Ren Ziyang, Du Yushan, Lian Xinyao, Luo Yanan, Zheng Xiaoying, Liu Jufen
Institute of Reproductive and Child Health/ National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China.
Soc Sci Med. 2023 Oct 27;338:116346. doi: 10.1016/j.socscimed.2023.116346.
Whether adverse childhood experiences (ACEs) preferentially induce depressive symptoms or somatic conditions remains to be explored.
Data were from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018. Fourteen ACEs were retrospectively reported and divided into 0, 1, 2, 3, and 4 or more. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression (CESD-10) scale. Somatic conditions were assessed by pain, falls, chronic diseases, multimorbidity, activities of daily living (ADL), and instrumental activities of daily living (IADL). Weibull regression and mediation analysis were used to explore the bidirectional associations between depressive symptoms and somatic conditions after ACEs.
4 or more (vs. 0) ACEs were associated with new-onset pain, falls, chronic diseases, multimorbidity, ADL limitations, and IADL limitations, with HRs (95% CIs) of 1.57 (1.37-1.79), 1.84 (1.55-2.18), 1.43 (1.19-1.72), 1.55 (1.32-1.83), 1.85 (1.54-2.23), and 1.46 (1.24-1.71), all of which were mediated by depressive symptoms by 12.3%, 8.6%, 9.6%, 11.9%, 15.3%, and 22.5%, respectively. 4 or more (vs. 0) ACEs were also associated with about 1.90-time higher risk of new-onset depressive symptoms. However, only pain, chronic diseases, and multimorbidity mediated the association by 4.1%, 3.3%, and 2.2%. All the above associations were more pronounced in women than men.
ACEs tend to induce depressive symptoms before somatic conditions assessed by pain, falls, chronic diseases, multimorbidity, and functional limitations rather than vice versa. Future strategies should focus first on mental health in older Chinese to lessen the burden attributed to ACEs to the greatest extent.
童年不良经历（ACEs）是优先诱发抑郁症状还是躯体疾病仍有待探索。
数据来自2011 - 2018年中国健康与养老追踪调查（CHARLS）。回顾性报告了14种ACEs，并分为0、1、2、3以及4种及以上。使用10项流行病学研究中心抑郁量表（CESD - 10）评估抑郁症状。通过疼痛、跌倒、慢性病、多种疾病共存、日常生活活动（ADL）以及工具性日常生活活动（IADL）评估躯体疾病情况。采用威布尔回归和中介分析来探讨ACEs后抑郁症状与躯体疾病之间的双向关联。
4种及以上（相比于0种）ACEs与新发疼痛、跌倒、慢性病、多种疾病共存、ADL受限以及IADL受限相关，风险比（HRs）（95%置信区间）分别为1.57（1.37 - 1.79）、1.84（1.55 - 2.18）、1.43（1.19 - 1.72）、1.55（1.32 - 1.83）、1.85（1.54 - 2.23）以及1.46（1.24 - 1.71），所有这些关联分别有12.3%、8.6%、9.6%、11.9%、15.3%以及22.5%由抑郁症状介导。4种及以上（相比于0种）ACEs还与新发抑郁症状风险高出约1.90倍相关。然而，只有疼痛、慢性病以及多种疾病共存介导了4.1%、3.3%以及2.2%的关联。上述所有关联在女性中比男性中更为明显。
相比于相反情况，ACEs倾向于在通过疼痛、跌倒、慢性病、多种疾病共存以及功能受限评估的躯体疾病之前诱发抑郁症状。未来策略应首先关注中国老年人的心理健康，以最大程度减轻ACEs带来的负担。
