Adverse Childhood Experiences, Anxiety and Depression in School-going Ugandan Adolescents: The Mediating Role of...

Childhood trauma is a major risk factor for unfavorable behavioral and mental health outcomes later in life. However, the precise pathway via which traumatic experiences early in life convey risks later in life, in particular in adolescents living in poor and post-conflict situations remains unknown. The aim of this study was to investigate whether physical activity behaviors may play a mediating role between early traumatic experiences and depressive and anxiolytic symptoms in school-going adolescents in Central and Northern Uganda. In total, 2821 adolescents (1273 boys; 16.3 ± 1.0 years) from 4 secondary schools completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), Physical Activity Vital Sign (PAVS), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder - 7 (GAD-7). We then computed bootstrapping mediation models using CTQ-SF scores as a predictor, PAVS scores as a mediator and PHQ-9 and GAD-7 scores as dependent variables. CTQ-SF scores had a significant indirect effect on PHQ-9 and GAD-7 via PAVS scores (b=-0.005, P < 0.001 and b=-0.003, P < 0.001, respectively). Using mediation analyses, we show that childhood trauma is linked to decreased physical activity, which in turn is linked to higher levels of depression and anxiety. While other pathways most certainly exist and replication is needed, the current study suggests a meaningful pathway via which childhood trauma leads to adverse mental health outcomes in adolescents living in challenging conditions. Trauma-informed physical activity interventions within school settings should be investigated in adolescents living in poor and post-conflict situations.