Examining causal pathways between family adversity and soiling: a prospective cohort study

Objective We aimed to examine the associations between family adversity in infancy with subsequent daytime soiling at primary school age. We also examined factors on the casual pathway between family adversity and soiling, specifically the child’s emotional/behaviour problems and constipation. Design This prospective cohort study included children from the Avon Longitudinal Study of Parents and Children (N=10 033) with data on the Family Adversity Index (FAI; birth to age 2), daytime soiling at age 7.5, emotional/behaviour problems at age 4, and constipation at age 6. We examined the relationships between the FAI, soiling, emotional/behaviour problems, and constipation. We then evaluated the mediating effects of emotional/behaviour problems and constipation. All analyses were adjusted for child and family related confounders.

A one-unit increase in infancy FAI was associated with increased odds of 12% for daytime soiling at age 7.5 (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.07, 1.17), emotional/behaviour problems score at age 4 (beta 0.52, 95%CI 0.47, 0.58) and increased odds of constipation at age 6 (OR 1.07, 95%CI 1.03, 1.11). The presence of constipation at age 6 was strongly associated with increased odds of soiling at age 7.5 (OR 3.34, 95%CI 2.68, 4.16). There was weak evidence that the associations between FAI and daytime soiling were mediated by emotional/behaviour problems and constipation (ORnatural_indirect_effect 1.03, 95%CI 0.99-1.07).

Clinicians should be aware that exposure to family adversity in the early years places children at greater risk of subsequent constipation and soiling. What is already known on this topic? Adversities including exposure to stressful life events, maternal psychopathology, and family discord, play a role in determining a child’s later risk of soiling. What this study adds? The total burden of family adversity during infancy increases the odds of soiling at primary school age. There is weak evidence that emotional/behaviour problems and constipation mediates some of the relationship between family adversity and soiling. How this study might affect research, practice or policy? Clinicians should be aware that exposure to family adversity in the early years places children at greater risk of subsequent soiling. Increased resources need to be directed at providing support and interventions for families who are experiencing adversities to reduce the impact on children’s health and development. Competing Interest Statement The authors have declared no competing interest. Funding Statement This work is supported by funding from the Medical Research Council [grant ref: MR/V033581/1: Mental Health and Incontinence]. JH is a member of the MRC Integrative Epidemiology Unit at the University of Bristol [MC_UU_00011/7]. The UK Medical Research Council and Wellcome [grant ref: 217065/Z/19/Z] and the University of Bristol provide core support for ALSPAC. This publication is the work of the authors and Kimberley Burrows will serve as guarantors for the contents of this paper. A comprehensive list of grants funding is available on the ALSPAC website: http://www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval for ALSPAC was obtained from the ALSPAC Ethics and Law Committee and the Local Research Ethics Committees. Informed consent for the use of data collected via questionnaires and clinics was obtained from participants following the recommendations of the ALSPAC Ethics and Law Committee at the time. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes DATA AVAILABILITY The ALSPAC data underlying this article are available upon request from the ALSPAC Executive Committee for researchers who meet the criteria for access to confidential data (https://bristol.ac.uk/alspac/researchers/access/). Code to conduct these analyses can be found on https://github.com/burrowsk/Family-adversity-constipation-soiling (upon publication).