Prevalence of Adverse Childhood Experiences and Suicidal Ideation Among Bhutanese Adolescents

Adverse Childhood Experiences (ACEs) refer to stressful or potentially traumatic events witnessed or experienced by children during their childhood. This cross-sectional exploratory survey among Bhutanese adolescents (students aged 13-21 years) aimed to estimate ACEs prevalence and build Random Forest (RF) and Multiple Logistic Regression (MLR) models to identify specific ACEs influencing Bhutanese adolescents' suicidal ideation (SI). The study employed the Adverse Childhood Experiences International Questionnaire (ACE-IQ), excluding items related to war and collective violence. A total of 751 adolescents (42.7% male, 57.3% female, mean age = 15.6) were selected through a stratified two-stage sampling method. The findings revealed that ACEs were more prevalent among adolescents from Bhutan`s Western region, male adolescents, and those aged 16-18 years. The prevalence of SI in the sampled population was 11.1%. Classification RF analysis, Variable Selection using Random Forest (VSURF) technique, and MLR analysis identified bullying victimisation and sexual abuse (SA) as the ACEs most significantly associated with adolescents` SI. These findings emphasise the critical need for targeted, evidence-based interventions to mitigate the effects of such ACEs. Currently, efforts to prevent and address such ACEs are under way but require strengthening to ensure their effectiveness. This study provides actionable recommendations for prevention and management of such ACEs, drawing on insights from Western countries. Recommendations for future research include examining ancillary factors contributing to regional variations in ACE prevalence and examining the ancillary factors linking bullying, SA, and SI. Such research will be important in guiding policy and intervention strategies to protect the mental health of Bhutanese adolescents.