Pathways from Adverse Childhood Family Environment to Lower Urinary Tract Symptoms and Impact Among Women

Background: 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 (n = 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. Materials and Methods: 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. Results: 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. Conclusions: 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.