Brady Sonya S, Arguedas Andrés, Huling Jared D, Hellemann Gerhard, Jacobs David R, Lewis Cora E, Fok Cynthia S, Van Den Eeden Stephen K, Markland Alayne D
Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
J Womens Health (Larchmt). 2025 Apr;34(4):549-561. doi: 10.1089/jwh.2024.0790. Epub 2025 Feb 18.
To advance existing knowledge, this study examined mechanisms that may link retrospectively reported adverse childhood family environment (ACFE) to lower urinary tract symptoms and their impact (LUTS/impact), a composite variable with four levels (bladder health and mild, moderate, or severe LUTS/impact), among women ( = 1,026) in the Coronary Artery Risk Development in Young Adults cohort study. A prior study demonstrated that ACFE was associated with greater LUTS/impact. In 2000-01, the frequency of ACFE events was retrospectively assessed. In 2012-13, data on LUTS/impact were collected. Between 1985-86 and 2010-11, data on proposed mediators were collected at varying time points and averaged to form composite variables. A series of proportional odds ordinal logistic regression analyses were conducted. LUTS/impact was regressed on ACFE, adjusting for age, race, education, and parity. A single proposed mediator was added to the model at one time to determine whether the strength of the association between ACFE and LUTS/impact was attenuated. When entered into regression models individually, life stressors, low levels of emotional support, and depressive symptoms each significantly attenuated the association between ACFE and LUTS/impact, with the association becoming nonsignificant when depressive symptoms were entered. Remaining proposed mediators (social network extensiveness, health behaviors, physiological health, cognitive function) did not mediate the association. ACFE may place women at risk for repeated or chronic episodes of experiencing life stressors, low support, and depressive symptoms during early and midlife adulthood, which in turn may place women at risk for more LUTS and impact during midlife adulthood.
为了拓展现有知识，本研究在“青年成人冠状动脉风险发展”队列研究中的1026名女性中，考察了可能将回顾性报告的不良童年家庭环境（ACFE）与下尿路症状及其影响（LUTS/影响，一个有四个水平的复合变量：膀胱健康以及轻度、中度或重度LUTS/影响）联系起来的机制。先前的一项研究表明，ACFE与更高的LUTS/影响相关。在2000 - 2001年，对ACFE事件的发生频率进行了回顾性评估。在2012 - 2013年，收集了关于LUTS/影响的数据。在1985 - 1986年至2010 - 2011年期间，在不同时间点收集了关于拟议中介变量的数据，并进行平均以形成复合变量。进行了一系列比例优势有序逻辑回归分析。将LUTS/影响对ACFE进行回归，并对年龄、种族、教育程度和生育状况进行了调整。每次向模型中添加一个拟议的中介变量，以确定ACFE与LUTS/影响之间关联的强度是否减弱。当分别纳入回归模型时，生活压力源、低水平的情感支持和抑郁症状均显著减弱了ACFE与LUTS/影响之间的关联，当纳入抑郁症状时，该关联变得不显著。其余拟议的中介变量（社交网络广度、健康行为、生理健康、认知功能）并未介导这种关联。ACFE可能使女性在成年早期和中年期面临反复或慢性经历生活压力源、低支持和抑郁症状的风险，这反过来可能使女性在中年期面临更多下尿路症状及其影响的风险。
