Childhood trauma, substance use and mental health: Gender comparison among Tunisian prisoners

Abstract Introduction Incarceration represents an increasing public health issue, costing the United States $80.7 billion. Focusing on mental health issues and exploring gender differences among prisoners is lacking worldwide. We aimed to assess gender differences in childhood trauma, substance use, and mental health among Tunisian prisoners. Methods Two cross-sectional studies were conducted among male and female adult prisoners in April 2023 and July 2024, respectively. We used Arabic-validated versions of the Adverse Childhood Experiences-International Questionnaire, the Hospital Anxiety and Depression Scale, and the Rosenberg Self-Esteem Scale. Substance use and suicidal thoughts were assessed through a yes or no question. The questionnaire was anonymous and participation was voluntary. Results A total of 568 prisoners answered the questionnaire. The majority were males (71%) with a median age of 31 years [26­40]. We found that female prisoners reported higher rates of childhood sexual abuse (25.6% vs 7.8%, p < 0.001). Physical abuse was more common among males (74.6% vs 58.8%, p < 0.001). Community and collective childhood violence were significantly more prevalent among male prisoners (94.8% vs 74.5%, p < 0.001 and 57.3% vs 43.6%, p = 0.003, respectively). Males were more likely to consume all substance types. Females reported more severe anxiety symptoms (69.1% vs 23.6%, p < 0.001) and depressive symptoms (96.4% vs 80.1%, p < 0.001). About 46% of female prisoners reported experiencing suicidal thoughts during incarceration, compared to 35.1% of males (p = 0.014). Male prisoners were more likely to have lower self-esteem (87.4% versus 69.1%, p < 0.001). Conclusions Implementing rehabilitation programs for prisoners is essential to reduce incarceration rates and mitigate these alarming negative outcomes. Key messages • We found gender differences in childhood trauma, mental health and substance use among prisoners. • it is urgently necessary to implement specific strategies and interventions that focus on gender differences to ensure reintegration into society.