Adverse childhood experiences and gastrointestinal symptoms in US youth: Psychosocial pathways and protective contexts.

OBJECTIVE

Although adverse childhood experiences (ACEs) have been linked to gastrointestinal (GI) conditions in children, it remains unclear which specific adversities confer greatest risk and how psychosocial or contextual factors modify these associations. This study identified ACEs most strongly associated with GI symptoms in US youth and evaluated emotional, behavioral, and environmental pathways that may affect these relationships.

METHODS

We analyzed nationally representative data from 73,055 US children and adolescents in the 2021-2023 National Survey of Children's Health. Least Absolute Shrinkage and Selection Operator regression identified ACEs most predictive of GI symptoms (primary outcome), with co-occurring GI symptoms and chronic pain examined secondarily. Mediation and moderation analyses assessed psychosocial mechanisms and potential protective factors.

RESULTS

GI symptoms were reported in 6% of children. Five ACEs were retained for the primary outcome; strongest associations were for household mental illness (adjusted odds ratio [aOR] 1.56; 95% confidence interval [CI] 1.44-1.70) and economic insecurity (aOR 1.38; 95% CI 1.26-1.50), followed by neighborhood violence (aOR 1.34; 95% CI 1.19-1.52) and racial discrimination (aOR 1.31; 95% CI 1.16-1.47). Emotional/behavioral difficulties mediated 20%-35% of effects; food insecurity mediated 26% for economic insecurity. School and neighborhood safety and community support attenuated several ACE-GI associations.

CONCLUSIONS

Household mental illness and economic insecurity were the strongest ACEs associated with GI symptoms in US youth. Emotional distress and perceived environmental safety mitigated these associations. Integrating psychosocial and contextual factors into evaluation of recurrent GI symptoms may improve care and identify targets for early intervention.