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

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.