Role of Sex, Anxiety, and Resilience in the Association Between Adverse Childhood Experiences and Irritable Bowel Syndrome - PubMed (original) (raw)

Role of Sex, Anxiety, and Resilience in the Association Between Adverse Childhood Experiences and Irritable Bowel Syndrome

Anna H Lee et al. Clin Gastroenterol Hepatol. 2025 Jan.

Abstract

Background & aims: Adverse childhood experiences (ACE) are associated with increased risk of irritable bowel syndrome (IBS), a female-predominant chronic abdominal disorder. Factors contributing to this association have not been well-studied. We compared sex differences in ACE for adults with and without IBS and evaluated the impact of anxiety and resilience on the relationship between ACE and IBS.

Methods: Sex and disease differences in total score and ACE subtypes from the ACE Questionnaire in subjects with IBS and control subjects were assessed. Cross-sectional mediation analysis determined if anxiety (Hospital Anxiety and Depression Scale) and resilience (Connor-Davidson Resilience Scale or Brief Resilience Scale) mediated the relationship between ACE and IBS.

Results: Of 798 participants studied, 368 met IBS diagnostic criteria (265 women, 103 men) and 430 were healthy control subjects (277 women, 153 men). Prevalence and number of ACE were higher in IBS versus control subjects (P < .001) but similar between IBS women and men. Household mental illness increased odds of having IBS in women (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.35-2.85; false discovery rate [FDR], 0.002) and men (OR, 2.32; 95% CI, 1.26-4.33; FDR, 0.014). Emotional abuse increased odds of having IBS in women (OR, 1.94; 95% CI, 1.23-3.09; FDR, 0.019) and sexual abuse increased odds of IBS in men (OR, 3.54; 95% CI, 1.35-10.38; FDR, 0.027). Anxiety mediated 54% (P < .001) of ACE's effect on IBS risk and resilience mediated 12%-14% (Connor-Davidson Resilience Scale, P = .008; Brief Resilience Scale, P = .018).

Conclusions: Both men and women with a history of ACE are twice as likely to have IBS than those without an ACE. Anxiety mediated the relationship between ACE and IBS in men and women and resilience mediated this relationship only in women.

Keywords: Adverse Childhood Experience; Anxiety; Irritable Bowel Syndrome; Resilience; Sex Difference.

Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.

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Conflict of interest statement

Conflicts of interest

The authors disclose no conflicts.

Figures

Figure 1.

Figure 1.

Prevalence (%, above each bar) of ACE by total score for (A) each diagnosis, (B) each sex, and (C) IBS × sex subgroups. Overall, 63% of women versus 53% men reported at least 1 ACE (P = .005), and women had higher ACE scores than men (P = .049).

Figure 2.

Figure 2.

Prevalence (%, above each bar) of ACE subscores including Household (HH) Mental Illness, Emotional Abuse, and Sexual Abuse in IBS × sex interaction groups. Odds of having IBS increased with Emotional Abuse in women (FDR, 0.019), Sexual Abuse in men (FDR, 0.027), and HH Mental Illness for both women (FDR, 0.002) and men (FDR, 0.014).

Figure 3.

Figure 3.

Anxiety mediation diagram. Standardized regression coefficients for the relationship between ACE score and IBS status mediated by HADS anxiety in (A) women and (B) men. The proportions mediated (95% confidence interval) are shown in each figure’s center. Significance represented as *P < .05, **P < .01, ***P < .001. Anxiety significantly mediated the effects of ACE on IBS status in women (P < .01) and men (P < .01).

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