Peer-reviewed article

Childhood maltreatment, internalizing symptoms, and the short-term course of disorders of gut-brain interaction in children and adolescents: a longitudinal counterfactual mediation study.

Hailiang Ran, Jin Lu, Xizi Yang, Fengchen Gao, Zijing Yang et al. · 28 Sept 2026

Abstract

OBJECTIVE: Childhood maltreatment is linked to internalizing symptoms and physical health problems, but its role in pediatric disorders of gut-brain interaction (DGBIs) remains unclear. We examined whether depressive and anxiety symptoms mediated associations with DGBI course. METHODS: We analyzed three-wave data from 5112 students aged 10-17 years in southwest China. Childhood maltreatment was assessed at baseline, depressive and anxiety symptoms at 3 months, and Rome IV-based DGBIs at each wave. DGBI course was defined from baseline and 6-month status. Logistic regression and counterfactual mediation analyses examined these outcomes. RESULTS: Among 4485 participants without DGBIs at baseline, 246 (5.5%) developed DGBIs; among 627 with baseline DGBIs, 166 (26.5%) had persistent DGBIs and 461 (73.5%) no longer met DGBI criteria at 6 months. Each 1-SD higher total childhood maltreatment score was associated with higher odds of newly developed DGBIs (OR 1.22, 95% CI 1.07-1.38) and persistent DGBIs (OR 1.26, 95% CI 1.04-1.52), and lower odds of no longer meeting DGBI criteria (OR 0.79, 95% CI 0.66-0.96). Depressive and anxiety symptoms partly mediated these associations; pure natural indirect effects ranged from 0.91 to 1.16 and from 0.94 to 1.12, respectively. CONCLUSIONS: Childhood maltreatment was associated with an unfavorable short-term DGBI course, partly through depressive and anxiety symptoms. Interpretation should consider the short follow-up, reliance on same-informant self-report, and the brief 2-week symptom window captured at a single intermediate assessment. Emotional symptom assessment may nevertheless help identify maltreatment-exposed children at risk of emerging or persistent DGBIs.