Dose–response relationship between adverse childhood experiences and digestive diseases among Chinese adults: the mediating role of depression

ABSTRACT Background and aims Adverse childhood experiences (ACEs) have been associated with various adverse health outcomes, potentially including digestive diseases. We conducted a population-based cross-sectional study aimed at examining the mediating effect of depression in the longitudinal relationship between ACEs and digestive diseases. Methods For this study, we recruited 5145 participants aged ≥ 45 years from the 2014 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS). Multivariable mediation analysis with bootstrap resampling was used to assess the mediating role of depression in the association between ACEs and digestive diseases. Results In the 5145 middle-aged and older Chinese adults (mean age, 63.9 years), cumulative childhood adversity was found to be a significant predictor of the risk of digestive diseases ( B = 0.023 per ACE, standard error (SE) = 0.005, P < 0.001). Depressive symptoms (prevalence, 28.1%) mediated 33.3% of this association (indirect effect = 0.0078, 95% confidence interval (CI): 0.0056–0.0101, P < 0.001), while the direct effect of ACE persisted ( B = 0.0156, 95% CI: 0.0057–0.0259, P = 0.004). Conclusions ACEs are associated with a higher susceptibility to digestive diseases directly and through depression-mediated pathways. The findings of this study indicate that interventions targeting depression may attenuate the pathogenesis of digestive diseases in those with ACE, particularly in high-risk subgroups with ≥ 4 ACEs and concurrent depression (10-item Center for Epidemiologic Studies Depression Scale score ≥ 10).