The longitudinal association between depressive and anxious symptoms and functional abdominal pain disorders (FAPDs) in children and adolescents: A mediation via emotion dysregulation.

Objective: The sequential association between depressive/anxious symptoms and FAPDs in youths, and the mediation of emotion dysregulation in the above association, remains inconclusive. We aim to fill these knowledge gaps in the current study.

Methods: A three-wave longitudinal study with 5018 subjects aged 11-17 years was conducted in southwest China. The sequential associations between baseline depressive/anxious symptoms (measured at T) and FAPDs (measured at T) were estimated using autoregressive cross-lagged models and binary logistic regression models. Path analysis was applied to estimate the mediation of emotion dysregulation measured at T in the above sequential associations. Stratified analysis was further performed to test effect modification by important demographics.

Results: A total of 87 and 66 participants were identified as newly occurred FAPD cases at T and T, respectively. Both depressive and anxious symptoms assessed at T were significantly associated with FAPDs at T. Each 1-point increase in PHQ-9 and GAD-7 scores at T corresponded to a 13 % and 11 % increase in the odds of developing FAPDs at T (PHQ-9: OR = 1.13; GAD-7: OR = 1.11; both p < 0.001).Path analysis revealed that emotion dysregulation measured at T prominently mediated the above sequential associations, accounted for 21.2 % of depression-FAPDs association, and the entire anxiety-FAPDs association, particularly for the dimension of "strategies". Sex, developmental stage, and left-behind status posed noticeable effect modification on the mediation of emotion dysregulation.

Conclusion: Our findings highlight the promising intervention role of improving emotion regulation ability in antagonizing depressive and anxious symptoms associated subsequent FAPDs risk in the youngsters.