The research, published in the Journal of Child & Adolescent Trauma by Tien Sy Pham of Hue University and Thi Nu Nguyen, examined 273 adolescents living in institutional care in Vietnam. Rather than looking at simple two-variable relationships, as most earlier studies had done, the team built an integrated structural equation model that treated childhood abuse, coping style, emotional distress, and suicidal behavior as parts of a single interconnected pathway. The goal was to answer a deceptively simple question: what actually happens between the experience of abuse and the emergence of suicidal behavior?

The participants completed a battery of validated instruments, including the Childhood Trauma Questionnaire, a brief screening tool that captures experiences of physical, emotional, and sexual abuse as well as neglect; the Brief COPE Inventory, which measures how people respond to stress across a range of strategies; standardized depression and anxiety scales previously validated for use with Vietnamese adolescents; and three suicide-related items assessing suicidal ideation and behavior. With these data, the researchers used structural equation modeling, a statistical technique that allows scientists to test whether a chain of indirect effects, known as mediation, links an early adversity to a later outcome through identifiable psychological mechanisms.

The first finding concerns coping. Childhood abuse was not directly destiny. Instead, its influence on emotional wellbeing flowed largely through avoidant coping, a style of handling stress in which a person disengages from problems rather than confronting them: denying difficulties, distracting themselves, using substances, or simply refusing to think about painful events. In the model, adolescents with histories of abuse were more likely to rely on these avoidant strategies, and in turn, avoidant coping was associated with both higher depressive symptoms and higher anxiety symptoms. The psychological literature offers a plausible mechanism for this chain. Maltreatment in childhood can sensitize the stress-response system and teach children that emotional expression is dangerous or futile, producing what researchers call experiential avoidance. Over time, avoiding problems prevents the very problem-solving and emotional processing that would otherwise defuse distress, allowing symptoms to accumulate.

The second and arguably most consequential finding involves suicidal behavior. When the researchers tested a serial mediational model, in which childhood abuse leads first to avoidant coping, then to emotional distress, and finally to suicidal behavior, one specific route emerged clearly. The pathway running through avoidant coping and then through anxiety symptoms was statistically supported. The parallel pathway running through avoidant coping and then depressive symptoms, by contrast, was not. In other words, among these institutionalized adolescents, it was anxiety, not depression, that appeared to serve as the emotional bridge between abuse-linked coping styles and suicidal behavior.

This asymmetry is striking because depression has historically been treated as the primary emotional predictor of suicide. Yet the result is consistent with a growing body of evidence from other populations. Longitudinal studies have found that anxiety symptoms can precede both major depression and suicidal ideation in young people, and psychological autopsy studies have documented combined effects of anxiety and depression on completed suicide. Theoretical models of suicidal behavior, including the integrated motivational-volitional model, also emphasize that states of agitation, threat, and entrapment, which are hallmarks of anxiety, can propel a person from passive ideation toward action. For adolescents who cope by avoiding, anxiety may be particularly corrosive: the avoided problem never resolves, the sense of threat never dissipates, and the feeling of being trapped intensifies until escape through self-harm begins to seem like the only exit.

The setting of the study matters as much as its findings. Vietnam, like many countries, has been working toward deinstitutionalization and alternative family-based care, but large numbers of children still grow up in residential facilities, often because of family poverty, parental illness, orphanhood, or abuse. Research from around the world shows that young people in institutional care face elevated rates of sexual victimization, peer violence, harsh punishment, depression, post-traumatic stress, and suicidality compared with peers in family settings. Earlier work by the same lead author had already documented high prevalences of childhood trauma, depressive and anxiety symptoms, and suicidal behavior among institutionalized adolescents in Vietnam. The new study extends that work by explaining the psychological architecture connecting those problems.

The practical implications are significant. If avoidant coping and anxiety form a transmissible chain from trauma to suicide risk, then interventions can be aimed directly at the links in that chain rather than only at the distant origin. Coping-skills training programs have already shown promise with adolescents in orphanage settings; a multicentre randomized controlled trial in Malaysia demonstrated that a life skills education program improved coping mechanisms among institutionalized youth. Similarly, therapeutic approaches that reduce experiential avoidance, such as those helping young people accept and process painful emotions rather than suppress them, have reduced traumatic stress in trauma-exposed populations. The present findings suggest that such programs should incorporate explicit anxiety screening and anxiety-focused treatment components, and that institutional caregivers should be trained to recognize anxiety as a suicide warning sign in its own right, not merely as a secondary feature of depression.

The authors are careful to note the limits of their design. The data are cross-sectional, meaning all variables were measured at a single point in time, and methodologists have long warned that cross-sectional mediation can bias estimates of longitudinal processes. Suicidal behavior was assessed with three self-report items rather than structured clinical interviews, and retrospective reports of childhood abuse, while generally supported by the evidence, are subject to recall limitations. The study also involved a single sample in one national context, and cultural factors specific to Vietnam, including stigma surrounding mental illness, may shape both coping styles and willingness to report suicidal thoughts. Future longitudinal studies that follow institutionalized adolescents over time, ideally across multiple countries, will be needed to confirm the causal structure of the pathway and to test whether the anxiety-mediated route generalizes beyond Vietnam.

Even with those caveats, the study adds a valuable piece to one of the most urgent puzzles in child and adolescent mental health. Hundreds of millions of young people worldwide experience abuse, and those in institutional care are among the most vulnerable. By showing that the road from childhood trauma to suicidal behavior runs through how adolescents cope and what they feel, rather than through trauma alone, the research transforms a grim correlation into an actionable target. Maladaptive coping and anxiety are modifiable. Teaching institutionalized adolescents to face problems instead of fleeing them, and treating their anxiety early and aggressively, could interrupt the cascade that turns yesterday’s abuse into tomorrow’s tragedy, offering concrete hope for suicide prevention in one of the world’s most overlooked populations.

Subject of Research: The serial mediation of childhood abuse and suicidal behavior through avoidant coping and anxiety among institutionalized adolescents in Vietnam

Article Title: Pathways From Childhood Abuse To Suicidal Behaviors Among Institutionalized Adolescents In Vietnam: The Role of Avoidant Coping, Anxiety, and Depression

Article References: Pham, T. S., & Nguyen, T. N. (2026). Pathways From Childhood Abuse To Suicidal Behaviors Among Institutionalized Adolescents In Vietnam: The Role of Avoidant Coping, Anxiety, and Depression. Journal of Child & Adolescent Trauma. https://doi.org/10.1007/s40653-026-00973-5

Image Credits: AI Generated

DOI: 10.1007/s40653-026-00973-5

Keywords: childhood abuse, avoidant coping, anxiety, depression, suicidal behavior, institutionalized adolescents, Vietnam, structural equation modeling, childhood trauma, suicide prevention, adolescent mental health, mediation analysis