Differential roles of peer bullying and childhood maltreatment in suicidal ideation and attempts among Chinese adolescents

The progression from suicidal ideation to attempt is a multi-stage process, yet it is unknown how different victimization contexts contribute uniquely to each stage. We compared the associations of school-based peer bullying and family-based childhood maltreatment with suicidal ideation, suicide planning, and suicide attempts in adolescents to identify the primary intervention target for halting suicidality at each step. A multicenter, school-based survey of 18,910 Chinese students aged 12–22 years was conducted. Participants were categorized into four groups: none, peer bullying only, childhood maltreatment only, and both. Logistic regression and population attributable fraction analyses were applied. Overall, 10.9% reported peer bullying only, 18.7% maltreatment only, and 8.9% both. Peer bullying showed a stronger association with suicidal ideation than maltreatment (OR 1.35; 95% CI:1.14–1.60), particularly among females < 15 years (OR 1.68; 95% CI:1.21–2.32). Childhood maltreatment had a stronger link to suicide attempts (OR 1.34; 95% CI: 1.06–1.70) and a higher PAF (13% vs. 2% for peer bullying). Among ideators, maltreatment increased progression to attempts (OR 1.70, 95% CI: 1.32–2.19). Notably, co-exposure sharply raised the risk of suicide attempts (PAF: 25%).