School connectedness and adverse childhood experiences in relation to suicidal behaviors among nationally representative adolescents

Abstract Adverse childhood experiences (ACEs) are strongly associated with adolescent suicidality. Since these exposures have already occurred, prevention depends on identifying modifiable protective factors. School connectedness is a theoretically grounded candidate, yet its role in the context of cumulative childhood adversity has not been examined in nationally representative data. We analysed 10,605 U.S. high-school students from the 2023 national Youth Risk Behavior Survey, the first cycle to include a dedicated ACE module. Survey-weighted modified Poisson regression estimated prevalence ratios (PRs) for associations of cumulative ACEs and school connectedness with past-year suicidal ideation and suicide attempt, adjusting for sex, grade, and race/ethnicity. Cumulative ACEs showed a strong dose-response association with both outcomes (four or more ACEs: ideation PR = 11.49, 95% CI 8.83 to 14.95; attempt PR = 14.80, 95% CI 9.32 to 23.52). School connectedness was independently associated with lower prevalence of ideation (PR = 0.68, 95% CI 0.62 to 0.76) and attempt (PR = 0.75, 95% CI 0.64 to 0.87), and this association persisted after adjustment for a cumulative adverse-school-experience index. Interaction analyses showed no consistent buffering; connectedness was protective across all adversity levels. School connectedness is a broadly relevant, modifiable target for adolescent suicide prevention.