Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, 566 Xuefu Avenue, Nanchang, Jiangxi, 330006, China.
School of Public Health, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China.
BMC Public Health. 2024 Aug 19;24(1):2246. doi: 10.1186/s12889-024-19787-x.
Many studies have shown that adverse childhood experiences (ACEs) lead to adverse social relations in middle-aged and older adults and harm physical and mental health, but few studies have focused on the impact of ACEs on marital status in middle-aged and older adults and the potential influence of marital status between ACEs and depressive symptoms.
This study aimed to analyze the effect of ACEs on marital status and depressive symptoms in the Chinese middle-aged and older adults, and to explore the mediating role of marital status in the association between ACEs and depressive symptoms in middle-aged and older adults.
This study used the China Health and Retirement Longitudinal Study (CHARLS) 2014 life history survey and 2015 and 2018 follow-up data to analyze, ten ACEs conditions and marital status were collected by questionnaire, using the Center for Epidemiological Studies Depression Scale (CESD-10) 10-item short form to assess depressive symptoms. The association between cumulative ACEs and marital status was assessed by constructing a multinomial logistic regression (MLR) model, as well as a binary logistic regression model to assess the association between ACEs and depressive symptoms. The mediating role of marital status in the association between ACEs and depressive symptoms was also assessed.
A total of 10,246 individuals aged 45 years or older were included in the analysis. Compared to individuals who did not experience ACEs, those who experienced two or more ACEs had a higher risk of being unmarried (seperated/divorced/never married) (OR = 1.67, 95% CI=[1.10,2.51]) and a higher risk of depressive symptoms (OR = 1.66, 95% CI=[1.49,1.84]) in middle and old age. Unmarried status partially mediated the association of ACEs with depressive symptoms.
Chinese middle-aged and older people who experienced two or more ACEs have higher risks of unmarried status and depressive symptoms, and unmarried status partially mediated the ACEs-depressive symptom association. These findings reveal the fact that we need to develop life-cycle public health strategies to reduce exposure to ACEs and society should give more attention to the marital status of older people, thereby reducing the risk of depression among middle-aged and older adults in China.
许多研究表明，不良的童年经历（ACEs）会导致中年和老年人不良的社会关系，并损害身心健康，但很少有研究关注 ACEs 对中年和老年人婚姻状况的影响，以及 ACEs 和抑郁症状之间的潜在影响。
本研究旨在分析 ACEs 对中国中年和老年人婚姻状况和抑郁症状的影响，并探讨婚姻状况在 ACEs 与中年和老年人抑郁症状之间的中介作用。
本研究使用中国健康与退休纵向研究（CHARLS）2014 年生活史调查和 2015 年和 2018 年的随访数据进行分析，通过问卷调查收集了十种 ACEs 情况和婚姻状况，使用流行病学研究抑郁量表（CESD-10）10 项简短形式评估抑郁症状。通过构建多项逻辑回归（MLR）模型评估累积 ACEs 与婚姻状况之间的关联，以及二元逻辑回归模型评估 ACEs 与抑郁症状之间的关联。还评估了婚姻状况在 ACEs 与抑郁症状之间的关联中的中介作用。
共有 10246 名 45 岁或以上的人纳入分析。与未经历 ACEs 的人相比，经历两种或更多 ACEs 的人未婚（分居/离婚/从未结婚）的风险更高（OR=1.67，95%CI=[1.10，2.51]），且中年和老年时抑郁症状的风险更高（OR=1.66，95%CI=[1.49，1.84]）。未婚状态部分中介了 ACEs 与抑郁症状的关系。
中国中年和老年人经历两种或更多 ACEs 的人，未婚状态和抑郁症状的风险更高，未婚状态部分中介了 ACEs 与抑郁症状的关系。这些发现揭示了一个事实，即我们需要制定全生命周期的公共卫生策略，以减少 ACEs 的暴露，社会应更加关注老年人的婚姻状况，从而降低中国中年和老年人的抑郁风险。
