Childhood emotional abuse and gastrointestinal symptoms among college students: a chain mediation model with physical exercise as the moderating variable and network analysis

Objective: To examine the longitudinal association between childhood emotional abuse and gastrointestinal symptoms among college students, assess the serial indirect effects of negative emotional symptoms and drinking frequency, evaluate the moderating role of physical exercise, and use network analysis to identify central symptom nodes and bridge nodes across constructs. Methods: A three-wave longitudinal study was conducted among 1,896 college students recruited from Hunan, Hubei, Guizhou, and Chongqing, China. Data were collected using measures of childhood trauma, negative emotional symptoms, drinking frequency, physical exercise, and gastrointestinal symptoms. After adjustment for sex, age, and economic status, a moderated serial mediation model was estimated. Network analysis was additionally performed to characterize conditional associations among the study constructs and their individual symptom indicators. Results: Childhood emotional abuse was significantly and positively associated with subsequent gastrointestinal symptoms. Negative emotional symptoms and drinking frequency each showed a significant specific indirect effect, accounting for 36.23% and 5.10% of the total effect, respectively. The partially time-ordered serial indirect effect along the pathway from childhood emotional abuse to negative emotional symptoms, drinking frequency, and gastrointestinal symptoms accounted for 2.03% of the total effect; none of the bootstrap confidence intervals for the indirect effects included zero. The positive association between childhood emotional abuse and negative emotional symptoms was significantly weaker at higher levels of physical exercise. In the network, anxiety- and stress-related nodes showed relatively high node strength and bridge centrality. A prominent cross-community conditional association was observed between drinking frequency and upper abdominal pain or heartburn, and node-strength estimates showed good stability. Conclusion: Childhood emotional abuse was closely associated with subsequent gastrointestinal symptoms among college students, and this association may be partly accounted for by negative emotional symptoms and drinking frequency. Physical exercise may buffer the association between early emotional adversity and negative emotional symptoms. Prevention and intervention efforts addressing gastrointestinal health in college students should therefore consider early-trauma screening, emotion regulation, alcohol-risk management, and regular physical exercise.