Characterization and validation of electronic medical record data for pharmacoepidemiologic research.

This study highlights an important pathway through which childhood abuse affects mental health in adulthood by identifying alexisomia – difficulties in recognizing and interpreting bodily and emotional signals – as a key mediating factor. By clarifying this mechanism, the findings go beyond documenting associations and help explain how early trauma translates into higher levels of depression and stress later in life. The results have meaningful implications for clinical practice. They suggest that mental health problems linked to childhood abuse are not only emotional in nature but also involve disrupted mind–body awareness. Interventions that strengthen emotional and physical awareness, such as mindfulness-based or body-focused approaches, may therefore complement traditional psychological treatments and improve outcomes for individuals with trauma histories. At a broader level, this study provides locally relevant evidence from a Lebanese adult population, a context marked by multiple stressors and limited mental health resources. The findings support the adoption of trauma-informed and culturally sensitive care models and underscore the value of preventive and early interventions targeting awareness and coping. Overall, this research contributes to a more integrative understanding of mental health by linking early adversity, bodily awareness and psychological well-being. With their growing prevalence (Hoying et al., ; Dagher et al., ), depression and stress are two major public health challenges associated with substantial functional impairment (Tenk et al., ; Gutiérrez-Rojas et al., ; Maier et al., ; WHO, ). Depression, as defined by the WHO, is a persistent low mood, anhedonia and/or diminished interest in activities, leading to significant impairments in daily functioning (WHO, ). Stress, on the other hand, is a multifaceted phenomenon often described as a state of mental tension or worry caused by adverse circumstances (WHO, ). Conceptually, stress arises when environmental demands exceed an individual’s capacity to cope, posing a threat to well-being (Mathur et al., ). Both conditions share overlapping risk factors and mechanisms (Hoying et al., ). Because of these shared mechanisms, studying depression and stress together is relevant for their interconnected nature. A key shared risk factor for both depression and stress is exposure to violence or trauma, particularly during the critical developmental period (Ranasinghe et al., ; Hoying et al., ). Childhood abuse has repeatedly been associated with heightened depression and stress levels in adults (Gutiérrez-Rojas et al., ; Humphreys et al., ; Thurston et al., ). Childhood abuse, defined as any harmful mistreatment of individuals under 18 years of age that causes physical or psychological harm (WHO, ), is a well-documented risk factor for both depression and stress. Globally, an estimated one billion children endure abuse annually (Hillis et al., ; El Zouki et al., ), which falls into four main categories: physical, sexual, emotional abuse and neglect (WHO, ). All of these forms are associated with a series of adverse effects in adulthood, including severe psychological distress (Thurston et al., ). They disrupt emotional and cognitive development, increasing vulnerability to mood disorders and chronic stress responses in adulthood (Lang et al., ). The link between childhood abuse and depression and stress is well-established in the literature (Li et al., ). Systematic reviews (Li et al., ), meta-analyses (Humphreys et al., ; Mandelli et al., ; Watters et al., ) and both retrospective (Berber Çelik and Odacı, ) and longitudinal studies (Thurston et al., ) demonstrated a strong association between childhood abuse and the risk of depression over the lifespan. A meta-analysis including 184 studies and a total of 255 effect sizes demonstrated that individuals who experienced childhood abuse are 2.66–3.73 times more prone to developing depression, with emotional abuse showing the strongest predictive value for depression severity compared to physical or sexual abuse (Nelson et al., ). In survivors, this often manifests as earlier onset of depression, recurrent episodes and resistance to treatment (Humphreys et al., ).