What does this research mean for the field?

Adverse childhood experiences (ACEs) and adverse adulthood experiences (AAEs) are independently associated with an increased risk of incident depressive symptoms in middle-aged and older Chinese adults. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

The study aims to investigate the relationships between adverse childhood and adulthood experiences and their impact on the emergence of depressive symptoms in adults aged 45 and older.

March 16, 2026Open Access

Complex associations of adverse childhood and adulthood experiences with incident depressive symptoms in middle-aged and older Chinese adults

Key Points

The study aims to investigate the relationships between adverse childhood and adulthood experiences and their impact on the emergence of depressive symptoms in adults aged 45 and older.
Analyzed data from 4516 participants aged 45 years and older from the China Health and Retirement Longitudinal Study.
Collected information on adverse childhood experiences, adulthood experiences, depressive symptoms, and other health-related factors.
Employed modified Poisson regression, mediation analysis, and interaction analysis to examine the data.
Adverse childhood experiences and adulthood experiences were independently associated with increased risk of depressive symptoms.
Each additional adverse experience increased the risk of depressive symptoms in a dose-response manner.
Adulthood experiences mediated 5.78% of the effect of childhood experiences on depressive symptoms.

Abstract

The associations of adverse childhood experiences (ACEs) and adverse adulthood experiences (AAEs) with incident depressive symptoms remain incompletely understood. The study sought to explore the complex associations of ACEs and AAEs with incident depressive symptoms among middle-aged and older adults. Data of 4516 participants aged ≥ 45 years were sourced from the China Health and Retirement Longitudinal Study. Information on ACEs, AAEs, depressive symptoms, sociodemographic profiles, health behaviors, self-reported chronic diseases, retirement status, and adulthood social support was collected. Modified Poisson regression analysis, Karlson-Holm-Breen mediation analysis and interaction analysis were conducted. The overall numbers of ACEs (RR: 1.12; 95% CI: 1.08, 1.16) and AAEs (RR: 1.10; 95% CI: 1.06, 1.14) were independently associated with an increased risk of incident depressive symptoms. Significant dose-response relationships were detected between the numbers of ACEs (P-trend < 0.001) and AAEs (P-trend < 0.001) and the risk of incident depressive symptoms. The overall AAEs mediated 5.78% of the total effect of ACEs on incident depressive symptoms. No significant multiplicative (RR: 0.99; 95% CI: 0.77, 1.25) or additive RERI (95% CI): 0.02 (-0.27, 0.30); AP (95% CI): 0.01 (-0.19, 0.21); SI (95% CI): 1.04 (0.49, 2.20) interactions were detected between ACEs and AAEs on incident depressive symptoms. Both ACEs and AAEs were independently associated with an increased risk of incident depressive symptoms in a dose-response manner, with AAEs partially mediating the total effect of ACEs on incident depressive symptoms. These findings support preventive strategies targeting ACEs and AAEs to mitigate the risk of incident depressive symptoms in later adulthood.

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