Adverse childhood experiences and age-trajectories of depressive symptoms in older adults from China

BACKGROUND: Adverse childhood experiences (ACEs) have profound lifelong consequences. Less is known about their impact on outcomes in late life, such as psychological distress in older adults. Moreover, there is a paucity of evidence on associations of ACEs with age-trajectories in depressive symptoms, especially with distinct patterns of trajectories. We investigated associations between ACEs and trajectories of depressive symptoms at mid-to-older ages in a Chinese population sample. METHODS: We used the longitudinal data from the China Health and Retirement Longitudinal Survey (13846 participants ≥45y). Depressive symptoms were measured by CES-D10 (Centre for Epidemiologic Studies Depression Scale) at four waves (2011-18). A range of ACEs (<17y) were retrospectively reported by participants. Growth Mixture Models were used to identify distinct age-trajectories of depressive symptoms and their associations with ACEs. RESULTS: We identified two trajectory groups: (1) persistent high (men 14%; women 19.2%) and (2) low/normal levels of depressive symptoms. Several ACE measures were associated with increased risk of having persistent high levels of depressive symptoms (mid-to-older ages) after adjusting for other ACEs, sex, childhood SES (financial status, parental education, occupation), adult SES (education, financial status, urban/rural residence), health behaviors and limitations in daily activities. For example, adjusted OR was 1.35 (95% CI:1.17,1.55) for physical abuse (28.2%), 1.38(1.19,1.59) for domestic violence (24.3%), 1.48(1.23,1.78) for parental drinking, drug or mental health problems (9.4%), 1.59(1.38,1.84) for those had a bedridden parent (18.7%). CONCLUSIONS: ACEs have a long lasting effect on trajectories of depressive symptoms in older adults, independent of childhood SES and adult factors, highlighting the need to act early to reduce the long lasting impact on mental health in later life. KEY MESSAGES: • Adverse childhood experiences are associated with persistent high levels of depressive symptoms from mid-to-older ages. • Associations are independent of childhood SES and adult factors.