# Attachment insecurity, adverse childhood experiences (ACEs), and suicidality in French residential-care adolescents: a gender-differentiated study

## TL;DR

This study explores how childhood trauma and attachment issues contribute to suicidal thoughts in French residential-care adolescents, with different patterns for girls and boys.

## Contribution

The study identifies gender-specific pathways linking ACEs, attachment insecurity, and suicidality in institutionalized youth.

## Key findings

- Suicidality was reported by 33% of residential-care adolescents.
- Girls' suicidality was linked to maternal alienation and emotional dysregulation.
- Boys' suicidality was more related to cumulative trauma and depressive symptoms.

## Abstract

Suicidality is alarmingly prevalent among adolescents placed in residential child welfare facilities, often as a consequence of early adverse childhood experiences (ACEs) and disrupted attachment relationships. Although these vulnerabilities are well established, the gender-specific mechanisms underlying suicidality in institutionalized youth remain poorly understood. Clarifying how trauma exposure and attachment insecurity interact with mental health symptoms is critical to inform targeted prevention.

In a cross-sectional study, 98 adolescents aged 12–17 years (54 girls, 44 boys; M = 14.34, SD = 2.08) living in French residential care completed validated self-report instruments assessing ACEs, attachment security, depressive and anxiety symptoms, and suicidality. Descriptive statistics, gender comparisons, and multivariate logistic regressions were used to identify predictors of suicidality, with all predictors standardized prior to entry.

One-third of participants (33%) reported suicidal ideation or at least one suicide attempt. Emotional and physical abuse were the most frequent ACEs. Cumulative ACEs and attachment insecurity were independently associated with suicidality, and both correlated with heightened anxiety and depressive symptoms. Gender-stratified analyses showed that suicidality in girls was primarily linked to maternal alienation and emotional dysregulation, whereas in boys it was more strongly related to cumulative trauma exposure and depressive symptoms.

Findings highlight suicidality as a major concern in residential care and identify two complementary risk pathways: adversity-related and attachment‐related. Trauma-informed and attachment-based approaches—supported by systematic screening and the integration of mental health professionals within child welfare systems—may enhance early detection and individualized care. While contextualized in the French system, these mechanisms likely generalize across jurisdictions, underscoring the global need for gender-sensitive, relationally focused suicide prevention.

The online version contains supplementary material available at 10.1186/s13034-025-01010-3.