Self-esteem mediates the path from childhood trauma to criminality: A case-control study in Tunisia

Abstract Introduction Adverse childhood experiences (ACEs) significantly influence the physical and mental health of adults, and lead to poor behavioral outcomes such as crime and delinquency. However, the relationship between ACEs and criminal behavior is not fully understood, particularly in the Middle East and North Africa (MENA) region. Our study aims to explore this relationship in the Tunisian context while also examining the potential mediating role of self-esteem. Methods We conducted a case-control study comparing two groups of adult males in Tunisia: A case group of 403 inmates from the Mahdia prison and a control group of 408 age-matched males from the general population. We evaluated exposure to ACEs using the validated Arabic version of the World Health Organization (WHO) ACE questionnaire. Additionally, we assessed the self-esteem levels of participants using the Rosenberg self-esteem scale (RSES). Results Community violence was the most common ACE in both groups, reported by 94.8% of cases compared to 83.3% in controls (p < 0.001). Five ACE categories significantly increased the likelihood of criminal behavior: sexual abuse (ORa=1.9, 95%CI [1.31-4.98]), physical abuse (ORa=2.1, 95%CI [1.44-2.65]), physical neglect (ORa=2.2, 95%CI [1.79-3.35]), collective violence (ORa=2.8, 95%CI [2.33-4.15]), and community violence (ORa=3.3, 95%CI [2.17-6.04]). The case group exhibited notably higher rates of mental health issues, particularly low self-esteem (9.3% vs. 3%, p < 0.001). Mediation analysis revealed that self-esteem significantly mediated the relationship between criminal behavior and four ACE categories, with sexual abuse showing the strongest mediation effect (44.1%). Conclusions This study underscores the need for trauma-informed approaches to address childhood adversities, enhance self-esteem, and reduce criminal behavior, ultimately fostering societal well-being in Tunisia. Key messages • Childhood trauma increased the risk of criminal behaviours in adulthood. • Low self-esteem mediated the path from childhood trauma especially sexual abuse to criminal behaviours among adult males.