Exploring the relation between childhood adversity and diabetes medication adherence: a cross-sectional study

Abstract

Adverse Childhood Experiences (ACE) are associated with poor health outcomes, but their effect on the medication adherence of patients with type 2 diabetes (T2DM) remains unclear. This study aimed to assess the relation between ACE and medication adherence, while also exploring whether the association between ACE and medication adherence persisted after adjustment for psychopathological symptoms. This cross-sectional study included 50 adults with type 2 diabetes mellitus recruited from the outpatient endocrinology clinic of Centro Hospitalar e Universitário São João and from community-based settings. Participants completed validated self-report questionnaires, including the Childhood Trauma Questionnaire-Short Form (CTQ-SF) for ACE assessment, the Brief Symptom Inventory (BSI) for psychopathological symptoms evaluation, and the Medication Adherence Scale (MAS). Physical activity levels were assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Spearman’s correlation was used to examine associations between these variables. Partial correlation analysis was performed to assess whether psychopathological symptoms influenced the relation between ACE and adherence. Childhood sexual abuse correlated with lower adherence (ρ = -0.382, p = 0.006), while psychopathology (Global Severity Index (GSI)) was weakly associated with lower adherence (ρ = -0.297, p = 0.037). Among the dimensions of BSI, hostility showed a moderate negative correlation with adherence (ρ = -0.377, p = 0.007). No significant associations were found between ACE, GSI, and physical activity levels. Partial correlation analysis revealed that the association between childhood sexual abuse and adherence strengthened after adjusting for the GSI of BSI (ρ = -0.686, p < 0.001). Childhood sexual abuse was associated with lower self-reported medication adherence, and this association remained after adjustment for overall psychological distress. Integrating trauma-informed care into diabetes management may help address adherence barriers. Larger longitudinal studies are needed to clarify mechanisms and guide interventions.