Dai Qianqian, Li Ming, Wang Zhaoyu, Xu Qianqian, Zhang Xinyi, Tao Liyuan
Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China.
School of Social Sciences, Tsinghua University, Beijing 100084, China.
Healthcare (Basel). 2024 Dec 16;12(24):2539. doi: 10.3390/healthcare12242539.
Numerous studies have established a link between adverse childhood experiences (ACEs) and the development of depression in later life. However, the interactive relationships between ACEs, depression, and chronic diseases are still not well understood. In this study, the aim was to investigate the impact of ACEs on depressive trajectories among middle-aged and elderly individuals in China, as well as to examine the mediating roles of chronic diseases in this association. Data were drawn from 6921 participants aged 45 and older, using the China Health and Retirement Longitudinal Study (CHARLS) data from 2011, 2013, 2015, and 2018, combined with the 2014 life history survey. Depressive symptom scores were assessed using the widely recognized CES-D-10 scale. The trajectories of depressive symptoms were identified via group-based trajectory modeling (GBTM). The association between ACEs and depressive trajectories was analyzed using multinomial logistic regression, and the KHB method was employed to test the mediating effects of different chronic diseases. The age of the 6921 participants was 57.2 ± 8.0 years, with females comprising 53.9% and males 46.1%. We found that approximately 70% of Chinese middle-aged and older adults had experienced at least one ACE, and 4.8% had experienced four or more ACEs. The following four distinct trajectories of depressive symptoms were identified: continuing-low (N = 1897, 27.4%), continuing-low-to-middle (N = 2937, 42.4%), continuing-middle-to-high (N = 1649, 23.8%), and continuing-high (N = 438, 6.3%). Compared to individuals without ACEs, those with four or more ACEs had a significantly higher likelihood of following the continuing-low-to-middle trajectory (OR = 2.407, 95%CI: 1.633-3.550), the continuing-middle-to-high trajectory (OR = 7.458, 95%CI: 4.999-11.127), and the continuing-high trajectory (OR = 20.219, 95%CI: 12.115-33.744), rather than the continuing-low trajectory. Exposure to a greater number of ACEs was associated with an increased risk of following an adverse trajectory of depressive symptoms. Multiple chronic diseases significantly mediated the relationship between ACEs and depressive trajectories, with arthritis or rheumatism exerting the largest mediating effect, followed by digestive and respiratory diseases. These findings indicated that ACEs were associated with a higher risk of worse depressive symptom trajectories, with different chronic diseases mediating this relationship. Therefore, developing public measures to prevent ACEs can reduce the risk of chronic diseases and depression in middle-aged and elderly people. Additionally, strengthening the prevention and management of chronic diseases in individuals exposed to ACEs may further reduce their subsequent risk of depression.
众多研究已证实童年不良经历（ACEs）与晚年抑郁症的发展之间存在联系。然而，ACEs、抑郁症和慢性病之间的交互关系仍未得到充分理解。在本研究中，目的是调查ACEs对中国中老年人群抑郁轨迹的影响，并检验慢性病在这种关联中的中介作用。数据来自6921名年龄在45岁及以上的参与者，使用了2011年、2013年、2015年和2018年的中国健康与养老追踪调查（CHARLS）数据，并结合了2014年的生活史调查。使用广泛认可的CES-D-10量表评估抑郁症状得分。通过基于群体的轨迹模型（GBTM）确定抑郁症状的轨迹。使用多项逻辑回归分析ACEs与抑郁轨迹之间的关联，并采用KHB方法检验不同慢性病的中介作用。6921名参与者的年龄为57.2±8.0岁，其中女性占53.9%，男性占46.1%。我们发现，约70%的中国中老年人至少经历过一次ACEs，4.8%的人经历过四次或更多次ACEs。确定了以下四种不同的抑郁症状轨迹：持续低水平（N = 1897，27.4%）、持续低到中水平（N = 2937，42.4%）、持续中到高水平（N = 1649，23.8%）和持续高水平（N = 438，6.3%）。与没有ACEs的个体相比，经历过四次或更多次ACEs的个体更有可能遵循持续低到中水平轨迹（OR = 2.407，95%CI：1.633 - 3.550）、持续中到高水平轨迹（OR = 7.458，95%CI：4.999 - 11.127）和持续高水平轨迹（OR = 20.219，95%CI：12.115 - 33.744），而不是持续低水平轨迹。暴露于更多的ACEs与抑郁症状不良轨迹风险增加相关。多种慢性病显著介导了ACEs与抑郁轨迹之间的关系，其中关节炎或风湿病的中介作用最大，其次是消化系统和呼吸系统疾病。这些发现表明，ACEs与更差的抑郁症状轨迹风险较高相关，不同的慢性病介导了这种关系。因此，制定预防ACEs的公共措施可以降低中老年人群患慢性病和抑郁症的风险。此外，加强对暴露于ACEs个体的慢性病预防和管理可能会进一步降低他们随后患抑郁症的风险。
