Depression mediates link between adverse childhood experiences, cognition in older women

Among midlife and older women in China, some of their own and their spouse’s adverse childhood experiences — mediated to some extent by depression — were associated with poorer cognitive function, according to study data.

Depression is a known risk factor for cognitive decline, and studies show that people who undergo negative experiences in childhood are more likely to develop depression and experience deteriorating cognition, according to study background.

“Recent research from the English Longitudinal Study of Ageing survey revealed that depression mediated the effect of adverse childhood experiences on cognitive decline, but it did not distinguish intra- and extrafamilial adverse childhood experiences,” Ziyang Ren, MD, a PhD candidate at the Institute of Reproductive and Child Health at Peking University in China, and colleagues wrote. “Given the different effects of adverse childhood experiences occurring within and outside of the family on mental health, the specific impacts of intra- and extrafamilial adverse childhood experiences are worth exploring.

“Furthermore, though women with adverse childhood experiences are at a higher risk of depression that is significantly associated with cognitive decline, limited research has comprehensively explored the associations of intra- and extrafamilial adverse childhood experiences with cognitive function and the mediating role of depression among Chinese women,” they wrote.

Methods

Ren and colleagues identified study participants using data from the China Health and Retirement Longitudinal Study (CHARLS), a study that began enrolling people aged 45 years and older in 2011 to create a comprehensive database of information on people’s health. CHARLS participants contributed retrospective details about their life experiences starting in 2014.

The researchers included 4,613 women from the CHARLS cohort who had complete records on depression, cognitive function, adverse childhood experiences and other health and sociodemographic data. A subset of 2,522 married women with complete data on their spouses’ characteristics and adverse childhood experiences, as well as their own satisfaction with their marriage, were included in a separate analysis.

Adverse childhood experiences were defined as having negative intrafamilial and/or extrafamilial experiences before age 17 years. Some of these included emotional neglect, family violence and economic adversity for intrafamilial experiences and bullying, loneliness and community violence for extrafamilial experiences. Intrafamilial, extrafamilial and overall adverse childhood experiences were ranked as mild, moderate, severe or most severe.

Women’s adverse childhood experiences

Analyses of the full study population (median age, 59 years) revealed that overall, intrafamilial and extrafamilial adverse childhood experiences were associated with depression across the cohort.

The most severe overall experiences were associated with worse global cognition (beta = –0.364; 95% CI, –0.433 to –0.295), episodic memory (beta = –0.282; 95% CI, –0.353 to –0.21) and mental intactness (beta = –0.353; 95% CI, –0.424 to –0.281) compared with mild overall experiences. Depression mediated 12.3%, 14.6% and 9.5% of the effects the most severe overall experiences had on global cognition, episodic memory and mental intactness, respectively.

Similarly, the most severe extrafamilial experiences were associated with worse global cognition (beta = –0.771; 95% CI, –0.839 to –0.703), episodic memory (beta = –0.517; 95% CI, –0.59 to –0.445) and mental intactness (beta = –0.841; 95% CI, –0.91 to –0.772) compared with mild extrafamilial experiences. There were no differences between intrafamilial experiences of different severities.

Spousal adverse childhood experiences

Women’s depression mediated 19.8% of the association between their spouse’s overall adverse childhood experiences and their own mental intactness, such that the most severe vs. mild experiences were associated with worse mental intactness (beta = –0.12; 95% CI, –0.217 to –0.023).

The most severe spousal extrafamilial adverse childhood experiences were associated with worse global cognition (beta = –0.21; 95% CI, –0.297 to –0.123), episodic memory (beta = –0.15; 95% CI, –0.241 to –0.06) and mental intactness (beta = –0.211; 95% CI, –0.302 to –0.121) in women vs. mild spousal extrafamilial experiences. Depression mediated 7.6%, 9.4% and 6% of these effects, respectively.

“The spouses of individuals with adverse childhood experiences tend to develop high levels of stress and doubt key personal values and assumptions about the world,” Ren said in a press release. “‘Stress contagion’ within couples, where one person's stress has a significant impact on other close members of the family, may also play a role.”

Future studies should determine the effects adverse childhood experiences have on women during different stages of their lives, Ren and colleagues wrote.

References:

• Adverse childhood experiences contribute to cognitive decline in women in China in later life. www.keaipublishing.com/en/journals/global-transitions/news/adverse-childhood-experiences-contribute-to-cognitive-decline-in-women-in-china-in-later-life/. Published Jan. 12, 2023. Accessed Jan. 13, 2023.
• Ren Z, et al. Glob Transit. 2023;doi:10.1016/j.glt.2022.12.001.