. 2025 Aug:350:116555.

doi: 10.1016/j.psychres.2025.116555. Epub 2025 May 22.

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

Philippe Mortier¹, Xue Yang², Yasmin A Altwaijri³, Jacob A Holdcraft⁴, Sue Lee⁴, Nancy A Sampson⁴, Yesica Albor⁵, Ahmad N Alhadi⁶, Jordi Alonso⁷, Nouf K Al-Saud³, Claes Andersson⁸, Lukoye Atwoli⁹, Randy P Auerbach¹⁰, Caroline Ayuya Muaka¹¹, Patricia M Báez-Mansur¹², Laura Ballester¹, Jason Bantjes¹³, Harald Baumeister¹⁴, Marcus Bendtsen¹⁵, Corina Benjet⁵, Anne H Berman¹⁶, Ronny Bruffaerts¹⁷, Paula Carrasco¹⁸, Silver C N Chan¹⁹, Irina Cohut²⁰, María Anabell Covarrubias Díaz Couder²¹, Marcelo A Crockett²², Pim Cuijpers²³, Oana A David²⁴, Dong Dong², David D Ebert²⁵, Jorge Gaete²⁶, Mireia Felez-Nobrega²⁷, Carlos García Forero²⁸, Margalida Gili²⁹, Raúl A Gutiérrez-García³⁰, Josep Maria Haro³¹, Penelope Hasking³², Xanthe Hunt³³, Mathilde M Husky³⁴, Florence Jaguga³⁵, Leontien Jansen³⁶, Álvaro I Langer³⁷, Yan Liu³⁸, Scarlett Mac-Ginty³⁹, Vania Martínez⁴⁰, Andre Mason⁴¹, Muthoni Mathai⁴², Margaret McLafferty⁴³, Andrea Miranda-Mendizabal⁴⁴, Elaine K Murray⁴⁵, Catherine M Musyoka⁴², Siobhan M O'Neill⁴⁶, Claudiu C Papasteri⁴⁷, José A Piqueras⁴⁸, Codruta A Popescu⁴⁹, Charlene Rapsey⁵⁰, Kealagh Robinson⁵¹, Tiscar Rodriguez-Jimenez⁵², Damian Scarf⁵³, Oi-Ling Siu⁵⁴, Dan J Stein⁵⁵, Sascha Y Struijs⁵⁶, Cristina T Tomoiaga⁵⁷, Karla Patricia Valdés-García⁵⁸, Shelby Vereecke⁵⁹, Daniel V Vigo⁶⁰, Angel Y Wang⁵⁹, Samuel Y S Wong², Ronald C Kessler⁴; World Mental Health International College Student collaborators

Affiliations

¹ Health Services Research Group, Hospital del Mar Research Institute, Carrer del Doctor Aiguader, 88 08003 Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain.
² The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
³ Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
⁴ Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
⁵ Center for Global Mental Health Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico.
⁶ Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia; SABIC Psychological Health Research & Applications Chair (SPHRAC), Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
⁷ Health Services Research Group, Hospital del Mar Research Institute, Carrer del Doctor Aiguader, 88 08003 Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain; Department of Medicine and Life Sciences, Pompeu Fabra University (UPF), Barcelona, Spain. Electronic address: jalonso@researchmar.net.
⁸ Department of Criminology, Malmö University, Malmö, Sweden.
⁹ Department of Medicine, Medical College East Africa, the Aga Khan University, Nairobi, Kenya; Brain and Mind Institute, the Aga Khan University, Nairobi, Kenya; Department of Mental Health and Behavioural Sciences, Moi University School of Medicine, Eldoret, Kenya.
¹⁰ Department of Psychiatry, Columbia University, New York, NY, USA.
¹¹ Department of Psychology & Counselling, Daystar University, Nairobi, Kenya.
¹² Coordinación de Desarrollo Académico y Servicios Educativos, Universidad la Salle Ciudad Victoria, Ciudad Victoria, Mexico.
¹³ Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, South Africa; Institute for Life Course Health Research, Global Health, Stellenbosch University.
¹⁴ Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany.
¹⁵ Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden.
¹⁶ Department of Psychology, Uppsala University, Uppsala, Sweden.
¹⁷ Center for Public Health Psychiatry, Department of Neurosciences, Katholieke Universiteit Leuven (KUL), Leuven, Belgium; Universitair Psychiatrisch Centrum KU Leuven (UPC-KUL), Leuven, Belgium; WHO Collaborating Centre for Public Health Psychiatry, KU Leuven, Belgium.
¹⁸ Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain; Department of Medicine, Universitat Jaume I, Castellón de la Plana, Spain; Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain.
¹⁹ The Hong Kong University of Science and Technology, Hong Kong SAR, PR China.
²⁰ Career Counseling and Guidance Center, Technical University of Cluj-Napoca, Romania.
²¹ Coordinación de Investigación, Universidad La Salle Noroeste.
²² Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile.
²³ Faculty of Behavioural and Movement Science, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands; Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.
²⁴ DATA Lab, International Institute for Advanced Studies in Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania; Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.
²⁵ School of Medicine and Health, Department for Sport and Health Sciences, Technical University Munich, Germany.
²⁶ Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile; Centro de Investigación en Salud Mental Estudiantil (ISME), Facultad de Ciencias Sociales, Universidad de los Andes, Santiago, Chile.
²⁷ Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu (IRSJD), Sant Boi de Llobregat , Barcelona, Spain.
²⁸ Departamento de Medicina, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.
²⁹ Department of Psychology, University of the Balearic Islands (UIB), Palma, Mallorca, Spain.
³⁰ Universidad La Salle Bajío, campus Salamanca, Mexico.
³¹ Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu (IRSJD), Sant Boi de Llobregat , Barcelona, Spain; Centro de investigación Biomédica en Red en Salud Mental (CIBERSAM), ISCIII, Madrid, Spain.
³² School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Curtin enAble Institute, Curtin University, Perth, Australia.
³³ Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa; Africa Health Research Institute (AHRI), Durban, South Africa.
³⁴ Active Team, Bordeaux Population Health Research Center, INSERM U1219, University of Bordeaux, France.
³⁵ Department of Alcohol and Drug Abuse Rehabilitation Services, Moi Teaching and Referral Hospital, Eldoret, Kenya.
³⁶ Center for Public Health Psychiatry, Department of Neurosciences, Katholieke Universiteit Leuven (KUL), Leuven, Belgium; Universitair Psychiatrisch Centrum KU Leuven (UPC-KUL), Leuven, Belgium.
³⁷ Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile; Facultad de Psicología y Humanidades, Universidad San Sebastián, Santiago, Chile.
³⁸ School of Public Health, Jining Medical University, Jining 272067, Shandong Province, PR China.
³⁹ Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile; Department of Health Service & Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁴⁰ Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile; Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (Cemera), Facultad de Medicina, Universidad de Chile, Santiago, Chile.
⁴¹ School of Psychological and Social Sciences, University of Waikato, Hamilton, New Zealand.
⁴² Department of Psychiatry, Faculty of Health Sciences, University of Nairobi, Kenya.
⁴³ Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, UK; Atlantic Technological University, Donegal, Ireland.
⁴⁴ Centro de investigación Biomédica en Red en Salud Mental (CIBERSAM), ISCIII, Madrid, Spain; Sant Joan de Déu Research Institute, Carrer de Santa Rosa, 39-57, 08950, Esplugues del Llobregat, Spain.
⁴⁵ Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, UK.
⁴⁶ School of Psychology, Ulster University, Coleraine, UK.
⁴⁷ Department of Psychology and Cognitive Sciences, University of Bucharest, Romania.
⁴⁸ Department of Health Psychology, Universidad Miguel Hernandez de Elche (UMH), Alicante, Spain.
⁴⁹ Department of Human Sciences, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania.
⁵⁰ Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
⁵¹ School of Psychology, Massey University, Wellington, New Zealand.
⁵² Department of Psychology and Sociology, Universidad de Zaragoza (UNIZAR), Zaragoza, Spain.
⁵³ Department of Psychology, University of Otago, Dunedin, New Zealand.
⁵⁴ Department of Psychology, Lingnan University, Hong Kong, SAR, China.
⁵⁵ SAMRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, South Africa.
⁵⁶ Faculty of Behavioural and Movement Science, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands.
⁵⁷ DATA Lab, International Institute for Advanced Studies in Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania.
⁵⁸ Facultad de Psicología, Universidad Autónoma de Coahuila, Saltillo, Mexico.
⁵⁹ Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁶⁰ Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.

PMID: 40450963
PMCID: PMC12240005 (available on 2026-08-01)
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

Philippe Mortier et al. Psychiatry Res. 2025 Aug.

. 2025 Aug:350:116555.

doi: 10.1016/j.psychres.2025.116555. Epub 2025 May 22.

Authors

Affiliations

¹ Health Services Research Group, Hospital del Mar Research Institute, Carrer del Doctor Aiguader, 88 08003 Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain.
² The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
³ Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
⁴ Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
⁵ Center for Global Mental Health Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico.
⁶ Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia; SABIC Psychological Health Research & Applications Chair (SPHRAC), Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
⁷ Health Services Research Group, Hospital del Mar Research Institute, Carrer del Doctor Aiguader, 88 08003 Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain; Department of Medicine and Life Sciences, Pompeu Fabra University (UPF), Barcelona, Spain. Electronic address: jalonso@researchmar.net.
⁸ Department of Criminology, Malmö University, Malmö, Sweden.
⁹ Department of Medicine, Medical College East Africa, the Aga Khan University, Nairobi, Kenya; Brain and Mind Institute, the Aga Khan University, Nairobi, Kenya; Department of Mental Health and Behavioural Sciences, Moi University School of Medicine, Eldoret, Kenya.
¹⁰ Department of Psychiatry, Columbia University, New York, NY, USA.
¹¹ Department of Psychology & Counselling, Daystar University, Nairobi, Kenya.
¹² Coordinación de Desarrollo Académico y Servicios Educativos, Universidad la Salle Ciudad Victoria, Ciudad Victoria, Mexico.
¹³ Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, South Africa; Institute for Life Course Health Research, Global Health, Stellenbosch University.
¹⁴ Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany.
¹⁵ Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden.
¹⁶ Department of Psychology, Uppsala University, Uppsala, Sweden.
¹⁷ Center for Public Health Psychiatry, Department of Neurosciences, Katholieke Universiteit Leuven (KUL), Leuven, Belgium; Universitair Psychiatrisch Centrum KU Leuven (UPC-KUL), Leuven, Belgium; WHO Collaborating Centre for Public Health Psychiatry, KU Leuven, Belgium.
¹⁸ Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain; Department of Medicine, Universitat Jaume I, Castellón de la Plana, Spain; Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain.
¹⁹ The Hong Kong University of Science and Technology, Hong Kong SAR, PR China.
²⁰ Career Counseling and Guidance Center, Technical University of Cluj-Napoca, Romania.
²¹ Coordinación de Investigación, Universidad La Salle Noroeste.
²² Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile.
²³ Faculty of Behavioural and Movement Science, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands; Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.
²⁴ DATA Lab, International Institute for Advanced Studies in Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania; Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.
²⁵ School of Medicine and Health, Department for Sport and Health Sciences, Technical University Munich, Germany.
²⁶ Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile; Centro de Investigación en Salud Mental Estudiantil (ISME), Facultad de Ciencias Sociales, Universidad de los Andes, Santiago, Chile.
²⁷ Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu (IRSJD), Sant Boi de Llobregat , Barcelona, Spain.
²⁸ Departamento de Medicina, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.
²⁹ Department of Psychology, University of the Balearic Islands (UIB), Palma, Mallorca, Spain.
³⁰ Universidad La Salle Bajío, campus Salamanca, Mexico.
³¹ Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu (IRSJD), Sant Boi de Llobregat , Barcelona, Spain; Centro de investigación Biomédica en Red en Salud Mental (CIBERSAM), ISCIII, Madrid, Spain.
³² School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Curtin enAble Institute, Curtin University, Perth, Australia.
³³ Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa; Africa Health Research Institute (AHRI), Durban, South Africa.
³⁴ Active Team, Bordeaux Population Health Research Center, INSERM U1219, University of Bordeaux, France.
³⁵ Department of Alcohol and Drug Abuse Rehabilitation Services, Moi Teaching and Referral Hospital, Eldoret, Kenya.
³⁶ Center for Public Health Psychiatry, Department of Neurosciences, Katholieke Universiteit Leuven (KUL), Leuven, Belgium; Universitair Psychiatrisch Centrum KU Leuven (UPC-KUL), Leuven, Belgium.
³⁷ Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile; Facultad de Psicología y Humanidades, Universidad San Sebastián, Santiago, Chile.
³⁸ School of Public Health, Jining Medical University, Jining 272067, Shandong Province, PR China.
³⁹ Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile; Department of Health Service & Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁴⁰ Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile; Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (Cemera), Facultad de Medicina, Universidad de Chile, Santiago, Chile.
⁴¹ School of Psychological and Social Sciences, University of Waikato, Hamilton, New Zealand.
⁴² Department of Psychiatry, Faculty of Health Sciences, University of Nairobi, Kenya.
⁴³ Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, UK; Atlantic Technological University, Donegal, Ireland.
⁴⁴ Centro de investigación Biomédica en Red en Salud Mental (CIBERSAM), ISCIII, Madrid, Spain; Sant Joan de Déu Research Institute, Carrer de Santa Rosa, 39-57, 08950, Esplugues del Llobregat, Spain.
⁴⁵ Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, UK.
⁴⁶ School of Psychology, Ulster University, Coleraine, UK.
⁴⁷ Department of Psychology and Cognitive Sciences, University of Bucharest, Romania.
⁴⁸ Department of Health Psychology, Universidad Miguel Hernandez de Elche (UMH), Alicante, Spain.
⁴⁹ Department of Human Sciences, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania.
⁵⁰ Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
⁵¹ School of Psychology, Massey University, Wellington, New Zealand.
⁵² Department of Psychology and Sociology, Universidad de Zaragoza (UNIZAR), Zaragoza, Spain.
⁵³ Department of Psychology, University of Otago, Dunedin, New Zealand.
⁵⁴ Department of Psychology, Lingnan University, Hong Kong, SAR, China.
⁵⁵ SAMRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, South Africa.
⁵⁶ Faculty of Behavioural and Movement Science, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands.
⁵⁷ DATA Lab, International Institute for Advanced Studies in Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania.
⁵⁸ Facultad de Psicología, Universidad Autónoma de Coahuila, Saltillo, Mexico.
⁵⁹ Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁶⁰ Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.

PMID: 40450963
PMCID: PMC12240005 (available on 2026-08-01)
DOI: 10.1016/j.psychres.2025.116555

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=1.5 [1.3-1.8]). 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.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Randy P. Auerbach reports financial support was provided by Get Sonar Inc. Randy P. Auerbach reports financial support was provided by RPA Health Consulting, Inc. Randy P. Auerbach reports financial support was provided by Covington & Burling LLP. Ronny Bruffaerts reports financial support was provided by Eli Lilly (IIT-H6U-BX-I002). Xanthe Hunt reports financial support was provided by Sexual Violence Research Institute. Xanthe Hunt reports financial support was provided by Volkswagen Foundation. Xanthe Hunt reports financial support was provided by Wellspring Philanthropies. Xanthe Hunt reports financial support was provided by Foreign. Xanthe Hunt reports financial support was provided by Commonwealth and Development Office (UK government). Xanthe Hunt reports financial support was provided by PANDA Holding Limited. Xanthe Hunt reports financial support was provided by National Research Foundation of South Africa. Xanthe Hunt reports financial support was provided by Center for Inclusive Policy. Xanthe Hunt reports financial support was provided by Mastercard Foundation. Xanthe Hunt reports financial support was provided by Missing Billion Initiative. Xanthe Hunt reports financial support was provided by UNICEF. Xanthe Hunt reports financial support was provided by CGIAR International Food Policy Research Institute. Xanthe Hunt reports financial support was provided by African Union. Xanthe Hunt reports financial support was provided by Charité University Hospital Berlin. David D. Ebert reports financial support was provided by Sanofi. David D. Ebert reports financial support was provided by Novartis. David D. Ebert reports financial support was provided by Minddistrict. David D. Ebert reports financial support was provided by Lantern. David D. Ebert reports financial support was provided by Schoen Kliniken. David D. Ebert reports financial support was provided by Ideamed. David D. Ebert reports financial support was provided by BARMER. David D. Ebert reports financial support was provided by Techniker Krankenkasse. David D. Ebert reports financial support was provided by HelloBetter. Mathilde M. Husky reports financial support was provided by Child Mind Institute Inc. Ronald C. Kessler reports was provided by Cambridge Health Alliance. Ronald C. Kessler reports financial support was provided by Canandaigua VA Medical Center. Ronald C. Kessler reports financial support was provided by Child Mind Institute Inc. Ronald C. Kessler reports financial support was provided by Holmusk. Ronald C. Kessler reports financial support was provided by Massachusetts General Hospital. Ronald C. Kessler reports financial support was provided by Partners Healthcare, Inc. Ronald C. Kessler reports financial support was provided by RallyPoint Networks, Inc. Ronald C. Kessler reports financial support was provided by Sage Therapeutics. Ronald C. Kessler reports financial support was provided by University of North Carolina. Ronald C. Kessler reports financial support was provided by Cerebral Inc. Ronald C. Kessler reports financial support was provided by Mirah. Ronald C. Kessler reports financial support was provided by PYM (Prepare Your Mind). Ronald C. Kessler reports financial support was provided by Roga Sciences. Ronald C. Kessler reports financial support was provided by Verisense Health. Dan J Stein reports financial support was provided by Discovery Vitality. Dan J Stein reports financial support was provided by Johnson & Johnson. Dan J Stein reports financial support was provided by Kanna. Dan J Stein reports financial support was provided by L’Oréal SA. Dan J Stein reports financial support was provided by Lundbeck. Dan J Stein reports financial support was provided by Orion. Dan J Stein reports financial support was provided by Servier. Dan J Stein reports financial support was provided by Seaport Therapeutics. Dan J Stein reports financial support was provided by Takeda. Dan J Stein reports financial support was provided by Vistagen. Dan J Stein reports financial support was provided by Wellcome. Daniel V. Vigo reports financial support was provided by Health Canada. Daniel V. Vigo reports financial support was provided by Provincial Health Services Authority. Daniel V. Vigo reports financial support was provided by Province of BC and Vancouver Coastal Health Authority. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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

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

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