Depression as a mediator in the relationship between adverse childhood events, pelvic pain, and pelvic organ prolapse: A cross-sectional study using structural equation modeling

Abstract

Background

Adverse childhood events (ACEs) have been linked to chronic pain, yet their relationship with pelvic floor symptoms, including pelvic pain and pelvic organ prolapse (POP), is less understood. This study investigates whether depressive symptoms mediate the association between ACEs and pelvic floor symptoms.

Method

A secondary analysis of a population-based cohort (age ≥ 16 years) was conducted. Participants completed validated questionnaires assessing ACEs, POP symptoms, and depressive symptoms, while pelvic pain was determined by a study-specific questionnaire. Structural equation modeling (SEM) and path analysis were used to assess direct and indirect relationships, stratified by sex.

Results

Complete data were available for 552 males and 780 females. Depression mediated the relationship between ACEs and pelvic pain in both sexes, as well as between ACEs and POP in females. In females, ACEs were associated with pelvic pain (p = 0.020), with depression partially mediating this relationship (p = 0.001, R² = 0.116, moderate effect). In males, ACEs were not directly associated with pelvic pain (p = 0.196), but a significant indirect effect was observed through depression (p = 0.023), indicating full mediation (R² = 0.042, small effect). For POP, ACEs had no direct effect (p = 0.722), but depression significantly mediated the relationship (p = 0.001, R² = 0.161, moderate effect). Findings from SEM and path analysis were comparable.

Conclusion

This study highlights the association between ACEs, pelvic pain and POP in adulthood. Depression emerged as a key mediator in these relationships, with differences observed between males and females.