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

BACKGROUND AND 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 IBS and controls were assessed. Cross-sectional mediation analysis determined if anxiety (Hospital Anxiety and Depression Scale) and resilience (Connor-Davidson Resilience Scale [CD-RISC] or Brief Resilience Scale [BRS]) 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 controls (277 women, 153 men). Prevalence and number of ACE were higher in IBS vs. controls (p's<.001) but similar between IBS women and men. Household Mental Illness increased odds of having IBS in women (OR 1.95, 95% CI 1.35-2.85, FDR=.002) and men (OR 2.32, 95% CI 1.26-4.33, FDR=.014). Emotional Abuse increased odds of having IBS in women (OR 1.94, 95% CI 1.23-3.09, FDR=.019) and Sexual Abuse increased odds of IBS in men (OR 3.54, 95% CI 1.35-10.38, FDR=.027). Anxiety mediated 54% (p<.001) of ACE's effect on IBS risk and resilience mediated 12-14% (CD-RISC p=.008; BRS p=.018).

CONCLUSION

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.

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