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. 2024 Dec 24;24(1):947.
doi: 10.1186/s12888-024-06312-y.

Longitudinal relationship between adverse childhood experiences and depressive symptoms: the mediating role of physical pain

Min Bao  1 , Rongji Ma  2
Affiliations

Longitudinal relationship between adverse childhood experiences and depressive symptoms: the mediating role of physical pain

Min Bao et al. BMC Psychiatry. .

Abstract

Background: This study explored the relationship between Adverse Childhood Experiences (ACE), physical pain, and depressive symptoms, and examined the mediating role of pain in the correlation between ACE and depressive symptoms among middle-aged and elderly Chinese (over the age of 45).

Methods: Cox proportional hazards regression models were used to analysis the association between ACE, physical pain, and depressive symptoms. To assess the mediating role of physical pain in the relationship between ACE and depressive symptoms, mediation analysis was conducted. Indirect, direct, and total effects were estimated by combining mediation and outcome models, adjusting for relevant covariates. Bayesian network models were used to visually demonstrate the interrelations between factors influencing depressive symptoms, further verifying the association between ACE, physical pain, and depressive symptoms.

Results: In the fully adjusted model, middle-aged and elderly individuals reporting ACE had a higher risk of developing depressive symptoms (hazard ratios [HR] and 95% confidence intervals [95% CI], 1.379 [1.266-1.503]). Compared to those without physical pain, individuals reporting severe physical pain were at an increased risk of depressive symptoms (HR [95% CI], 1.438 [1.235-1.673]). The risk was even higher for those with both ACE and severe physical pain compared to those with neither (HR [95% CI], 2.020 [1.630-2.505]). The intensity of pain explained 7.48% of the association between ACE and depressive symptoms, while the number of pain sites accounted for 7.86%.

Conclusions: Physical pain partially mediated the association between ACE and depressive symptoms. The study findings highlighted the importance of early screening and intervention for physical pain in middle-aged and older adults with ACE.

Clinical trial number: Not applicable.

Keywords: Adverse childhood experiences; China; Depressive symptoms; Middle-aged and elderly; Physical pain.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Review Committee of Peking University, and all CHARLS participants provided written informed consent. All methods were carried out by the principle embodied in the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow-chart of the selection of study participants. Abbreviations: ACE, adverse childhood experiences
Fig. 2
Fig. 2
Relationship between adverse childhood experiences, physical pain and new-onset depressive symptoms during the period 2013–2020. Abbreviations: HR, hazard ratio; CI, confidence interval; ACE, adverse childhood experiences a adjusted for age, sex, residents, education, marital status, BMI, smoking, drinking, ADL, IADL, social activity, exercise, number of chronic diseases, Cystatin C, high density lipoprotein cholesterol
Fig. 3
Fig. 3
Effect of physical pain on the Association between ACE and the Aew-onset of Aepressive Aymptoms. Abbreviations: ACE, adverse childhood experiences. *p < 0.001. Adjusted for age, sex, residents, education, marital status, BMI, smoking, drinking, ADL, IADL, social activity, exercise, number of chronic diseases, Cystatin C, high density lipoprotein cholesterol.
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References

    1. Steel Z, Marnane C, Iranpour C, et al. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. Int J Epidemiol. 2014;43(2):476–93. 10.1093/ije/dyu038. - PMC - PubMed
    1. Tang T, Jiang J, Tang X. Prevalence of depressive symptoms among older adults in mainland China: a systematic review and meta-analysis. J Affect Disord. 2021;293:379–90. 10.1016/j.jad.2021.06.050. - PubMed
    1. Wang F, Zhang QE, Zhang L, et al. Prevalence of major depressive disorder in older adults in China: a systematic review and meta-analysis. J Affect Disord. 2018;241:297–304. 10.1016/j.jad.2018.07.061. - PubMed
    1. Huang Y, Wang Y, Wang H, et al. Prevalence of mental disorders in China: a cross-sectional epidemiological study. Lancet Psychiatry. 2019;6(3):211–24. 10.1016/S2215-0366(18)30511-X. - PubMed
    1. Lu J, Xu X, Huang Y, et al. Prevalence of depressive disorders and treatment in China: a cross-sectional epidemiological study. Lancet Psychiatry. 2021;8(11):981–90. 10.1016/S2215-0366(21)00251-0. - PubMed

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