Respiratory Sinus Arrhythmia Moderates the Association Between Adverse Childhood Experiences and Depressive Symptoms Through Stress Appraisals and Perseverative Thinking

OBJECTIVE: Adverse childhood experiences (ACEs) confer risk for depressive symptoms in adulthood, potentially through maladaptive cognitive-affective responses to stress. The neurovisceral integration model suggests that resting respiratory sinus arrhythmia (RSA), an index of parasympathetic regulation, shapes capacity to regulate cognitive-affective stress responses. The present study tested whether stress-related appraisals and perseverative thinking mediated the association between ACEs and depressive symptoms, whether RSA moderated these pathways, and whether effects varied under chronic caregiving stress. METHODS: Participants were 222 middle-aged mothers (mean age=46.83, SD=6.03) experiencing higher (n=125) and lower (n=97) caregiving stress. ACEs and depressive symptoms were assessed with the Childhood Trauma Questionnaire and CES-D. Perceived threat, perceived control, and perseverative thinking were measured via daily diaries. Resting RSA, CES-D, and daily measures were collected at three timepoints across 30 months. RESULTS: Lower RSA strengthened the association between ACEs and depressive symptoms (b=0.269, SE=0.060, P<.001). Lower perceived control (b=0.022, 95% CI [0.001, 0.049]) and greater perseverative thinking (b=0.072, 95% CI [0.020, 0.128]) mediated the association between ACEs and depressive symptoms; lower RSA strengthened associations between ACEs and these mediators. Higher ACEs were associated with greater perceived threat among mothers with higher caregiving stress and lower RSA (b=0.014, SE=0.004, P<.001). CONCLUSIONS: Early adversity is associated with depressive symptoms through stress-related cognitive-affective pathways. Lower RSA may reflect diminished regulatory capacity that strengthens associations between ACEs and maladaptive cognitive-affective stress responses.