Early-life adversities are associated with anxiety and somatic symptoms among university students: Moderation by family support

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However, few studies have examined the relationship between early-life adversity and anxiety and somatic symptoms among Chinese university students, as well as the buffering effect of family support. Methods A convenience sampling method was used to survey 485 undergraduate students from a university in Western China. Data were collected using the Early-Life Adversity Scale, the Generalized Anxiety Disorder-7 (GAD-7) scale, the Somatic Symptom Scale-8 (SSS-8), and the family support subscale of the Multidimensional Scale of Perceived Social Support (MSPSS). Structural equation modeling was employed to examine the main effects of early-life adversity on anxiety and somatic symptoms, as well as the moderating effect of family support. Results Early-life adversity significantly and positively predicted anxiety (β = 0.387, p < 0.01) and somatic symptoms (β = 0.597, p < 0.01). Family support significantly negatively moderated the relationship between early-life adversity and anxiety/somatic symptoms (interaction term β = -0.164 / -0.181, p < 0.01). The buffering effect of family support was stronger for anxiety (nearly complete buffering) than for somatic symptoms (partial buffering). Conclusion Early-life adversity is a significant risk factor for anxiety and somatic symptoms among Chinese university students. Family support can buffer the long-term association between early-life adversity and these symptoms. Integrating family support into university health intervention systems may help alleviate anxiety and somatic symptoms among students. Figures Figure 1 Figure 2 Introduction Anxiety and somatic symptoms represent prevalent health concerns among Chinese university students. A study involving 6,032 Chinese college students revealed that approximately one-third experienced anxiety symptoms ranging from mild to very severe [ 1 ]. A large-scale university-based survey revealed that approximately 70% of Chinese college students experience somatic symptoms of varying severity, such as headaches, dizziness, nausea, and shortness of breath[ 2 ]. A systematic review demonstrates a high comorbidity between somatic symptom disorder and anxiety/depressive disorders, with over 50% of individuals with somatic symptoms also having a co-occurring anxiety or depressive disorder [ 3 ]. Anxiety and somatic symptoms exhibit a bidirectional relationship, underpinned by shared neural mechanisms involving brain regions such as the insula, and the precentral, postcentral, and cingulate gyri [ 4 ]. Anxiety and somatic symptoms among university students can be partially attributed to early-life adversity. Early-life adversity refers to a range of negative events and chronic stressors experienced during early life including, but are not limited to, physical and emotional abuse, physical and emotional neglect, parental divorce, parental substance abuse, serious illness and death in family, or parental incarceration [ 5 , 6 ]. According to Life History Theory, individuals who experience adversity early in life are inclined to have increased vigilance and enhanced reactivity to stress, as adverse environments signal persistent threat and promote a sustained state of hyper-alertness[ 7 , 8 ], Such persistent vigilance is a core characteristic of anxiety-related symptoms [ 9 , 10 ]. Harsh environments in childhood lead individuals to adopt a faster life history strategy for development, accompanied by mental health issues[ 11 ]. Life History Theory posits that individuals raised in unstable and adverse environments tend to develop heightened stress response mechanisms. This increased reactivity may subsequently elevate their vulnerability to various physical health problems, including somatic symptoms [ 12 , 13 ]. Numerous empirical studies provide support for this theoretical proposition [ 14 – 16 ]. For instance, a nationally representative survey conducted in China revealed that middle-aged and older adults with a history of adverse childhood experiences reported significantly more somatic symptoms compared to those with fewer such experiences [ 14 ]. Similarly, university students exposed to greater childhood trauma—such as physical abuse, verbal abuse, and emotional neglect—are more likely to exhibit anxiety-related symptoms, including tension, restlessness, and irritability[ 17 ]. Although early-life adversity exerts enduring effects on individuals’ health, such impact is not entirely immutable. According to the Buffering Hypothesis, social support can effectively mitigate the detrimental effects of toxic stress on both physical and mental health, thereby serving a protective function [ 18 – 20 ]. Prior empirical studies have provided substantiating evidence for this hypothesis [ 20 – 23 ]. For instance, one study demonstrated that social support from family, friends, and other sources negatively moderates the association between childhood adversity and depression in late life [ 21 ]. Another study indicated that social support significantly buffers the negative influence of adverse childhood experiences on health outcomes in adulthood—including measures such as physical functioning, bodily pain, vitality, and mental health [ 20 ]. Previous studies examining the buffering effect of social support on the relationship between early-life adversity and adult health have two major limitations. First, few studies have focused on Chinese college students to investigate the long-term impact of early-life adversity on their physical and mental health. Second, existing research often subsumes family support under the broader construct of social support, thereby failing to highlight its unique buffering role. In Chinese culture, the family represents a spiritual anchor and an ultimate source of emotional support, playing a crucial role in individual well-being [ 24 ]. The present study aims to address these gaps by elucidating the distinctive function of family support, thereby contributing to the advancement of Life History Theory and the Buffering Hypothesis, as well as informing intervention strategies for anxiety and somatic symptoms among university students. Based on the literature review above, this study proposes the following four research hypotheses: Hypothesis 1 Early-life adversity positively predicts anxiety among university students; Hypothesis 2 Early-life adversity positively predicts somatic symptoms among university students; Hypothesis 3 Family support negatively moderates the effect of early-life adversity on anxiety among university students; Hypothesis 4 Family support negatively moderates the effect of early-life adversity on somatic symptoms among university students. Research Methods 2.1 Sampling process According to the common sample size estimation principle (N:q rule), the required sample size should be 10 to 20 times the number of observed variables[ 25 ]. This study includes a total of 27 observed items (8 for early-life adversity, 8 for somatic symptoms, 7 for anxiety, and 4 for family support). Thus, the theoretically appropriate sample size ranges between 270 and 540. Furthermore, considering the anticipated questionnaire return rate and the presence of invalid responses, an effective return rate of 80% was estimated. To ensure a sufficient number of valid samples, this study planned to distribute 600 questionnaires, with an expected return of approximately 485 valid responses. 2.2 Instruments The anxiety levels were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale[ 26 ]. This instrument has been widely used in China and demonstrates good reliability and validity[ 27 ]. It consists of seven items, one of which is “Feeling afraid, as if something awful might happen.” Participants were asked to rate each item on a 4-point Likert scale from 0 to 3 based on their psychological experiences over the past week, with the following anchors: 0 = “Not at all,” 1 = “Several days,” 2 = “More than half the days,” and 3 = “Nearly every day.” The somatic symptoms were measured using the 8-item Somatic Symptom Scale (SSS-8)[ 28 ]. This scale has demonstrated good reliability and validity when applied to Chinese youth and adolescent populations [ 29 ]. It comprises eight items, one of which is “stomach or bowel problems.” Participants were asked to rate each item on a 4-point Likert scale ranging from 0 to 3 based on their physical experiences over the past seven days, with 0 indicating “not at all bothered” and 3 representing “very much bothered.” An index of childhood adversity was computed by summing dichotomous responses (0 = no, 1 = yes) across eight items adapted from a Chinese version of the Early-Life Adversity Scale[ 30 ]. The items include death of a family member, severe illness of a family member, parental divorce, parental separation, physical or verbal abuse directed at the participant, witnessing abuse toward a family member, experiencing a serious illness oneself, incarceration of a family member, and prolonged parental unemployment or unstable employment. Participants were asked to retrospectively report whether they had encountered each event from birth until elementary school graduation(in China, this generally refers to children between the 0–13 years old). The family support measure in this study consisted of four items derived from the Family Support subscale of the Multidimensional Scale of Perceived Social Support (MSPSS) )[ 31 ]. This subscale has demonstrated good reliability and validity within Chinese cultural contexts)[ 32 ]. One sample item is: “I can talk about my problems with my family.” Participants were asked to rate each item on a 5-point scale based on the support they received from family members over the past month, ranging from 0 (“hardly any”) to 4 (“a lot”). 2.3 Data analysis methods The data analysis was conducted in two stages. First, SPSS version 27.0 was employed for preliminary analyses, which included assessing test-retest reliability for early-life adversity, computing Cronbach's alpha coefficients for anxiety and somatic symptoms, performing Pearson correlation analyses, and examining common method bias using Harman's single-factor test. Subsequently, Mplus version 7.4 was utilized to conduct structural equation modeling (SEM) to test the hypothesized relationships among the variables. Research Results 3.1 Characteristics of the valid sample Participants with any missing responses were excluded from the analysis, resulting in a final valid sample of 485 individuals. The mean age of the participants was 19.43 years (SD = 1.25), with a minimum of 18 and a maximum of 23 years. Other demographic characteristics are presented in Table 1 . Table 1 Characteristics of the valid sample (N = 485) Variables Levels Frequency Percentage Gender Male 293 60.4 Female 192 39.6 Ethnicity Han 409 84.3 Minority 76 15.7 Number of siblings 0–1 sibling 281 57.9 ≥ 2 siblings 204 42.1 Grade Freshman 187 38.6 Sophomore 132 27.2 Junior 105 21.6 Senior 61 12.6 3.2 Means, standard deviations, reliabilities, and correlations of the variables Table 2 presents the means, standard deviations, reliability estimates, and linear correlation coefficients among the key variables. Table 2 Means, standard deviations, correlation coefficients, and reliability M SD Early-life adversity Anxiety Somatic symptoms Family support Early-life adversity 1.47 1.12 0.878 a Anxiety 0.70 0.64 0.420 ** 0.870 Somatic symptoms 0.70 0.60 0.592 ** 0.361 ** 0.855 Family support 2.29 0.88 -0.183 ** -0.245 ** -0.128 ** 0.802 Note: The italicized numbers on the diagonal are the reliability coefficients. a The reliability of early-life adversity was assessed based on test-retest measurements from 33 freshman students, with a 30-day interval between administrations. The reliability estimates for the remaining three variables represent Cronbach’s alpha coefficients. ** p < 0.01. As shown in Table 2 , correlation analysis revealed that early-life adversity was positively and significantly associated with both anxiety (r = 0.420, p < 0.01) and somatic symptoms (r = 0.592, p < 0.01). Anxiety and somatic symptoms were also positively correlated (r = 0.361, p < 0.01). Conversely, family support was negatively correlated with early-life adversity (r = -0.183, p < 0 .01), anxiety (r = -0.245, p < 0 .01), and somatic symptoms (r = -0.128, p < 0.01), suggesting its potential protective role. In addition, all constructs exhibited good to excellent reliability. Specifically, the test-retest reliability for early-life adversity was 0.878, while the internal consistency (Cronbach’s α) for the remaining variables ranged from 0.802 to 0.870, indicating satisfactory measurement stability and consistency across the study constructs. 3.3 Common method bias test To assess common method bias, Harman’s single-factor test was performed using all 27 items measuring early-life adversity, anxiety, and somatic symptoms. The first factor accounted for 23.87% of the total variance, below the 40% threshold, indicating that common method bias was not a major issue in this study. 3.4 Structural equation modeling results Previous studies have indicated that gender is significantly associated with adolescent health outcomes [ 33 ]. Meanwhile, resource dilution theory suggests a negative correlation between the number of siblings and adolescents' mental health [ 34 ]. Therefore, gender and number of siblings were included as control variables in the analysis. First, a main effect model was tested, in which early-life adversity was specified as the predictor, and both anxiety and somatic symptoms were included as outcome variables. In the main effect model, the degrees of freedom were 0 (saturated model), with AIC = 1509.544 and BIC = 1555.569. As shown in Fig. 1, early-life adversity had a significant effect on somatic symptoms (β = 0.597, p < 0.01), supporting Hypothesis 1 that early-life adversity positively predicts somatic symptoms among university students. Figure 1 also indicates that early-life adversity exerted a significant effect on anxiety (β = 0.387, p < 0.01), which supports Hypothesis 2 , suggesting that early-life adversity is a significant positive predictor of anxiety in college students. Next, the moderation model was tested by incorporating family support and the interaction term into the analysis. In the moderation model, the degrees of freedom were 0 (saturated model), with AIC = 1467.777 and BIC = 1530.518. Compared to the main effect model, both AIC and BIC decreased in the moderation model, indicating a better model fit. As shown in Fig. 2, the interaction effect on somatic symptoms was significant (β = − 0.181, p < 0.01), supporting Hypothesis 3 that family support negatively moderates the relationship between early-life adversity and somatic symptoms among college students. Figure 2 also shows that the interaction effect on anxiety was significant (β = − 0.164, p < 0.01), which supports Hypothesis 4 , indicating that family support serves as a significant negative moderator between early-life adversity and anxiety. Table 3 presents the simple slopes and further illustrates the specific buffering effect of family support. Table 3 Simple slopes and buffering effects Outcome Variable (Y) Family Support (W) Computational Process Simple Slope (β) Simple Effect Description (Simple Slope = βX + βX*W × W) Anxiety Low Support (-1 SD) 0.304 + (-0.164) × (-1) = 0.304 + 0.164 0.468 ** effect of adversity is strongest Mean Level (0 SD) 0.304 + (-0.164) × (0) = 0.304 + 0 0.304 ** Baseline main effect High Support (+ 1 SD) 0.304 + (-0.164) × (1) = 0.304 − 0.164 0.140 Effect is completely buffered Somatic Symptoms Low Support (-1 SD) 0.534 + (-0.181) × (-1) = 0.534 + 0.181 0.715 ** Effect of early-life adversity is strongest Mean Level (0 SD) 0.534 + (-0.181) × (0) = 0.534 + 0 0.534 ** Baseline main effect High Support (+ 1 SD) 0.534 + (-0.181) × (1) = 0.534 − 0.181 0.353 ** Effect is partially buffered Note : Simple slope analyses were conducted following the procedures outlined by Preacher and Curran (2006) [ 35 ]. Male = 1, female = 2. X = early-life adversity. * P < 0.05, ** P < 0.01. As shown in Table 3 , a distinct pattern emerged for anxiety, in which high levels of family support completely buffered the negative effect of early-life adversity. The simple slope was reduced from 0.468 (p 0.05) under high support—a reduction of approximately 70%—indicating a near-complete buffering effect. In contrast, for somatic symptoms, high support substantially attenuated but did not eliminate the effect of adversity. The simple slope decreased by approximately 50%, from 0.715 to 0.353 (both p < 0.001), demonstrating a partial buffering effect. Moreover, as presented in Table 3 , the moderation model indicated that gender had a significant positive effect on anxiety (β = =0.080, p < 0.05), suggesting that female university students reported higher levels of anxiety than their male counterparts. Meanwhile, the number of siblings also showed a significant positive association with anxiety (β = 0.151, p 0.05) nor number of siblings (β = − 0.043, p > 0.05) had a statistically significant effect on somatic symptoms. Discussion This study employed structural equation modeling to examine the relationship between early-life adversity and both anxiety and somatic symptoms among university students, as well as the moderating role of family support. The main effect model revealed that early-life adversity significantly predicted anxiety (β = 0.387, p < 0.01, see Fig. 1), supporting Hypothesis 1 . According to Cohen’s (1988) conventional criteria, an effect size around .30 is considered a ‘medium’ effect[ 36 ], indicating that early-life adversity has a moderate predictive effect on student anxiety. Additionally, as shown in Fig. 1, early-life adversity also significantly predicted somatic symptoms (β = 0.597, p < 0.01. see Fig. 1), which supports Hypothesis 2 . Based on Cohen’s (1988) guidelines, an effect size around .50 represents a ‘large’ effect [ 36 ]. Thus, early-life adversity demonstrates a strong predictive effect on somatic symptoms in university students. The findings of the main effect model are consistent with previous research [ 37 , 38 ]. A longitudinal study conducted in the United States demonstrated that childhood adversity—including childhood abuse and parental separation or divorce—significantly predicted a composite measure of mental health outcomes, including generalized anxiety disorder scores, among undergraduate students [ 37 ]. Another study indicated that multiple and specific types of adverse childhood events serve as risk factors for chronic pain conditions in university students [ 38 ]. According to Life History Theory, unpredictable adverse events early in life can lead individuals to develop psychological tendencies characterized by heightened vigilance and alertness. This increased sensitivity to potential threats may result in elevated levels of tension, restlessness, and anxiety. Such psychological patterns often persist into adulthood, contributing to sustained anxiety response patterns [ 7 ]. A substantial body of research grounded in Life History Theory suggests that individuals exposed to early-life adversity tend to adopt faster life history strategies as an adaptive response to harsh environments. However, these strategies come with long-term health costs[ 39 ], including accelerated physiological wear and tear[ 40 ], and chronic low-grade inflammation, which may subsequently lead to medically unexplained somatic symptoms[ 41 ]. Furthermore, the main effect model indicated that the predictive effect of early-life adversity on somatic symptoms (β = 0.597, see Fig. 1) was stronger than its effect on anxiety (β = 0.387, see Fig. 1), suggesting that the impact of early-life adversity on long-term health outcomes varies across symptom domains. The moderation model revealed that family support negatively moderated the relationship between early-life adversity and anxiety (β=-0.164, p < 0.01; see Fig. 2), fully supporting Hypothesis 3 . Similarly, family support also negatively moderated the association between early-life adversity and somatic symptoms (β=-0.181, p < 0.01; see Fig. 2), supporting Hypothesis 4 . Simple slope analysis indicated that family support exerted a near-complete buffering effect on the relationship between early-life adversity and anxiety (see Table 3 ), and demonstrated a partial buffering effect on the link between early-life adversity and somatic symptoms (see Table 3 ). The results of the moderation effect model are highly consistent with findings from previous similar studies [ 20 , 21 , 42 ]. For example, a study conducted in China revealed that social support, including support from family, exerts a significant negative moderating effect on the relationship between childhood adversity and mental health (indexed by anxiety and depression) at college[ 42 ]. Similarly, a study focusing on North American adults demonstrated that social support significantly negatively moderates the impact of adverse childhood experiences on health outcomes in adulthood—including measures such as bodily pain, physical functioning, and mental health[ 20 ]. In accordance with the Buffering Hypothesis, social support can mitigate the detrimental effects of stress on individuals' physical and mental health. Specifically, the enduring stress resulting from early-life adversity may impair adult health, while support from family in adulthood can buffer this sustained detrimental effect on health. Finally, the present study identified a significant positive effect of gender on anxiety levels among college students, indicating that female students report higher levels of anxiety compared to their male counterparts—a finding consistent with previous research [ 33 ]. Additionally, the number of siblings was also found to exert a positive effect on anxiety, suggesting a positive correlation between the number of siblings and somatic symptoms among college students, which aligns with existing literature [ 34 ]. 5 Implications of the Study This study carries significant theoretical value. First, the findings provide cross-cultural evidence for Life History Theory and reveal symptom-specific variations in the health costs associated with early-life adversity. Specifically, its predictive power for somatic symptoms (β = 0.597, see Fig. 1) was substantially stronger than for anxiety (β = 0.387, see Fig. 1) among Chinese university students, suggesting that somatization may represent a more prominent pathway for stress manifestation. Second, this research refines the Buffering Hypothesis by uncovering symptom-specific protective effects of family support: while support nearly completely buffers against anxiety, it only partially mitigates somatic symptoms. This indicates distinct mechanisms through which social support influences psychological versus physiological pathways, highlighting the need for future theoretical frameworks to account for these differences. This study offers clear practical implications for intervention strategies. First, it underscores the necessity of screening for early-life adversity among university students to identify high-risk groups and provide proactive support. Second, the findings highlight the central role of integrating “family” into intervention frameworks. Universities should guide families, through methods such as parental education, to offer effective support—one of the most powerful means to mitigate the impact of adversity. Finally, the results suggest the need for differentiated intervention approaches: enhancing family support may be particularly effective for students with anxiety, whereas those exhibiting prominent somatic symptoms may require integrated physiological interventions to achieve concurrent psychological and somatic treatment. 6 Limitations of the Study First, the cross-sectional research design limits the strength of causal inferences. Data for all variables in this study were collected at a single time point. Although the theoretical model posits pathways from early-life adversity to health outcomes, the possibility of reverse causality or the influence of unmeasured third variables cannot be fully ruled out. For instance, elevated anxiety levels may lead to a negative recall bias in individuals' recollections of early experiences [ 43 ]. Second, retrospective self-report data may be subject to bias. The assessment of early-life adversity relied on participants' retrospective self-reports of childhood experiences, which may be influenced by memory decay, current emotional state, or social desirability, thereby potentially compromising the accuracy of the data. Third, the use of a convenience sampling method constrains the external validity of the study. The sample may not adequately represent the broader population of university students from diverse geographical regions and cultural backgrounds (such as ethnic minorities), which limits the generalizability of the findings. Finally, social support is a multidimensional construct. This study did not differentiate between distinct dimensions of family support—such as emotional versus instrumental support—and their potentially divergent underlying mechanisms [ 18 ]. Conclusion This study, grounded in Life History Theory and the Buffering Hypothesis, examined the relationship between early-life adversity and symptoms of anxiety and somatization among Chinese university students, along with the protective role of family support. The findings indicate that early-life adversity serves as a significant risk factor for both anxiety and somatic symptoms, with a particularly pronounced effect on somatization. Furthermore, family support played a crucial protective role in the association between early-life adversity and psychological and physical health. High levels of family support were found to almost completely buffer the negative impact of early-life adversity on anxiety, whereas for somatic symptoms, the buffering effect, though significant, was partial. These results underscore the importance of incorporating family systems into university support frameworks to assist students in effectively coping with anxiety and somatic symptoms. Declarations Ethics approval and consent to participate The Academic Committee of the Department of Teacher Education at Xichang University serves as the institutional review board (IRB) of the university. Ethical approval for this study (Project No. 240323) was granted by this committee and the study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent to participate was obtained from all of the participants Consent for publication Not Applicable Availability of data and materials The raw data supporting the findings of this study are available from the corresponding author upon reasonable request. Competing interests There is no any competing interest among them. Funding This study was supported by two projects: （1）Doctoral Startup Fund in Xichang University，Project Title: "Impact of Early Adversity on Psychological Resilience in College Students"Project ID: YBS2025002. （2）The 2025 Research Grant from the Xichang Federation of Social Science Circles , Project Title: "An Integrated Psychology-Sports-Medicine Approach to Depression Intervention for Students in Underdeveloped Counties of Liangshan Prefecture." (Grant No. 202570). Authors' contributions Xin zhuwang and Shu yunyang are responsible for writing and reviewing; Kai xianfu, Yu xiazhang and Cheng jiatang conducted the survey. Acknowledgements NO. References Yu, Y., et al., Prevalence and Associated Factors of Complains on Depression, Anxiety, and Stress in University Students: An Extensive Population-Based Survey in China. Front Psychol, 2022. 13 : p. 842378. 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LaBar, Retrieval-induced forgetting of emotional memories. Cognition and Emotion, 2024. 38 (1): p. 131-147. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 06 Jan, 2026 Read the published version in BMC Psychology → Version 1 posted Editorial decision: Revision requested 14 Oct, 2025 Reviews received at journal 08 Oct, 2025 Reviews received at journal 04 Oct, 2025 Reviewers agreed at journal 02 Oct, 2025 Reviewers agreed at journal 02 Oct, 2025 Reviewers agreed at journal 30 Sep, 2025 Reviewers invited by journal 30 Sep, 2025 Submission checks completed at journal 26 Sep, 2025 First submitted to journal 26 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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03:19:37","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":94270,"visible":true,"origin":"","legend":"","description":"","filename":"220cf123281849d088baeff12c3eece41structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7599981/v1/d95e4e05ed27f7487b119a62.xml"},{"id":93450416,"identity":"02d1ac93-340b-49b5-9f02-a3c80695e198","added_by":"auto","created_at":"2025-10-14 03:19:37","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":104508,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7599981/v1/f52f9d89988ed2c0e3e53473.html"},{"id":93450405,"identity":"157dd786-7e1e-4bee-a568-a4a33bc0c3bf","added_by":"auto","created_at":"2025-10-14 03:19:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":94913,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe main effect model\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote. *P\u0026lt;0.05，**P\u0026lt;0.01. The values shown in the figure are STDYX standardized estimates. Sibling = number of siblings; somatic = somatic symptoms; adversity = early-life adversity.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7599981/v1/39b3d6deb273bd0ecec27600.png"},{"id":93451143,"identity":"a99ebc75-6aff-4cbe-b347-51cbcc1c59cc","added_by":"auto","created_at":"2025-10-14 03:27:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":131503,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe moderation model\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote. The interaction term was created by multiplying the standardized values of early-life adversity and family support. \u003csup\u003e*\u003c/sup\u003eP\u0026lt;0.05，\u003csup\u003e**\u003c/sup\u003eP\u0026lt;0.01. Values in the figure represent STDYX standardized estimates. Sibling = number of siblings; somatic = somatic symptoms; adversity = early-life adversity; Inter = interaction.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7599981/v1/dddcc4527b2f6d8dc126dabd.png"},{"id":100070550,"identity":"517f95c3-5181-4043-a211-87378cdf6c38","added_by":"auto","created_at":"2026-01-12 16:18:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1026623,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7599981/v1/31f318d4-6bc0-4773-8bf6-4abbdeb5484e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEarly-life adversities are associated with anxiety and somatic symptoms among university students: Moderation by family support\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAnxiety and somatic symptoms represent prevalent health concerns among Chinese university students. A study involving 6,032 Chinese college students revealed that approximately one-third experienced anxiety symptoms ranging from mild to very severe [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. A large-scale university-based survey revealed that approximately 70% of Chinese college students experience somatic symptoms of varying severity, such as headaches, dizziness, nausea, and shortness of breath[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A systematic review demonstrates a high comorbidity between somatic symptom disorder and anxiety/depressive disorders, with over 50% of individuals with somatic symptoms also having a co-occurring anxiety or depressive disorder [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Anxiety and somatic symptoms exhibit a bidirectional relationship, underpinned by shared neural mechanisms involving brain regions such as the insula, and the precentral, postcentral, and cingulate gyri [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAnxiety and somatic symptoms among university students can be partially attributed to early-life adversity. Early-life adversity refers to a range of negative events and chronic stressors experienced during early life including, but are not limited to, physical and emotional abuse, physical and emotional neglect, parental divorce, parental substance abuse, serious illness and death in family, or parental incarceration [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. According to Life History Theory, individuals who experience adversity early in life are inclined to have increased vigilance and enhanced reactivity to stress, as adverse environments signal persistent threat and promote a sustained state of hyper-alertness[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], Such persistent vigilance is a core characteristic of anxiety-related symptoms [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Harsh environments in childhood lead individuals to adopt a faster life history strategy for development, accompanied by mental health issues[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLife History Theory posits that individuals raised in unstable and adverse environments tend to develop heightened stress response mechanisms. This increased reactivity may subsequently elevate their vulnerability to various physical health problems, including somatic symptoms [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Numerous empirical studies provide support for this theoretical proposition [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. For instance, a nationally representative survey conducted in China revealed that middle-aged and older adults with a history of adverse childhood experiences reported significantly more somatic symptoms compared to those with fewer such experiences [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Similarly, university students exposed to greater childhood trauma\u0026mdash;such as physical abuse, verbal abuse, and emotional neglect\u0026mdash;are more likely to exhibit anxiety-related symptoms, including tension, restlessness, and irritability[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough early-life adversity exerts enduring effects on individuals\u0026rsquo; health, such impact is not entirely immutable. According to the Buffering Hypothesis, social support can effectively mitigate the detrimental effects of toxic stress on both physical and mental health, thereby serving a protective function [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Prior empirical studies have provided substantiating evidence for this hypothesis [\u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. For instance, one study demonstrated that social support from family, friends, and other sources negatively moderates the association between childhood adversity and depression in late life [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Another study indicated that social support significantly buffers the negative influence of adverse childhood experiences on health outcomes in adulthood\u0026mdash;including measures such as physical functioning, bodily pain, vitality, and mental health [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePrevious studies examining the buffering effect of social support on the relationship between early-life adversity and adult health have two major limitations. First, few studies have focused on Chinese college students to investigate the long-term impact of early-life adversity on their physical and mental health. Second, existing research often subsumes family support under the broader construct of social support, thereby failing to highlight its unique buffering role. In Chinese culture, the family represents a spiritual anchor and an ultimate source of emotional support, playing a crucial role in individual well-being [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The present study aims to address these gaps by elucidating the distinctive function of family support, thereby contributing to the advancement of Life History Theory and the Buffering Hypothesis, as well as informing intervention strategies for anxiety and somatic symptoms among university students.\u003c/p\u003e\u003cp\u003eBased on the literature review above, this study proposes the following four research hypotheses:\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHypothesis 1\u003c/strong\u003e\u003cp\u003eEarly-life adversity positively predicts anxiety among university students;\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHypothesis 2\u003c/strong\u003e\u003cp\u003eEarly-life adversity positively predicts somatic symptoms among university students;\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHypothesis 3\u003c/strong\u003e\u003cp\u003eFamily support negatively moderates the effect of early-life adversity on anxiety among university students;\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHypothesis 4\u003c/strong\u003e\u003cp\u003eFamily support negatively moderates the effect of early-life adversity on somatic symptoms among university students.\u003c/p\u003e\u003c/p\u003e"},{"header":"Research Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Sampling process\u003c/h2\u003e\u003cp\u003eAccording to the common sample size estimation principle (N:q rule), the required sample size should be 10 to 20 times the number of observed variables[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This study includes a total of 27 observed items (8 for early-life adversity, 8 for somatic symptoms, 7 for anxiety, and 4 for family support). Thus, the theoretically appropriate sample size ranges between 270 and 540. Furthermore, considering the anticipated questionnaire return rate and the presence of invalid responses, an effective return rate of 80% was estimated. To ensure a sufficient number of valid samples, this study planned to distribute 600 questionnaires, with an expected return of approximately 485 valid responses.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Instruments\u003c/h2\u003e\u003cp\u003eThe anxiety levels were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This instrument has been widely used in China and demonstrates good reliability and validity[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. It consists of seven items, one of which is \u0026ldquo;Feeling afraid, as if something awful might happen.\u0026rdquo; Participants were asked to rate each item on a 4-point Likert scale from 0 to 3 based on their psychological experiences over the past week, with the following anchors: 0 = \u0026ldquo;Not at all,\u0026rdquo; 1 = \u0026ldquo;Several days,\u0026rdquo; 2 = \u0026ldquo;More than half the days,\u0026rdquo; and 3 = \u0026ldquo;Nearly every day.\u0026rdquo;\u003c/p\u003e\u003cp\u003eThe somatic symptoms were measured using the 8-item Somatic Symptom Scale (SSS-8)[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This scale has demonstrated good reliability and validity when applied to Chinese youth and adolescent populations [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. It comprises eight items, one of which is \u0026ldquo;stomach or bowel problems.\u0026rdquo; Participants were asked to rate each item on a 4-point Likert scale ranging from 0 to 3 based on their physical experiences over the past seven days, with 0 indicating \u0026ldquo;not at all bothered\u0026rdquo; and 3 representing \u0026ldquo;very much bothered.\u0026rdquo;\u003c/p\u003e\u003cp\u003eAn index of childhood adversity was computed by summing dichotomous responses (0\u0026thinsp;=\u0026thinsp;no, 1\u0026thinsp;=\u0026thinsp;yes) across eight items adapted from a Chinese version of the Early-Life Adversity Scale[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The items include death of a family member, severe illness of a family member, parental divorce, parental separation, physical or verbal abuse directed at the participant, witnessing abuse toward a family member, experiencing a serious illness oneself, incarceration of a family member, and prolonged parental unemployment or unstable employment. Participants were asked to retrospectively report whether they had encountered each event from birth until elementary school graduation(in China, this generally refers to children between the 0\u0026ndash;13 years old).\u003c/p\u003e\u003cp\u003eThe family support measure in this study consisted of four items derived from the Family Support subscale of the Multidimensional Scale of Perceived Social Support (MSPSS) )[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. This subscale has demonstrated good reliability and validity within Chinese cultural contexts)[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. One sample item is: \u0026ldquo;I can talk about my problems with my family.\u0026rdquo; Participants were asked to rate each item on a 5-point scale based on the support they received from family members over the past month, ranging from 0 (\u0026ldquo;hardly any\u0026rdquo;) to 4 (\u0026ldquo;a lot\u0026rdquo;).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Data analysis methods\u003c/h2\u003e\u003cp\u003eThe data analysis was conducted in two stages. First, SPSS version 27.0 was employed for preliminary analyses, which included assessing test-retest reliability for early-life adversity, computing Cronbach's alpha coefficients for anxiety and somatic symptoms, performing Pearson correlation analyses, and examining common method bias using Harman's single-factor test. Subsequently, Mplus version 7.4 was utilized to conduct structural equation modeling (SEM) to test the hypothesized relationships among the variables.\u003c/p\u003e\u003c/div\u003e"},{"header":"Research Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Characteristics of the valid sample\u003c/h2\u003e\n \u003cp\u003eParticipants with any missing responses were excluded from the analysis, resulting in a final valid sample of 485 individuals. The mean age of the participants was 19.43 years (SD\u0026thinsp;=\u0026thinsp;1.25), with a minimum of 18 and a maximum of 23 years. Other demographic characteristics are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCharacteristics of the valid sample (N\u0026thinsp;=\u0026thinsp;485)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLevels\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eEthnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e84.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMinority\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eNumber of siblings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;1 sibling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;2 siblings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eGrade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFreshman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSophomore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJunior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSenior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Means, standard deviations, reliabilities, and correlations of the variables\u003c/h2\u003e\n \u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents the means, standard deviations, reliability estimates, and linear correlation coefficients among the key variables.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMeans, standard deviations, correlation coefficients, and reliability\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEarly-life adversity\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSomatic symptoms\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFamily support\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEarly-life adversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.878\u003c/em\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.420\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.870\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSomatic symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.592\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.361\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.855\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFamily support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.183\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.245\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.128\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.802\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eNote: The italicized numbers on the diagonal are the reliability coefficients. \u003csup\u003ea\u003c/sup\u003e The reliability of early-life adversity was assessed based on test-retest measurements from 33 freshman students, with a 30-day interval between administrations. The reliability estimates for the remaining three variables represent Cronbach\u0026rsquo;s alpha coefficients. \u003csup\u003e**\u003c/sup\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eAs shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, correlation analysis revealed that early-life adversity was positively and significantly associated with both anxiety (r\u0026thinsp;=\u0026thinsp;0.420, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and somatic symptoms (r\u0026thinsp;=\u0026thinsp;0.592, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Anxiety and somatic symptoms were also positively correlated (r\u0026thinsp;=\u0026thinsp;0.361, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Conversely, family support was negatively correlated with early-life adversity (r = -0.183, p\u0026thinsp;\u0026lt;\u0026thinsp;0 .01), anxiety (r = -0.245, p\u0026thinsp;\u0026lt;\u0026thinsp;0 .01), and somatic symptoms (r = -0.128, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), suggesting its potential protective role.\u003c/p\u003e\n \u003cp\u003eIn addition, all constructs exhibited good to excellent reliability. Specifically, the test-retest reliability for early-life adversity was 0.878, while the internal consistency (Cronbach\u0026rsquo;s \u0026alpha;) for the remaining variables ranged from 0.802 to 0.870, indicating satisfactory measurement stability and consistency across the study constructs.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 Common method bias test\u003c/h2\u003e\n \u003cp\u003eTo assess common method bias, Harman\u0026rsquo;s single-factor test was performed using all 27 items measuring early-life adversity, anxiety, and somatic symptoms. The first factor accounted for 23.87% of the total variance, below the 40% threshold, indicating that common method bias was not a major issue in this study.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4 Structural equation modeling results\u003c/h2\u003e\n \u003cp\u003ePrevious studies have indicated that gender is significantly associated with adolescent health outcomes [\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e]. Meanwhile, resource dilution theory suggests a negative correlation between the number of siblings and adolescents\u0026apos; mental health [\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e]. Therefore, gender and number of siblings were included as control variables in the analysis.\u003c/p\u003e\n \u003cp\u003eFirst, a main effect model was tested, in which early-life adversity was specified as the predictor, and both anxiety and somatic symptoms were included as outcome variables.\u003c/p\u003e\n \u003cp\u003eIn the main effect model, the degrees of freedom were 0 (saturated model), with AIC\u0026thinsp;=\u0026thinsp;1509.544 and BIC\u0026thinsp;=\u0026thinsp;1555.569.\u003c/p\u003e\n \u003cp\u003eAs shown in Fig. 1, early-life adversity had a significant effect on somatic symptoms (\u0026beta;\u0026thinsp;=\u0026thinsp;0.597, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), supporting Hypothesis \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e that early-life adversity positively predicts somatic symptoms among university students.\u003c/p\u003e\n \u003cp\u003eFigure 1 also indicates that early-life adversity exerted a significant effect on anxiety (\u0026beta;\u0026thinsp;=\u0026thinsp;0.387, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), which supports Hypothesis \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, suggesting that early-life adversity is a significant positive predictor of anxiety in college students.\u003c/p\u003e\n \u003cp\u003eNext, the moderation model was tested by incorporating family support and the interaction term into the analysis.\u003c/p\u003e\n \u003cp\u003eIn the moderation model, the degrees of freedom were 0 (saturated model), with AIC\u0026thinsp;=\u0026thinsp;1467.777 and BIC\u0026thinsp;=\u0026thinsp;1530.518. Compared to the main effect model, both AIC and BIC decreased in the moderation model, indicating a better model fit.\u003c/p\u003e\n \u003cp\u003eAs shown in Fig. 2, the interaction effect on somatic symptoms was significant (\u0026beta; = \u0026minus;\u0026thinsp;0.181, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), supporting Hypothesis \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e that family support negatively moderates the relationship between early-life adversity and somatic symptoms among college students.\u003c/p\u003e\n \u003cp\u003eFigure 2 also shows that the interaction effect on anxiety was significant (\u0026beta; = \u0026minus;\u0026thinsp;0.164, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), which supports Hypothesis \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, indicating that family support serves as a significant negative moderator between early-life adversity and anxiety.\u003c/p\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e presents the simple slopes and further illustrates the specific buffering effect of family support.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSimple slopes and buffering effects\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eOutcome Variable (Y)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFamily Support (W)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComputational Process\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSimple Slope (\u0026beta;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSimple Effect Description\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(Simple Slope\u0026thinsp;=\u0026thinsp;\u0026beta;X\u0026thinsp;+\u0026thinsp;\u0026beta;X*W \u0026times; W)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow Support (-1 SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.304 + (-0.164) \u0026times; (-1)\u0026thinsp;=\u0026thinsp;0.304\u0026thinsp;+\u0026thinsp;0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.468\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eeffect of adversity is strongest\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean Level (0 SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.304 + (-0.164) \u0026times; (0)\u0026thinsp;=\u0026thinsp;0.304\u0026thinsp;+\u0026thinsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.304\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaseline main effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh Support (+\u0026thinsp;1 SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.304 + (-0.164) \u0026times; (1)\u0026thinsp;=\u0026thinsp;0.304\u0026thinsp;\u0026minus;\u0026thinsp;0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEffect is completely buffered\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eSomatic Symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow Support (-1 SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.534 + (-0.181) \u0026times; (-1)\u0026thinsp;=\u0026thinsp;0.534\u0026thinsp;+\u0026thinsp;0.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.715\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEffect of early-life adversity is strongest\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean Level (0 SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.534 + (-0.181) \u0026times; (0)\u0026thinsp;=\u0026thinsp;0.534\u0026thinsp;+\u0026thinsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.534\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaseline main effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh Support (+\u0026thinsp;1 SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.534 + (-0.181) \u0026times; (1)\u0026thinsp;=\u0026thinsp;0.534\u0026thinsp;\u0026minus;\u0026thinsp;0.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.353\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEffect is partially buffered\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e\u003cstrong\u003eNote\u003c/strong\u003e: Simple slope analyses were conducted following the procedures outlined by Preacher and Curran (2006) [\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e]. Male\u0026thinsp;=\u0026thinsp;1, female\u0026thinsp;=\u0026thinsp;2. X\u0026thinsp;=\u0026thinsp;early-life adversity. \u003csup\u003e*\u003c/sup\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05, \u003csup\u003e**\u003c/sup\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eAs shown in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, a distinct pattern emerged for anxiety, in which high levels of family support completely buffered the negative effect of early-life adversity. The simple slope was reduced from 0.468 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) under low support to a non-significant 0.140 (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) under high support\u0026mdash;a reduction of approximately 70%\u0026mdash;indicating a near-complete buffering effect. In contrast, for somatic symptoms, high support substantially attenuated but did not eliminate the effect of adversity. The simple slope decreased by approximately 50%, from 0.715 to 0.353 (both p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), demonstrating a partial buffering effect.\u003c/p\u003e\n \u003cp\u003eMoreover, as presented in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, the moderation model indicated that gender had a significant positive effect on anxiety (\u0026beta; = =0.080, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), suggesting that female university students reported higher levels of anxiety than their male counterparts. Meanwhile, the number of siblings also showed a significant positive association with anxiety (\u0026beta;\u0026thinsp;=\u0026thinsp;0.151, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). In contrast, neither gender (\u0026beta;\u0026thinsp;=\u0026thinsp;0.017, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) nor number of siblings (\u0026beta; = \u0026minus;\u0026thinsp;0.043, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) had a statistically significant effect on somatic symptoms.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study employed structural equation modeling to examine the relationship between early-life adversity and both anxiety and somatic symptoms among university students, as well as the moderating role of family support. The main effect model revealed that early-life adversity significantly predicted anxiety (β\u0026thinsp;=\u0026thinsp;0.387, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, see Fig.\u0026nbsp;1), supporting Hypothesis \u003cspan refid=\"FPar1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. According to Cohen\u0026rsquo;s (1988) conventional criteria, an effect size around .30 is considered a \u0026lsquo;medium\u0026rsquo; effect[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], indicating that early-life adversity has a moderate predictive effect on student anxiety. Additionally, as shown in Fig.\u0026nbsp;1, early-life adversity also significantly predicted somatic symptoms (β\u0026thinsp;=\u0026thinsp;0.597, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01. see Fig.\u0026nbsp;1), which supports Hypothesis \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Based on Cohen\u0026rsquo;s (1988) guidelines, an effect size around .50 represents a \u0026lsquo;large\u0026rsquo; effect [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Thus, early-life adversity demonstrates a strong predictive effect on somatic symptoms in university students.\u003c/p\u003e\u003cp\u003eThe findings of the main effect model are consistent with previous research [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. A longitudinal study conducted in the United States demonstrated that childhood adversity\u0026mdash;including childhood abuse and parental separation or divorce\u0026mdash;significantly predicted a composite measure of mental health outcomes, including generalized anxiety disorder scores, among undergraduate students [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Another study indicated that multiple and specific types of adverse childhood events serve as risk factors for chronic pain conditions in university students [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. According to Life History Theory, unpredictable adverse events early in life can lead individuals to develop psychological tendencies characterized by heightened vigilance and alertness. This increased sensitivity to potential threats may result in elevated levels of tension, restlessness, and anxiety. Such psychological patterns often persist into adulthood, contributing to sustained anxiety response patterns [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A substantial body of research grounded in Life History Theory suggests that individuals exposed to early-life adversity tend to adopt faster life history strategies as an adaptive response to harsh environments. However, these strategies come with long-term health costs[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], including accelerated physiological wear and tear[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], and chronic low-grade inflammation, which may subsequently lead to medically unexplained somatic symptoms[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurthermore, the main effect model indicated that the predictive effect of early-life adversity on somatic symptoms (β\u0026thinsp;=\u0026thinsp;0.597, see Fig.\u0026nbsp;1) was stronger than its effect on anxiety (β\u0026thinsp;=\u0026thinsp;0.387, see Fig.\u0026nbsp;1), suggesting that the impact of early-life adversity on long-term health outcomes varies across symptom domains.\u003c/p\u003e\u003cp\u003eThe moderation model revealed that family support negatively moderated the relationship between early-life adversity and anxiety (β=-0.164, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01; see Fig.\u0026nbsp;2), fully supporting Hypothesis \u003cspan refid=\"FPar3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Similarly, family support also negatively moderated the association between early-life adversity and somatic symptoms (β=-0.181, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01; see Fig.\u0026nbsp;2), supporting Hypothesis \u003cspan refid=\"FPar4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Simple slope analysis indicated that family support exerted a near-complete buffering effect on the relationship between early-life adversity and anxiety (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), and demonstrated a partial buffering effect on the link between early-life adversity and somatic symptoms (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe results of the moderation effect model are highly consistent with findings from previous similar studies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. For example, a study conducted in China revealed that social support, including support from family, exerts a significant negative moderating effect on the relationship between childhood adversity and mental health (indexed by anxiety and depression) at college[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Similarly, a study focusing on North American adults demonstrated that social support significantly negatively moderates the impact of adverse childhood experiences on health outcomes in adulthood\u0026mdash;including measures such as bodily pain, physical functioning, and mental health[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In accordance with the Buffering Hypothesis, social support can mitigate the detrimental effects of stress on individuals' physical and mental health. Specifically, the enduring stress resulting from early-life adversity may impair adult health, while support from family in adulthood can buffer this sustained detrimental effect on health.\u003c/p\u003e\u003cp\u003eFinally, the present study identified a significant positive effect of gender on anxiety levels among college students, indicating that female students report higher levels of anxiety compared to their male counterparts\u0026mdash;a finding consistent with previous research [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Additionally, the number of siblings was also found to exert a positive effect on anxiety, suggesting a positive correlation between the number of siblings and somatic symptoms among college students, which aligns with existing literature [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003e5 Implications of the Study\u003c/h3\u003e\n\u003cp\u003eThis study carries significant theoretical value. First, the findings provide cross-cultural evidence for Life History Theory and reveal symptom-specific variations in the health costs associated with early-life adversity. Specifically, its predictive power for somatic symptoms (β\u0026thinsp;=\u0026thinsp;0.597, see Fig.\u0026nbsp;1) was substantially stronger than for anxiety (β\u0026thinsp;=\u0026thinsp;0.387, see Fig.\u0026nbsp;1) among Chinese university students, suggesting that somatization may represent a more prominent pathway for stress manifestation. Second, this research refines the Buffering Hypothesis by uncovering symptom-specific protective effects of family support: while support nearly completely buffers against anxiety, it only partially mitigates somatic symptoms. This indicates distinct mechanisms through which social support influences psychological versus physiological pathways, highlighting the need for future theoretical frameworks to account for these differences.\u003c/p\u003e\u003cp\u003eThis study offers clear practical implications for intervention strategies. First, it underscores the necessity of screening for early-life adversity among university students to identify high-risk groups and provide proactive support. Second, the findings highlight the central role of integrating \u0026ldquo;family\u0026rdquo; into intervention frameworks. Universities should guide families, through methods such as parental education, to offer effective support\u0026mdash;one of the most powerful means to mitigate the impact of adversity. Finally, the results suggest the need for differentiated intervention approaches: enhancing family support may be particularly effective for students with anxiety, whereas those exhibiting prominent somatic symptoms may require integrated physiological interventions to achieve concurrent psychological and somatic treatment.\u003c/p\u003e\n\u003ch3\u003e6 Limitations of the Study\u003c/h3\u003e\n\u003cp\u003eFirst, the cross-sectional research design limits the strength of causal inferences. Data for all variables in this study were collected at a single time point. Although the theoretical model posits pathways from early-life adversity to health outcomes, the possibility of reverse causality or the influence of unmeasured third variables cannot be fully ruled out. For instance, elevated anxiety levels may lead to a negative recall bias in individuals' recollections of early experiences [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Second, retrospective self-report data may be subject to bias. The assessment of early-life adversity relied on participants' retrospective self-reports of childhood experiences, which may be influenced by memory decay, current emotional state, or social desirability, thereby potentially compromising the accuracy of the data. Third, the use of a convenience sampling method constrains the external validity of the study. The sample may not adequately represent the broader population of university students from diverse geographical regions and cultural backgrounds (such as ethnic minorities), which limits the generalizability of the findings. Finally, social support is a multidimensional construct. This study did not differentiate between distinct dimensions of family support\u0026mdash;such as emotional versus instrumental support\u0026mdash;and their potentially divergent underlying mechanisms [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study, grounded in Life History Theory and the Buffering Hypothesis, examined the relationship between early-life adversity and symptoms of anxiety and somatization among Chinese university students, along with the protective role of family support. The findings indicate that early-life adversity serves as a significant risk factor for both anxiety and somatic symptoms, with a particularly pronounced effect on somatization. Furthermore, family support played a crucial protective role in the association between early-life adversity and psychological and physical health. High levels of family support were found to almost completely buffer the negative impact of early-life adversity on anxiety, whereas for somatic symptoms, the buffering effect, though significant, was partial. These results underscore the importance of incorporating family systems into university support frameworks to assist students in effectively coping with anxiety and somatic symptoms.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Academic Committee of the Department of Teacher Education at Xichang University serves as the institutional review board (IRB) of the university. Ethical approval for this study (Project No. 240323) was granted by this committee and the study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent to participate was obtained from all of the participants\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe raw data supporting the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no any competing interest among them.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by two projects:\u003c/p\u003e\n\u003cp\u003e（1）Doctoral Startup Fund in Xichang University，Project Title: \"Impact of Early Adversity on Psychological Resilience in College Students\"Project ID: YBS2025002.\u003c/p\u003e\n\u003cp\u003e（2）The 2025 Research Grant from the Xichang Federation of Social Science Circles , Project Title: \"An Integrated Psychology-Sports-Medicine Approach to Depression Intervention for Students in Underdeveloped Counties of Liangshan Prefecture.\" (Grant No. 202570).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXin zhuwang and Shu yunyang are responsible for writing and reviewing; Kai xianfu, Yu xiazhang and \u0026nbsp;Cheng jiatang conducted the survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNO.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eYu, Y., et al., \u003cem\u003ePrevalence and Associated Factors of Complains on Depression, Anxiety, and Stress in University Students: An Extensive Population-Based Survey in China.\u003c/em\u003e Front Psychol, 2022. \u003cstrong\u003e13\u003c/strong\u003e: p. 842378.\u003c/li\u003e\n \u003cli\u003eLv, S., et al., \u003cem\u003eAssociation between Negative Life Events and Somatic Symptoms: A Mediation Model through Self-Esteem and Depression.\u003c/em\u003e Behav Sci (Basel), 2023. \u003cstrong\u003e13\u003c/strong\u003e(3): p. 1-12.\u003c/li\u003e\n \u003cli\u003eL\u0026ouml;we, B., et al., \u003cem\u003eSomatic symptom disorder: a scoping review on the empirical evidence of a new diagnosis.\u003c/em\u003e Psychological Medicine, 2022. \u003cstrong\u003e52\u003c/strong\u003e(4): p. 632-648.\u003c/li\u003e\n \u003cli\u003eKong, Z., et al., \u003cem\u003eSomatic symptoms mediate the association between subclinical anxiety and depressive symptoms and its neuroimaging mechanisms.\u003c/em\u003e BMC psychiatry, 2022. \u003cstrong\u003e22\u003c/strong\u003e(1): p. 835.\u003c/li\u003e\n \u003cli\u003eWarner, T.D., et al., \u003cem\u003eContextualizing Adverse Childhood Experiences: The Intersections of Individual and Community Adversity.\u003c/em\u003e Journal of Youth and Adolescence, 2022. \u003cstrong\u003e52\u003c/strong\u003e(3): p. 570-584.\u003c/li\u003e\n \u003cli\u003eKirkbride, J.B., et al., \u003cem\u003eThe social determinants of mental health and disorder: evidence, prevention and recommendations.\u003c/em\u003e World psychiatry, 2024. \u003cstrong\u003e23\u003c/strong\u003e(1): p. 58-90.\u003c/li\u003e\n \u003cli\u003eDel Giudice, M., B.J. 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Juster, and M. Picard, \u003cem\u003eThe energetic cost of allostasis and allostatic load.\u003c/em\u003e Psychoneuroendocrinology, 2022. \u003cstrong\u003e146\u003c/strong\u003e: p. 105951.\u003c/li\u003e\n \u003cli\u003eViljoen, M. and B.L. Thomas, \u003cem\u003eLow-grade systemic inflammation and the workplace.\u003c/em\u003e Work, 2021. \u003cstrong\u003e69\u003c/strong\u003e(3): p. 903-915.\u003c/li\u003e\n \u003cli\u003eKong, Y., et al., \u003cem\u003eImpulsivity and social support as intervening and interactive variables in the link between childhood socioeconomic status and mental health among first-year college students.\u003c/em\u003e Frontiers in Psychiatry, 2025. \u003cstrong\u003e16\u003c/strong\u003e: p. 1569001.\u003c/li\u003e\n \u003cli\u003eReeck, C. and K.S. LaBar, \u003cem\u003eRetrieval-induced forgetting of emotional memories.\u003c/em\u003e Cognition and Emotion, 2024. \u003cstrong\u003e38\u003c/strong\u003e(1): p. 131-147.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7599981/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7599981/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eEarly-life adversity has been shown to predict physical and mental health issues in adulthood. However, few studies have examined the relationship between early-life adversity and anxiety and somatic symptoms among Chinese university students, as well as the buffering effect of family support.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA convenience sampling method was used to survey 485 undergraduate students from a university in Western China. Data were collected using the Early-Life Adversity Scale, the Generalized Anxiety Disorder-7 (GAD-7) scale, the Somatic Symptom Scale-8 (SSS-8), and the family support subscale of the Multidimensional Scale of Perceived Social Support (MSPSS). Structural equation modeling was employed to examine the main effects of early-life adversity on anxiety and somatic symptoms, as well as the moderating effect of family support.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eEarly-life adversity significantly and positively predicted anxiety (β\u0026thinsp;=\u0026thinsp;0.387, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and somatic symptoms (β\u0026thinsp;=\u0026thinsp;0.597, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Family support significantly negatively moderated the relationship between early-life adversity and anxiety/somatic symptoms (interaction term β = -0.164 / -0.181, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The buffering effect of family support was stronger for anxiety (nearly complete buffering) than for somatic symptoms (partial buffering).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eEarly-life adversity is a significant risk factor for anxiety and somatic symptoms among Chinese university students. Family support can buffer the long-term association between early-life adversity and these symptoms. Integrating family support into university health intervention systems may help alleviate anxiety and somatic symptoms among students.\u003c/p\u003e","manuscriptTitle":"Early-life adversities are associated with anxiety and somatic symptoms among university students: Moderation by family support","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-14 03:19:33","doi":"10.21203/rs.3.rs-7599981/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-14T06:46:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-08T22:36:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-04T19:21:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"154166300836115041809679978027104162406","date":"2025-10-02T17:04:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214433742650932132162098981218305941387","date":"2025-10-02T15:54:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80277464460357876879367852853924899819","date":"2025-09-30T15:53:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-30T15:45:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-26T06:42:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-09-26T06:39:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6a997283-008d-45f1-a5cd-31df73d9409c","owner":[],"postedDate":"October 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:14:49+00:00","versionOfRecord":{"articleIdentity":"rs-7599981","link":"https://doi.org/10.1186/s40359-025-03839-x","journal":{"identity":"bmc-psychology","isVorOnly":false,"title":"BMC Psychology"},"publishedOn":"2026-01-06 15:57:57","publishedOnDateReadable":"January 6th, 2026"},"versionCreatedAt":"2025-10-14 03:19:33","video":"","vorDoi":"10.1186/s40359-025-03839-x","vorDoiUrl":"https://doi.org/10.1186/s40359-025-03839-x","workflowStages":[]},"version":"v1","identity":"rs-7599981","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7599981","identity":"rs-7599981","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}