Childhood adversity affects somatic symptoms among high school students: the mediation of mental health

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A total of 449 high school students (mean age = 17.31 years) were surveyed. CHA and SS were measured at Wave 1, and depression, anxiety, and SS were assessed at Wave 2, seven months later. Structural equation modeling revealed that CHA significantly influenced SS in high school students, and MH mediated the relationship between CHA and SS. The mediating effect of MH accounted for more than 50% of the total effect of CHA on SS at both Wave 1 and Wave 2. This study enriches the life history theory, deepens the understanding of the relationship between CHA, adolescent MH, and SS, and contributes to the prevention of physical and mental health issues among adolescents. Health sciences/Health care Biological sciences/Psychology Social science/Psychology Childhood adversity Somatic symptoms High school students Life history theory Mediating effect Figures Figure 1 Figure 2 1. Introduction Somatic symptoms refer to physical manifestations—such as tension headaches, gastrointestinal discomfort, nausea, and back pain—that lack a clear medical explanation. Somatic symptoms are highly prevalent among Chinese adolescent populations[1-3]，and is associated with poorer mental health, lower academic performance [4, 5], and easily lead to a significant burden on public health[6]. Prior studies have revealed that childhood adversities have a lasting negative impact on somatic symptoms into adulthood. However, to date, few studies have examined the long-term effects of childhood adversities on somatic symptoms and the underlying psychological mechanisms among Chinese adolescents. Childhood adversity refers to a range of negative events and chronic stressors experienced during childhood that may exert enduring effects on an individual's overall development [7]. Such adversities include, but are not limited to, physical abuse, emotional abuse, sexual abuse, physical neglect, emotional neglect, exposure to domestic violence, parental divorce, parental substance abuse, parental mental illness, or parental incarceration [7, 8]. Childhood adversity is a highly prevalent phenomenon in human societies and profoundly influences an individual's emotional well-being, physical health, and cognitive functioning [9]. Based on the life history theory for psychopathology, exposure to adversity during childhood often promotes the adoption of accelerated life history strategies, thereby elevating the likelihood of disorders associated with such strategies—including somatic symptom manifestations. More precisely, individuals raised in unstable and adverse environments are inclined to acquire hypersensitive stress response mechanisms. This heightened reactivity may subsequently contribute to a greater susceptibility to physical health issues including somatic symptoms[10, 11]. Based on large-scale U.S. population-based studies, harshness and unpredictability in early childhood demonstrate concurrent effects on physical health—as reflected by a wide range of physical symptoms in adolescence—as well as longitudinal effects that persist into young adulthood[12]. Studies based on Chinese adult samples indicate that childhood adversity is closely associated with future somatic symptoms in individuals [13, 14]. For instance，a nationally representative survey revealed that middle-aged and older adults in China who experienced childhood adversities reported significantly more somatic symptoms compared to those with fewer adverse childhood experiences[13]. This study will extend this line of inquiry by examining the psychological mechanisms through which early adversity influences somatic symptoms. 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[15], Such persistent vigilance is a core characteristic of anxiety-related symptoms [16]. Meanwhile，the life history theory proposes that sadness and low mood evolved as beneficial responses to adversity, and that depressive disorder is dysfunctional sadness and low mood[17]. Harsh environments in childhood lead individuals to adopt a faster life history strategy for development, accompanied by mental health issues[12]. A prior study suggests that somatic symptoms may be triggered by or give rise to anxiety symptoms[18]. Somatization is a tendency to experiecne and communicate somatic distress in response to psychosocial stress, and it is most often associated with depressie and anxiety disorders[19]. Somatic symptoms are indeed closely related to depression, often presenting as physical complaints that accompany or even dominate the clinical picture[20]. Large-scale studies conducted by Chinese researchers have demonstrated that mental and somatic conditions are bidirectionally associated following exposure to childhood adversities. Furthermore, these studies indicate that childhood adversities tend to initially induce depressive symptoms rather than directly manifesting as somatic conditions[13]. Using the tripartite model, some prior studies revealed that experiencing symptoms of anxiety and depression is an antecedent to the onset of somatic symptoms[21, 22]. Based on the above reasoning, this study proposes that childhood adversity is associated with a higher susceptibility to negative mental health outcomes (e.g., depression and anxiety) in late adolescence, which in turn contributes to a higher prevalence of somatic symptoms. This proposition is supported by increasing evidence, particularly from research on adolescent populations in Western countries[23-25]. For example, [24] found that depression and anxiety symptoms mediated the relationships between family dysfunction during the first 6 years of life and migraine diagnosis in adolescence (ages 14–15). Furthermore, a longitudinal cross-lagged path analysis revealed that anxiety/depression symptoms mediate the concurrent relationships between recent adverse childhood experiences and somatic symptoms at ages 12, 14, and 16[23]. In summary, there is some evidence that anxiety and depression mediate the relationship between ACEs and somatic symptoms in adolescence. Although previous studies have employed diverse methodologies to analyze the impact of childhood adversity on somatic symptoms in late adolescents, as well as the emotional mechanisms underlying this relationship, few have focused on Chinese adolescent populations. Consequently, existing findings may not adequately reflect the reality of this demographic group in China. To address this gap, the present study investigates the long-term effects of childhood adversity (occurring between ages 0–13, i.e., prior to completing elementary school) on somatic symptoms among Chinese high school–aged adolescents, with a specific focus on the mediating role of mental health. This study proposes two research hypotheses : Hypothesis 1: Childhood adversity positively predicts somatic symptoms among high school students. Hypothesis 2: Mental health mediates the relationship between childhood adversity and somatic symptoms in high school students. 2. Methods 2.1 Measurement instrument To assess depressive symptoms, the Patient Health Questionnaire-9 (PHQ-9) was employed, utilizing a four-point Likert scale ranging from 0 ("not at all") to 3 ("nearly every day")[26]. This widely validated instrument captures the frequency and severity of depressive symptoms over the preceding two weeks, with total scores ranging from 0 to 27. Higher scores indicate more severe depressive symptomatology. Anxiety symptoms were assessed using the Generalized Anxiety Disorder 7-item (GAD-7) scale, a widely validated self-report instrument designed to measure the severity of generalized anxiety symptoms[27]. Participants rated the frequency of each symptom over the past two weeks on a four-point Likert scale ranging from 0 ("not at all") to 3 ("nearly every day"). Total scores range from 0 to 21, with higher scores indicating greater severity of anxiety symptoms. Somatic symptoms were assessed using the Somatic Symptom Scale–8 (SSS-8), a concise and validated self-report instrument designed to measure the perceived burden of common somatic symptoms[28]. Participants rated the severity of each symptom (e.g., headaches, trouble sleeping, chest pain or shortness of breath) over the past seven days on a four-point Likert scale ranging from 0 ("not at all bothered") to 3 ("very much bothered"). Total scores range from 0 to 24, with higher scores indicating greater somatic symptom burden. 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[29]. The items assessed the following experiences during primary school: 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, having a family member incarcerated due to illegal behavior, and experiencing 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). 2.2 Participants All participants were recruited from a single high school in Sichuan, China. Prior to the survey, informed written consent was obtained from all respondents or their guardians. At the first wave (W1) of data collection, 476 students completed the baseline assessment, including childhood adversity experiences and somatic symptoms. Seven months later, 449 students took part in the follow-up survey, representing an attrition rate of 5.67%, and somatic symptoms and mental health were measured. Analyses comparing those who dropped out with those who remained in the study showed no significant differences in sociodemographic variables (age, gender, ethnicity, household registration, and number of siblings) or key variables. After adjusting for demographic variables, the two groups did not differ significantly at Wave 1 in childhood adversity (β = -.006, p = .895, R² = 0.029), or somatic symptoms (β = -.052, p = .237, R² = 0.032). These results indicate that attrition had a negligible effect on the findings. Other items surveyed the students' gender, age, household registration, ethnicity, and number of siblings. 3. Results 3.1 Basic characteristics of the valid sample The basic characteristics of the valid sample are presented in Table 1. Table 1 The basic characteristics of the valid sample （ N=449 ） Variables Levels Frequency Percentage Age（M=17.31,SD=1.20） 15 8 1.8 16 137 30.5 17 109 24.3 18 141 31.4 19 54 12.0 Gender Male 235 52.3 Female 214 47.7 Household Registration Urban 204 45.4 Rural 245 54.6 Ethnicity Han 341 75.9 Minority 108 24.1 Number of siblings 0-1 siblings 259 57.7 2-6 siblings 190 42.3 3.2 Tests for common method bias The Harman's single-factor test was conducted to assess common method bias. A total of 32 items measuring depression, anxiety, and somatic symptoms (assessed at Wave 1 and Wave 2) using a four-point Likert scale were included in the analysis. The results showed that the first factor accounted for 37.098% of the total variance, which is below the critical threshold of 40%. This indicates that no single factor explained the majority of the variance, suggesting that common method bias is not a significant concern in this study. 3.3 Descriptive statistics, correlations, and reliability The means, standard deviations, correlations, and Cronbach's alpha coefficients of the key variables are presented in Table 2. Table 2. Means, Standard Deviations, Correlations, and Reliability M SD CHA dep anx SS W1 SS W2 CHA 1.535 1.384 1 dep 6.105 5.356 .481 ** .867 anx 4.987 4.531 .472 ** .788 ** .870 SS W1 5.521 5.022 .497 ** .673 ** .579 ** .847 SS W2 5.920 5.081 .480 ** .566 ** .518 ** .602 ** .844 Note: ** p<0.01 ; CHA = Childhood adversity, SS W1= somatic symptom at wave 1, SS W2= somatic symptom at wave 2. The italicized numbers on the diagonal represent Cronbach's alpha coefficients . Table 2 indicates that all correlation coefficients among the key variables in this study were statistically significant, ranging from 0.45 to 0.80, indicating moderate to strong associations. Furthermore, Cronbach’s alpha values for the measures of depression, anxiety, and somatic symptoms—each assessed using a four-point Likert scale—exceeded 0.80, demonstrating good reliability. 3.4 Results of the structural equation modeling. This study employed Mplus version 8.10 to establish a structural equation model. Mental health was modeled as a latent variable, with its two observed indicators being composite scores of depression and anxiety. Both childhood adversity and somatic symptoms were treated as observed variables and analyzed using composite scores. Firstly, the impact of childhood adversity on somatic symptoms in high school students was estimated using the maximum likelihood method. The saturated model yielded the following fit indices: χ²(0) = 0.000, RMSEA = 0.000 (90% CI: 0.000–0.000), CFI = 1.000, TLI = 1.000, SRMR = 0.000. Path coefficients are presented in Figure 1. As shown in Figure 1, childhood adversity positively predicted somatic symptoms at Wave 1 (β = 0.497, p < 0.01) and also exerted a significant positive effect on somatic symptoms at Wave 2 (β = 0.241, p < 0.01). Thus, Hypothesis 1 of the current study was supported. After incorporating mental health into the model simultaneously, the results are presented in Figure 2. The model fit indices indicated that the hypothesized model fit the data well: χ²(2) = 5.390, p = 0.0675, RMSEA = 0.061 (90% CI: 0.000–0.127), CFI = 0.997, TLI = 0.985, SRMR = 0.010. All indices met the criteria for excellent model fit, suggesting that the theoretical model is acceptable. Subsequently, the mediating effect of mental health at Wave 1 was analyzed. The results are presented in Table 3. Table 3 Mediation effect analysis for symptoms at wave 1 Effect Type Specific Path Standardized Estimate Calculation Process Total Effect CHA→SS W1 0.497 0.173+0.324 Direct Effect CHA → SS W1 0.173 - Indirect Effect CHA → MH → SS W1 0.324 0.524 × 0.619 = 0.324 Notes：Based on STDYX standardized coefficients. CHA = Childhood adversity, MH=mental health, dep=depression, anx=anxiety, SS W1= somatic symptom at wave 1. According to the results presented in Table 3, the proportion of the indirect effect at Wave 1 is 65.2% (i.e., 0.324 / 0.497). This indicates that mental health, measured concurrently with somatic symptoms, accounts for 65.2% of the total effect of childhood adversity on somatic symptoms. Finally, the mediating effect of mental health assessed at Wave 1 on the relationship between childhood adversity and somatic symptoms at Wave 2 was analyzed. The computational procedures are presented in Table 4. Table 4 Analysis of decomposed mediation effects for somatic symptoms at wave 2 Effect Type Specific Path Standardized Estimate Calculation Process Total Effect CHA → SS W2 0.480 0.172+0.308 Direct Effect CHA → SS W2 0.172 - Indirect Effect CHA → SS W2 0.308 0.158+0.098+0.052 Including: CHA → MH → SS W2 0.158 0.524 × 0.301 = 0.158 CHA → MH → SS W1 → SS W2 0.098 0.524 × 0.619 × 0.303 = 0.098 CHA → SS W1 → SS W2 0.052 0.173 × 0.303 = 0.052 Notes：Based on STDYX standardized coefficients. CHA = Childhood adversity, MH=mental health, dep=depression, anx=anxiety, SS W1= somatic symptom at wave 1, SS W2= somatic symptom at wave 2. As shown in Table 4, the total mediating effect of mental health is 0.256 (i.e., 0.158 + 0.098), accounting for 53.3% of the total effect (i.e., 0.256 / 0.480). This indicates that mental health explains 53.3% of the effect of childhood adversity on somatic symptoms measured six months later. In summary, the findings demonstrate that mental health serves as a mediator in the relationship between childhood adversity and somatic symptoms at both time points, with the mediation effect accounting for more than half of the respective total effects—a substantial magnitude of mediation [30] . Thus, the hypotheses proposed in this study are strongly supported. 4. Discussion 4.1 Childhood adversity has positive effect on somatic symptoms This study examined the relationship between childhood adversity and somatic symptoms among high school students, along with the underlying psychological mechanisms. The results from structural equation Model 1 indicated that childhood adversity had significant positive effects on somatic symptoms at both Wave 1 and Wave 2 (see Figure 1). Therefore, Hypothesis 1 was strongly supported, confirming that childhood adversity positively predicts somatic symptoms in high school students. This finding is consistent with previous studies conducted with Western adolescent populations [25, 31]. For example, one study using a sample of adolescents from the Netherlands demonstrated that negative life events before age 13 exerted strong effects on functional somatic symptoms at ages 16 and 19 [25]. The adaptive calibration model of the life history theory posits that early-life adversity calibrates an individual's stress response system, resulting in a physiological pattern characterized by high vigilance yet high physiological cost. This pattern manifests as hyperactivity of the HPA axis, increased sympathetic nervous system arousal, and diminished parasympathetic regulatory function. Although such calibration may be adaptive in the short term, it leads to allostatic load over the long term, contributing to immune dysregulation, chronic inflammation, and accelerated cellular aging. These processes ultimately give rise to various future somatic symptoms, such as chronic pain, fatigue, and digestive disorders[15]. 4.2 The mediating role of mental health Hypothesis 2 of this study proposed that mental health mediates the effect of childhood adversity on somatic symptoms among high school students. The results of structural equation Model 2 fully supported Hypothesis 2, revealing that the mediating effect of mental health accounted for more than 50% of the total effect (see Figure 2, Table 3, and Table 4). This finding is consistent with previous studies involving Western adolescent samples [23, 24]. For instance, a study of adolescents in the United States demonstrated that mental health—measured by depression and anxiety at age 12—fully mediated the effect of life adversity at age 12 on somatic symptoms at age 14; similarly, mental health at age 14 fully mediated the effect of life adversity at age 14 on somatic symptoms at age 16 [23]. The life history theory posits that childhood adversity serves as a critical environmental signal, indicating to the individual that the environment is hazardous and unpredictable. This perception of environmental threat promotes the adoption of a fast life history strategy, which is characterized by heightened anxiety and vigilance—core features that predispose individuals to develop anxiety-related emotional disturbances [32, 33] Moreover, although this fast strategy represents an adaptive response to adversity, individuals following this trajectory often continue to experience a lack of crucial social resources—such as status, dominance, and support—which contributes to recurrent episodes of depressed mood and increases vulnerability to clinical depression [10] . Multiple mechanisms have been proposed to explain how poor mental health contributes to somatic symptoms. One study suggests that direct expression of psychological distress is often stigmatized, whereas reporting physical discomfort serves as a safer and more socially accepted "idiom of distress" that is more likely to elicit support [34]. Other research indicates that depression and anxiety are associated with negative cognitive schemas—such as catastrophizing—which may lead to the misinterpretation and amplification of the subjective severity of somatic sensations [35]. Furthermore, chronic depression and anxiety can induce central sensitization and promote inflammatory responses, thereby lowering pain thresholds and exacerbating the perception of somatic symptoms[36, 37]. 5. Strengths and limitations This study has two main strengths. First, it controlled for the level of somatic symptoms at Time 1 when examining the psychological mechanisms through which childhood adversity influences somatic symptoms across two time points. This approach allows for a more precise estimation of the effect of prior adverse mental health on subsequent somatic symptoms, thereby enhancing the internal validity of the study. Second, this study provided a detailed analysis of the mediating effect of mental health and its proportion of the total effect, which contributes to a deeper understanding of the important role mental health plays in the relationship between childhood adversity and somatic symptoms among high school students. This study also has three limitations. First, although structural equation modeling was used to examine the "effect" of childhood adversity on somatic symptoms in high school students, the findings reflect correlational rather than causal relationships. Second, convenience sampling was employed within a single school, which means the sample may not be representative of the broader high school student population. Therefore, the external validity of the results should be interpreted with caution. Third, to maintain clarity and parsimony in the structural equation model, variables such as gender and household registration (hukou) were not controlled for, despite their potential influence on mental health and somatic symptoms. This omission may have compromised the internal validity of the study. 6. Research significance The theoretical contribution of this study lies in its demonstration of the psychological mechanism through which childhood adversity leads to future somatic symptoms. Specifically, childhood adversity contributes to negative mental health outcomes (such as depression and anxiety symptoms), which in turn gradually lead to the development of various somatic symptoms. The life history theory posits that early-life adversity fosters hypersensitive stress response mechanisms, thereby increasing susceptibility to both psychological issues and somatic symptoms. However, this theory does not explicitly delineate the specific relationship between psychological problems and somatic symptoms following exposure to early adversity. A large-sample study conducted in China indicated that although mental health issues and somatic symptoms are bidirectionally linked in adulthood after early-life adversities, it appeared that such adversities lead to depression first, rather than directly to somatic symptoms [13]. In contrast, the present study demonstrates that childhood adversity can lead to somatic symptoms through the mediation of poor mental health. These findings extend the life history theory and enhance understanding of the relationship between childhood adversity, adolescent mental health, and somatic symptoms. On a practical level, this study contributes to the early prevention of physical and mental health issues among adolescents. As indicated by the findings, childhood adversity is strongly associated with both negative psychological outcomes and somatic symptoms during adolescence (see Table 2 and Figure 1). Therefore, timely psychological support should be provided after adverse experiences to interrupt the development or mitigate the progression of hypersensitive stress response mechanisms, thereby enhancing individual psychological resilience[38, 39]. In this regard, school-based psychological interventions are of great importance [40, 41] . Secondly, given the significant impact of mental health on somatic symptoms, educators in China should adopt an integrated biopsychosocial perspective when supporting adolescents who have experienced childhood adversity. Intervention strategies should incorporate both emotional coping techniques and somatic symptom management to improve overall health outcomes. Third, the government should raise parental awareness about the detrimental effects of early adversity on children’s long-term health, with the aim of preventing the occurrence of childhood adversity and reducing the likelihood of children adopting a fast life history strategy[33] . Declarations Human Ethics and Consent to Participate declarations Prior to the survey, written consent was obtained from all respondents or their guardians. All the participants agreed to take part in the survey. Ethics approval declaration The study was conducted in accordance with the Declaration of Helsinki and received approval and support from the School of teacher education, Xichang University. Consent for publication Not Applicable Availability of data and materials The data that support 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）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). （2）Doctoral Startup Fund in Xichang University，Project Title: "Impact of Early Adversity on Psychological Resilience in College Students"Project ID: YBS2025002 Authors' contributions Xinzhu wang and Kaixian Fu were responsible for paper writing and proof editing, Zhenyu Chen and Yuxia Zhang overseed formal analysis and proof editing, and Zhongyuan Fu, Gaicong Xu, and Junchao Yuan assisted in conducting data investigation, and proof editing. Acknowledgements Not applicable References Zhou, J., et al., Prevalence of depressive symptoms among children and adolescents in China: a systematic review and meta-analysis. 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European Journal of Public Health, 2024. 34 : p. ckae144. 112. Rith-Najarian, L.R., et al., Identifying intervention strategies for preventing the mental health consequences of childhood adversity: A modified Delphi study. Development and Psychopathology, 2021. 33 (2): p. 748-765. Karam, E.G., et al., Universal school-based intervention: personal competence among public school children. European Child & Adolescent Psychiatry, 2025. 3 (35-46). Dewi, E.R., et al., Optimizing Early Childhood Adversity: The Impact of Play-Based Learning and Counselor Competence in Indonesia. SEACE Official Conference Proceedings, 2024. 3 : p. 247-252. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7469405","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":619164917,"identity":"ec8ba8c8-fabc-4d6e-928f-6de5ad6687c2","order_by":0,"name":"xinzhu wang","email":"","orcid":"","institution":"Xichang University","correspondingAuthor":false,"prefix":"","firstName":"xinzhu","middleName":"","lastName":"wang","suffix":""},{"id":619164921,"identity":"accd7bed-e8bc-4339-b8d6-d625a56bbf34","order_by":1,"name":"kaixian fu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYBACNvbGxgcf/9nIMTYcPkCcFj6ew4cNZ7ClGTM3HksgTouchFuaNA/b4UT25jMGRDpMgsdMgocnLYG37czHG28Y7OR0Gwhpke4xtpCQsMmT7Dm72XIOQ7Kx2QFCWmTOGN4wMEgrNpxxdps0D8OBxG0EtUjkGEgkJBxO3H//zTNitaQlSRw4cDixseEMG5FaQIHc2JBmzNhwzNhyjgERfpFvb2x8/LcBHJUPb7ypsJMjqAUFSPAQGTXIWkjVMQpGwSgYBSMCAACxekbfna7toQAAAABJRU5ErkJggg==","orcid":"","institution":"Xichang University","correspondingAuthor":true,"prefix":"","firstName":"kaixian","middleName":"","lastName":"fu","suffix":""},{"id":619164925,"identity":"99e5a725-ccd2-4d37-8cbe-7f5041452ddb","order_by":2,"name":"zhenyu chen","email":"","orcid":"","institution":"Xichang University","correspondingAuthor":false,"prefix":"","firstName":"zhenyu","middleName":"","lastName":"chen","suffix":""},{"id":619164928,"identity":"4fc7bd47-6091-4615-b0f4-d7dfd214cd82","order_by":3,"name":"yuxia zhang","email":"","orcid":"","institution":"Xichang University","correspondingAuthor":false,"prefix":"","firstName":"yuxia","middleName":"","lastName":"zhang","suffix":""},{"id":619164931,"identity":"fee58317-a439-479e-a048-7633fb63bb5f","order_by":4,"name":"zhongyuan fu","email":"","orcid":"","institution":"Xichang University","correspondingAuthor":false,"prefix":"","firstName":"zhongyuan","middleName":"","lastName":"fu","suffix":""},{"id":619164932,"identity":"534cf67e-d891-4d88-b34e-4092e30b8250","order_by":5,"name":"gaicong xu","email":"","orcid":"","institution":"Xichang University","correspondingAuthor":false,"prefix":"","firstName":"gaicong","middleName":"","lastName":"xu","suffix":""},{"id":619164933,"identity":"62772168-7e77-466e-b438-d27742dcd184","order_by":6,"name":"junchao yuan","email":"","orcid":"","institution":"Xichang University","correspondingAuthor":false,"prefix":"","firstName":"junchao","middleName":"","lastName":"yuan","suffix":""}],"badges":[],"createdAt":"2025-08-27 08:23:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7469405/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7469405/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106444303,"identity":"f89b9b34-bc2d-4578-bdac-5e24086eb96c","added_by":"auto","created_at":"2026-04-08 15:15:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":78339,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe effect of Childhood adversity on somatic symptom\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7469405/v1/890d11bf393035b4500de8b4.png"},{"id":106724160,"identity":"d7a6ffc0-2e80-483d-b965-be2d6f36e063","added_by":"auto","created_at":"2026-04-12 18:26:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":107208,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe moderating role of mental health\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7469405/v1/ee6646e44fe5d98b9799344b.png"},{"id":109481516,"identity":"03c11c6c-4fef-4cfb-8950-c8bdc750f4dc","added_by":"auto","created_at":"2026-05-18 15:11:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":397819,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7469405/v1/4678f903-a4c9-4f25-8371-25d7d1da3f53.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Childhood adversity affects somatic symptoms among high school students: the mediation of mental health","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSomatic symptoms refer to physical manifestations\u0026mdash;such as tension headaches, gastrointestinal discomfort, nausea, and back pain\u0026mdash;that lack a clear medical explanation. Somatic symptoms are highly prevalent among Chinese adolescent populations[1-3]，and is associated with poorer mental health, lower academic performance\u0026nbsp;[4, 5], and easily lead to a significant burden on public health[6]. Prior studies have revealed that childhood adversities have a lasting negative impact on somatic symptoms into adulthood. However, to date, few studies have examined the long-term effects of childhood adversities on somatic symptoms and the underlying psychological mechanisms among Chinese adolescents.\u003c/p\u003e\n\u003cp\u003eChildhood adversity refers to a range of negative events and chronic stressors experienced during childhood that may exert enduring effects on an individual\u0026apos;s overall development [7]. Such adversities include, but are not limited to, physical abuse, emotional abuse, sexual abuse, physical neglect, emotional neglect, exposure to domestic violence, parental divorce, parental substance abuse, parental mental illness, or parental incarceration [7, 8]. Childhood adversity is a highly prevalent phenomenon in human societies and profoundly influences an individual\u0026apos;s emotional well-being, physical health, and cognitive functioning [9].\u003c/p\u003e\n\u003cp\u003eBased\u0026nbsp;on the life history theory for psychopathology, exposure to adversity during childhood often promotes the adoption of accelerated life history strategies, thereby elevating the likelihood of disorders associated with such strategies\u0026mdash;including somatic symptom manifestations. More precisely, individuals raised in unstable and adverse environments are inclined to acquire hypersensitive stress response mechanisms. This heightened reactivity may subsequently contribute to a greater susceptibility to physical health issues including somatic symptoms[10, 11]. Based on large-scale U.S. population-based studies, harshness and unpredictability in early childhood demonstrate concurrent effects on physical health\u0026mdash;as reflected by a wide range of physical symptoms in adolescence\u0026mdash;as well as longitudinal effects that persist into young adulthood[12]. Studies based on Chinese adult samples indicate that childhood adversity is closely associated with future somatic symptoms in individuals [13, 14]. For instance，a nationally representative survey revealed that middle-aged and older adults in China who experienced childhood adversities reported significantly more somatic symptoms compared to those with fewer adverse childhood experiences[13]. This study will extend this line of inquiry by examining the psychological mechanisms through which early adversity influences somatic symptoms.\u003c/p\u003e\n\u003cp\u003eAccording 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[15], Such persistent vigilance is a core characteristic of anxiety-related symptoms [16]. Meanwhile，the life history theory proposes that sadness and low mood evolved as beneficial responses to adversity, and that depressive disorder is dysfunctional sadness and low mood[17]. Harsh environments in childhood lead individuals to adopt a faster life history strategy for development, accompanied by mental health issues[12].\u003c/p\u003e\n\u003cp\u003eA prior study suggests that somatic symptoms may be triggered by or give rise to anxiety symptoms[18]. Somatization is a tendency to experiecne and communicate somatic distress in response to psychosocial stress, and it is most often associated with depressie and anxiety disorders[19]. Somatic symptoms are indeed closely related to depression, often presenting as physical complaints that accompany or even dominate the clinical picture[20].\u0026nbsp;Large-scale studies conducted by Chinese researchers have demonstrated that mental and somatic conditions are bidirectionally associated following exposure to childhood adversities. Furthermore, these studies indicate that childhood adversities tend to initially induce depressive symptoms rather than directly manifesting as somatic conditions[13]. Using the tripartite model, some prior studies revealed that experiencing symptoms of anxiety and depression is an antecedent to the onset of somatic symptoms[21, 22].\u003c/p\u003e\n\u003cp\u003eBased on the above reasoning, this study proposes that childhood adversity is associated with a higher susceptibility to negative mental health outcomes (e.g., depression and anxiety) in late adolescence, which in turn contributes to a higher prevalence of somatic symptoms. This proposition is supported by increasing evidence, particularly from research on adolescent populations in Western countries[23-25]. For example, [24] found that depression and anxiety symptoms mediated the relationships between family dysfunction during the first 6 years of life and migraine diagnosis in adolescence (ages 14\u0026ndash;15). Furthermore, a longitudinal cross-lagged path analysis revealed that anxiety/depression symptoms mediate the concurrent relationships between recent adverse childhood experiences and somatic symptoms at ages 12, 14, and 16[23]. In summary, there is some evidence that anxiety and depression mediate the relationship between ACEs and somatic symptoms in adolescence.\u003c/p\u003e\n\u003cp\u003eAlthough previous studies have employed diverse methodologies to analyze the impact of childhood adversity on somatic symptoms in late adolescents, as well as the emotional mechanisms underlying this relationship, few have focused on Chinese adolescent populations. Consequently, existing findings may not adequately reflect the reality of this demographic group in China. To address this gap, the present study investigates the long-term effects of childhood adversity (occurring between ages 0\u0026ndash;13, i.e., prior to completing elementary school) on somatic symptoms among Chinese high school\u0026ndash;aged adolescents, with a specific focus on the mediating role of mental health. This study proposes two research hypotheses\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHypothesis 1: Childhood adversity positively predicts somatic symptoms among high school students.\u003c/p\u003e\n\u003cp\u003eHypothesis 2: Mental health mediates the relationship between childhood adversity and somatic symptoms in high school students.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1\u0026nbsp;\u003c/strong\u003eMeasurement instrument\u003c/p\u003e\n\u003cp\u003eTo assess depressive symptoms, the Patient Health Questionnaire-9 (PHQ-9) was employed, utilizing a four-point Likert scale ranging from 0 (\u0026quot;not at all\u0026quot;) to 3 (\u0026quot;nearly every day\u0026quot;)[26]. This widely validated instrument captures the frequency and severity of depressive symptoms over the preceding two weeks, with total scores ranging from 0 to 27. Higher scores indicate more severe depressive symptomatology.\u003c/p\u003e\n\u003cp\u003eAnxiety symptoms were assessed using the Generalized Anxiety Disorder 7-item (GAD-7) scale, a widely validated self-report instrument designed to measure the severity of generalized anxiety symptoms[27]. Participants rated the frequency of each symptom over the past two weeks on a four-point Likert scale ranging from 0 (\u0026quot;not at all\u0026quot;) to 3 (\u0026quot;nearly every day\u0026quot;). Total scores range from 0 to 21, with higher scores indicating greater severity of anxiety symptoms.\u003c/p\u003e\n\u003cp\u003eSomatic symptoms were assessed using the Somatic Symptom Scale\u0026ndash;8 (SSS-8), a concise and validated self-report instrument designed to measure the perceived burden of common somatic symptoms[28]. Participants rated the severity of each symptom (e.g., headaches, trouble sleeping, chest pain or shortness of breath) over the past seven days on a four-point Likert scale ranging from 0 (\u0026quot;not at all bothered\u0026quot;) to 3 (\u0026quot;very much bothered\u0026quot;). Total scores range from 0 to 24, with higher scores indicating greater somatic symptom burden.\u003c/p\u003e\n\u003cp\u003eAn 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[29]. The items assessed the following experiences during primary school: 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, having a family member incarcerated due to illegal behavior, and experiencing 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).\u003c/p\u003e\n\u003cp\u003e2.2 Participants\u003c/p\u003e\n\u003cp\u003eAll participants were recruited from a single high school in Sichuan, China. Prior to the survey, informed written consent was obtained from all respondents or their guardians. At the first wave (W1) of data collection, 476 students completed the baseline assessment, including childhood adversity experiences and somatic symptoms. Seven months later, 449 students took part in the follow-up survey, representing an attrition rate of 5.67%, and somatic symptoms and mental health were measured. Analyses comparing those who dropped out with those who remained in the study showed no significant differences in sociodemographic variables (age, gender, ethnicity, household registration, and number of siblings) or key variables. After adjusting for demographic variables, the two groups did not differ significantly at Wave 1 in childhood adversity (\u0026beta; = -.006, p = .895, R\u0026sup2; = 0.029), or somatic symptoms (\u0026beta; = -.052, p = .237, R\u0026sup2; = 0.032). These results indicate that attrition had a negligible effect on the findings.\u003c/p\u003e\n\u003cp\u003eOther items surveyed the students\u0026apos; gender, age, household registration, ethnicity, and number of siblings.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e3.1 Basic characteristics of the valid sample\u003c/p\u003e\n\u003cp\u003eThe basic characteristics of the valid sample are presented in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 The basic characteristics of the valid sample\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003eN=449\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"451\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevels\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" rowspan=\"5\" style=\"width: 151px;\"\u003e\n \u003cp\u003eAge（M=17.31,SD=1.20）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 105px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 105px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e30.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 105px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e24.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 105px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e31.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 105px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 105px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e52.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 105px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e47.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003eHousehold Registration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e45.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e245\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e54.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003eEthnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cem\u003eHan\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e341\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e75.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 105px;\"\u003e\n \u003cp\u003eMinority\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003eNumber of siblings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0-1 siblings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e57.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2-6 siblings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 97px;\"\u003e\n \u003cp\u003e42.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e3.2 Tests for common method bias\u003c/p\u003e\n\u003cp\u003eThe Harman\u0026apos;s single-factor test was conducted to assess common method bias.\u0026nbsp;A total of 32 items measuring depression, anxiety, and somatic symptoms (assessed at Wave 1 and Wave 2) using a four-point Likert scale were included in the analysis. The results showed that the first factor accounted for 37.098% of the total variance, which is below the critical threshold of 40%. This indicates that no single factor explained the majority of the variance, suggesting that common method bias is not a significant concern in this study.\u003c/p\u003e\n\u003cp\u003e3.3\u0026nbsp;Descriptive statistics, correlations, and reliability\u003c/p\u003e\n\u003cp\u003eThe means, standard deviations, correlations, and Cronbach\u0026apos;s alpha coefficients of the key variables are presented in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Means, Standard Deviations, Correlations, and Reliability\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"539\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 66px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 57px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003eCHA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003edep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003eanx\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 58px;\"\u003e\n \u003cp\u003eSS W1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 66px;\"\u003e\n \u003cp\u003eSS W2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003eCHA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 58px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003edep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 57px;\"\u003e\n \u003cp\u003e5.356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003e.481\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cem\u003e.867\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 58px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003eanx\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4.987\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 57px;\"\u003e\n \u003cp\u003e4.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003e.472\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003e.788\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cem\u003e.870\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 58px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003eSS W1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.521\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 57px;\"\u003e\n \u003cp\u003e5.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003e.497\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003e.673\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003e.579\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cem\u003e.847\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003eSS W2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.920\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 57px;\"\u003e\n \u003cp\u003e5.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003e.480\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003e.566\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003e.518\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 58px;\"\u003e\n \u003cp\u003e.602\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e.844\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eNote: \u003csup\u003e**\u003c/sup\u003e\u003c/strong\u003ep\u0026lt;0.01\u003cstrong\u003e;\u0026nbsp;\u003c/strong\u003eCHA = Childhood adversity, SS W1= somatic symptom at wave 1, SS W2= somatic symptom at wave 2. The italicized numbers on the diagonal represent Cronbach\u0026apos;s alpha coefficients\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 indicates that all correlation coefficients among the key variables in this study were statistically significant, ranging from 0.45 to 0.80, indicating moderate to strong associations.\u003c/p\u003e\n\u003cp\u003eFurthermore, Cronbach\u0026rsquo;s alpha values for the measures of depression, anxiety, and somatic symptoms\u0026mdash;each assessed using a four-point Likert scale\u0026mdash;exceeded 0.80, demonstrating good reliability.\u003c/p\u003e\n\u003cp\u003e3.4\u0026nbsp;Results of the structural equation modeling.\u003c/p\u003e\n\u003cp\u003eThis study employed Mplus version 8.10 to establish a structural equation model. Mental health was modeled as a latent variable, with its two observed indicators being composite scores of depression and anxiety. Both childhood adversity and somatic symptoms were treated as observed variables and analyzed using composite scores.\u003c/p\u003e\n\u003cp\u003eFirstly, the impact of childhood adversity on somatic symptoms in high school students was estimated using the maximum likelihood method. The saturated model yielded the following fit indices: \u0026chi;\u0026sup2;(0) = 0.000, RMSEA = 0.000 (90% CI: 0.000\u0026ndash;0.000), CFI = 1.000, TLI = 1.000, SRMR = 0.000. Path coefficients are presented in Figure 1.\u003c/p\u003e\n\u003cp\u003eAs shown in Figure 1, childhood adversity positively predicted somatic symptoms at Wave 1 (\u0026beta; = 0.497, p \u0026lt; 0.01) and also exerted a significant positive effect on somatic symptoms at Wave 2 (\u0026beta; = 0.241, p \u0026lt; 0.01). Thus, Hypothesis 1 of the current study was supported.\u003c/p\u003e\n\u003cp\u003eAfter incorporating mental health into the model simultaneously, the results are presented in Figure 2.\u003c/p\u003e\n\u003cp\u003eThe model fit indices indicated that the hypothesized model fit the data well: \u0026chi;\u0026sup2;(2) = 5.390, p = 0.0675, RMSEA = 0.061 (90% CI: 0.000\u0026ndash;0.127), CFI = 0.997, TLI = 0.985, SRMR = 0.010. All indices met the criteria for excellent model fit, suggesting that the theoretical model is acceptable.\u003c/p\u003e\n\u003cp\u003eSubsequently, the mediating effect of mental health at Wave 1 was analyzed. The results are presented in Table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Mediation effect analysis for symptoms at wave 1\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"524\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 108px;\"\u003e\n \u003cp\u003eEffect Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 178px;\"\u003e\n \u003cp\u003eSpecific Path\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 88px;\"\u003e\n \u003cp\u003eStandardized Estimate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003eCalculation Process\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 108px;\"\u003e\n \u003cp\u003eTotal Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 178px;\"\u003e\n \u003cp\u003eCHA\u0026rarr;SS W1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.173+0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 108px;\"\u003e\n \u003cp\u003eDirect Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 178px;\"\u003e\n \u003cp\u003eCHA \u0026rarr; SS W1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 108px;\"\u003e\n \u003cp\u003eIndirect Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 178px;\"\u003e\n \u003cp\u003eCHA \u0026rarr; MH \u0026rarr; SS W1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.524 \u0026times; 0.619 = 0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNotes：Based on STDYX standardized coefficients. CHA = Childhood adversity, MH=mental health, dep=depression, anx=anxiety, SS W1= somatic symptom at wave 1.\u003c/p\u003e\n\u003cp\u003eAccording to the results presented in Table 3, the proportion of the indirect effect at Wave 1 is 65.2% (i.e., 0.324 / 0.497). This indicates that mental health, measured concurrently with somatic symptoms, accounts for 65.2% of the total effect of childhood adversity on somatic symptoms.\u003c/p\u003e\n\u003cp\u003eFinally, the mediating effect of mental health assessed at Wave 1 on the relationship between childhood adversity and somatic symptoms at Wave 2 was analyzed. The computational procedures are presented in Table 4.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Analysis of decomposed mediation effects for somatic symptoms at wave 2\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"558\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003eEffect Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 180px;\"\u003e\n \u003cp\u003eSpecific Path\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003eStandardized Estimate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 161px;\"\u003e\n \u003cp\u003eCalculation Process\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003eTotal Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCHA \u0026rarr; SS W2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.480\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.172+0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003eDirect Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCHA \u0026rarr; SS W2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 161px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003eIndirect Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCHA \u0026rarr; SS W2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.158+0.098+0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" rowspan=\"3\" style=\"width: 104px;\"\u003e\n \u003cp\u003eIncluding:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCHA \u0026rarr; MH \u0026rarr; SS W2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.524 \u0026times; 0.301 = 0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCHA \u0026rarr; MH \u0026rarr; SS W1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u0026rarr; SS W2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.524 \u0026times; 0.619 \u0026times; 0.303 = 0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCHA \u0026rarr; SS W1 \u0026rarr; SS W2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.173 \u0026times; 0.303 = 0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNotes：Based on STDYX standardized coefficients. CHA = Childhood adversity, MH=mental health, dep=depression, anx=anxiety, SS W1= somatic symptom at wave 1, SS W2= somatic symptom at wave 2.\u003c/p\u003e\n\u003cp\u003eAs shown in Table 4, the total mediating effect of mental health is 0.256 (i.e., 0.158 + 0.098), accounting for 53.3% of the total effect (i.e., 0.256 / 0.480). This indicates that mental health explains 53.3% of the effect of childhood adversity on somatic symptoms measured six months later.\u003c/p\u003e\n\u003cp\u003eIn summary, the findings demonstrate that mental health serves as a mediator in the relationship between childhood adversity and somatic symptoms at both time points, with the mediation effect accounting for more than half of the respective total effects\u0026mdash;a substantial magnitude of mediation\u003cstrong\u003e[30]\u003c/strong\u003e. Thus, the hypotheses proposed in this study are strongly supported.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e4.1 Childhood adversity has positive effect on somatic symptoms\u003c/p\u003e\n\u003cp\u003eThis study examined the relationship between childhood adversity and somatic symptoms among high school students, along with the underlying psychological mechanisms. The results from structural equation Model 1 indicated that childhood adversity had significant positive effects on somatic symptoms at both Wave 1 and Wave 2 (see Figure 1). Therefore, Hypothesis 1 was strongly supported, confirming that childhood adversity positively predicts somatic symptoms in high school students. This finding is consistent with previous studies conducted with Western adolescent populations\u0026nbsp;[25, 31]. For example, one study using a sample of adolescents from the Netherlands demonstrated that negative life events before age 13 exerted strong effects on functional somatic symptoms at ages 16 and 19 [25].\u003c/p\u003e\n\u003cp\u003eThe adaptive calibration model of the life history theory posits that early-life adversity calibrates an individual\u0026apos;s stress response system, resulting in a physiological pattern characterized by high vigilance yet high physiological cost. This pattern manifests as hyperactivity of the HPA axis, increased sympathetic nervous system arousal, and diminished parasympathetic regulatory function. Although such calibration may be adaptive in the short term, it leads to allostatic load over the long term, contributing to immune dysregulation, chronic inflammation, and accelerated cellular aging. These processes ultimately give rise to various future somatic symptoms, such as chronic pain, fatigue, and digestive disorders[15].\u003c/p\u003e\n\u003cp\u003e4.2 The mediating role of mental health\u003c/p\u003e\n\u003cp\u003eHypothesis 2 of this study proposed that mental health mediates the effect of childhood adversity on somatic symptoms among high school students. The results of structural equation Model 2 fully supported Hypothesis 2, revealing that the mediating effect of mental health accounted for more than 50% of the total effect (see Figure 2, Table 3, and Table 4). This finding is consistent with previous studies involving Western adolescent samples\u0026nbsp;[23, 24]. For instance, a study of adolescents in the United States demonstrated that mental health\u0026mdash;measured by depression and anxiety at age 12\u0026mdash;fully mediated the effect of life adversity at age 12 on somatic symptoms at age 14; similarly, mental health at age 14 fully mediated the effect of life adversity at age 14 on somatic symptoms at age 16 [23].\u003c/p\u003e\n\u003cp\u003eThe life history theory posits that childhood adversity serves as a critical environmental signal, indicating to the individual that the environment is hazardous and unpredictable. This perception of environmental threat promotes the adoption of a fast life history strategy, which is characterized by heightened anxiety and vigilance\u0026mdash;core features that predispose individuals to develop anxiety-related emotional disturbances\u003cstrong\u003e[32, 33]\u003c/strong\u003e Moreover, although this fast strategy represents an adaptive response to adversity, individuals following this trajectory often continue to experience a lack of crucial social resources\u0026mdash;such as status, dominance, and support\u0026mdash;which contributes to recurrent episodes of depressed mood and increases vulnerability to clinical depression\u003cstrong\u003e[10]\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eMultiple mechanisms have been proposed to explain how poor mental health contributes to somatic symptoms. One study suggests that direct expression of psychological distress is often stigmatized, whereas reporting physical discomfort serves as a safer and more socially accepted \u0026quot;idiom of distress\u0026quot; that is more likely to elicit support [34]. Other research indicates that depression and anxiety are associated with negative cognitive schemas\u0026mdash;such as catastrophizing\u0026mdash;which may lead to the misinterpretation and amplification of the subjective severity of somatic sensations [35]. Furthermore, chronic depression and anxiety can induce central sensitization and promote inflammatory responses, thereby lowering pain thresholds and exacerbating the perception of somatic symptoms[36, 37].\u003c/p\u003e"},{"header":"5. Strengths and limitations","content":"\u003cp\u003eThis study has two main strengths. First, it controlled for the level of somatic symptoms at Time 1 when examining the psychological mechanisms through which childhood adversity influences somatic symptoms across two time points. This approach allows for a more precise estimation of the effect of prior adverse mental health on subsequent somatic symptoms, thereby enhancing the internal validity of the study. Second, this study provided a detailed analysis of the mediating effect of mental health and its proportion of the total effect, which contributes to a deeper understanding of the important role mental health plays in the relationship between childhood adversity and somatic symptoms among high school students.\u003c/p\u003e\n\u003cp\u003eThis study also has three limitations. First, although structural equation modeling was used to examine the \u0026quot;effect\u0026quot; of childhood adversity on somatic symptoms in high school students, the findings reflect correlational rather than causal relationships. Second, convenience sampling was employed within a single school, which means the sample may not be representative of the broader high school student population. Therefore, the external validity of the results should be interpreted with caution. Third, to maintain clarity and parsimony in the structural equation model, variables such as gender and household registration (hukou) were not controlled for, despite their potential influence on mental health and somatic symptoms. This omission may have compromised the internal validity of the study.\u003c/p\u003e"},{"header":"6. Research significance","content":"\u003cp\u003eThe theoretical contribution of this study lies in its demonstration of the psychological mechanism through which childhood adversity leads to future somatic symptoms. Specifically, childhood adversity contributes to negative mental health outcomes (such as depression and anxiety symptoms), which in turn gradually lead to the development of various somatic symptoms. The life history theory posits that early-life adversity fosters hypersensitive stress response mechanisms, thereby increasing susceptibility to both psychological issues and somatic symptoms. However, this theory does not explicitly delineate the specific relationship between psychological problems and somatic symptoms following exposure to early adversity. A large-sample study conducted in China indicated that although mental health issues and somatic symptoms are bidirectionally linked in adulthood after early-life adversities, it appeared that such adversities lead to depression first, rather than directly to somatic symptoms\u0026nbsp;[13]. In contrast, the present study demonstrates that childhood adversity can lead to somatic symptoms through the mediation of poor mental health. These findings extend the life history theory and enhance understanding of the relationship between childhood adversity, adolescent mental health, and somatic symptoms.\u003c/p\u003e\n\u003cp\u003eOn a practical level, this study contributes to the early prevention of physical and mental health issues among adolescents. As indicated by the findings, childhood adversity is strongly associated with both negative psychological outcomes and somatic symptoms during adolescence (see Table 2 and Figure 1). Therefore, timely psychological support should be provided after adverse experiences to interrupt the development or mitigate the progression of hypersensitive stress response mechanisms, thereby enhancing individual psychological resilience[38, 39].\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eIn this regard, school-based psychological interventions are of great importance [40, 41]\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eSecondly, given the significant impact of mental health on somatic symptoms, educators in China should adopt an integrated biopsychosocial perspective when supporting adolescents who have experienced childhood adversity. Intervention strategies should incorporate both emotional coping techniques and somatic symptom management to improve overall health outcomes. Third, the government should raise parental awareness about the detrimental effects of early adversity on children\u0026rsquo;s long-term health, with the aim of preventing the occurrence of childhood adversity and reducing the likelihood of children adopting a fast life history strategy[33]\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrior to the survey, written consent was obtained from all respondents or their guardians. All the participants agreed to take part in the survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki and received approval and support from the School of teacher education, Xichang University.\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 data that support 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）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（2）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\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXinzhu wang and Kaixian Fu were responsible for paper writing and proof editing, Zhenyu Chen and Yuxia Zhang overseed formal analysis and proof editing, and Zhongyuan Fu, Gaicong Xu, and Junchao Yuan assisted in conducting data investigation, and proof editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZhou, J., et al., \u003cem\u003ePrevalence of depressive symptoms among children and adolescents in China: a systematic review and meta-analysis.\u003c/em\u003e Child and Adolescent Psychiatry and Mental Health, 2024. \u003cstrong\u003e18\u003c/strong\u003e(1): p. 150.\u003c/li\u003e\n\u003cli\u003eJi, Y., et al., \u003cem\u003eAssociations between somatic symptoms and suicidal behavior: a cohort study in Chinese adolescents.\u003c/em\u003e BMC psychology, 2025. \u003cstrong\u003e13\u003c/strong\u003e(1): p. 788.\u003c/li\u003e\n\u003cli\u003ejinqi, C., \u003cem\u003eChildhood Physical and Emotional Abuse Experiences Among 391 College Students and Their Impact on Mental Health.\u003c/em\u003e Chinese Journal of School Doctor, 2005. \u003cstrong\u003e19\u003c/strong\u003e(04): p. 341-344.\u003c/li\u003e\n\u003cli\u003eVoerman, J.S., et al., \u003cem\u003ePain is Associated With Poorer Grades, Reduced Emotional Well-Being, and Attention Problems in Adolescents.\u003c/em\u003e The Clinical Journal of Pain, 2017. \u003cstrong\u003e33\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eZhang, W. and J. 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Scientific evidence for central sensitisation in chronic fatigue syndrome.\u003c/em\u003e European journal of clinical investigation, 2012. \u003cstrong\u003e42\u003c/strong\u003e(2): p. 203-212.\u003c/li\u003e\n\u003cli\u003eWalker, A.K., et al., \u003cem\u003eNeuroinflammation and comorbidity of pain and depression.\u003c/em\u003e Pharmacological Reviews, 2014. \u003cstrong\u003e66\u003c/strong\u003e(1): p. 80-101.\u003c/li\u003e\n\u003cli\u003eAdjei, N., et al., \u003cem\u003eHow does family support mitigate the impact of childhood adversity on adolescent mental health?\u003c/em\u003e European Journal of Public Health, 2024. \u003cstrong\u003e34\u003c/strong\u003e: p. ckae144. 112.\u003c/li\u003e\n\u003cli\u003eRith-Najarian, L.R., et al., \u003cem\u003eIdentifying intervention strategies for preventing the mental health consequences of childhood adversity: A modified Delphi study.\u003c/em\u003e Development and Psychopathology, 2021. \u003cstrong\u003e33\u003c/strong\u003e(2): p. 748-765.\u003c/li\u003e\n\u003cli\u003eKaram, E.G., et al., \u003cem\u003eUniversal school-based intervention: personal competence among public school children.\u003c/em\u003e European Child \u0026amp; Adolescent Psychiatry, 2025. \u003cstrong\u003e3\u003c/strong\u003e(35-46).\u003c/li\u003e\n\u003cli\u003eDewi, E.R., et al., \u003cem\u003eOptimizing Early Childhood Adversity: The Impact of Play-Based Learning and Counselor Competence in Indonesia.\u003c/em\u003e SEACE Official Conference Proceedings, 2024. \u003cstrong\u003e3\u003c/strong\u003e: p. 247-252.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Childhood adversity, Somatic symptoms, High school students, Life history theory, Mediating effect","lastPublishedDoi":"10.21203/rs.3.rs-7469405/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7469405/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"This study examined the impact of childhood adversity (CHA, from birth to elementary school) on somatic symptoms (SS) among high school students, as well as the mediating effect of mental health (MH). A total of 449 high school students (mean age = 17.31 years) were surveyed. CHA and SS were measured at Wave 1, and depression, anxiety, and SS were assessed at Wave 2, seven months later. Structural equation modeling revealed that CHA significantly influenced SS in high school students, and MH mediated the relationship between CHA and SS. The mediating effect of MH accounted for more than 50% of the total effect of CHA on SS at both Wave 1 and Wave 2. This study enriches the life history theory, deepens the understanding of the relationship between CHA, adolescent MH, and SS, and contributes to the prevention of physical and mental health issues among adolescents.","manuscriptTitle":"Childhood adversity affects somatic symptoms among high school students: the mediation of mental health","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-08 15:14:58","doi":"10.21203/rs.3.rs-7469405/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"092e4e11-8b2f-46ee-b761-96739b7e45ba","owner":[],"postedDate":"April 8th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-18T14:59:18+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":65887095,"name":"Health sciences/Health care"},{"id":65887096,"name":"Biological sciences/Psychology"},{"id":65887097,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2026-05-18T15:11:08+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-08 15:14:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7469405","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7469405","identity":"rs-7469405","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}