Prisma Health, Greer, SC, USA.
Saint Louis University School of Medicine, St. Louis, MO, USA.
Prev Med. 2024 Apr;181:107921. doi: 10.1016/j.ypmed.2024.107921. Epub 2024 Feb 27.
This study aimed to assess the association between number of Adverse Childhood Experiences (ACE) and history of depression among older adults and to explore the interaction by race.
This study was a cross-sectional analysis of the 2020 Behavioral Risk Factor Surveillance System (BRFSS) data among 60,122 older respondents (≥ 60 years old). The ACE score (zero, one, two-three, ≥four) included questions assessing exposure to eight types of ACEs before age 18. The outcome was the respondent's self-report depression diagnosed (yes/no). Multivariable logistic regression models examined the association between ACEs and depression stratified by race. Each model adjusted for age, smoking status, income, education, marital status, and body mass index.
In this sample of older adults, 47%, 23%, 19% and 10% reported having experienced zero, one, two-three, and four or more types of ACEs, respectively. Depression was reported by 16% of survey respondents. There was a significant interaction between ACE score and race and depression (p = 0.038). Respondents who experienced ≥4 ACEs had higher likelihood of reporting depression for all race/ethnicity groups: non-Hispanic Whites (aOR = 3.83; 95% CI: 3.07, 4.79), non-Hispanic Blacks (aOR = 3.39, 95% CI: 1.71, 6.71), or Hispanics (aOR = 12.61; 95% CI: 4.75, 33.43). This translated to a large effect size for non-Hispanic Whites and Hispanics although the magnitude was bigger for Hispanics.
The association between number of ACEs and depression was strongest for older adults who identify as Hispanic, but weaker and less consistent for adults who identify as White and Black.
本研究旨在评估老年人经历的不良童年经历（ACE）数量与抑郁史之间的关联，并探讨种族间的相互作用。
本研究是对 2020 年行为风险因素监测系统（BRFSS）中 60122 名老年受访者（≥60 岁）的横断面分析。ACE 评分（零、一、二至三、≥四）包括评估受访者在 18 岁之前经历的八种 ACE 类型的问题。结果是受访者自我报告的抑郁诊断（是/否）。多变量逻辑回归模型按种族分层检查 ACE 与抑郁之间的关联。每个模型均根据年龄、吸烟状况、收入、教育程度、婚姻状况和体重指数进行调整。
在本研究的老年人群样本中，分别有 47%、23%、19%和 10%的人报告经历了零、一、二至三、和四种或更多种 ACE。16%的调查受访者报告患有抑郁。ACE 评分与种族和抑郁之间存在显著交互作用（p=0.038）。经历过≥4 种 ACE 的受访者，所有种族/族裔群体报告抑郁的可能性更高：非西班牙裔白人（优势比[aOR] = 3.83；95%置信区间[CI]：3.07，4.79）、非西班牙裔黑人（aOR = 3.39，95% CI：1.71，6.71）或西班牙裔（aOR = 12.61；95% CI：4.75，33.43）。这意味着非西班牙裔白人和西班牙裔的影响较大，尽管对西班牙裔的影响更大。
对于自认为是西班牙裔的老年人，ACE 数量与抑郁之间的关联最强，而对于自认为是白人和黑人的成年人，这种关联较弱且不一致。
