Childhood adversities and mid-late depressive symptoms over the life course: evidence from a retrospective cohort study in China

Background

The cumulative effect of childhood adversities on depressive symptoms in later life is well documented in many countries. However, there is a dearth of accurate information about this effect in the Chinese population. We aimed to examine the cumulative effect of childhood adversities on depressive symptoms in mid-to-late life, using data from the Chinese population.

Methods

We retrieved data from the third and fourth wave of the China Health and Retirement Longitudinal Study (CHARLS), which was carried out in 2014 and 2015. We included anonymised data from 17?425 respondents aged 45 years and older, and retrospectively collected information about childhood history, including socioeconomic status, health status, child neglect and abuse, friendship, and parental mental health. The information about socioeconomic status and health status in mid-to-late life was also included. The depressive symptoms were assessed using a ten-item Center for Epidemiologic Studies Depression Scale (CES-D). We used a structural equation model and depicted the direct or indirect pathways from five aspects of childhood adversities to depressive symptoms in mid-to-late life. Socioeconomic status and health status in mid-to-late life acted as a mediated factor in this model.

Findings

The structural equation model had a good satisfactory fit (comparative fit index 0·927; Tucker–Lewis index 0·922; root mean square error of approximation 0·020). Parental mental health problems had a significant direct effect on depressive symptoms in mid-to-late life (β=0·180, p<0·001). Having no friends also showed a direct effect (β= 0·118, p<0·001) and there was an indirect effect of low socioeconomic status and poor health status in mid-to-late life (β=0·054, p<0·001). Poor health status, child neglect and abuse, and low socioeconomic status in childhood had an indirect effect on depressive symptoms in mid-to-late life (poor health status β=0·128, p<0·001; child neglect and abuse β=0·040, p<0·001; low socioeconomic status β=0·098, p<0·001).

Interpretation

Childhood adversities were directly or indirectly associated with depressive symptoms in mid-to-late life, and the cumulative effects were mediated by poor health status and low socioeconomic status in mid-to-late life. These findings are crucial for the development of integrated practices and deployment of available resources to prevent childhood adversities, subsequently reducing the prevalence of depression. Moreover, the indirect pathways from childhood adversities to depressive symptoms in mid-to-late life indicate that early inequality may develop along multiple axes and shape life outcomes in later life, such as socioeconomic status. The findings suggested the interruptive potential of early resource mobilisation and human agency to curb the cumulative effects of adversity.

Funding

China Medical Board (14-198)