Intra-Familial Adverse Childhood Experiences and Suicidal Behaviors among Tunisian Youth: The Mediating Effects of Impulsivity and Resilience

Abstract

Given that resilience is the ability to cope with adversities, and impulsivity is characterized with rapid reactions without foresight, we aimed to explore the pathways between intra-familial childhood adversities, resilience, impulsivity and suicidal behaviors among adolescents in Mahdia and Gafsa cities (Tunisia). We conducted a cross-sectional study in secondary schools from January to February 2020. Exposure to intra-familial early life experiences was evaluated by the Adverse Childhood Experiences (ACEs)-International Questionnaire. Resilience and impulsivity were assessed via the Adolescent Psychological Resilience and the Barratt Impulsivity Scale. A total of 3170 students were recruited with a response rate of 74%. About 81.1% of them reported being emotionally abused. The resilience mean score was 86.10 ± 9.85. Impulsivity was screened among 42.2% of them. About 38% of students presented suicidal thoughts, 16.4% had a suicide plan, and 10.8% have made a suicide attempt. We found that exposure to intra-familial ACEs predicts suicidal behaviors through impulsiveness (% mediated = 18% for emotional violence) and interpersonal resilience (% mediated = 24% for emotional violence; % mediated = 20.4% for physical violence). Our results emphasize the need to prevent ACEs, and to seek out a way to promote ACE protective factors among adolescents such as resilience.