BMC Geriatr. 2025 Dec 30;25(1):1076. doi: 10.1186/s12877-025-06740-9.
ABSTRACT
BACKGROUND: Adverse childhood experiences (ACEs) are linked to depression in later life; however, the mediating pathways in older Chinese adults remain underexplored. Sleep disorders, highly prevalent in geriatrics, may mediate this pathway through chronic stress mechanisms, yet evidence from Asian cohorts is limited. This study examines the mediating roles of sleep duration, chronic diseases, and other factors in the ACEs-depression associations using a nationally representative sample.
METHODS: We conducted a cross-sectional analysis of data from 6,585 adults aged 60 years and older, obtained from the 2020 wave of the China Health and Retirement Longitudinal Study (CHARLS). ACEs (range 0-12) were assessed via a 12-item scale, and depression via the CES-D-10 (cutoff ≥ 12). Mediators included sleep duration, chronic diseases, and social isolation. Multivariable logistic regression and causal mediation analysis (1,000 bootstraps) were used, adjusting for relevant covariates.
RESULTS: The prevalence of depressive symptoms was 32.1%. Each additional ACE increased depression risk (adjusted OR = 1.17, 95% CI = 1.11-1.24). Sleep duration mediated 9.4% (β=-0.09) and chronic diseases 4.3% (β = 0.09) of the total associations; social isolation showed negligible mediation (0.03%). Stronger ACEs-depression associations occurred in Central China (OR = 1.35 vs. 1.15 in West, p-interaction = 0.029) and higher-educated groups.
CONCLUSIONS: ACEs are associated with increased late-life depression risk in older Chinese adults, partially mediated by short sleep duration and chronic diseases. These findings suggest the potential value of ACEs screening and targeted interventions addressing sleep and multimorbidity in geriatric care. Longitudinal studies are needed to confirm these pathways.
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