The sequential association between depression, anxiety, and functional constipation among Chinese children and...

The sequential associations between depression, anxiety and functional constipation (FC) in children and adolescents remain inadequately discussed. Existing evidence suggests that resilience might play a mediation in the above sequential associations, and this hypothesis has not been tested, especially through studies of prospective design.

We conducted a longitudinal study with two waves of surveys in December 2023 and three months later in March 2024, among a large, representative sample of Chinese children and adolescents aged 10-18 years, selected using a population-based probability sampling design in southwest China. Data were collected through self-report questionnaires and assessments by pediatric psychiatrists. The primary outcome was the newly developed FC at wave two, while the exposures of interest were baseline depression and anxiety. Poisson regression was used to analyze the sequential associations between depression, anxiety and FC. Path analysis tested the mediating role of baseline resilience in these relationships.

A total of 5499 participants with a mean age of 14 were included, 50.6 % of whom were girls. The prevalence of baseline depression and anxiety were 16.5 % and 9.7 %. Baseline depression and anxiety were related to 1.65 (95 % CI: 1.25, 2.18) and 1.64 (95 % CI: 1.18, 2.27) times odds of developing FC in the future three months. Resilience significantly and entirely mediated the above sequential associations, with family support emerging as the most influential dimension.

Resilience-based interventions, especially those focusing on strengthening the parent-child bond, could be considered to buffer against depression and anxiety related FC in children and adolescents.