Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
Department of Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.
J Affect Disord. 2023 Nov 1;340:711-718. doi: 10.1016/j.jad.2023.08.082. Epub 2023 Aug 18.
Limited research has simultaneously examined the link between adverse childhood experiences (ACEs), short sleep duration, and depressive symptoms among middle-aged or older Chinese adults. This study aims to investigate the association between ACEs and later-life depressive symptoms, and to examine the mediating role of short sleep duration (<6 h/night) in this association.
Data of 11,452 participants aged ≥45 years were obtained from the China Health and Retirement Longitudinal Study. Information on ACEs, depressive symptoms, and sleep duration were reported via questionnaires. The mediating effect of short sleep duration in the association between ACEs and depressive symptoms was examined by Baron and Kenny's causal steps method and Karlson/Holm/Breen (KHB) method.
Compared to non-exposed group, exposure to ACEs was significantly associated with increased odds of depressive symptoms in a dose-response pattern. The odds ratio of depressive symptoms increased from 1.27 (95 % CI: 1.11-1.46) for one ACE to 3.38 (95 % CI: 2.92-3.90) for ≥4 ACEs. The KHB method identified significant mediating role of short sleep duration in the association between experiencing three or more ACEs and depressive symptoms, with the proportional mediation estimated at 8.96 % and 8.85 % for the groups with 3 ACEs and ≥4 ACEs, respectively. The results were consistent across genders and gender did not moderate these associations.
The cross-sectional design limited the ability to make causal inference.
ACEs were positively associated with depressive symptoms, and short sleep duration partially mediated this association. Promoting optimal sleep duration among ACE-exposed individuals might improve their mental health.
有限的研究同时考察了不良童年经历（ACEs）、睡眠时间短和中老年中国人抑郁症状之间的联系。本研究旨在探讨 ACEs 与晚年抑郁症状之间的关联，并检验短睡眠时间（<6 小时/晚）在这一关联中的中介作用。
本研究数据来自中国健康与退休纵向研究，共纳入了 11452 名年龄≥45 岁的参与者。通过问卷调查收集 ACEs、抑郁症状和睡眠持续时间的信息。采用 Baron 和 Kenny 的因果步骤法和 Karlson/Holm/Breen（KHB）法检验短睡眠时间在 ACEs 与抑郁症状之间的中介作用。
与未暴露组相比，ACEs 暴露与抑郁症状呈剂量-反应关系，发生 ACEs 的数量越多，抑郁症状的发生风险越高。发生一个 ACE 的抑郁症状发生比为 1.27（95%CI：1.11-1.46），发生≥4 个 ACE 的抑郁症状发生比为 3.38（95%CI：2.92-3.90）。KHB 法发现，短睡眠时间在经历 3 个或更多 ACEs 与抑郁症状之间的关系中具有显著的中介作用，对于经历 3 个 ACEs 和≥4 个 ACEs 的个体，比例中介效应估计值分别为 8.96%和 8.85%。这些结果在不同性别中均一致，且性别未调节这些关联。
横断面设计限制了因果推断的能力。
ACEs 与抑郁症状呈正相关，短睡眠时间部分介导了这种关联。在 ACEs 暴露个体中促进最佳睡眠时间可能会改善他们的心理健康。
