Understanding ACEs and suicide risk in depressed adolescents: The mediating effects of self-hate and anhedonia

J Affect Disord. 2026 Mar 21:121659. doi: 10.1016/j.jad.2026.121659. Online ahead of print.

ABSTRACT

OBJECTIVE: Although adverse childhood experiences (ACEs) have been recognized as a crucial risk factor for suicide, how self-hate and anhedonia mediate this relationship remains understudied. This gap is particularly pronounced among adolescent patients with major depressive disorder (MDD), where clarifying these connections is pivotal for developing effective suicide prevention and intervention strategies.

METHODS: This study included 159 adolescent inpatients diagnosed with MDD. Diagnoses of MDD and suicide risk were assessed using the Mini-International Neuropsychiatric Interview (MINI). ACEs were measured with the adverse childhood experiences international questionnaire (ACE-IQ), while self-hate and anhedonia were evaluated using the self-hate scale (SHS) and the anhedonia scale for adolescents (ASA), respectively. Temperament characteristics were assessed with the revised early adolescent temperament questionnaire (EATQ-R). Mediation and moderation analyses were performed using the PROCESS macro in SPSS.

RESULTS: ACEs were positively associated with suicide risk, a relationship that was serially mediated by self-hate and anhedonia. Regarding moderating effects, social support acted as a protective factor against ACEs-related self-hate. Temperamental surgency moderated the relationships between ACEs and both self-hate and suicide risk. Furthermore, temperamental effortful control buffered the link between ACEs and both self-hate and anhedonia, as well as the association between self-hate and suicide risk.

CONCLUSION: The sequential mediation model elucidates the potential pathways linking early-life traumas to adolescent mental health outcomes. It also offers important evidence-based support for suicide prevention among depressed adolescents with diverse temperaments.

PMID:41871635 | DOI:10.1016/j.jad.2026.121659