Wei Mengna, Wang Miyuan, Chang Rui, Li Chunan, Xu Ke, Jiang Yanfen, Wang Yimin, Tuerxun Paiziyeti, Zhang Jianduan
Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, China.
Depress Anxiety. 2023 Aug 2;2023:8439527. doi: 10.1155/2023/8439527. eCollection 2023.
Adverse childhood experiences (ACEs) are recognized as key risk factors linked to poor mental health throughout life. However, research on the specific associations between ACE dimensions and depressive symptoms (DSs) among the Chinese population during mid to late life is rare.
This study aims to investigate the specific effects of different dimensions of ACEs on the new occurrence of DSs and the number of times with DSs among the middle-aged and elderly Chinese populations.
The analysis included 3979 adults aged ≥45 years with four repeated measurements of the 10-item Center for Epidemiological Studies Depression Scale from the China Health and Retirement Longitudinal Study 2011-2018. Three types of ACE dimensions (total, deprivation, and threat-related ACEs) were conceptualized in accordance with the 15 types of ACEs that occurred before the age of 18 years recorded using the Life History Survey Questionnaire in 2014. In addition, latent class analysis (LCA) was utilized as an additional method for identifying distinct ACE clusters. The Cox regression and ordered logistic regression were used to estimate the risk of ACEs on DSs.
Among the 3979 participants, 1656 developed a new occurrence of DSs during follow-up, with 998, 438, and 220 exhibiting DSs one, two, and three times. For total and deprivation-related ACEs, only the group with ≥3 ACEs was significant with the new occurrence of DSs when compared with the no ACE group, and the adjusted hazard ratios (HRs) (95% confidence interval) were 1.562 (1.296, 1.882) and 1.446 (1.221, 1.712), respectively. With regard to threat-related ACEs, all three groups (1 ACE, 2 ACEs, and ≥3 ACEs) were significantly associated with the new occurrence of DSs. The HRs were 1.260 (1.115, 1.425), 1.407 (1.212, 1.634), and 1.585 (1.366, 1.840), respectively. The findings of total, deprivation-related, and threat-related ACEs and their associations with the number of times with DSs represent a similar phenomenon. The LCA revealed five ACE clusters. Compared to the "low risk" cluster, the "poor parent relationship" cluster and the "physical abuse" cluster were linked to an increased risk of the new occurrence of DSs and the number of times with DSs. The results of the subgroup analysis by sex and age were consistent with the total population.
Individuals who have experienced higher ACE scores in early life face a higher risk of developing a new occurrence of DSs and multiple detected DSs in mid to late life, particularly in the case of threat-related ACEs. Parsing ACEs is imperative to explore their distinct effects on DSs and the underlying mechanisms. In addition, Incorporating ACE screening into regular health checks among the middle-aged and elderly populations is recommended. Moreover, targeted mental health interventions should be delivered to those who have experienced early life adversities, particularly threat-related ACEs, to promote healthy aging.
童年不良经历（ACEs）被认为是与一生中心理健康不佳相关的关键风险因素。然而，关于中国中年及老年人群中ACE维度与抑郁症状（DSs）之间具体关联的研究很少。
本研究旨在调查ACEs不同维度对中国中老年人群中DSs新发病例以及DSs发作次数的具体影响。
分析纳入了3979名年龄≥45岁的成年人，他们在2011 - 2018年中国健康与养老追踪调查中对10项流行病学研究中心抑郁量表进行了四次重复测量。根据2014年使用生活史调查问卷记录的18岁之前发生的15种ACEs类型，将ACE维度分为三种类型（总计、剥夺和威胁相关的ACEs）。此外，潜在类别分析（LCA）被用作识别不同ACE集群的另一种方法。使用Cox回归和有序逻辑回归来估计ACEs对DSs的风险。
在3979名参与者中，1656人在随访期间出现了DSs新发病例，其中998人、438人和220人分别出现了1次、2次和3次DSs。对于总计和剥夺相关的ACEs，与无ACE组相比，只有ACEs≥3的组在DSs新发病例方面具有显著性，调整后的风险比（HRs）（95%置信区间）分别为1.562（1.296，1.882）和1.446（1.221，1.712）。关于威胁相关的ACEs，所有三组（1次ACE、2次ACE和≥3次ACE）均与DSs新发病例显著相关。HRs分别为1.260（1.115，1.425）、1.407（1.212，1.634）和1.585（1.366，1.840）。总计、剥夺相关和威胁相关的ACEs及其与DSs发作次数的关联结果呈现出类似的现象。LCA揭示了五个ACE集群。与“低风险”集群相比，“不良亲子关系”集群和“身体虐待”集群与DSs新发病例风险增加以及DSs发作次数增加有关。按性别和年龄进行的亚组分析结果与总体人群一致。
早年经历较高ACE分数的个体在中年及老年时出现DSs新发病例和多次检测到DSs的风险更高，特别是在威胁相关的ACEs情况下。剖析ACEs对于探索它们对DSs的不同影响及其潜在机制至关重要。此外，建议将ACE筛查纳入中老年人群的定期健康检查中。此外，应该对那些早年经历过逆境，特别是威胁相关的ACEs的人进行有针对性的心理健康干预，以促进健康老龄化。
