Adverse Childhood Experiences, Inflammation, and Depressive Symptoms in Late Life: A Population-Based Study

Abstract

Objectives: This study investigated the association and dose-response relationship between adverse childhood experiences (ACEs) and depressive symptoms in late life and explored the mediating roles of inflammatory markers in the ACEs-depressive symptom association among Chinese older adults.

Methods: This study was conducted using 2014 life history survey data and 2015 follow-up data from the China Health and Retirement Longitudinal Study. Data on ACEs and depression, inflammatory markers of high-sensitivity C-reactive protein (CRP), and white blood cell were collected. The association between ACEs and depressive symptoms was examined using logistic regression, and the mediation effects of inflammatory markers were evaluated.

Results: A total of 6,518 individuals over 60 years were included in the analysis. Compared to no ACE exposure, the adjusted odd ratios ranged from 1.377 (95% confidence interval [CI], 1.133-1.673) when participants had been exposed to 2 ACEs to 1.809 (95% CI, 1.451-2.256) when participants were exposed to 4 or more ACEs. A significant dose-response relationship between cumulative ACE scores and depression was observed. Six of the 12 ACE exposures were related to increased odds of depressive symptoms. CRP appeared to partially mediate the ACE-depressive symptom association, and the proportion of the effect of ACEs on depression was 1.17% (P = 0.008).

Discussion: A dose-response association exists between ACEs and the prevalence of depressive symptoms among older Chinese adults. CRP partially mediated the ACE-depressive symptom association in late life. Emphasizing interventions targeting individuals with ACE exposure may minimize the burden of late-life depression in China.

Keywords: Adverse childhood experiences; Depression; Inflammatory markers; Mediation effects; Older adults.