The pathway from childhood unpredictability to somatic symptoms among college students: The mediating role of anxiety symptoms and the moderating role of coping strategies

Although it has been suggested that childhood adversity could have a long-lasting influence on health, such as somatic symptoms in later life, less is known about the role of childhood unpredictability, an independent and important environmental signal, and the potential mechanism underlying this association. Besides, the extent to which different coping strategies may either mitigate or amplify this negative association is not adequately investigated. To fill this research gap, the present study investigated the relationship between childhood unpredictability and somatic symptoms among college students, whilst exploring the mediating role of anxiety symptoms and the moderating role of coping strategies. Using two-wave longitudinal data over a six-month period, a total of 992 Chinese college freshmen (67.7 % female; ages 17 to 23, M_age = 18.32, SD_age = 0.62) completed self-reported questionnaires measuring childhood unpredictability, coping strategies, anxiety symptoms, and somatic symptoms. Results showed that childhood unpredictability significantly predicted subsequent somatic symptoms among college students through increased anxiety symptoms. Moreover, both approach and avoidant coping significantly moderated the indirect association between childhood unpredictability and somatic symptoms. Specifically, employing approach coping was beneficial in reducing anxiety symptoms only among participants who experienced low childhood unpredictability. Conversely, adopting low levels of avoidant coping was particularly effective in reducing anxiety symptoms among participants who experienced high childhood unpredictability. These effects, in turn, further influenced somatic symptoms. Recommended intervention and prevention strategies include raising parental awareness of childhood unpredictability, reducing anxiety symptoms, and promoting specific coping strategies for particular stressors to alleviate somatic symptoms among college students.