Bidirectional mediation of psychological distress and food addiction influenced by childhood trauma among adolescents

Background: This study aims to explore the relationship between childhood trauma, psychological distress, and food addiction in adolescents. Methods: The sample comprised 4560 adolescents (46.67 % females) aged 12-19 years (15.21 +/- 1.75) who participated in the School-based Evaluation Advancing Response for Child Health (SEARCH) survey, a mixed longitudinal cohort study in Jiangsu, China. Bidirectional mediation was used to assess the interplay among childhood trauma, psychological distress, and food addiction derived from a self-report survey. Results: Among participants, 29.67 % reported experiencing at least one type of trauma during childhood, and 2.80 % exhibited significant symptoms of food addiction. The prevalence of depression, anxiety, and stress among participants were 32.85 %, 47.52 %, and 24.80 %, respectively. Emotional neglect (OR = 2.12 [1.44-3.14]), emotional abuse (OR = 5.77 [3.96-8.41]), physical neglect (OR = 1.73 [1.17-2.56]), and physical abuse (OR = 3.53 [2.26-5.52]) had a direct positive predictive effect on food addiction. Trend analyses showed that more types of childhood traumas, and higher levels of depression, anxiety, and stress were significantly associated with higher food addiction incidence. Bidirectional mediation analysis identified that both psychological distress and food addiction mediated their respective relationships with childhood trauma. The mediating effect of psychological distress was larger than that of food addiction. Limitations: The study was limited by the use of self-reported cross-sectional data. Conclusion: This study indicated a bidirectional mediation between psychological distress and food addiction in adolescents, within the context of childhood trauma. The effect size of the forward mediator was larger than the reverse mediator, which may guide future treatments.