Early Adversity & Self-Harm in Tunisian Prisoners: Mediated by Recent Violence Exposure?
Year: 2025
Type: article
Abstract: Introduction Despite the high number of incarcerated individuals, limited research addresses their mental health needs. Childhood exposure to social adversities (social ACEs) is linked to self-directed violence, yet the mechanisms remain poorly understood. This study aimed to explore whether recent exposure to violence mediates the relationship between social ACEs and self-directed violence among incarcerated males in Tunisia. Methods We conducted a cross-sectional study in April 2023 among male inmates in a Tunisian civil prison. Participation was voluntary, anonymous, and self-administered; illiterate participants were assisted by investigators. Social ACEs were assessed using the WHO's validated Arabic ACE questionnaire. Exposure to in-prison violence included psychological and physical forms. Self-directed violence was subdivided into suicidal behaviors and self-harm. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Results Among 540 participants (response rate 74.6%, mean age 33.75±10.89 years), 35% had recent suicidal thoughts and 45.9% reported self-harm. Nearly all (96.8%) had experienced at least one social ACE. Anxiety and depression were present in 83.2% and 79.6%, respectively. Over half experienced recent violence, mainly psychological. A dose-response effect was found: self-directed violence risk increased with the number of ACEs. After adjusting for anxiety and depression, recent violence mediated 24% of the relationship between social ACEs and self-directed violence (p = 0.01). Conclusions Social ACEs significantly contribute to self-directed violence among prisoners, with recent violence as a key mediator. Targeted interventions are needed to break this cycle within correctional settings. Key messages • Childhood social adversities are linked to self-harm and suicidal behavior in Tunisian prisoners, with recent in-prison violence acting as a key mediator. • Given high rates of social ACEs, mental distress, and prison violence, trauma-informed care is urgently needed to break the cycle of violence among incarcerated populations.
Authors: E Hariz, I Mlouki, A Silini, Y Abess, M Boussaid, S El Mhamdi
Institution: University of Monastir
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $3,181
OpenAlex ID: W7101424204
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