The path from extrafamilial childhood adversities to self-directed violence mediated by recent exposure to violence among male prisoners in Tunisia.

Abstract

Objective: We sought to investigate the impact of recent violence exposure on the relationship between extrafamilial adverse childhood experiences (ACEs) and self-inflicted violence in male Tunisian prisoners.

Method: We performed a cross-sectional study among adult male prisoners during April 2023. We used the validated Arabic versions of the World Health Organization ACE questionnaire and the Hospital Anxiety and Depression Scale. We assessed exposure to violence during the incarceration. Self-directed violence was subdivided into suicidal behaviors and self-harm. The participation was anonymous and voluntary, and the questionnaire was self-administered.

Results: A total of 540 prisoners were recruited with a response rate of 74.6%. Exposure to at least one extrafamilial ACE was reported by 96.8% of them. Anxiety and depression were screened in 83.2% and 79.6% of cases, respectively. Approximately the half (51.5%) reported recent violence exposure mainly psychological (45.8%). About 35% of prisoners had suicidal thoughts and 45.9% reported self-harming. We found that the risk of self-directed violence was significantly higher when the number of extrafamilial ACEs increased. After adjusting for anxiety and depression, our study revealed that childhood collective and peer violence predict self-directed violence through recent exposure to violence (%mediated = 41.6 and %mediated = 30.8, respectively).

Conclusions: This survey underscores the urgent need for targeted interventions to break the vicious cycle of violence in jails. (PsycInfo Database Record (c) 2025 APA, all rights reserved).