Depressive symptoms as mediator between adverse childhood events and fecal incontinence and constipation in community-dwelling men and women

IF 1.2

Continence (Amsterdam, Netherlands) Pub Date : 2025-09-17 DOI:10.1016/j.cont.2025.102287

Dina M. Mahjoob , Gommert A. van Koeveringe , Marco H. Blanker , Grietje E. Knol‐de Vries

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Abstract

Background

Fecal incontinence (FI) and constipation affect quality of life and are influenced by intricate interactions between psychological and physiological factors. This study explores the association between adverse childhood events (ACEs) and adult bowel dysfunction (FI and constipation) in community-dwelling men and women, examining depressive symptoms as a potential mediator.

Method

A secondary analysis was conducted using baseline data from a population-based cohort (n = 1,691, age ≥16 years). Participants completed validated questionnaires on FI, constipation, history of emotional neglect, psychological, physical, sexual abuse, and depressive symptoms. Regression models were used, for men and women separately, to examine the associations between ACEs, FI, and constipation, and to test for mediation via depressive symptoms. Analyses were adjusted for age, body mass index, and smoking status.

Result

Complete data were available for 553 men and 787 women. Depressive symptoms significantly mediated the relationship between ACEs and both FI and constipation. For FI, ACEs had a small direct effect (β = 0.104, p < 0.001) and a small, mediated effect (β = 0.057, p < 0.001, Sobel test: z = 6.47). For constipation, ACEs showed a moderate direct effect (β = 0.171, p < 0.001) and a moderate mediated effect (β = 0.130, p < 0.001, Sobel test: z = 10.84).

Conclusion

Depression mediates the relationship between ACEs and bowel dysfunction, with a stronger role in constipation (moderate effect) compared to FI (small effect). These findings underscore the importance of addressing psychological factors and childhood adversity in understanding bowel dysfunction and informing clinical approaches.

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抑郁症状在儿童不良事件与社区男女大便失禁和便秘之间的中介作用

背景：大便失禁（FI）和便秘影响生活质量，并受到心理和生理因素复杂的相互作用的影响。本研究探讨了社区男性和女性儿童不良事件（ace）与成人肠功能障碍（FI和便秘）之间的关系，并研究了抑郁症状作为潜在的中介。方法采用基于人群的队列（n = 1,691，年龄≥16岁）的基线数据进行二次分析。参与者完成了关于FI、便秘、情感忽视史、心理、身体、性虐待和抑郁症状的有效问卷。分别对男性和女性使用回归模型来检验ace、FI和便秘之间的关系，并通过抑郁症状来检验其中介作用。对年龄、体重指数和吸烟状况进行了调整。结果男性553例，女性787例。抑郁症状显著介导ace与FI和便秘的关系。对于FI， ace具有较小的直接效应（β = 0.104, p < 0.001）和较小的中介效应（β = 0.057, p < 0.001， Sobel检验：z = 6.47）。对于便秘，ace表现出中度直接作用（β = 0.171, p < 0.001）和中度介导作用（β = 0.130, p < 0.001， Sobel检验：z = 10.84）。结论抑郁在ace与肠功能障碍之间起中介作用，在便秘方面的作用（中等作用）强于FI（小作用）。这些发现强调了心理因素和童年逆境在理解肠功能障碍和告知临床方法中的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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