Adverse childhood experiences, inflammation, and depression: evidence of sex- and stressor specific effects in a nationally representative longitudinal sample of U.S. adolescents

Abstract

Although adverse childhood experiences (ACEs) are commonly associated with depressive symptoms in adulthood, studies frequently collapse ACEs into a single unitary index, making it difficult to identify specific targets for intervention and prevention. Furthermore, studies rarely explore sex differences in this area despite males and females often differing in the experiences of ACEs, depressive symptoms, and inflammatory activity. To address these issues, we used data from the National Longitudinal Study of Adolescent to Adult Health to model the effects of 10 different ACEs on C-reactive protein (CRP) and depressive symptoms in adulthood. Path modeling was used to measure the effects of ACEs on CRP and depressive symptoms conjointly while also assigning covariances among ACEs to assess their interrelations. Sex-by-ACE interaction terms and sex-disaggregated models were used to test for potential differences. Emotional abuse and parental incarceration were consistently related to both CRP and depressive symptoms for males and females. Childhood maltreatment was associated with depressive symptoms for females, whereas sexual abuse was associated with inflammation for males. Several covariances among ACEs were identified, indicating potential networks through which ACEs are indirectly associated with CRP and depressive symptoms. These data demonstrate that ACEs have differing direct effects on CRP and depressive symptoms - and that they differ with respect to how they cluster - for males versus females. These differences should be considered in theory and clinical workflows aiming to understand, treat, and prevent the long-term impacts of ACEs on depressive symptoms and inflammation-related health conditions in adulthood.

Keywords: C-reactive protein; adverse childhood experiences; depression; sex differences; stress.

Figure 1.

Depiction of the analytic model. Adverse childhood experiences (ACEs) are predictors C-reactive protein and depressive symptoms. Covariances between ACEs, as well as between the residuals of C-reactive protein and depressive symptoms, are also modeled. Some covariances between ACEs are omitted for visual clarity (e.g., emotional abuse ↔ sexual abuse, emotional abuse ↔ emotional neglect, physical abuse ↔ emotional neglect).

Figure 2.

Associations between adverse childhood experiences (ACEs), C-reactive protein, and depressive symptoms. Only significant paths are presented. Positive associations are depicted by a solid line. Negative associations are depicted with a dashed line. Covariances are omitted for visual clarity. Betas and standard errors are presented in Table 4.