Wielaard Ilse, Hoyer Mathijs, Rhebergen Didi, Stek Max L, Comijs Hannie C
GGZ inGeest/Department of Psychiatry and Amsterdam Public Health Research Institute, Department of Mental Health, VU University Medical Centre, Amsterdam, The Netherlands.
Int J Geriatr Psychiatry. 2018 Mar;33(3):537-545. doi: 10.1002/gps.4828. Epub 2018 Jan 10.
Childhood abuse makes people vulnerable to developing depression, even in late life. Psychosocial factors that are common in late life, such as loneliness or lack of a partner, may explain this association. Our aim was to investigate whether the association between childhood abuse and depression in older adults can be explained by psychosocial factors.
Cross-sectional data were derived from the Netherlands Study of Depression in Older Persons (aged 60-93), including 132 without lifetime depression, 242 persons with an early-onset depression (<60 years), and 125 with a late-onset (≥60 years) depression. Childhood abuse (yes/no) and a frequency-based childhood abuse index were included. Multinomial regression and multivariable mediation analyses were used to examine the association between childhood abuse and the onset of depression, and the influence of loneliness, social network, and partner status.
Multinomial regression analyses showed a significant association between childhood abuse and the childhood abuse index with early- and late-onset depression. Multivariable mediation analyses showed that the association between childhood abuse and early-onset depression was partly mediated by social network size and loneliness. This was particularly present for emotional neglect and psychological abuse, but not for physical and sexual abuse. No psychosocial mediators were found for the association between childhood abuse and late-onset depression.
A smaller social network and feelings of loneliness mediate the association between childhood abuse and early-onset depression in older adults. Our findings show the importance of detecting childhood abuse as well as the age at depression onset and mapping of relevant psychosocial factors in the treatment of late-life depression.
童年期受虐会使人易患抑郁症，即使在晚年也是如此。晚年常见的心理社会因素，如孤独或缺乏伴侣，可能解释了这种关联。我们的目的是调查老年人童年期受虐与抑郁症之间的关联是否可由心理社会因素来解释。
横断面数据来自荷兰老年人抑郁症研究（年龄在60 - 93岁之间），包括132名无终生抑郁症患者、242名早发性抑郁症患者（<60岁）和125名晚发性抑郁症患者（≥60岁）。纳入童年期受虐情况（是/否）以及基于频率的童年期受虐指数。采用多项回归和多变量中介分析来检验童年期受虐与抑郁症发病之间的关联，以及孤独感、社交网络和伴侣状况的影响。
多项回归分析显示童年期受虐及童年期受虐指数与早发性和晚发性抑郁症之间存在显著关联。多变量中介分析表明，童年期受虐与早发性抑郁症之间的关联部分由社交网络规模和孤独感介导。这在情感忽视和心理虐待方面尤为明显，但在身体虐待和性虐待方面并非如此。未发现童年期受虐与晚发性抑郁症之间存在心理社会中介因素。
较小的社交网络和孤独感介导了老年人童年期受虐与早发性抑郁症之间的关联。我们的研究结果表明，在治疗晚年抑郁症时，检测童年期受虐情况以及抑郁症发病年龄并梳理相关心理社会因素具有重要意义。
