The Moderating Role of Adverse Childhood Experiences in the Relationship Between Disability and Depression in Old Age: Evidence From China

Objective To investigate the association between adverse childhood experiences (ACEs) and depression in old age, and further examine the moderating role of ACEs on the relationship between later-life disability and depression. Methods This study utilizes data from the 2018 China Health and Retirement Longitudinal Study and the 2014 life course survey, employing the binary logistic regression to explore the relationship between ACEs and depression in old age, and applying a multiplicative interaction analysis method to explore the moderating effect of ACEs on the relationship between later-life disability and depression. Results The results show a positive association between ACEs and the likelihood of depression in old age (moderate relationship with parents: odds ratio [OR]=1.140, 95% confidence interval [CI] [1.006–1.293]; poor relationship with parents: OR=1.438, 95% CI [1.229– 1.684]; experiencing family stress events: OR=1.214, 95% CI [1.077–1.369]; living in an unsafe community: OR=1.284, 95% CI [1.049– 1.571]; sometimes or often being bullied by peers: OR=1.415, 95% CI [1.188–1.685]). Additionally, the association between later-life disability and depression is significantly weaker among older adults who reported sometimes or often being bullied by peers during childhood, compared to those without such experiences (OR=0.410, 95% CI [0.204–0.826]). Conclusion ACEs are positively associated with the likelihood of depression in old age, yet they may also serve a protective role in mental health during later-life severe adversity, such as disability. This protective effect may be attributed to post-traumatic psychological resilience, highlighting the importance of targeted interventions to enhance resilience in individuals exposed to trauma, as well as the integration of trauma-informed care into mental health services for older adults.