Meta-analysis links Adverse Childhood Experiences to increased risk of Non-suicidal Self-Injury
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Key Takeaway
Consider ACEs as risk factors for NSSI, but note high heterogeneity limits certainty.
This systematic review and meta-analysis included 13 articles, focusing on individuals with Adverse Childhood Experiences (ACEs) such as physical abuse, sexual abuse, emotional abuse, and cumulative exposure (ACEs≥2, ACEs≥3), compared to those without specified ACEs. The primary outcome was risk of Non-suicidal Self-Injury (NSSI). Main results showed associations with increased NSSI risk: physical abuse had an odds ratio (OR) of 2.38 (95% CI 1.36, 4.16), sexual abuse OR = 1.88 (95% CI 1.24, 2.87), emotional abuse OR = 1.65 (95% CI 1.18, 2.32), ACEs≥2 OR = 3.23 (95% CI 2.62, 3.99), and ACEs≥3 OR = 6.13 (95% CI 4.07, 9.24). Absolute numbers, follow-up, and safety data were not reported.
Key limitations include high heterogeneity across studies, with I2 values ranging from 89.9% to 99.9%, indicating substantial variability in effect estimates. This reduces the reliability of pooled results. Additionally, the analysis is observational, so it cannot establish causation, and details on population settings, funding, and conflicts of interest were not provided.
In practice, this meta-analysis provides evidence-based guidance for prevention and early intervention strategies by highlighting associations between ACEs and NSSI risk. However, clinicians should recognize the study's limitations, including high heterogeneity and lack of causal data, and use these findings as part of a broader assessment without overstating clinical outcomes.
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View Original Abstract ↓
BackgroundSystematically evaluate the association between Adverse Childhood Experiences (ACEs) and the risk of Non-suicidal Self-Injury (NSSI), thereby providing evidence-based guidance for relevant prevention and early intervention strategies.MethodsA systematic search was conducted across PubMed, Embase, Web of Science, and the Cochrane Library, from their inception to 30 November 2025, to identify observational studies reporting associations between ACEs and NSSI. Two researchers independently performed literature screening, data extraction, and quality assessment. Effect sizes were pooled using a random-effects model, with association strength expressed as odds ratios (OR) and their 95% confidence intervals (CI). Data analysis was conducted using Stata 15.ResultsA total of 13 articles included. The meta-analysis results suggest that physical abuse [OR = 2.38, 95% CI (1.36, 4.16), I2 = 99%], sexual abuse [OR = 1.88, 95% CI (1.24, 2.87), I2 = 94.9%], ACEs≥2 [OR = 3.23, 95% CI (2.62, 3.99), I2 = 89.9%], ACEs≥3 [OR = 6.13, 95% CI (4.07, 9.24), I2 = 96.9%], emotional abuse [OR = 1.65, 95% CI (1.18, 2.32), I2 = 97.9%] may increase the risk of NSSI.ConclusionIn summary, the findings of this meta-analysis suggest that exposure to adverse childhood experiences may be related to an increased likelihood of non-suicidal self-injury. Different forms of childhood adversity, including physical abuse, sexual abuse, and emotional abuse, as well as cumulative exposure to multiple ACEs, were associated with higher risks of NSSI.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42026128495.
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