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Adverse childhood experiences (ACEs) are associated with increased suicidal behaviors in adolescents and most research has been restricted to certain types of or cumulative exposure to ACEs. Few studies have examined the association between patterns of ACEs and suicidal behaviors. To identify the contributions of type and pattern of exposure to ACEs to suicidal behaviors and their gender differences among middle school students in China. A school-based health survey was conducted in four provinces in China between 2017 and 2018. 14 500 st