Adverse childhood experiences and suicidality in adolescents and young adults with internet gaming disorder: a large-scale school-based study in 13,509 Chinese students

Background: Growing evidence points an association between internet gaming disorder (IGD) and suicide risk. However, the interplay with adverse childhood experiences (ACEs) and comorbid negative emotional states remains unclear. This knowledge gap hinders effective risk identification and targeted intervention for young people, underscoring the urgent need for comprehensive research in this area. Methods: We conducted a cross-sectional, multicenter study involving 13,509 participants aged 12-25 years from six provinces in China. Participants completed the Internet Gaming Disorder Scale-Short Form (IGDS9-SF), Adverse Childhood Experiences-International Questionnaire (ACE-IQ), Depression Anxiety Stress Scales-21 (DASS-21). Suicidal thoughts and suicidal behavior items were analyzed with Chi-square tests, ANOVA, logistic regression models and mediation analysis. Results: Among 2141 participants who met the criteria for IGD, 32.8% reported experiencing suicidal thoughts while 6.4% disclosed having suicidal behavior. High exposure to ACEs (≥5 events) was significantly more prevalent among those with suicidality (50.74% for thoughts; 45.23% for behaviors) compared to those without (16.36%). Key risk factors associated with increased suicide risk included male gender (OR = 1.456), depression (OR = 1.091), emotional abuse (OR = 1.727), exclusion/bullying (OR = 1.565), and parental separation or divorce (OR = 1.581). Limitations: The retrospective, cross-sectional design cannot draw causality, and biases in self-report measurements cannot be ignored. Conclusion: This large-scale study demonstrates that male gender, depression and cumulative ACEs are significantly associated with suicide risk in young individuals with IGD in China. These findings highlight the necessity of early identification of ACEs, trauma-informed support, and prompt management of depression to mitigate suicidality in this population.