) = .55, p < .01). To address 
the potential issues of multicollinearity both ACEs and FF 
were mean-centered. This pre-processing step aimed to re-
duce the correlation between ACEs and FF, enhancing the 
precision of the results and contributing to a more reliable 
examination of their relationship (Iacobucci et al., 2017).
Hypothesis 2b: ACEs will be more strongly associ-
ated with SI among adolescents with higher PPC.
 Approximately 47% of the variability in SI severi-
ty in adolescents was predicted by ACEs and PPC (R2 
= 0.47, F(3, 22) = 6.42, p < .01; Table 3). The results indi-
cated that both ACEs (ß = 0.48, p < 001) and PPC (ß = 
0.29, p = .02) had a significant positive effect on SI sever-
ity. Furthermore, there was a significant interaction be-
tween ACEs and PPC (ß = 0.19, p = .04), indicating that 
PPC moderated the effect of ACEs on the severity of SI. 
Figure 2 visualizes this interaction. The prevalence of ACEs 
exhibited a significant positive impact on the severity of SI 
within all three groups of PPC, with the most pronounced 
association observed among adolescents with high PPC 
(ß = 0.67, p < .01; Table 5). A less pronounced association 
was observed for adolescents with moderate levels of PPC 
(ß = 0.47, p < .001), followed by adolescents with low 
PPC (ß = 0.28, p = .01). A significant correlation between 
ACEs and PPC was not observed (r(23) = -0.29, p = .15).
Hypothesis 2c: ACEs will be more strongly associated with 
SI among adolescents with higher PPC and lower FF.

ADVERSE EXPERIENCES, FAMILY, AND ADOLESCENT SUICIDALITY



69

PARK, GOGER, & CHA

 This model explained approximately 72% of the variabil-
ity in SI severity (R2 = 0.72, F(4, 19) = 5.89, p < .01; Table 3). 
The analysis revealed that ACEs (ß = 0.18, p = .38), PPC (ß = 
0.12, p = .29), and FF (ß = 0.17, p = .41) did not have a signifi-
cant independent effect on the severity of SI. Interactions be-
tween ACEs x PPC (ß = -0.11, p = .41), PPC x FF (ß = 0.06, 
p = .64), and ACEs x PPC x FF (ß = -0.03, p = .77) were also 
not found to be significant. Nonetheless, the interaction be-
tween ACEs and FF remained significant (ß = 0.32, p = .02). 
 The interactions are visualized in Figure 3. The figure 
showed that ACEs had a negative impact on the severity of 
SI for adolescents with high FF, irrespective of varying levels 
of PPC. However, upon further investigation, these inter-
actions were not significant (i.e., High FF x Low PPC (ß = 
-0.06, p = .72; Table 6), High FF x Moderate PPC (ß = -0.15, 
p = .60), High FF x High PPC (ß = -0.23, p = .58). Lastly, 
out of nine slopes visualized in Figure 3, two showed signif-
icant associations: Low PPC x Low FF (ß = 0.64, p = .01; 
Table 6) and Moderate PPC x Low FF (ß = 0.50, p = .01). 

Discussion
 The current study examined how ACEs predict the 
severity of SI in adolescents, and to what extent this rela-
tionship was moderated by familial factors such as FF and 
PPC. The results indicated that low FF and high PPC 
independently exacerbated the impact of childhood ad-
versity on the severity of adolescent SI. This moderating 
effect, however, was not observed when examining FF and 
PPC compositely. Furthermore, specific forms of ACEs 
were significantly associated with the severity of SI in ad-
olescents. Nonetheless, the presence and counts of ACEs 
were not significantly associated with the severity of SI.
Moderating Role of FF and PPC
 As hypothesized, ACEs were more strongly associ-
ated with SI among adolescents who had lower FF. This 
finding suggests that the combined impact of ACEs and 
lower FF exacerbates      the risk of SI in adolescents. Visu-
alizing the moderating effects of FF revealed intriguing 
patterns (Figure 1). Prior to conducting post hoc analysis, 
positive associations between the count of ACEs and se-
verity of SI were expected for all three groups of FF (i.e., 
low, moderate, and high). Indeed, this pattern was observed 
among adolescents in both low- and moderate-FF groups. 
 Although the impact was more pronounced in the low 
FF group than the moderate FF group, this finding indicated 
that adolescents with moderate FF face comparable risks to 
those with low FF. Given that not talking to family adults 
about concerns or lacking a trusted adult in one’s life has 

been linked to an elevated risk of teen suicidality (Weissing-
er et al., 2023), it is plausible that adolescents from families 
with low and moderate functioning may not perceive their 
parents or guardians as trusted adults with whom they can 
discuss concerns when experiencing potentially traumatic 
life events. This inability to openly share the experiences of 
adverse events could exacerbate SI among adolescents and 
prevent them from receiving timely and appropriate help. 
 In contrast, the opposite trend was observed in the high 
FF group; the severity of SI decreased as the count of ACEs 
increased. This unanticipated trajectory can be attributed 
to several plausible explanations. In families with high FF, 
children may generally perceive their parents or guardians as 
trusted adults and be more inclined to seek help from them 
when faced with potentially traumatic events. Additional-
ly, families characterized by high general FF may be better 
equipped to provide appropriate assistance when adolescents 
experience crises and reach out for help. Adolescents’ willing-
ness to seek help, coupled with the family’s competency in 
providing necessary support, may act as a buffer against the 
exacerbation of SI associated with childhood adverse events.
 Furthermore, the increased severity of SI observed in 
adolescents with fewer ACEs within the high FF group 
could be attributed to these adolescents perceiving their 
few ACEs as not substantial enough to justify seeking help, 
despite the less apparent but surely debilitating negative 
consequences of ACEs. As the count of ACEs rises, ad-
olescents may feel more justified and validated in seeking 
support from their families, which can diminish the det-
rimental effects of ACEs. However, the downward trend 
observed in the high FF group should be interpreted with 
caution, as the slopes are not statistically significant (Table 4). 
 As predicted, ACEs were more strongly associated 
with SI among adolescents with higher PPC. This finding 
suggests that the risk of SI is exacerbated when ACEs are 
conjoined with a higher level of adolescents’ perception 
of parental criticism. As visualized in Figure 2, across all 
varying levels of PPC, the severity of SI increased as ACEs 
experienced by adolescents increased. The most prom-
inent association was observed in the high PPC group, 
followed by the moderate, and then the low PPC groups. 
 There may be several reasons why higher levels of PPC 
intensify the association between adverse events in child-
hood and SI in adolescence. Parental criticism is associated 
with the development of internalizing symptoms (i.e., sad-
ness, anxiety, and loneliness) in children (Ahmadzadeh et al., 
2022; Ehrenreich & Underwood, 2016). In a longitudinal 
study conducted by Piqueras and colleagues (2019), inter-



70

nalizing symptoms (e.g., symptoms of depression) had a 
significant association with current suicidal behaviors in 239 
adolescents. Given this body of research, it can be speculated 
that persistent parental criticisms may significantly shape ad-
olescents' self-perception. The internalization of critical mes-
sages from a caregiver may lead to the cultivation of a more 
pessimistic self-view. This curtailed self-esteem in youth may 
intensify feelings of thwarted belongingness and perceived 
burdensomeness (Eades et al., 2019). Thus, adolescents may 
experience heightened feelings of isolation and a diminished 
sense of emotional support from their parents. Consequent-
ly, both thwarted belongingness and perceived burden-
someness can compound emotional distress, amplifying the 
impact of ACEs and further elevating the risk of adolescent 
STBs (Ogrodniczuk et al., 2023; Roeder & Cole, 2019).
 Given that PPC is a construct designed to gauge ado-
lescents' perception of parental criticism, there is ambiguity 
regarding its direct correlation with the frequency or actual 
intensity of criticism received. It is conceivable that PPC does 
not solely reflect the objective frequency or severity of paren-
tal reproach, but rather encompasses a subjective element 
influenced by individual interpretations. This suggests that 
certain adolescents may be more prone to interpreting their 
parents' feedback as highly critical, irrespective of the actual 
tone or intention of such expressions. Likewise, it is plausi-
ble that certain adolescents exhibit greater resilience in the 
face of potentially unwarranted and harsh parental criticism. 
While PPC captures external factors (i.e., how critical the 
parents are), it also encompasses the subjective filters through 
which adolescents interpret and process parental behaviors.
 Finally, there was insufficient evidence to conclude 
that FF and PPC compositely moderate the association 
between ACEs and adolescent SI. Thus, we could not 
conclude that ACEs are more strongly associated with SI 
among adolescents with both lower FF and higher PPC. 
Since FF and PPC independently moderated the association 
between ACEs and adolescent SI, the absence of a signif-
icant result in evaluating FF and PPC as composite mod-
erators raises questions. Potentially, the interplay between 
FF, PPC, ACEs, and SI may have been more complex than 
initially hypothesized. It is also possible that other variables 
or interactions that were not accounted for in the study 
design could have contributed to the observed outcomes. 
 In this composite model, while all other interactions 
were not significant, the interaction between ACEs and FF 
remained significant, once again validating the finding in 
Hypothesis 2a. This finding becomes clearer when inspect-
ing Figure 3. Among the nine interactions depicted in the 

figure, statistical significance was exclusively observed in the 
interactions involving the low FF group (i.e., low FF x low 
PPC and low FF x moderate PPC). This illustrates the pivot-
al role of FF as a moderating variable in the complex interplay 
between adverse events in childhood and SI in adolescence. 
 Moreover, the intriguing pattern depicted in Figure 1 
reemerged in Figure 3. The figure displayed that ACEs had 
a negative impact on the severity of SI for adolescents with 
high FF, irrespective of varying levels of PPC. Once again, 
this suggested that adolescents in the high ACEs group with 
high FF endorsed lower SI than those in the lower ACEs 
group. While these interactions were not significant (Ta-
ble 6), this recurring trend warrants further investigation.
Association Between ACEs and SI
 Select forms of childhood adversity were associated 
with the severity of SI in adolescents. These include emo-
tional abuse, emotional neglect, and mental illness or suicide 
attempts in the household. In contrast, physical abuse, sexual 
abuse, physical neglect, parental separation, witnessing do-
mestic violence, household substance and alcohol abuse, and 
incarceration of household members did not correspond 
to SI severity in adolescents. This finding is partially aligned 
with the current literature and the hypothesis. Most studies 
examining the association between ACEs and SI report that 
the majority, if not all, subcategories of ACEs predict lat-
er suicidality (Wang et al., 2019). While there is conflicting 
evidence regarding the consistent prediction of suicidality 
by household challenges, such as parental separation or in-
carceration of a family member (Sahle et al., 2022), a more 
robust body of research consistently associates emotional, 
physical, and sexual abuse, as well as emotional and physi-
cal neglect during childhood with later STBs (Miller et al., 
2013; Pournaghash-Tehrano et al., 2021; Wang et al., 2022). 
 Given this evidence, it is worth noting that only three 
out of 10 subcategories of ACEs were significantly asso-
ciated with SI severity in the current study. The nonsignif-
icant results across seven subcategories of ACEs should 
be interpreted with caution, as significant outcomes were 
identified solely within the three most prevalent categories 
of ACEs in the sample, with parental separation being the 
only exception (i.e., parental separation was prevalent, but 
the interaction was not significant; Table 2). Hence, the lack 
of significant results in the remaining seven ACE categories 
associated with SI severity may be due to insufficient rep-
resentation of adolescents who experienced those specific 
adversities in the sample. Moreover, subcategories of ACEs 
that are consistently associated with SI severity, such as phys-
ical and sexual abuse, exhibited potential significance. While 

ADVERSE EXPERIENCES, FAMILY, AND ADOLESCENT SUICIDALITY



71

PARK, GOGER, & CHA

not significant at p = .05, both physical abuse (β = 0.37, p = 
.08; Table 2) and sexual abuse (β = 0.40, p = .09) were signif-
icant at p = .10. The detection of some significance despite 
the small sample size may suggest a moderate association 
between the adolescent SI severity and specific ACE types.
 Contrary to the hypothesis, the result did not suggest 
that adolescents with at least one ACE endorse a higher se-
verity of SI than those without ACEs. This finding is not 
aligned with the existing literature and should be interpreted 
with caution for several reasons. Scoring one on the ACE-Q 
may not definitively indicate the presence of adverse events in 
childhood. For instance, question six on the ACE-Q evalu-
ates parental separation or divorce, which is generally associat-
ed with various negative mental health outcomes in children 
(Çaksen, 2022). However, the impact of divorce depends on 
factors such as the intensity and duration of the separation 
process, as well as the availability of familial or non-familial 
support (Spremo, 2020). Since the ACE-Q lacks detailed as-
sessments of these nuanced aspects, it is difficult to determine 
whether an affirmative response to question six or other 
questions signifies an adverse event experienced in childhood. 
 Moreover, Spremo (2020) suggests that family dy-
namics typically stabilize two to four years after divorce. 
Without knowing the timing of parental divorce relative 
to the date of assessment, we lack the temporal context to 
accurately gauge how the presence of at least one ACE, es-
pecially parental separation, predicts adolescent SI. Lastly, 
it is plausible that the negative impact of ACEs may not 
fully manifest itself when assessed in close proximity to the 
occurrence of the adverse event. However, this explana-
tion appears less likely as a large body of research suggests 
that ACEs are generally associated with an increased risk 
of SI and suicide attempts across community, clinical, and 
high-risk samples of adolescents (Miller et al. 2013). 
 Once again, contrary to the hypothesis, no significant 
association was observed between the count of ACEs and 
the severity of SI. This finding should also be interpret-
ed with caution, considering a body of research that sug-
gests an alternative perspective. For instance, a study with 
a sample of 989 Chinese college students concluded that a 
cumulative effect was observed between ACEs and SI, in-
dicating that a higher count of ACEs corresponded to an 
increased likelihood of endorsing SI (Wang et al., 2019). 
While Chinese society has increasingly integrated elements 
of individualism through Western influence, it remains 
more collectivistic than the U.S., particularly in its empha-
sis on family interdependence (Kolstad & Gjesvik, 2014). 
 Cultural factors like these may influence how indi-

viduals perceive and respond to adversity within the fam-
ily context (Oyserman & Lee, 2008). However, cultural 
explanations alone appear insufficient to account for the 
discrepancy between the current findings and those from 
studies conducted in collectivistic contexts. Notably, simi-
lar associations between the cumulative negative impact of 
ACEs on SI have been observed in a sample of 1,532 U.S.-
based adolescents (Meeker et al., 2021). It is possible that 
the absence of a significant association in the current study 
is attributable, at least in part, to the limited sample size.
Limitations and Future Directions
 There are several limitations to consider in interpreting 
the findings. Although the current sample was ethnically di-
verse, the small sample size may impact the generalizability of 
the findings. Several negative findings did not align with the 
existing literature (i.e., nonsignificant association between the 
presence of one ACE, counts of ACEs, and selected forms of 
ACEs with SI severity). The analyses should be replicated in a 
larger sample for more precise and representative findings.     .      
 Furthermore, although not statistically significant, the 
recurring pattern of negative association between counts of 
ACEs and severity of SI in high FF warrants future investi-
gation in a larger sample. If replicating this analysis in a larger 
sample reveals a statistically significant decrease in SI for ado-
lescents from families with high FF, it would suggest that not 
only are the negative effects of ACEs on adolescent suicidality 
potentially more pronounced in those with lower FF, but also 
that higher FF could serve as a protective factor. Lastly, FF and 
PPC should be evaluated as composite moderators in a larger 
sample, as the current study may have lacked the statistical 
power in the analysis to detect a significant interaction effect. 
 Additionally, the study did not include measures of psy-
chiatric disorders (e.g., major depressive disorder, generalized 
anxiety disorder, or posttraumatic stress disorder), which 
are known to be closely associated with both ACE exposure 
(Daníelsdóttir et al., 2024) and SI (Gilmour, 2016; Panagioti 
et al., 2015; Rihmer & Rihmer, 2019). Due to limitations 
in available data, key demographic variables such as house-
hold income, single-parent status, and parental education 
level were not included in the analyses either. The absence of 
these variables limits the ability to assess potential confound-
ing effects or to better contextualize the observed association.
 The cross-sectional design of the study also limits 
our ability to explore the dynamic changes in adolescent 
experiences with ACEs over time. Future research could 
benefit from longitudinal investigations which capture 
the evolving impact of ACEs throughout adolescents’ 
lives. Additionally, the use of self-report measures intro-



72

ADVERSE EXPERIENCES, FAMILY, AND ADOLESCENT SUICIDALITY

duces potential biases. Recall bias, along with individual 
differences in how adolescents define events as adverse, 
may impact the accuracy of reported ACEs. Relatedly, 
FF and PPC assessments may have been influenced by 
transient factors such as recent adolescent-parent conflicts 
(e.g., arguing with parents right before the assessments).      
 The utilization of the Ecological Momentary Assess-
ment (EMA) has the potential to address both concerns. 
With the use of appropriate questions, the EMA method-
ology may enable the capture of real-time fluctuations in 
family interactions. This includes assessing the frequency, 
intensity, and content of parental criticism, as well as ad-
olescents' corresponding STBs. Finally, despite both vari-
ables being mean-centered to improve the interpretability 
of the regression model, the multicollinearity between 
ACEs and FF should be noted in interpreting results.
Clinical Implications
 Given that FF and PPC are found to independently 
amplify and attenuate the effects of ACEs in adolescent 
suicidality, strategies focused on enhancing FF while simul-
taneously mitigating PPC should be considered. Clinical-
ly, targeted interventions can be developed to achieve the 
desired goal. When treating youth with suicidal thoughts, 
clinicians can assess for ACEs, FF, and PPC to identify at-
risk individuals and provide appropriate early prevention 
support within the family context (e.g., implementing 
targeted family therapy, providing specific parenting sup-
port, or designing programs that address FF and PPC). 
Evidence-based treatment targeting family cohesion can 
also be employed (e.g., Attachment-Based Family Thera-
py; ABFT; Diamond et al., 2010; Diamond et al., 2003). 
 Fostering an environment that promotes open com-
munication and supportive family relationships becomes 
crucial at home. Encouraging positive interactions, ac-
tive listening, and constructive dialogue can enhance FF 
and mitigate potential PPC issues. Implementing struc-
tured family activities such as shared meals may further 
strengthen familial bonds (Utter et al., 2013). Additional-
ly, educational initiatives can be extended to parents and 
caregivers to raise awareness about the impact of ACEs 
and the role of FF and PPC in adolescent mental health. 
 Providing resources and guidance on effective parenting 
strategies and communication skills can empower families to 
create a nurturing and resilient environment. While it is ideal 
for parents or guardians to be involved in treating adolescents 
for their STBs, there are situations in which this is not feasible 
(e.g., intense family conflict, abuse, neglect, or when caregiv-
ers are unavailable or unwilling to participate). Cultural stig-

ma or differing beliefs about mental health treatment may 
also limit caregiver involvement. In such cases, treatment can 
focus on building adolescents’ skills (e.g., emotion regulation, 
distress tolerance) to help them manage their well-being in-
dependently. This approach may still be effective, as both FF 
and PPC reflect not only the objective reality of familial dy-
namics but also adolescents’ subjective perceptions of them. 

Conclusion
 The present study found that family functioning 
(FF) and perceived parental criticism (PPC) independent-
ly moderated the relationship between adverse childhood 
experiences (ACEs) and suicidal ideation (SI) in an ethni-
cally diverse adolescent sample. This novel contribution to 
the literature highlights how specific family dynamics may 
either buffer or exacerbate the impact of early adversity on 
youth suicidal thoughts. Several unexpected null findings 
also emerged: (1) only certain forms of ACEs were signifi-
cantly associated with adolescent SI; (2) the presence of 
at least one ACE and the total number of ACEs were not 
significantly associated with SI; and (3) the moderation 
model was nonsignificant when FF and PPC were assessed 
as a composite variable. These findings should be inter-
preted with caution, particularly considering the study’s 
limitations, as they diverge from previous research. To gain 
a more nuanced understanding of the critical role of fam-
ily in adolescent development in the context of ACEs and 
suicidality, future studies should replicate this research in a 
larger sample and collect more detailed information on ad-
olescents’ perceptions and reports of ACEs, FF, and PPC.

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Table 1

Demographic Characteristics of the Participants 

Note. N = 46



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Table 2

Linear Regression Analyses: Severity of Suicidal Ideation (SI) and Subcategories of Adverse Childhood Experiences 

(ACEs)

Note. SE = Standard Error; LL = Lower Limit; UL = Upper Limit; SA = Suicide Attempts.
*p < .05



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Table 3

Summary of Moderated Regression Analyses Predicting Suicidal Ideation (SI) Severity in Adolescents

Note. ACEs = Adverse Childhood Experiences; FF = Family Functioning; PPC = Perceived Parental Criticism; 
SE = Standard Error; LL = Lower Limit; UL = Upper Limit.
aACEs will be more strongly associated with SI among adolescents who have lower family functioning; n = 24, 
R2 = .68. 
bACEs will be more strongly associated with SI among adolescents who have higher perceived parental criticism; 
n = 26, R2 = .47.
cACEs will be more strongly associated with SI among adolescents who have higher perceived parental criticism 
and lower family functioning; n = 24, R2 = .72.
*p < .05



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Table 4

Conditional Effects of Adverse Childhood Experiences (ACEs) at Values of Family Functioning (FF)

Note. SD = Standard Deviation; SE = Standard Error; LL = Lower Limit; UL = Upper Limit; FAD-GF = The 
McMaster Family Assessment Device – General Functioning.
aHigher score in FAD-GF indicates worse FF. This table based on the results of FAD-GF.
*p < .05



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Table 5

Conditional Effects of Adverse Childhood Experiences (ACEs) at Values of Perceived Parental Criticism (PPC)

Note. SD = Standard Deviation; SE = Standard Error; LL = Lower Limit; UL = Upper Limit.
*p < .05



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Table 6

Conditional Effects of Adverse Childhood Experiences (ACEs) at Values of Family Functioning (FF) and Perceived 

Parental Criticism (PPC)

Note.  SD = Standard Deviation; SE = Standard Error; LL = Lower Limit; UL = Upper Limit.
*p < .05



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ADVERSE EXPERIENCES, FAMILY, AND ADOLESCENT SUICIDALITY

Figure 1

Moderating Effects of Family Functioning (FF) on the Association Between Adverse Childhood Experiences (ACEs) 
and Adolescent Suicidal Ideation (SI)

Note: The interactions between variables are statistically significant (p < .05) for Low FF and Mid FF. However, 
the downward trend observed in High FF was not significant. Additional details are available in Table 4.



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Figure 2

Moderating Effects of Perceived Parental Criticism (PPC) on the Association Between Adverse Childhood Experi-
ences (ACEs) and Adolescent Suicidal Ideation (SI)

Note: The interactions between variables are statistically significant (p < .05) for all categories of PPC. Addition-
al details are available in Table 5.



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Figure 3

Moderating Effects of Family Functioning (FF) on the Association Between Adverse Childhood Experiences (ACEs) 
and Adolescent Suicidal Ideation (SI)

Note: Among the nine slopes depicted in the figure, only Low PPC x Low FF and Moderate PPC x Low FF were 
statistically significant at p < .05. Additional details are available in Table 6.


