Abstract
Background
Many studies have shown that adverse childhood experiences (ACEs) lead to adverse social relations in middle-aged and elderly people and harm physical and mental health, but few studies have focused on the impact of ACEs on marital status in middle-aged and elderly people and the potential influence of marital status between ACEs and depressive symptoms.
Purpose
This study aimed to analyze the effect of ACEs on marital status and depressive symptoms in the middle-aged and elderly Chinese population, and to explore the mediating role of marital status in the association between ACEs and depressive symptoms in middle-aged and older adults.
Method
This study used the China Health and Retirement Longitudinal Study (CHARLS) 2014 life history survey and 2015 and 2018 follow-up data to analyze,ten ACEs conditions and marital status were collected by questionnaire,using the Center for Epidemiological Studies Depression Scale (CESD-10) 10-item short form to assess depressive symptoms. The association between cumulative ACEs and marital status was assessed by constructing a multinomial logistic regression (MLR) model, as well as a binary logistic regression model to assess the association between ACEs and depressive symptoms. The mediating role of marital status in the association between ACEs and depressive symptoms was also assessed.
Results
A total of 10,246 individuals aged 45 years or older were included in the analysis. Compared to individuals who did not experience ACEs, those who experienced two or more ACEs had a higher risk of being unmarried (divorced/never married) (OR = 1.67, 95% CI=[1.10,2.51]) and a higher risk of depressive symptoms (OR = 1.66, 95% CI=[1.49,1.84]) in middle and old age.There was a significant dose-response relationship between cumulative ACEs counts and both divorce/unmarried and depressive symptoms. Unmarried status partially mediated the association of ACEs with depressive symptoms.
Conclusion
Chinese middle-aged and older people who experienced two or more ACEs have higher risks of unmarried status and depressive symptoms, and unmarried status partially mediated the ACEs-depressive symptom association. These findings reveal the fact that we need to develop life-cycle public health strategies to reduce exposure to ACEs and improve the marital status of middle-aged people, thereby reducing the risk of depression among middle-aged and older adults in China.