Adverse Childhood Experiences, Psychopathology, and Self-Harming Behavior

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Arvo building, lecture hall A210-211, address: Arvo Ylpön katu 34

Doctoral defence of MNSc Minna Rytilä-Manninen

Adverse Childhood Experiences, Psychopathology, and Self-Harming Behavior : A study of Finnish adolescent inpatients and their age- and gender-matched non-referred controls

The field of science of the dissertation is Social Psychiatry.

The opponent is docent Max Karukivi (University of Turku). Docent Sari Fröjd acts as the custos.

The language of the dissertation defence is Finnish.

Adverse childhood experiences, psychopathology, and self-harming behavior

Adverse childhood experiences (ACE) are stressful or traumatic events, which an individual can encounter before he/she is 18 years old. Mild or tolerable stress is essential for child development because it promotes growth by helping children to understand and cope with life’s challenges and hardships. If stress is frequent or prolonged without a supportive adult, it is harmful and can disrupt child’s normal development. ACEs have a tendency to accumulate. Accumulated adversities have a relationship with many adulthood stress-related diseases, social, and cognitive impairments, as well as mental health disorders. This study aimed to investigate whether ACEs relate to adolescents’ psychopathology and self-harming behavior.

The study sample comprised 206 adolescent psychiatric inpatients and 203 age- and gender-matched pupils and students from the community. All participants were between 13 and 17 years of age. In this study, ACES included parental psychiatric and alcohol use problems, parents’ divorce, witnessing intimate partner violence, experience of physical and sexual abuse, and parental criminality. According to this study, the most predominant ACE was parents’ divorce followed by parental mental health problems. Adolescent inpatients had faced sexual abuse significantly more often than controls. Further, they had faced multiple ACEs; while 20% of adolescent inpatients had experienced at least four different ACEs, the corresponding proportion in community youths was only 2%.

The Symptom Checklist- 90 (SCL-90) is a multidimensional self-questionnaire. To get a more accurate picture of the questionnaire`s usefulness among adolescents, its psychometric properties were investigated. The SCL-90 proved to be mostly unidimensional, but it turned out to be a useful tool for screening overall psychopathology in adolescents. SCL-90 is a useful tool in a clinical setting as it performs well as a screening instrument and, especially, as it is sensitive to change over time.

The mediating roles of psychiatric symptoms, impulsivity, alcohol misuse, and family and social dysfunction between ACEs and suicidality were evaluated. ACEs had a positive direct effect on suicidality, while psychiatric symptoms, impulsivity, social dysfunction, and family dysfunction had a positive indirect effect. However, alcohol use was not a significant mediator. Multiple mediation analysis revealed that psychiatric symptoms followed by impulsivity were the most significant mediators between ACEs and suicidality.

To shed light on the risk factors related to adolescent inpatient suicidality, suicidality was divided into the following categories: “no self-harming behavior”, “suicidal behavior”, “non-suicidal self-injury”, and “suicidal behavior with non-suicidal self-injury”. Suicidal behavior associated with diagnoses of depression and bipolar disorder, as well as with self-reported depression. Suicidal behavior with non-suicidal self-injury related to sexual abuse, impulsivity, and self-reported symptoms of depression. Non-suicidal self-injury associated with social dysfunction.  

These results indicate that ACEs are a serious risk for both psychopathology and suicidality later in life. Healthcare professionals should pay attention to possible ACEs when they meet an adolescent needing help for mental health problems and/or suicidality. Early identification and treatment of adolescents with adversities may prevent later psychopathology.


The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2411, Tampere University Press, Tampere 2018. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1921, Tampere University Press 2018.

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