Adverse childhood experiences (ACEs) and bullying victimization are risk factors for adolescent suicidal ideation, yet the interaction between ACEs and bullying victimization in affecting suicidal ideation remains inadequately explored. A retrospective cohort study was conducted among adolescents. ACEs, bullying victimization and Suicidal ideation were assessed through questionnaire survey. Logistic regression analyses were used to examine the relationship between ACEs, bullying victimization, and suicidal ideation. Interaction analyses were performed to explore the interaction of ACEs and bullying victimization on suicidal ideation. One thousand one hundred nine adolescents were included and 7.2% of adolescents reported suicidal ideation. A significant dose–response relationship was observed between the severity of ACEs or bullying victimization and the odds of suicidal ideation. Stratified analysis revealed that the association between bullying victimization and suicidal ideation was significant among adolescents with ACEs exposure, but not among those without ACEs. Notably, the odds of suicidal ideation were highest among adolescents with joint exposure to both ACEs and bullying victimization, compared to those experiencing either factor alone. This study supports that both ACEs and bullying victimization are associated with higher odds of suicidal ideation in adolescents. In addition, co-exposure to ACEs and bullying victimization was associated with even higher odds of suicidal ideation. These findings emphasize the necessity of early screening and intervention for ACEs and bullying victimization among adolescents, as well as early prevention of bullying victimization among adolescents with ACE exposure.
Zhang et al. (2026) studied this question.