Psychological Flexibility as a Mechanism and Buffer Linking Adverse and Positive Childhood Experiences to Suicidal Thoughts in Youth
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The sample comprised 559 youths aged between 17 and 24 years (M age = 21.89, SD age = 2.17), including 415 women (74.15%) and 144 men. Participants completed the Adverse Childhood Experiences Scale, the Positive Childhood Experiences Scale, the Brief Suicide Cognitions Scale (BSCS), the Acceptance and Action Questionnaire-II (AAQ-II), and a demographic information form. Data were analysed using Hayes’s PROCESS macro for SPSS (Model 4). The results revealed a significant positive association between ACEs and suicidal thoughts. Psychological flexibility was negatively related to suicidal thoughts and partially mediated the relationship between ACEs, PCEs, and suicidal thoughts. These findings highlight the dual influence of childhood experiences on suicidal cognition, demonstrating the detrimental effects of adversity alongside the protective contribution of positive early experiences. Importantly, the findings should not be interpreted as implying that childhood experiences can be retrospectively altered in adulthood. Rather, ACEs and PCEs function as developmental risk and protective markers, whereas psychological flexibility represents a modifiable and clinically actionable intervention target. From this perspective, interventions aimed at enhancing psychological flexibility—such as Acceptance and Commitment Therapy–informed approaches—may mitigate suicidal risk among youths with elevated exposure to childhood adversity. Future research should extend this model by testing psychological flexibility as a buffering moderator and by examining the interactive effects of ACEs and PCEs on suicidal thoughts. Suicidal Thoughts Adverse Childhood Experiences Positive Childhood Experiences Psychological Flexibility Youth Figures Figure 1 Figure 2 Introduction Childhood represents a critical developmental period that profoundly shapes individuals’ cognitive, emotional, and social trajectories, forming the foundation for lifelong psychosocial functioning (Sousa et al., 2025). Experiences during this critical developmental phase significantly affect physical and mental health and have enduring consequences on behavioral regulation and adaptive functioning in adulthood (Jones et al., 2022).Within this period, individuals may encounter both adverse childhood experiences (ACEs) and positive childhood experiences (PCEs)—two distinct yet interrelated constructs that function in opposing directions (Han et al., 2023a). In contemporary developmental models, these dimensions are frequently conceptualized as dual poles of a continuum: ACEs operate as potent risk factors, whereas PCEs function as protective mechanisms that buffer individuals against psychosocial vulnerability (Hinojosa & Hinojosa, 2024). Adverse childhood experiences constitute a pervasive global phenomenon (Perez et al., 2016). Such experiences encompass various forms of trauma, including physical, sexual, or emotional abuse; neglect; parental psychopathology; and substance misuse (Sacks & Murphey, 2018). Exposure to these adversities has been consistently associated with heightened risks for chronic diseases, psychiatric disorders, and maladaptive behavioral patterns extending into adulthood (Crandall et al., 2019; Hunt et al., 2017). Foundational research first elucidated the robust link between ACEs and adverse health outcomes across the lifespan (Felitti et al., 2019). Subsequent empirical investigations have substantiated these associations, identifying ACEs as predictors of depression (Ye et al., 2024), sleep disturbances (Duraccio et al., 2024; Wu et al., 2024), anxiety and rumination (Mansueto et al., 2021), substance use disorders (Leza et al., 2021), and attention-deficit/hyperactivity disorder (Zhang et al., 2022). Among the myriad consequences of ACEs, their relationship with suicidal behavior is particularly alarming. ACEs are widely recognized as salient predictors of suicidal thoughts and attempts during both adolescence and adulthood (Brodsky & Stanley, 2008). The suicide represented the third leading cause of mortality among individuals aged 15–29 years, accounting for approximately 720,000 deaths annually (WHO, 2024). A recent meta-analysis encompassing 19,588 participants across 17 countries, confirmed a significant and robust association between ACEs and suicidal behaviors (Baldini et al., 2025). These findings underscore that ACEs not only contribute to a spectrum of psychological disorders but also precipitate life-threatening outcomes (Angelakis et al., 2020; Sahle et al., 2022). Conversely, positive childhood experiences emerge as crucial protective factors that enhance psychosocial adjustment, foster flexibility, and attenuate the detrimental effects of adversity (Narayan et al., 2018). Experiences characterized by love, trust, emotional security, and social support—particularly within family and peer contexts—serve as buffers that mitigate the psychological impact of early trauma and lay the groundwork for adaptive functioning (Bethell et al., 2019). Therefore, a comprehensive understanding of both ACEs and PCEs is essential for elucidating the complex pathways that shape lifelong mental health and well-being. Positive Childhood Experiences (PCEs) In contrast to the potentially deleterious consequences of adverse childhood experiences (ACEs), the identification of protective factors that promote individuals’ lifelong psychological adjustment has become increasingly salient in contemporary research (Crandall et al., 2019). Within this context, positive childhood experiences (PCEs) constitute a crucial set of developmental assets that foster psychological, social, and cognitive growth. The developmental psychology literature consistently indicates that PCEs exert a substantial positive influence on psychological well-being (Bethell et al., 2019), psychological resilience (Kocatürk & Çiçek, 2023), and the quality of interpersonal and social relationships (Narayan et al., 2018). Positive Childhood Experiences (PCEs) are conceptualized as a constellation of emotionally supportive and relational experiences that collectively foster a secure and nurturing developmental environment (Bethell et al., 2019). These experiences encompass open communication about emotions within the family, the availability of parental support during challenging times, active participation in social and recreational activities, a sense of belonging at school, emotional support from peers, attentive and responsive parenting, and a perceived sense of safety and protection by a caring adult figure (Li & Li, 2024). Empirical evidence demonstrates that the positive impact of PCEs extends well into adulthood, shaping individuals’ mental health, coping mechanisms, and adaptive functioning (Han et al., 2023b). For instance, PCEs have been shown to enhance psychological well-being through mechanisms of psychological flexibility and meaning-orientated coping (Maral et al., 2024). Similarly, adults who report higher levels of PCEs in childhood exhibit greater productivity, a stronger sense of responsibility, and higher levels of prosocial behaviour (Kosterman et al., 2011). In a large-scale study involving 28,000 young offenders, it was found that individuals with elevated ACEs demonstrated higher rates of recidivism, whereas those with high levels of PCEs exhibited a significantly lower likelihood of reoffending (Baglivio & Wolff, 2021). Furthermore, recent research has provided compelling evidence that PCEs play a crucial protective role against psychopathological outcomes. Individuals with high levels of PCEs show a reduced likelihood of developing common mental disorders, anxiety, self-harm behaviours, and suicidal thoughts (Akbulut, 2025; Bunting et al., 2023). Collectively, these findings underscore the pivotal role of PCEs as a multidimensional protective construct that enhances mental flexibility, buffers the adverse effects of stressful or traumatic life events, and supports adaptive psychosocial functioning across the lifespan. The Mediating Role of Psychological Flexibility Acceptance and Commitment Therapy (ACT), which aims to help individuals live meaningfully in the present moment, accept internal experiences without avoidance, and engage in actions congruent with personal values, is fundamentally grounded in the construct of psychological flexibility (Kashdan & Rottenberg, 2010). Psychological flexibility is defined as the capacity to attend to one’s internal experiences—thoughts, emotions, and sensations—with openness and awareness, to remain connected to the present moment, and to commit to value-consistent behavior despite psychological discomfort (S. C. Hayes et al., 2006). The construct is operationalized through six interrelated core processes: (a) flexible contact with the present moment, (b) acceptance, (c) contact with values, (d) self-as-context, (e) committed action, and (f) cognitive defusion (S. C. Hayes et al., 2011). In essence, psychological flexibility involves recognizing and acknowledging inner experiences without attempting to alter their intensity or content, thereby diminishing their control over behavior and enabling individuals to act in alignment with personally meaningful goals and values (S. C. Hayes et al., 2006). A growing body of empirical evidence highlights the central role of psychological flexibility in mental health and well-being. Previous research has demonstrated that psychological flexibility is negatively associated with psychological maltreatment, suicidal ideation, and various mental health difficulties (Bryan et al., 2015; Türk et al., 2024). Conversely, it is positively correlated with psychological well-being (Guerrini Usubini et al., 2021), life satisfaction (Graham et al., 2016), and psychological flexibility (Büyüköksüz & Tekin, 2023), while exhibiting negative associations with psychological distress (Tindle et al., 2022), stress (Wang et al., 2023), anxiety (McCracken et al., 2021), depressive symptoms (Fonseca et al., 2020), and burnout (Kent et al., 2019). Moreover, research has identified psychological flexibility as a protective factor mitigating the impact of early adverse experiences on later mental health. Empirical findings indicate that psychological flexibility reduces the detrimental influence of ACEs on suicidal thoughts (Türk et al., 2024) and moderates the relationship between ACEs and various psychopathological outcomes (Arslan et al., 2025). Complementarily, psychological flexibility has been found to mediate the relationship between PCEs and spiritual well-being, suggesting that it facilitates adaptive meaning-making and psychological growth following positive developmental contexts (Maral et al., 2024). In parallel, studies have demonstrated that psychological flexibility serves a buffering function between ACEs and mental health problems, thereby reducing vulnerability to adverse outcomes (Makriyianis et al., 2019; Parfait et al., 2022; Sachdeva & Shukla, 2024). Taken together, these findings highlight the functional importance of psychological flexibility and flexibility as central mechanisms shaping the relationship between childhood experiences and mental health in young populations. Accordingly, the present study posits that psychological flexibility mediates the relationship between adverse and positive childhood experiences and suicidal thoughts among young adults, thereby elucidating the underlying psychological processes that link early developmental experiences to later mental health outcomes. The Present Study According to the extant literature, only a limited number of studies have examined the interactive effects of positive childhood experiences (PCEs) and adverse childhood experiences (ACEs) on suicidal thoughts among young individuals. Empirical findings have demonstrated strong associations between adverse childhood experiences and suicidal thoughts, as well as other psychological difficulties, in adulthood (Arslan et al., 2025; Tindle et al., 2022; Türk et al., 2024). In this context, identifying protective factors that can mitigate the detrimental effects of early adversity and enhance psychological flexibility represents a critical research priority. In line with this perspective, psychological flexibility may function not only as an explanatory mechanism but also as a protective factor that buffers the impact of adverse childhood experiences on suicidal thoughts. Evidence suggests that PCEs, independent of ACEs, contribute to strengthening individuals’ psychological flexibility, thereby attenuating the negative consequences of early adversity (Crandall et al., 2019; Han et al., 2023b). Within this framework, psychological flexibility emerges as a particularly salient construct, as it reflects the capacity to maintain emotional balance and adaptive functioning in the face of adverse life experiences (Arslan et al., 2025). Moreover, prior research indicates that psychological flexibility may play a mediating role in the relationship between ACEs, PCEs, and suicidal thoughts, acting as a preventive mechanism that reduces vulnerability to self-destructive cognition and behaviors (Bryan et al., 2015; Misitano et al., 2024). Furthermore, considering ACEs and PCEs simultaneously allows for the examination of whether positive childhood experiences may attenuate the adverse effects of childhood adversity on suicidal thoughts, rather than assuming that these developmental experiences operate independently. Acceptance and Commitment Therapy (ACT), which aims to enhance psychological flexibility, encourages individuals to accept inevitable psychological pain as a natural part of the human experience and to pursue a rich and meaningful life consistent with their personal values (S. C. Hayes et al., 2011). By reframing distressing emotions and thoughts as integral components of normal psychological functioning—rather than as pathological symptoms—ACT promotes greater psychosocial adjustment and emotional well-being. Although research on psychological flexibility has expanded considerably recently, empirical studies specifically addressing its mediating role in the relationship between adverse childhood experiences (ACEs), positive childhood experiences (PCEs), and suicidal thoughts among young people remain limited. Therefore, the present study aims to investigate the mediating role of psychological flexibility in the relationship between ACEs, PCEs, and suicidal thoughts in young adults. Understanding this relationship may offer important clues to developing targeted preventive and therapeutic interventions designed to reduce suicidal thoughts among youth. At the same time, the present focus on mediation does not preclude the potential moderating role of psychological flexibility or the interactive effects of ACEs and PCEs, which warrant examination in future research. Accordingly, the following hypotheses were proposed: H1: Adverse childhood experiences (ACEs) significantly and positively predict suicidal thoughts. H2: Positive childhood experiences (PCEs) significantly and negatively predict suicidal thoughts. H3: Psychological flexibility mediates the relationship between ACEs, PCEs, and suicidal thoughts. INSERT FIGURE 1 ABOUT HERE Methods Participants The participants in this study consisted of 559 youths in Türkiye. Of these, 74% were female and 26% were male, with ages ranging from 18 to 24 years (M = 21.89, SD = 2.17). Regarding marital status, 4.7% (n = 26) were married, while 95.3% (n = 533) were single. In terms of educational level, 44% (n = 246) were undergraduate students, 54.7% (n = 306) were graduate students, and 1.3% (n = 7) were postgraduate students. Participants reported their socio-economic status as very low (3.8%), low (12%), middle (77.5%), high (5.5%), and very high (1.3%), indicating that the majority of the sample belonged to the middle socio-economic class. The inclusion criteria were (i) being a youth enrolled in a university in Türkiye, (ii) being aged between 17 and 24 years, and (iii) voluntarily agreeing to participate in the study. The exclusion criteria included (i) not being a youth enrolled in a university, (ii) being outside the age range of 17–24 years, and (iii) not consenting to participate voluntarily. Measures Positive Childhood Experiences Scale (PCES): The Positive Childhood Experiences Scale was developed by Bethell et al. (2019) to assess individuals’ positive experiences during childhood. The scale consists of seven items rated on a five-point Likert scale ranging from 1 (Never) to 5 (Always). Higher scores indicate that individuals have had more positive childhood experiences. There are no reverse-scored items, and the total score ranges from 7 to 35. The scale is applicable to individuals aged 18 years and older. An example item is: “How often did you feel that your family stood by you in difficult times?” The Turkish adaptation of the scale was carried out by Çi̇çek & Çeri̇ (2021). In the current study, the Cronbach’s alpha coefficient for the PCES was .75. Brief Suicide Cognitions Scale (BSCS): The Brief Suicide Cognitions Scale, developed by Rudd & Bryan (2021), consists of six items rated on a five-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Higher scores indicate a higher level of suicidal cognitions. The scale has no reverse-coded items, and total scores range from 5 to 25. An example item is: “I do not deserve to be loved.” The Turkish adaptation was conducted by Arslan (2024), and the Cronbach’s alpha coefficient obtained in the present study was .87. Acceptance and Action Questionnaire-II (AAQ-II) : The Acceptance and Action Questionnaire-II was developed by Bond et al. (2011) to measure psychological flexibility. The Turkish version was adapted by Yavuz et al. (2016). The scale consists of seven items rated on a seven-point Likert scale, ranging from 1 (Never true) to 7 (Always true). There are no reverse-scored items. An example item is: “It seems like most people are handling their lives better than I am.” Higher scores indicate greater psychological flexibility. In the current study, the Cronbach’s alpha coefficient for the AAQ-II was .87. Adverse Childhood Experiences Scale (ACES) : The Adverse Childhood Experiences Scale was developed by Felitti et al. (1998) to assess negative experiences during childhood. The Turkish adaptation of the scale was conducted by Gündüz et al. (2018). The scale consists of 10 dichotomous (Yes/No) items that inquire about adverse experiences occurring before the age of 18 . Example items include: “Did you live with someone who had an alcohol or drug problem?” , which focus on various forms of childhood adversity. The total score ranges from 0 to 10 , with higher scores indicating greater exposure to adverse childhood experiences . In the present study, the Cronbach’s alpha coefficient for the ACES was .70 . Procedure In this cross-sectional study, data were collected online via Google Forms between March 15, 2025, and May 15, 2025. The sample comprised students enrolled in associate, undergraduate, and graduate programs. Prior to data collection, participants were provided with an informed consent form detailing the purpose and procedures of the study. Confidentiality of responses was strictly maintained, and participants did not receive any compensation for their involvement. Ethical approval was obtained from the Bitlis Eren University Social and Humanities Ethics Committee ( Decision No: 30.05.2025/178062 ) prior to the initiation of data collection. Completing the questionnaires required approximately 15 minutes per participant. Data Analysis The present study examines the mediating role of psychological flexibility in the relationship between adverse childhood experiences (ACEs), positive childhood experiences (PCEs), and suicidal thoughts among young adults. Mediation analysis, a robust statistical method that accounts for measurement error and facilitates the examination of complex variable relationships, was employed (Kline, 2023). Within this framework, it is hypothesised that ACEs and PCEs may influence suicidal thoughts in youth and that psychological flexibility plays a crucial mediating role in buffering or attenuating these effects. Although psychological flexibility may also function as a moderating protective factor and ACEs and PCEs may interact in predicting suicidal thoughts, the present study focuses specifically on testing the mediating mechanism in line with its primary theoretical aim. Prior to conducting the main analyses, descriptive statistics for all study variables—including means, standard deviations, skewness, kurtosis, and correlations—were calculated using SPSS version 25. Subsequently, Pearson’s product-moment correlation analyses were conducted to examine the bivariate relationships among variables. Finally, the mediation effects of psychological flexibility on the relationship between ACEs, PCEs, and suicidal thoughts were tested using the PROCESS macro for SPSS (Model 4). Indirect effects were evaluated using bias-corrected 95% confidence intervals based on 5,000 bootstrap samples (Hayes, 2018). Preliminary analyses Preliminary analyses indicated that the study variables were approximately normally distributed, with skewness values ranging from -0.23 to 1.08 and kurtosis values ranging from -0.60 to 1.48, all within the acceptable limits for normality (≤ |2|) as suggested in the literature (Tabachnick & Fidell, 2019). Following the descriptive analyses, correlation analyses were conducted to examine the relationships among the study variables. Results indicated a significant negative correlation between ACEs and psychological flexibility ( r = -0.27, p < .01) and a significant positive correlation between ACEs and suicidal thoughts ( r = 0.28, p < .01). In contrast, PCEs were positively and significantly correlated with psychological flexibility ( r = 0.40, p < .01) and negatively and significantly correlated with suicidal thoughts ( r = -0.39, p < .01). Additionally, psychological flexibility demonstrated a significant negative association with suicidal thoughts ( r = -0.52, p < .01). These bivariate associations provided the empirical basis for subsequent mediation analyses and supported the theoretical ordering of variables specified in the proposed model. Examination of the internal consistency reliability coefficients for the scales used in the study revealed Cronbach’s alpha values ranging from 0.70 to 0.87 (see Table 1), providing evidence for the satisfactory reliability of the measures employed in this research. INSERT TABLE 1 ABOUT HERE Mediation Analysis Following the preliminary analyses, mediation analyses were conducted using the PROCESS macro (Model 4) to examine the mediating role of psychological flexibility in the relationship between ACEs, PCEs, and suicidal thoughts. Consistent with the primary aim of the study, these analyses focused on elucidating the indirect pathways through which childhood experiences relate to suicidal thoughts via psychological flexibility. The results indicated that ACEs positively and significantly predicted suicidal thoughts (β = 0.15, p < .001), whereas PCEs negatively and significantly predicted suicidal thoughts (β = -0.21, p < .001). Additionally, psychological flexibility was found to negatively and significantly predict suicidal thoughts (β = -0.47, p < .001 for ACEs pathway; β = -0.43, p < .001 for PCEs pathway). Path analyses revealed that psychological flexibility partially mediated the relationships between ACEs, PCEs, and suicidal thoughts (see Table 2; Figure 2). Specifically, the indirect effects of ACEs on suicidal thoughts through psychological flexibility were significant (effect = 0.13, 95% CI [0.09, 0.17]), as were the indirect effects of PCEs (effect = -0.17, 95% CI [-0.22, -0.12]). Direct and total effects for both ACEs and PCEs were also significant (see Table 2). All standardized regression coefficients (β), standard errors, and p-values for the paths were reported. These findings provide robust evidence that psychological flexibility partially mediates the relationship between ACEs, PCEs, and suicidal thoughts, highlighting its critical role as a protective factor in young adults’ psychosocial functioning. INSERT FIGURE 2 ABOUT HERE INSERT TABLE 2 ABOUT HERE Discussion The present study aimed to investigate the mediating role of psychological flexibility in the relationship between adverse childhood experiences (ACEs), positive childhood experiences (PCEs), and suicidal ideation among young adults. The key findings can be summarized as follows: (i) ACEs significantly and positively predicted suicidal thoughts; (ii) PCEs significantly and negatively predicted suicidal thoughts; and (iii) psychological flexibility mediated the relationships between ACEs, PCEs, and suicidal thoughts. First, the analyses revealed that ACEs were significantly and positively associated with suicidal thoughts in young adults, supporting the first hypothesis (H1). This finding suggests that individuals who have experienced adverse childhood events are at an increased risk of developing suicidal thoughts in later life. Consistent with prior research, ACEs have been linked to sleep disturbances, physical and mental health problems, depression, and suicidal ideation in both adolescents and adults (Baldini et al., 2025; Crandall et al., 2019; Duraccio et al., 2024; Felitti et al., 1998, 2019; E. E. Jones et al., 2024; Ye et al., 2024). Early adverse experiences—such as physical, emotional, or sexual abuse, parental loss, and neglect—can foster maladaptive cognitive patterns (Arslan et al., 2025) and contribute to the development of negative attributional styles, such as self-blame (e.g., feelings of worthlessness), thereby increasing vulnerability to suicidal ideation in later life (Sachs-Ericsson et al., 2016). Collectively, these findings underscore the role of negative childhood experiences as a significant risk factor for suicidal thoughts in youth. Second, the study found a significant negative association between PCEs and suicidal thoughts, confirming the second hypothesis (H2). Higher levels of PCEs were associated with lower levels of suicidal cognitions, consistent with prior evidence indicating that positive childhood experiences serve a protective function against psychological difficulties (Adachi et al., 2025; Akbulut, 2025). Positive experiences in early life—such as supportive relationships, feelings of safety, and engagement in social activities—contribute to overall well-being and developmental outcomes (Bethell et al., 2019; Cicchetti & Toth, 2009; Kocatürk & Çiçek, 2023; Şanli et al., 2024). These experiences enhance self-efficacy, psychological flexibility, and meaning in life (Southwick et al., 2014) and promote the development of adaptive coping strategies in response to stress (Compas et al., 2001). Recent empirical studies confirm that PCEs diminish the probability of suicidal behaviors and suicidal cognitions (Adachi et al., 2025; Bravo et al., 2024; Bunting et al., 2023; Liu et al., 2025). Overall, all these findings highlight the protective role of PCEs in relation to suicidal thoughts among young adults. Third, psychological flexibility was found to mediate the relationship between ACEs, PCEs, and suicidal thoughts. This finding emphasizes the potential of psychological flexibility to buffer the triggering effects of adverse childhood experiences on suicidal thoughts. Previous research has indicated that ACEs are positively associated with depression, sleep problems, substance use, and suicidal behaviors (Choi et al., 2017; Duraccio et al., 2024; Leza et al., 2021; Wu et al., 2024; Ye et al., 2024), and low levels of psychological flexibility may exacerbate these outcomes (Kashdan & Rottenberg, 2010). Numerous studies indicate that psychological flexibility confers protection against depression, anxiety, and general distress (Bond et al., 2011). Conversely, low psychological flexibility may promote avoidance behaviors, intensifying suicidal thoughts and motivating self-harming behaviors (Angelakis & Gooding, 2021). Psychological flexibility enables individuals to remain present, accept thoughts and emotions, and engage in value-driven behaviors (Kashdan & Rottenberg, 2010) thereby fostering flexibility against psychological distress. Enhancing psychological flexibility in individuals with high ACE exposure may increase their resistance to suicidal thoughts despite emotional challenges (Makriyianis et al., 2019; Türk et al., 2024). For example, psychological flexibility reduces the negative impact of adverse childhood experiences on mental health (Arslan et al., 2025). Moreover, psychological flexibility mediates the relationship between PCEs and suicidal thoughts, suggesting that positive experiences foster flexibility and protective mechanisms through enhanced psychological flexibility (Maral et al., 2024; Matos et al., 2017). Although the present findings support a mediating role of psychological flexibility, future research should extend this framework by examining psychological flexibility as a moderating protective factor and by testing the interactive effects of ACEs and PCEs to further clarify resilience pathways underlying suicidal thoughts. In summary, these findings collectively point out the vital role of developing psychological flexibility as a protective factor to buffer the negative impact of ACEs and enhance the protective effects of PCEs on suicidal thoughts among youth. Interventions targeting psychological flexibility may therefore be effective in reducing vulnerability to suicidal thoughts and promoting mental health resilience in young populations. Practical Implications Despite its limitations, the present study provides valuable insights into the mechanisms underlying the relationships between ACEs, PCEs, and suicidal ideation among young adults. The findings suggest that individuals with a history of ACEs are more prone to suicidal thoughts, whereas PCEs independently serve a protective role, supporting well-being in youth. Moreover, the results highlight the critical importance of promoting psychological flexibility as a means of buffering the triggering effects of adverse childhood experiences on suicidal thoughts. Positive childhood experiences also appear to contribute to the development of psychological flexibility, thereby creating a protective buffer against suicidal thoughts. Collectively, these findings underscore the relevance of enhancing resilience-promoting factors, such as psychological flexibility, to mitigate the risk associated with negative early-life experiences. Limitations and Future Directions While this study comprehensively examined the relationships among PCEs, ACEs, psychological flexibility, and suicidal thoughts, several limitations should be acknowledged. First, the cross-sectional design precludes causal inferences. Although cross-sectional studies are effective in detecting associations among variables, longitudinal research is necessary to clarify the temporal dynamics and causality of these relationships. Future studies should adopt longitudinal designs to investigate the long-term effects of childhood experiences on suicidal thoughts and psychological outcomes. Second, data were collected via self-report measures, which are susceptible to biases such as social desirability. While self-report instruments are valuable for assessing individuals’ perceptions and internal experiences, responses may reflect a tendency to present oneself in a socially acceptable manner. Future research could incorporate multi-method approaches, such as structured interviews or observational measures, to enhance data reliability and reduce subjective bias. Third, the study sample was limited to young adults within a specific cultural context, which may constrain the generalizability of the findings. Future research should consider diverse age groups, populations, and cultural settings to provide a broader understanding of how ACEs, PCEs, and psychological flexibility interact across different contexts. Based on these findings and limitations, several directions for future research are suggested. Longitudinal studies could clarify the long-term impact of positive and negative childhood experiences on psychological health and suicidal thoughts. Incorporating structured interviews alongside self-report measures could reduce subjective bias and improve measurement validity. Finally, expanding research to include varied age groups and cultural backgrounds would deepen our understanding of these complex relationships and inform culturally sensitive intervention strategies. Conclusions The present study provides empirical evidence regarding the interrelationships among Adverse Childhood Experiences (ACEs), Positive Childhood Experiences (PCEs), psychological flexibility, and suicidal thoughts in young adults. The findings indicate that exposure to ACEs significantly increases the risk of suicidal thoughts, while PCEs serve as a crucial protective buffer against these effects. Psychological flexibility has emerged as a strong protective factor, mitigating the impact of ACEs on suicidal thoughts. Furthermore, PCEs seem to enhance psychological flexibility, thereby bolstering flexibility and reducing the likelihood of suicidal thoughts. Importantly, these findings should not be interpreted as implying that childhood experiences can be retrospectively modified in adulthood; rather, they highlight psychological flexibility as a modifiable, clinically actionable process through which the long-term effects of early adversity on suicidal thoughts may be attenuated. These results point to the future of intervention programs designed to foster psychological flexibility in young people, providing mental health professionals with actionable strategies to alleviate the negative consequences of adverse childhood experiences. Abbreviations ACEs: Adverse Childhood Experiences Scale PCEs: Positive Childhood Experiences Scale BSCS: Brief Suicide Cognitions Scale AAQ-II: Acceptance and Action Questionnaire-II ACT: Acceptance and Commitment Therapy PROCESS: Hayes’s PROCESS Macro SPSS: Statistical Package for the Social Sciences PF: Psychological Flexibility Declarations Ethical Approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval was obtained from the Ethics Committee for Social and Humanities Research at Bitlis Eren University (Decision No: 30.05.2025/178062). Informed consent statement Informed consent was obtained from all participants prior to their participation in the study. Consent was obtained in written form on March 15, 2025, and May 15, 2025 by the members of the research team responsible for data collection. Participants were fully informed about the purpose of the study, the voluntary nature of participation, confidentiality of their responses, and their right to withdraw from the study at any time without any negative consequences.All participants were adults aged between 18 and 24 years, and therefore provided informed consent on their own behalf. Availability of data and materials The data supporting the findings of this study have not been published or made publicly available. However, they are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding The authors received no financial support for the research, authorship, and publication of this article. Author contributions All authors contributed to the study conception and design, material preparation, data collection and analysis, and approved the final manuscript. Acknowledgements The authors would like to thank all students who voluntarily participated in this research. We also acknowledge the support of Bitlis Eren University for facilitating the data collection process. References Adachi, M., Takahashi, M., & Mori, H. (2025). Positive childhood experiences reduce suicide risk in Japanese youth with ASD and ADHD traits: A population-based study. Frontiers in Psychiatry , 16 . https://doi.org/10.3389/fpsyt.2025.1566098 Akbulut, Ö. F. (2025). Positive Childhood Experiences, Suicide Cognitions, Subjective Happiness, and Mental Well-Being in Young Adults: A Half-Longitudinal Serial Mediation Study. Psychiatric Quarterly . https://doi.org/10.1007/s11126-025-10162-6 Angelakis, I., Austin, J. L., & Gooding, P. (2020). 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Path Effect size Standard error 95 % Confidence Interval Lower limit Upper limit Direct effect ACEs → Suicidal thoughts 0.491 0.117 0.260 0.723 PCEs → Suicidal thoughts -0.218 0.038 -0.293 -0.142 Indirect effect ACEs → Psychological flexibility → Suicidal thoughts 0.131 0.021 0.091 0.174 PCEs → Psychological flexibility → Suicidal thoughts -0.172 0.024 -0.222 -0.126 Total effect ACEs → Suicidal thoughts 0.90 0.129 0.655 0.902 PCEs → Suicidal thoughts -0.389 0.039 -0.466 -0.313 Additional Declarations No competing interests reported. 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Experiences during this critical developmental phase significantly affect physical and mental health and have enduring consequences on behavioral regulation and adaptive functioning in adulthood (Jones et al., 2022).Within this period, individuals may encounter both adverse childhood experiences (ACEs) and positive childhood experiences (PCEs)—two distinct yet interrelated constructs that function in opposing directions (Han et al., 2023a). In contemporary developmental models, these dimensions are frequently conceptualized as dual poles of a continuum: ACEs operate as potent risk factors, whereas PCEs function as protective mechanisms that buffer individuals against psychosocial vulnerability (Hinojosa \u0026amp; Hinojosa, 2024).\u003c/p\u003e\n\u003cp\u003eAdverse childhood experiences constitute a pervasive global phenomenon (Perez et al., 2016). Such experiences encompass various forms of trauma, including physical, sexual, or emotional abuse; neglect; parental psychopathology; and substance misuse (Sacks \u0026amp; Murphey, 2018). Exposure to these adversities has been consistently associated with heightened risks for chronic diseases, psychiatric disorders, and maladaptive behavioral patterns extending into adulthood (Crandall et al., 2019; Hunt et al., 2017). Foundational research first elucidated the robust link between ACEs and adverse health outcomes across the lifespan (Felitti et al., 2019). Subsequent empirical investigations have substantiated these associations, identifying ACEs as predictors of depression (Ye et al., 2024), sleep disturbances (Duraccio et al., 2024; Wu et al., 2024), anxiety and rumination (Mansueto et al., 2021), substance use disorders (Leza et al., 2021), and attention-deficit/hyperactivity disorder (Zhang et al., 2022).\u003c/p\u003e\n\u003cp\u003eAmong the myriad consequences of ACEs, their relationship with suicidal behavior is particularly alarming. ACEs are widely recognized as salient predictors of suicidal thoughts and attempts during both adolescence and adulthood (Brodsky \u0026amp; Stanley, 2008). The suicide represented the third leading cause of mortality among individuals aged 15–29 years, accounting for approximately 720,000 deaths annually (WHO, 2024). A recent meta-analysis encompassing 19,588 participants across 17 countries, confirmed a significant and robust association between ACEs and suicidal behaviors (Baldini et al., 2025). These findings underscore that ACEs not only contribute to a spectrum of psychological disorders but also precipitate life-threatening outcomes (Angelakis et al., 2020; Sahle et al., 2022).\u003c/p\u003e\n\u003cp\u003eConversely, positive childhood experiences emerge as crucial protective factors that enhance psychosocial adjustment, foster flexibility, and attenuate the detrimental effects of adversity (Narayan et al., 2018). Experiences characterized by love, trust, emotional security, and social support—particularly within family and peer contexts—serve as buffers that mitigate the psychological impact of early trauma and lay the groundwork for adaptive functioning (Bethell et al., 2019). Therefore, a comprehensive understanding of both ACEs and PCEs is essential for elucidating the complex pathways that shape lifelong mental health and well-being.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePositive Childhood Experiences (PCEs)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn contrast to the potentially deleterious consequences of adverse childhood experiences (ACEs), the identification of protective factors that promote individuals’ lifelong psychological adjustment has become increasingly salient in contemporary research (Crandall et al., 2019). Within this context, positive childhood experiences (PCEs) constitute a crucial set of developmental assets that foster psychological, social, and cognitive growth. The developmental psychology literature consistently indicates that PCEs exert a substantial positive influence on psychological well-being (Bethell et al., 2019), psychological resilience (Kocatürk \u0026amp; Çiçek, 2023), and the quality of interpersonal and social relationships (Narayan et al., 2018). Positive Childhood Experiences (PCEs) are conceptualized as a constellation of emotionally supportive and relational experiences that collectively foster a secure and nurturing developmental environment (Bethell et al., 2019). These experiences encompass open communication about emotions within the family, the availability of parental support during challenging times, active participation in social and recreational activities, a sense of belonging at school, emotional support from peers, attentive and responsive parenting, and a perceived sense of safety and protection by a caring adult figure (Li \u0026amp; Li, 2024). Empirical evidence demonstrates that the positive impact of PCEs extends well into adulthood, shaping individuals’ mental health, coping mechanisms, and adaptive functioning (Han et al., 2023b). For instance, PCEs have been shown to enhance psychological well-being through mechanisms of psychological flexibility and meaning-orientated coping (Maral et al., 2024). Similarly, adults who report higher levels of PCEs in childhood exhibit greater productivity, a stronger sense of responsibility, and higher levels of prosocial behaviour (Kosterman et al., 2011). In a large-scale study involving 28,000 young offenders, it was found that individuals with elevated ACEs demonstrated higher rates of recidivism, whereas those with high levels of PCEs exhibited a significantly lower likelihood of reoffending (Baglivio \u0026amp; Wolff, 2021). Furthermore, recent research has provided compelling evidence that PCEs play a crucial protective role against psychopathological outcomes. Individuals with high levels of PCEs show a reduced likelihood of developing common mental disorders, anxiety, self-harm behaviours, and suicidal thoughts (Akbulut, 2025; Bunting et al., 2023). Collectively, these findings underscore the pivotal role of PCEs as a multidimensional protective construct that enhances mental flexibility, buffers the adverse effects of stressful or traumatic life events, and supports adaptive psychosocial functioning across the lifespan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Mediating Role of Psychological Flexibility\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcceptance and Commitment Therapy (ACT), which aims to help individuals live meaningfully in the present moment, accept internal experiences without avoidance, and engage in actions congruent with personal values, is fundamentally grounded in the construct of psychological flexibility (Kashdan \u0026amp; Rottenberg, 2010). Psychological flexibility is defined as the capacity to attend to one’s internal experiences—thoughts, emotions, and sensations—with openness and awareness, to remain connected to the present moment, and to commit to value-consistent behavior despite psychological discomfort (S. C. Hayes et al., 2006). The construct is operationalized through six interrelated core processes: (a) flexible contact with the present moment, (b) acceptance, (c) contact with values, (d) self-as-context, (e) committed action, and (f) cognitive defusion (S. C. Hayes et al., 2011). In essence, psychological flexibility involves recognizing and acknowledging inner experiences without attempting to alter their intensity or content, thereby diminishing their control over behavior and enabling individuals to act in alignment with personally meaningful goals and values (S. C. Hayes et al., 2006).\u003c/p\u003e\n\u003cp\u003eA growing body of empirical evidence highlights the central role of psychological flexibility in mental health and well-being. Previous research has demonstrated that psychological flexibility is negatively associated with psychological maltreatment, suicidal ideation, and various mental health difficulties (Bryan et al., 2015; Türk et al., 2024). Conversely, it is positively correlated with psychological well-being (Guerrini Usubini et al., 2021), life satisfaction (Graham et al., 2016), and psychological flexibility (Büyüköksüz \u0026amp; Tekin, 2023), while exhibiting negative associations with psychological distress (Tindle et al., 2022), stress (Wang et al., 2023), anxiety (McCracken et al., 2021), depressive symptoms (Fonseca et al., 2020), and burnout (Kent et al., 2019).\u003c/p\u003e\n\u003cp\u003eMoreover, research has identified psychological flexibility as a protective factor mitigating the impact of early adverse experiences on later mental health. Empirical findings indicate that psychological flexibility reduces the detrimental influence of ACEs on suicidal thoughts (Türk et al., 2024) and moderates the relationship between ACEs and various psychopathological outcomes (Arslan et al., 2025). Complementarily, psychological flexibility has been found to mediate the relationship between PCEs and spiritual well-being, suggesting that it facilitates adaptive meaning-making and psychological growth following positive developmental contexts (Maral et al., 2024). In parallel, studies have demonstrated that psychological flexibility serves a buffering function between ACEs and mental health problems, thereby reducing vulnerability to adverse outcomes (Makriyianis et al., 2019; Parfait et al., 2022; Sachdeva \u0026amp; Shukla, 2024).\u003c/p\u003e\n\u003cp\u003eTaken together, these findings highlight the functional importance of psychological flexibility and flexibility as central mechanisms shaping the relationship between childhood experiences and mental health in young populations. Accordingly, the present study posits that psychological flexibility mediates the relationship between adverse and positive childhood experiences and suicidal thoughts among young adults, thereby elucidating the underlying psychological processes that link early developmental experiences to later mental health outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Present Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the extant literature, only a limited number of studies have examined the interactive effects of positive childhood experiences (PCEs) and adverse childhood experiences (ACEs) on suicidal thoughts among young individuals. Empirical findings have demonstrated strong associations between adverse childhood experiences and suicidal thoughts, as well as other psychological difficulties, in adulthood (Arslan et al., 2025; Tindle et al., 2022; Türk et al., 2024). In this context, identifying protective factors that can mitigate the detrimental effects of early adversity and enhance psychological flexibility represents a critical research priority.\u003c/p\u003e\n\u003cp\u003eIn line with this perspective, psychological flexibility may function not only as an explanatory mechanism but also as a protective factor that buffers the impact of adverse childhood experiences on suicidal thoughts. Evidence suggests that PCEs, independent of ACEs, contribute to strengthening individuals’ psychological flexibility, thereby attenuating the negative consequences of early adversity (Crandall et al., 2019; Han et al., 2023b). Within this framework, psychological flexibility emerges as a particularly salient construct, as it reflects the capacity to maintain emotional balance and adaptive functioning in the face of adverse life experiences (Arslan et al., 2025). Moreover, prior research indicates that psychological flexibility may play a mediating role in the relationship between ACEs, PCEs, and suicidal thoughts, acting as a preventive mechanism that reduces vulnerability to self-destructive cognition and behaviors (Bryan et al., 2015; Misitano et al., 2024).\u003c/p\u003e\n\u003cp\u003eFurthermore, considering ACEs and PCEs simultaneously allows for the examination of whether positive childhood experiences may attenuate the adverse effects of childhood adversity on suicidal thoughts, rather than assuming that these developmental experiences operate independently. Acceptance and Commitment Therapy (ACT), which aims to enhance psychological flexibility, encourages individuals to accept inevitable psychological pain as a natural part of the human experience and to pursue a rich and meaningful life consistent with their personal values (S. C. Hayes et al., 2011). By reframing distressing emotions and thoughts as integral components of normal psychological functioning—rather than as pathological symptoms—ACT promotes greater psychosocial adjustment and emotional well-being.\u003c/p\u003e\n\u003cp\u003eAlthough research on psychological flexibility has expanded considerably recently, empirical studies specifically addressing its mediating role in the relationship between adverse childhood experiences (ACEs), positive childhood experiences (PCEs), and suicidal thoughts among young people remain limited. Therefore, the present study aims to investigate the mediating role of psychological flexibility in the relationship between ACEs, PCEs, and suicidal thoughts in young adults. Understanding this relationship may offer important clues to developing targeted preventive and therapeutic interventions designed to reduce suicidal thoughts among youth. At the same time, the present focus on mediation does not preclude the potential moderating role of psychological flexibility or the interactive effects of ACEs and PCEs, which warrant examination in future research.\u003c/p\u003e\n\u003cp\u003eAccordingly, the following hypotheses were proposed:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH1:\u003c/strong\u003e Adverse childhood experiences (ACEs) significantly and positively predict suicidal thoughts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH2:\u003c/strong\u003e Positive childhood experiences (PCEs) significantly and negatively predict suicidal thoughts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH3:\u003c/strong\u003e Psychological flexibility mediates the relationship between ACEs, PCEs, and suicidal thoughts.\u003c/p\u003e\n\u003cp\u003eINSERT FIGURE 1 ABOUT HERE\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants in this study consisted of 559 youths in Türkiye. Of these, 74% were female and 26% were male, with ages ranging from 18 to 24 years (M = 21.89, SD = 2.17). Regarding marital status, 4.7% (n = 26) were married, while 95.3% (n = 533) were single. In terms of educational level, 44% (n = 246) were undergraduate students, 54.7% (n = 306) were graduate students, and 1.3% (n = 7) were postgraduate students. Participants reported their socio-economic status as very low (3.8%), low (12%), middle (77.5%), high (5.5%), and very high (1.3%), indicating that the majority of the sample belonged to the middle socio-economic class. The inclusion criteria were (i) being a youth enrolled in a university in Türkiye, (ii) being aged between 17 and 24 years, and (iii) voluntarily agreeing to participate in the study. The exclusion criteria included (i) not being a youth enrolled in a university, (ii) being outside the age range of 17–24 years, and (iii) not consenting to participate voluntarily.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePositive Childhood Experiences Scale (PCES):\u0026nbsp;\u003c/strong\u003eThe Positive Childhood Experiences Scale was developed by Bethell et al. (2019) to assess individuals’ positive experiences during childhood. The scale consists of seven items rated on a five-point Likert scale ranging from 1 (Never) to 5 (Always). Higher scores indicate that individuals have had more positive childhood experiences. There are no reverse-scored items, and the total score ranges from 7 to 35. The scale is applicable to individuals aged 18 years and older. An example item is: \u003cem\u003e“How often did you feel that your family stood by you in difficult times?”\u003c/em\u003e The Turkish adaptation of the scale was carried out by Çi̇çek \u0026amp; Çeri̇ (2021). In the current study, the Cronbach’s alpha coefficient for the PCES was .75.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBrief Suicide Cognitions Scale (BSCS):\u0026nbsp;\u003c/strong\u003eThe Brief Suicide Cognitions Scale, developed by Rudd \u0026amp; Bryan (2021), consists of six items rated on a five-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Higher scores indicate a higher level of suicidal cognitions. The scale has no reverse-coded items, and total scores range from 5 to 25. An example item is: \u003cem\u003e“I do not deserve to be loved.”\u003c/em\u003e The Turkish adaptation was conducted by Arslan (2024), and the Cronbach’s alpha coefficient obtained in the present study was .87.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcceptance and Action Questionnaire-II (AAQ-II)\u003c/strong\u003e: The Acceptance and Action Questionnaire-II was developed by Bond et al. (2011) to measure psychological flexibility. The Turkish version was adapted by Yavuz et al. (2016). The scale consists of seven items rated on a seven-point Likert scale, ranging from 1 (Never true) to 7 (Always true). There are no reverse-scored items. An example item is: \u003cem\u003e“It seems like most people are handling their lives better than I am.”\u003c/em\u003e Higher scores indicate greater psychological flexibility. In the current study, the Cronbach’s alpha coefficient for the AAQ-II was .87.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdverse Childhood Experiences Scale (ACES)\u003c/strong\u003e: The \u003cstrong\u003eAdverse Childhood Experiences Scale\u0026nbsp;\u003c/strong\u003ewas developed by Felitti et al. (1998) to assess negative experiences during childhood. The \u003cstrong\u003eTurkish adaptation\u003c/strong\u003e of the scale was conducted by Gündüz et al. (2018). The scale consists of \u003cstrong\u003e10 dichotomous (Yes/No) items\u003c/strong\u003e that inquire about adverse experiences occurring \u003cstrong\u003ebefore the age of 18\u003c/strong\u003e. Example items include: \u003cem\u003e“Did you live with someone who had an alcohol or drug problem?”\u003c/em\u003e, which focus on various forms of childhood adversity. The total score ranges from \u003cstrong\u003e0 to 10\u003c/strong\u003e, with higher scores indicating \u003cstrong\u003egreater exposure to adverse childhood experiences\u003c/strong\u003e. In the present study, the \u003cstrong\u003eCronbach’s alpha coefficient\u003c/strong\u003e for the ACES was \u003cstrong\u003e.70\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this cross-sectional study, data were collected online via Google Forms between March 15, 2025, and May 15, 2025. The sample comprised students enrolled in associate, undergraduate, and graduate programs. Prior to data collection, participants were provided with an informed consent form detailing the purpose and procedures of the study. Confidentiality of responses was strictly maintained, and participants did not receive any compensation for their involvement. Ethical approval was obtained from the Bitlis Eren University Social and Humanities Ethics Committee (\u003cem\u003eDecision No: 30.05.2025/178062\u003c/em\u003e) prior to the initiation of data collection. Completing the questionnaires required approximately 15 minutes per participant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study examines the mediating role of psychological flexibility in the relationship between adverse childhood experiences (ACEs), positive childhood experiences (PCEs), and suicidal thoughts among young adults. Mediation analysis, a robust statistical method that accounts for measurement error and facilitates the examination of complex variable relationships, was employed (Kline, 2023). Within this framework, it is hypothesised that ACEs and PCEs may influence suicidal thoughts in youth and that psychological flexibility plays a crucial mediating role in buffering or attenuating these effects. Although psychological flexibility may also function as a moderating protective factor and ACEs and PCEs may interact in predicting suicidal thoughts, the present study focuses specifically on testing the mediating mechanism in line with its primary theoretical aim. Prior to conducting the main analyses, descriptive statistics for all study variables—including means, standard deviations, skewness, kurtosis, and correlations—were calculated using SPSS version 25. Subsequently, Pearson’s product-moment correlation analyses were conducted to examine the bivariate relationships among variables. Finally, the mediation effects of psychological flexibility on the relationship between ACEs, PCEs, and suicidal thoughts were tested using the PROCESS macro for SPSS (Model 4). Indirect effects were evaluated using bias-corrected 95% confidence intervals based on 5,000 bootstrap samples (Hayes, 2018).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePreliminary analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePreliminary analyses indicated that the study variables were approximately normally distributed, with skewness values ranging from -0.23 to 1.08 and kurtosis values ranging from -0.60 to 1.48, all within the acceptable limits for normality (≤ |2|) as suggested in the literature (Tabachnick \u0026amp; Fidell, 2019).\u003c/p\u003e\n\u003cp\u003eFollowing the descriptive analyses, correlation analyses were conducted to examine the relationships among the study variables. Results indicated a significant negative correlation between ACEs and psychological flexibility (\u003cem\u003er\u003c/em\u003e = -0.27, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01) and a significant positive correlation between ACEs and suicidal thoughts (\u003cem\u003er\u003c/em\u003e = 0.28, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01). In contrast, PCEs were positively and significantly correlated with psychological flexibility (\u003cem\u003er\u003c/em\u003e = 0.40, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01) and negatively and significantly correlated with suicidal thoughts (\u003cem\u003er\u003c/em\u003e = -0.39, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01). Additionally, psychological flexibility demonstrated a significant negative association with suicidal thoughts (\u003cem\u003er\u003c/em\u003e = -0.52, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01).\u003c/p\u003e\n\u003cp\u003eThese bivariate associations provided the empirical basis for subsequent mediation analyses and supported the theoretical ordering of variables specified in the proposed model. Examination of the internal consistency reliability coefficients for the scales used in the study revealed Cronbach’s alpha values ranging from 0.70 to 0.87 (see Table 1), providing evidence for the satisfactory reliability of the measures employed in this research.\u003c/p\u003e\n\u003cp\u003eINSERT TABLE 1 ABOUT HERE\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMediation Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing the preliminary analyses, mediation analyses were conducted using the PROCESS macro (Model 4) to examine the mediating role of psychological flexibility in the relationship between ACEs, PCEs, and suicidal thoughts. Consistent with the primary aim of the study, these analyses focused on elucidating the indirect pathways through which childhood experiences relate to suicidal thoughts via psychological flexibility.\u003c/p\u003e\n\u003cp\u003eThe results indicated that ACEs positively and significantly predicted suicidal thoughts (β = 0.15, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), whereas PCEs negatively and significantly predicted suicidal thoughts (β = -0.21, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001). Additionally, psychological flexibility was found to negatively and significantly predict suicidal thoughts (β = -0.47, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001 for ACEs pathway; β = -0.43, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001 for PCEs pathway).\u003c/p\u003e\n\u003cp\u003ePath analyses revealed that psychological flexibility partially mediated the relationships between ACEs, PCEs, and suicidal thoughts (see Table 2; Figure 2). Specifically, the indirect effects of ACEs on suicidal thoughts through psychological flexibility were significant (effect = 0.13, 95% CI [0.09, 0.17]), as were the indirect effects of PCEs (effect = -0.17, 95% CI [-0.22, -0.12]). Direct and total effects for both ACEs and PCEs were also significant (see Table 2).\u003c/p\u003e\n\u003cp\u003eAll standardized regression coefficients (β), standard errors, and p-values for the paths were reported. These findings provide robust evidence that psychological flexibility partially mediates the relationship between ACEs, PCEs, and suicidal thoughts, highlighting its critical role as a protective factor in young adults’ psychosocial functioning.\u003c/p\u003e\n\u003cp\u003eINSERT FIGURE 2 ABOUT HERE\u003c/p\u003e\n\u003cp\u003eINSERT TABLE 2 ABOUT HERE\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study aimed to investigate the mediating role of psychological flexibility in the relationship between adverse childhood experiences (ACEs), positive childhood experiences (PCEs), and suicidal ideation among young adults. The key findings can be summarized as follows: (i) ACEs significantly and positively predicted suicidal thoughts; (ii) PCEs significantly and negatively predicted suicidal thoughts; and (iii) psychological flexibility mediated the relationships between ACEs, PCEs, and suicidal thoughts.\u003c/p\u003e\n\u003cp\u003eFirst, the analyses revealed that ACEs were significantly and positively associated with suicidal thoughts in young adults, supporting the first hypothesis (H1). This finding suggests that individuals who have experienced adverse childhood events are at an increased risk of developing suicidal thoughts in later life. Consistent with prior research, ACEs have been linked to sleep disturbances, physical and mental health problems, depression, and suicidal ideation in both adolescents and adults (Baldini et al., 2025; Crandall et al., 2019; Duraccio et al., 2024; Felitti et al., 1998, 2019; E. E. Jones et al., 2024; Ye et al., 2024). Early adverse experiences—such as physical, emotional, or sexual abuse, parental loss, and neglect—can foster maladaptive cognitive patterns (Arslan et al., 2025) and contribute to the development of negative attributional styles, such as self-blame (e.g., feelings of worthlessness), thereby increasing vulnerability to suicidal ideation in later life (Sachs-Ericsson et al., 2016). Collectively, these findings underscore the role of negative childhood experiences as a significant risk factor for suicidal thoughts in youth.\u003c/p\u003e\n\u003cp\u003eSecond, the study found a significant negative association between PCEs and suicidal thoughts, confirming the second hypothesis (H2). Higher levels of PCEs were associated with lower levels of suicidal cognitions, consistent with prior evidence indicating that positive childhood experiences serve a protective function against psychological difficulties (Adachi et al., 2025; Akbulut, 2025). Positive experiences in early life—such as supportive relationships, feelings of safety, and engagement in social activities—contribute to overall well-being and developmental outcomes (Bethell et al., 2019; Cicchetti \u0026amp; Toth, 2009; Kocatürk \u0026amp; Çiçek, 2023; Şanli et al., 2024). These experiences enhance self-efficacy, psychological flexibility, and meaning in life (Southwick et al., 2014) and promote the development of adaptive coping strategies in response to stress (Compas et al., 2001). Recent empirical studies confirm that PCEs diminish the probability of suicidal behaviors and suicidal cognitions (Adachi et al., 2025; Bravo et al., 2024; Bunting et al., 2023; Liu et al., 2025). Overall, all these findings highlight the protective role of PCEs in relation to suicidal thoughts among young adults.\u003c/p\u003e\n\u003cp\u003eThird, psychological flexibility was found to mediate the relationship between ACEs, PCEs, and suicidal thoughts. This finding emphasizes the potential of psychological flexibility to buffer the triggering effects of adverse childhood experiences on suicidal thoughts. Previous research has indicated that ACEs are positively associated with depression, sleep problems, substance use, and suicidal behaviors (Choi et al., 2017; Duraccio et al., 2024; Leza et al., 2021; Wu et al., 2024; Ye et al., 2024), and low levels of psychological flexibility may exacerbate these outcomes (Kashdan \u0026amp; Rottenberg, 2010). Numerous studies indicate that psychological flexibility confers protection against depression, anxiety, and general distress (Bond et al., 2011). Conversely, low psychological flexibility may promote avoidance behaviors, intensifying suicidal thoughts and motivating self-harming behaviors (Angelakis \u0026amp; Gooding, 2021). Psychological flexibility enables individuals to remain present, accept thoughts and emotions, and engage in value-driven behaviors (Kashdan \u0026amp; Rottenberg, 2010) thereby fostering flexibility against psychological distress. Enhancing psychological flexibility in individuals with high ACE exposure may increase their resistance to suicidal thoughts despite emotional challenges (Makriyianis et al., 2019; Türk et al., 2024). For example, psychological flexibility reduces the negative impact of adverse childhood experiences on mental health (Arslan et al., 2025). Moreover, psychological flexibility mediates the relationship between PCEs and suicidal thoughts, suggesting that positive experiences foster flexibility and protective mechanisms through enhanced psychological flexibility (Maral et al., 2024; Matos et al., 2017). Although the present findings support a mediating role of psychological flexibility, future research should extend this framework by examining psychological flexibility as a moderating protective factor and by testing the interactive effects of ACEs and PCEs to further clarify resilience pathways underlying suicidal thoughts.\u003c/p\u003e\n\u003cp\u003eIn summary, these findings collectively point out the vital role of developing psychological flexibility as a protective factor to buffer the negative impact of ACEs and enhance the protective effects of PCEs on suicidal thoughts among youth. Interventions targeting psychological flexibility may therefore be effective in reducing vulnerability to suicidal thoughts and promoting mental health resilience in young populations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePractical\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eImplications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite its limitations, the present study provides valuable insights into the mechanisms underlying the relationships between ACEs, PCEs, and suicidal ideation among young adults. The findings suggest that individuals with a history of ACEs are more prone to suicidal thoughts, whereas PCEs independently serve a protective role, supporting well-being in youth. Moreover, the results highlight the critical importance of promoting psychological flexibility as a means of buffering the triggering effects of adverse childhood experiences on suicidal thoughts. Positive childhood experiences also appear to contribute to the development of psychological flexibility, thereby creating a protective buffer against suicidal thoughts. Collectively, these findings underscore the relevance of enhancing resilience-promoting factors, such as psychological flexibility, to mitigate the risk associated with negative early-life experiences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations and Future Directions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile this study comprehensively examined the relationships among PCEs, ACEs, psychological flexibility, and suicidal thoughts, several limitations should be acknowledged. First, the cross-sectional design precludes causal inferences. Although cross-sectional studies are effective in detecting associations among variables, longitudinal research is necessary to clarify the temporal dynamics and causality of these relationships. Future studies should adopt longitudinal designs to investigate the long-term effects of childhood experiences on suicidal thoughts and psychological outcomes.\u003c/p\u003e\n\u003cp\u003eSecond, data were collected via self-report measures, which are susceptible to biases such as social desirability. While self-report instruments are valuable for assessing individuals’ perceptions and internal experiences, responses may reflect a tendency to present oneself in a socially acceptable manner. Future research could incorporate multi-method approaches, such as structured interviews or observational measures, to enhance data reliability and reduce subjective bias.\u003c/p\u003e\n\u003cp\u003eThird, the study sample was limited to young adults within a specific cultural context, which may constrain the generalizability of the findings. Future research should consider diverse age groups, populations, and cultural settings to provide a broader understanding of how ACEs, PCEs, and psychological flexibility interact across different contexts.\u003c/p\u003e\n\u003cp\u003eBased on these findings and limitations, several directions for future research are suggested. Longitudinal studies could clarify the long-term impact of positive and negative childhood experiences on psychological health and suicidal thoughts. Incorporating structured interviews alongside self-report measures could reduce subjective bias and improve measurement validity. Finally, expanding research to include varied age groups and cultural backgrounds would deepen our understanding of these complex relationships and inform culturally sensitive intervention strategies.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe present study provides empirical evidence regarding the interrelationships among Adverse Childhood Experiences (ACEs), Positive Childhood Experiences (PCEs), psychological flexibility, and suicidal thoughts in young adults. The findings indicate that exposure to ACEs significantly increases the risk of suicidal thoughts, while PCEs serve as a crucial protective buffer against these effects. Psychological flexibility has emerged as a strong protective factor, mitigating the impact of ACEs on suicidal thoughts. Furthermore, PCEs seem to enhance psychological flexibility, thereby bolstering flexibility and reducing the likelihood of suicidal thoughts. Importantly, these findings should not be interpreted as implying that childhood experiences can be retrospectively modified in adulthood; rather, they highlight psychological flexibility as a modifiable, clinically actionable process through which the long-term effects of early adversity on suicidal thoughts may be attenuated. These results point to the future of intervention programs designed to foster psychological flexibility in young people, providing mental health professionals with actionable strategies to alleviate the negative consequences of adverse childhood experiences.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eACEs:\u0026nbsp;\u003c/strong\u003eAdverse Childhood Experiences Scale\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePCEs:\u0026nbsp;\u003c/strong\u003ePositive Childhood Experiences Scale\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBSCS:\u0026nbsp;\u003c/strong\u003eBrief Suicide Cognitions Scale\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAAQ-II:\u0026nbsp;\u003c/strong\u003eAcceptance and Action Questionnaire-II\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACT:\u0026nbsp;\u003c/strong\u003eAcceptance and Commitment Therapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePROCESS:\u0026nbsp;\u003c/strong\u003eHayes\u0026rsquo;s PROCESS Macro\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSPSS:\u0026nbsp;\u003c/strong\u003eStatistical Package for the Social Sciences\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePF:\u0026nbsp;\u003c/strong\u003ePsychological Flexibility\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval was obtained from the Ethics Committee for Social and Humanities Research at Bitlis Eren University (Decision No: 30.05.2025/178062).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants prior to their participation in the study. Consent was obtained in written form on March 15, 2025, and May 15, 2025 by the members of the research team responsible for data collection. Participants were fully informed about the purpose of the study, the voluntary nature of participation, confidentiality of their responses, and their right to withdraw from the study at any time without any negative consequences.All participants were adults aged between 18 and 24 years, and therefore provided informed consent on their own behalf.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study have not been published or made publicly available. However, they are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design, material preparation, data collection and analysis, and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all students who voluntarily participated in this research. We also acknowledge the support of Bitlis Eren University for facilitating the data collection process.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAdachi, M., Takahashi, M., \u0026amp; Mori, H. (2025). Positive childhood experiences reduce suicide risk in Japanese youth with ASD and ADHD traits: A population-based study. \u003cem\u003eFrontiers in Psychiatry\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e. https://doi.org/10.3389/fpsyt.2025.1566098\u003c/li\u003e\n\u003cli\u003eAkbulut, \u0026Ouml;. F. (2025). Positive Childhood Experiences, Suicide Cognitions, Subjective Happiness, and Mental Well-Being in Young Adults: A Half-Longitudinal Serial Mediation Study. \u003cem\u003ePsychiatric Quarterly\u003c/em\u003e. https://doi.org/10.1007/s11126-025-10162-6\u003c/li\u003e\n\u003cli\u003eAngelakis, I., Austin, J. L., \u0026amp; Gooding, P. (2020). 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Psychological inflexibility mediates the relationship between adverse childhood experiences and mental health outcomes. \u003cem\u003eJournal of Contextual Behavioral Science\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e, 82\u0026ndash;89. https://doi.org/10.1016/j.jcbs.2019.09.007\u003c/li\u003e\n\u003cli\u003eMansueto, G., Cavallo, C., Palmieri, S., Ruggiero, G. M., Sassaroli, S., \u0026amp; Caselli, G. (2021). Adverse childhood experiences and repetitive negative thinking in adulthood: A systematic review. \u003cem\u003eClinical Psychology \u0026amp; Psychotherapy\u003c/em\u003e, \u003cem\u003e28\u003c/em\u003e(3), 557\u0026ndash;568. https://doi.org/10.1002/cpp.2590\u003c/li\u003e\n\u003cli\u003eMaral, S., Bilmez, H., \u0026amp; Satici, S. A. (2024). 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The role of psychological flexibility in the context of COVID-19: Associations with depression, anxiety, and insomnia. \u003cem\u003eJournal of Contextual Behavioral Science\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e, 28\u0026ndash;35. https://doi.org/10.1016/j.jcbs.2020.11.003\u003c/li\u003e\n\u003cli\u003eMisitano, A., Michelini, G., \u0026amp; Oppo, A. (2024). Understanding suicidal thoughts through psychological flexibility and inflexibility: A network analysis perspective. \u003cem\u003eJournal of Contextual Behavioral Science\u003c/em\u003e, \u003cem\u003e34\u003c/em\u003e, 100853. https://doi.org/10.1016/j.jcbs.2024.100853\u003c/li\u003e\n\u003cli\u003eNarayan, A. J., Rivera, L. M., Bernstein, R. E., Harris, W. W., \u0026amp; Lieberman, A. F. (2018). Positive childhood experiences predict less psychopathology and stress in pregnant women with childhood adversity: A pilot study of the benevolent childhood experiences (BCEs) scale. \u003cem\u003eChild Abuse \u0026amp; Neglect\u003c/em\u003e, \u003cem\u003e78\u003c/em\u003e, 19\u0026ndash;30. https://doi.org/10.1016/j.chiabu.2017.09.022\u003c/li\u003e\n\u003cli\u003eParfait, B., Sease, T. B., \u0026amp; Sandoz, E. K. (2022). Psychological inflexibility as a mediator of the relationship between adverse childhood experiences and dissociation. \u003cem\u003eJournal of Contextual Behavioral Science\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e, 92\u0026ndash;97. https://doi.org/10.1016/j.jcbs.2021.12.005\u003c/li\u003e\n\u003cli\u003ePerez, N. M., Jennings, W. G., Piquero, A. R., \u0026amp; Baglivio, M. T. (2016). Adverse Childhood Experiences and Suicide Attempts: The Mediating Influence of Personality Development and Problem Behaviors. \u003cem\u003eJournal of Youth and Adolescence\u003c/em\u003e, \u003cem\u003e45\u003c/em\u003e(8), 1527\u0026ndash;1545. https://doi.org/10.1007/s10964-016-0519-x\u003c/li\u003e\n\u003cli\u003eRudd, M. D., \u0026amp; Bryan, C. J. (2021). The Brief Suicide Cognitions Scale: Development and Clinical Application. \u003cem\u003eFrontiers in Psychiatry\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e. https://doi.org/10.3389/fpsyt.2021.737393\u003c/li\u003e\n\u003cli\u003eSachdeva, J., \u0026amp; Shukla, R. (2024). Exploring the Mediating Influence of Psychological Flexibility and Self-Compassion on the Relationship Between Adverse Childhood Experiences and Post-Traumatic Growth among Young Adults in India. \u003cem\u003ePsychological Reports\u003c/em\u003e, 00332941241302318. https://doi.org/10.1177/00332941241302318\u003c/li\u003e\n\u003cli\u003eSachs-Ericsson, N. J., Rushing, N. C., Stanley, I. H., \u0026amp; Sheffler, J. (2016). In my end is my beginning: Developmental trajectories of adverse childhood experiences to late-life suicide. \u003cem\u003eAging \u0026amp; Mental Health\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(2), 139\u0026ndash;165. https://doi.org/10.1080/13607863.2015.1063107\u003c/li\u003e\n\u003cli\u003eSacks, V., \u0026amp; Murphey, D. (2018). \u003cem\u003eThe prevalence of adverse childhood experiences, nationally, by state, and by race or ethnicity\u003c/em\u003e. https://www.childtrends.org/publications/prevalence-adverse-childhood-experiences-nationally-state-race-ethnicity\u003c/li\u003e\n\u003cli\u003eSahle, B. W., Reavley, N. J., Li, W., Morgan, A. J., Yap, M. B. H., Reupert, A., \u0026amp; Jorm, A. F. (2022). The association between adverse childhood experiences and common mental disorders and suicidality: An umbrella review of systematic reviews and meta-analyses. \u003cem\u003eEuropean Child \u0026amp; Adolescent Psychiatry\u003c/em\u003e, \u003cem\u003e31\u003c/em\u003e(10), 1489\u0026ndash;1499. https://doi.org/10.1007/s00787-021-01745-2\u003c/li\u003e\n\u003cli\u003eŞanli, M. E., \u0026Ccedil;i\u0026ccedil;ek, İ., Yıldırım, M., \u0026amp; \u0026Ccedil;eri, V. (2024). Positive childhood experiences as predictors of anxiety and depression in a large sample from Turkey. \u003cem\u003eActa Psychologica\u003c/em\u003e, \u003cem\u003e243\u003c/em\u003e, 104170. https://doi.org/10.1016/j.actpsy.2024.104170\u003c/li\u003e\n\u003cli\u003eSousa, M., Machado, A. B., Pinheiro, M., Pereira, B., Caridade, S., Almeida, T. C., Cruz, A. R., \u0026amp; Cunha, O. (2025). 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Childhood Abuse and Adolescent School Bullying: The Mediating Roles of Perceived Social Support and Loneliness. \u003cem\u003eJournal of Child and Family Studies\u003c/em\u003e, \u003cem\u003e32\u003c/em\u003e(10), 3120\u0026ndash;3133. https://doi.org/10.1007/s10826-022-02486-9\u003c/li\u003e\n\u003cli\u003eWHO. (2024). \u003cem\u003eSuicide\u003c/em\u003e. https://www.who.int/news-room/fact-sheets/detail/suicide\u003c/li\u003e\n\u003cli\u003eWu, P., Feng, R., \u0026amp; Zhang, J. (2024). The relationship between loneliness and problematic social media usage in Chinese university students: A longitudinal study. \u003cem\u003eBMC Psychology\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(1), 13. https://doi.org/10.1186/s40359-023-01498-4\u003c/li\u003e\n\u003cli\u003eYavuz, F., Ulusoy, S., Iskin, M., Esen, F. B., Burhan, H. S., Karadere, M. E., \u0026amp; Yavuz, N. (2016). Turkish Version of Acceptance and Action Questionnaire-II (AAQ-II): A reliability and Validity Analysis in Clinical and Non-Clinical Samples. \u003cem\u003eKlinik Psikofarmakoloji B\u0026uuml;lteni-Bulletin of Clinical Psychopharmacology\u003c/em\u003e, \u003cem\u003e26\u003c/em\u003e(4), 397\u0026ndash;408. https://doi.org/10.5455/bcp.20160223124107\u003c/li\u003e\n\u003cli\u003eYe, Z., Wei, X., Zhang, J., Li, H., \u0026amp; Cao, J. (2024). The impact of adverse childhood experiences on depression: The role of insecure attachment styles and emotion dysregulation strategies. \u003cem\u003eCurrent Psychology\u003c/em\u003e, \u003cem\u003e43\u003c/em\u003e(5), 4016\u0026ndash;4026. https://doi.org/10.1007/s12144-023-04613-1\u003c/li\u003e\n\u003cli\u003eZhang, N., Gao, M., Yu, J., Zhang, Q., Wang, W., Zhou, C., Liu, L., Sun, T., Liao, X., \u0026amp; Wang, J. (2022). Understanding the association between adverse childhood experiences and subsequent attention deficit hyperactivity disorder: A systematic review and meta-analysis of observational studies. \u003cem\u003eBrain and Behavior\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(10), e32748. https://doi.org/10.1002/brb3.2748\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e.\u0026nbsp;\u003cem\u003eSummary of Descriptive Statistics, and Correlation Analysis Results\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"605\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e3.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e4.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003e1. ACEs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e.-42\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e-.27\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e.28\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003e2. PCEs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e.40\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e-.39\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003e3. Psychological flexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e-.52\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003e4. Suicidal thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e23.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e26.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e11.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e4.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e8.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e4.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003e\u003cem\u003eSkewness\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e-.233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003e\u003cem\u003eKurtosis\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e.187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e-.600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003eInternal reliability (\u0026alpha;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e**\u003c/sup\u003eAll correlation coefficients are significant at level p\u0026lt;.001.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e: \u003cem\u003eMediation model path analysis.\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"618\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePath\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard error\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95 % Confidence Interval\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower limit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper limit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 411px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDirect effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 218px;\"\u003e\n \u003cp\u003e\u003cem\u003eACEs\u0026nbsp;\u003c/em\u003e\u0026rarr; Suicidal thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e0.491\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e0.723\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 218px;\"\u003e\n \u003cp\u003e\u003cem\u003ePCEs\u0026nbsp;\u003c/em\u003e\u0026rarr; Suicidal thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e-0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e-0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 411px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndirect effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 218px;\"\u003e\n \u003cp\u003e\u003cem\u003eACEs\u0026nbsp;\u003c/em\u003e\u0026rarr; Psychological flexibility \u0026rarr; Suicidal thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 218px;\"\u003e\n \u003cp\u003e\u003cem\u003ePCEs\u0026nbsp;\u003c/em\u003e\u0026rarr; Psychological flexibility \u0026rarr; Suicidal thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e-0.172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e-0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 218px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eTotal effect\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 218px;\"\u003e\n \u003cp\u003e\u003cem\u003eACEs\u0026nbsp;\u003c/em\u003e\u0026rarr; Suicidal thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.655\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e0.902\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 218px;\"\u003e\n \u003cp\u003e\u003cem\u003ePCEs\u0026nbsp;\u003c/em\u003e\u0026rarr; Suicidal thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e-0.389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e-0.313\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Suicidal Thoughts, Adverse Childhood Experiences, Positive Childhood Experiences, Psychological Flexibility, Youth","lastPublishedDoi":"10.21203/rs.3.rs-8831925/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8831925/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe present study investigates the mediating role of psychological flexibility in the relationship between adverse childhood experiences (ACEs), positive childhood experiences (PCEs), and suicidal thoughts among emerging adults. The sample comprised 559 youths aged between 17 and 24 years (M\u003csub\u003eage\u003c/sub\u003e = 21.89, SD\u003csub\u003eage\u003c/sub\u003e = 2.17), including 415 women (74.15%) and 144 men. Participants completed the Adverse Childhood Experiences Scale, the Positive Childhood Experiences Scale, the Brief Suicide Cognitions Scale (BSCS), the Acceptance and Action Questionnaire-II (AAQ-II), and a demographic information form. Data were analysed using Hayes\u0026rsquo;s PROCESS macro for SPSS (Model 4). The results revealed a significant positive association between ACEs and suicidal thoughts. Psychological flexibility was negatively related to suicidal thoughts and partially mediated the relationship between ACEs, PCEs, and suicidal thoughts. These findings highlight the dual influence of childhood experiences on suicidal cognition, demonstrating the detrimental effects of adversity alongside the protective contribution of positive early experiences. Importantly, the findings should not be interpreted as implying that childhood experiences can be retrospectively altered in adulthood. Rather, ACEs and PCEs function as developmental risk and protective markers, whereas psychological flexibility represents a modifiable and clinically actionable intervention target. From this perspective, interventions aimed at enhancing psychological flexibility\u0026mdash;such as Acceptance and Commitment Therapy\u0026ndash;informed approaches\u0026mdash;may mitigate suicidal risk among youths with elevated exposure to childhood adversity. Future research should extend this model by testing psychological flexibility as a buffering moderator and by examining the interactive effects of ACEs and PCEs on suicidal thoughts.\u003c/p\u003e","manuscriptTitle":"Psychological Flexibility as a Mechanism and Buffer Linking Adverse and Positive Childhood Experiences to Suicidal Thoughts in Youth","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-08 14:48:28","doi":"10.21203/rs.3.rs-8831925/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-24T06:36:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-23T16:27:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-11T20:23:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"202496177166060705999185991034695307625","date":"2026-04-02T20:39:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"315156671301802367508312240783887100289","date":"2026-03-31T21:13:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-26T10:43:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-17T06:51:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-15T12:34:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2026-02-15T12:30:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6326323c-d09b-4440-bd06-53cc1ab8e6ca","owner":[],"postedDate":"March 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T04:54:27+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-08 14:48:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8831925","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8831925","identity":"rs-8831925","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}
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