In 2023, for the first time, the CDC’s national youth survey asked high schoolers a battery of questions about what happened inside their childhood homes — abuse, a parent’s addiction or mental illness, jail, hunger. Half of students report at least one such experience. And each additional one stacks the odds of a suicide attempt with an arithmetic that is brutal in its regularity.
The eight experiences on the CDC’s list range from the material (an adult who didn’t make sure basic needs were met — 13.7%) to the interpersonal (regular insults and put-downs from a parent — 11.4%; physical abuse — 2.4%; sexual abuse by an adult — 7.2%) to the ambient (living with a parent battling addiction — 24.8% — or mental illness — 28.5%; a parent taken to jail — 14.4%; adults beating each other — 2.0%). Summed per student: 49% report none, 23% one, 14% two, 8% three, and 6% four or more. The averages of youth surveys are made of very different childhoods.
The famous finding of the adult ACE literature — risk rises with the count, not just the kind, of adversity — appears fully formed at seventeen. Persistent sadness climbs from 24% (zero ACEs) to 83% (four or more). Seriously considering suicide: 8% to 60%. Attempting it: 2.7% → 8.1% → 14.6% → 19.8% → 39.2%. There is no threshold, no safe number; every step up the count is a step up in risk, and the last step is the steepest.
Adjusting for sex, race/ethnicity, and grade, every one of the eight experiences independently predicts a suicide attempt, with adjusted odds ratios from 2.8 (incarcerated parent) to 7.0 (physical abuse). The violence items — physical abuse, sexual abuse, watching adults batter each other — cluster at the top; the household-condition items (addiction, mental illness, jail, unmet needs) cluster lower but affect far more students. And the count model tells the compounding story directly: one ACE triples the adjusted odds of an attempt, two multiply them nearly six-fold, and four or more multiply them twenty-fold.
Two readings coexist. The clinical one: ACE screening at pediatric visits has a strong evidence base, and these numbers show why — a two-minute checklist identifies the 6% of teenagers carrying a twenty-fold risk. The structural one: most ACEs are not parenting failures but poverty, untreated illness, and incarceration policy wearing a family’s face. A survey of teenagers turns out to be, unavoidably, a survey of the adults around them.