Adverse Childhood Experiences, Distress Tolerance, and Non-Suicidal Self-Injury: A Cross-Sectional Mediation Model Among College Students from Six Countries

Non-suicidal self-injury is defined as the deliberate, direct, and socially unacceptable destruction of body tissue without suicidal intent. Global estimates have shown high onset and frequency of NSSI in adolescents and is considered to be an issue of significant cross-national prevalence. Adverse childhood experiences (ACEs) have displayed strong empirical linkages to NSSI; however, more research identifying mechanisms linking ACEs to NSSI is needed. The present study examined the associations between ACEs, distress tolerance (DT), and NSSI severity among college students from six countries. Specifically, we examined whether ACEs predict past year NSSI severity via distress tolerance. Participants were 811 college students (78.4% female) from six countries (USA, Argentina, Spain, South Africa, England, Canada) who endorsed past year NSSI and completed study measures. Within our estimated model, we found that higher ACEs scores were associated with lower DT, which in turn was associated with greater NSSI severity (indirect β = .03, 99% CIs=0.01, 0.06). When accounting for DT, higher ACEs scores were still associated with greater NSSI severity (direct β = .23, 99% CIs = 0.14, 0.31). When testing for model invariance, we found that all effects were consistent across country and sex at birth groupings. These findings suggest that introducing and strengthening healthy coping mechanisms may provide emerging adults who experienced ACEs with adaptive strategies to manage distress and may reduce incidence of NSSI as a result.