Psychiatric diagnosis and perceived health impact attributed to adverse childhood experiences: multidimensional impulsivity pathways in Saudi adults

Background Adverse childhood experiences (ACEs) predict adult psychopathology, yet mechanisms linking early adversity to health burden remain unclear. It is unknown whether specific impulsivity dimensions differentially mediate associations of ACE exposure with (a) lifetime psychiatric diagnosis and (b) perceived health impact attributed to childhood experiences, particularly in non-Western populations. Objective To examine whether UPPS-P impulsivity facets mediate associations between ACE exposure and (1) lifetime psychiatric diagnosis and (2) perceived health impact attributed to childhood experiences, and to describe outcome profiles combining these indicators in Saudi adults. Methods: Cross-sectional data were collected from 385 Saudi adults (58.4% female, 72.8% aged 18–25) via online survey. Participants completed the Arabic ACE-IQ (10 domains) and Short UPPS-P assessing five impulsivity dimensions. Lifetime psychiatric diagnosis was assessed via a single self-report item. Perceived health impact was assessed with a 3-level item (“not much,” “to some extent,” “a lot”); for profile classification, responses were dichotomized. Parallel multiple-mediator models with bootstrap confidence intervals examined indirect effects. Results ACE exposure showed dose–response relationships with psychiatric diagnosis (10.3% at 0 ACEs to 49.5% at ≥4 ACEs) and perceived impact (20.6% to 82.8%). The Perceived Only group demonstrated elevated ACE exposure (M = 2.55) exceeding the Diagnosis Only group (M = 1.62). Negative Urgency specifically mediated the ACE–perceived impact relationship (indirect β = 0.074, 95% CI [0.028, 0.126]), while Lack of Perseverance mediated both outcomes (diagnosis: indirect β = 0.067, 95% CI [0.021, 0.118]; perceived impact: indirect β = 0.053, 95% CI [0.012, 0.098]). Mediation accounted for 18.6% and 31.8% of total ACE effects on diagnosis and perceived impact, respectively. Conclusions Nearly one-third of participants reported perceived health impact without a psychiatric diagnosis, highlighting potential under-recognition and the value of subjective appraisal alongside diagnostic history. Differential pathways via Negative Urgency and Lack of Perseverance support targeted interventions and culturally informed assessment integrating both diagnostic and subjective indicators of ACE-related burden.