Depressive Symptoms, Adverse Childhood Experiences, and Sleep Quality

Centers for Disease Control and Prevention Investments in Adverse Childhood Experience Prevention Efforts

Associations of adverse childhood and lifetime experiences with sleep quality and duration among women in midlife

Sleep quality and perceived health in college undergraduates with adverse childhood experiences

Adverse childhood experiences (ACEs) are known risk factors for mental health problems in adulthood, yet the underlying psychological and behavioral pathways remain insufficiently understood. Personality traits and sleep quality may play crucial mediating roles linking early adversity to later depressive symptoms. This study aimed to examine the chained mediation mechanism of Big Five personality traits and sleep quality in the association between ACEs and depressive symptoms among Chinese university students. A cross-sectional survey was conducted among 14,381 Chinese university students. The Adverse Childhood Experiences International Questionnaire (ACE-IQ), the 10-item Big Five Inventory (BFI-10), the brief Pittsburgh Sleep Quality Index (B-PSQI), and the Patient Health Questionnaire-9 (PHQ-9) were used to assess key variables. Structural equation modeling (SEM) was applied to test the chained mediation model while controlling for age and gender. Robustness and clustering analyses were conducted to ensure model stability and data independence. ACEs were positively associated with depressive symptoms (total standardized effect=0.202, p<0.001). Neuroticism and agreeableness significantly mediated this relationship both directly and indirectly through sleep quality. The chained mediation path-ACEs → neuroticism → sleep quality → depressive symptoms-was statistically significant (p<0.001) and demonstrated good model fit (CFI=0.867, GFI=0.924, RMSEA=0.077). Sensitivity analyses confirmed the robustness of the findings. The results support a chained mediation model in which adverse childhood experiences affect depressive symptoms through personality traits and sleep quality. Personality traits, especially neuroticism and agreeableness, together with sleep quality, represent key intervention targets for mitigating the long-term mental health consequences of early-life adversity among young adults.

Positive and adverse childhood experiences and mental health outcomes of children

Background: Many studies demonstrated the relationship between adverse childhood experiences (ACEs) and diminished health functioning in adulthood. A growing literature has shown that positive childhood experiences (PCEs) co-occurring with ACEs reduce the risks for negative outcomes. Objective: The aim was to investigate how ACEs and PCEs are simultaneously associated with health outcomes in adulthood, including self-rated health, physical and mental health outcomes, and health-risk behaviours. Methods: A panel sample of 4,847 Slovenian adults was used and the data were weighted to closely resemble the Slovenian population. A series of logistic regression analyses were performed to examine how ACEs and PCEs predict the risk of various health outcomes. Results: Significant associations, as measured by adjusted odds ratios, were found between higher ACEs exposure and each of the 16 health outcomes evaluated. Adjusting for above median PCEs attenuated the association between ACEs and 6 health outcomes (poor self-rated physical and mental health, depression, anxiety, suicide attempt, physical inactivity; OR for ≥ 4 vs. 0 ACEs, 1.48–9.34). Mirroring these findings, above median PCEs were associated with lowered odds of these 6 health outcomes after adjusting for ACEs (OR for above vs. below median PCEs, 0.46–0.67), but not with odds of physical health outcomes and most of the health-risk behaviours. Stratified analyses by ACEs exposure level showed that the association between PCEs and self-rated health remained stable across ACEs exposure levels, while the association between PCEs and mental health outcomes and physical inactivity varied across ACEs exposure levels. Conclusions: Our results suggest that above median PCEs attenuate the association between ACEs and poor self-rated health, mental health problems, and physical inactivity in later life, and are negatively associated with these health problems even in the concurrent presence of ACEs. Interventions to promote PCEs can help to reduce unfavourable long-term health outcomes following childhood adversity.

Objective: Adverse Childhood Experiences (ACEs) are traumatic exposures such as abuse, neglect, and household challenges that occur in childhood, and are associated with numerous psychiatric and cardiovascular conditions in adulthood. An expanded list of ACEs accounting for community-level stressors like experiences of racism, witnessing violence, bullying, foster care, and living in unsafe neighborhoods, have also been associated with poor health outcomes decades later. Black men may face structural inequities that increase the risk of exposure to ACEs, while also facing disparities in both cardiovascular health (CVH) and mental health outcomes. Despite these disproportionate risks, research examining household, family and community-level ACEs remain understudied in Black men. Given the importance of mental wellbeing to cardiovascular health, understanding how childhood adversity affects mental health warrants more study, particularly in Black men with unideal cardiovascular health. Methods: 149 Black men with low or moderate cardiovascular health participating in a community-based lifestyle intervention study, Black Impact, were surveyed for conventional ACEs, expanded ACEs, and validated measures of depressive symptoms, perceived stress, and social/emotional well-being. Linear regression models examined how ACEs predicted mental health measures. Logistic regression models examined ACEs’ effect on the odds of reaching clinically significant depression. Results: Each additional ACE was significantly associated with greater depressive symptoms, perceived stress, and social isolation, as well as lower emotional wellbeing and social functioning. An ACE score ≥ 4 was associated with 459% increased odds of reaching clinically significant depression (OR 4.59, 95% CI: 1.62 – 12.95) compared to 0-3 ACEs. Family and household-level ACEs were associated with all mental health measures. Community-level ACEs were associated with depressive symptoms, perceived stress and emotional wellbeing, but they were not associated with social functioning and social isolation. Conclusion: Increased ACEs predicted worse mental health symptoms across all measures in a sample of Black men with low or moderate cardiovascular health. Next steps include assessing the relationship between ACEs exposure and lifestyle intervention outcomes and exploring how to interrupt ACE-health outcome pathways to mitigate mental health and CVH disparities among Black men.

Adverse childhood experiences (ACE) are highly prevalent, with long-lasting effects on physical and mental health that vary among individuals across their lifespan. Notably, ACE is associated with depression and anxiety disorders, which are major public health concerns. However, the factors involved in the detrimental effects of ACE on women in the perinatal period, a time of heightened vulnerability to physical and mental health outcomes for both mothers and their offspring, require further investigation. To investigate the role of perceived stress in the association between ACE and maternal depressive and anxiety symptoms across the perinatal period, we included 138 pregnant women recruited for a prospective longitudinal study that examined the effects of increased maternal prenatal stress on pregnancy during the COVID-19 pandemic. Participants self-reported adverse childhood experiences and serial measures of perceived stress, anxiety, and depressive symptoms. Linear mixed-effects (LME) models were employed to assess the association between ACE, perceived stress, anxiety, and depressive symptoms and to determine an interaction effect between ACE and perceived stress on state anxiety, trait anxiety, and depressive symptoms. On average, participants were 34years of age and at 26weeks of gestation (gestational age; GA). We found a significant interaction between ACE and perceived stress on trait anxiety (β = 0.06, SE = 0.01, p < .001) and depressive symptoms (β = 0.07, SE = 0.01, p < .001) in the perinatal period. Perceived stress moderated the association between ACE and trait anxiety symptoms in the third trimester (β = 0.07, SE = 0.02, p < .001). The association between ACE and depressive symptoms was moderated by perceived stress in the first trimester (β = 0.23, SE = 0.09, p < .05), second trimester (β = 0.09, SE = 0.03, p < .05), and third trimester (β = 0.04, SE = 0.02, p < .05). These findings underscore the importance of assessing ACE as a risk factor when evaluating maternal mental health to identify individuals susceptible to depressive and anxiety disorders in the perinatal period. Moreover, multiple mental health screenings in the perinatal period reduce the risk of missed opportunities for intervention and preventative actions.

Adverse childhood experiences (ACEs) may precipitate depressive symptoms among children and adolescents, yet whether resilience and sleep quality jointly mediate this link remains unclear. Therefore, this study aimed to investigate these potential mediating pathways. From April to June 2024, a total of 3258 children and adolescents were included for this cross-sectional study from 11 primary and secondary schools in Chaohu City, Anhui Province, China. We used a series of scales to assess their depressive symptoms, ACEs, resilience, and sleep quality. To explore the potential mediating pathways between depressive symptoms, ACEs, resilience, and sleep quality, the chain mediation analysis was conducted using the PROCESS macro (Model 6). The prevalence of depressive symptoms was 30.1% among children and adolescents. The multivariate logistic regression analyses showed that females, ACEs total score, resilience, and poor sleep quality were independent correlates of depressive symptoms. When the dimensions of ACEs were involved in the regression model, emotional abuse, physical abuse, emotional neglect, physical neglect and mother suffered from domestic violence were also independent risk factors. Notably, resilience and sleep quality had a chain-mediated effect between ACEs and depressive symptoms. A high proportion of children and adolescents reported depressive symptoms. Moreover, resilience and sleep quality may have a chain-mediated effect between ACEs and depressive symptoms. Hence, the impact of ACEs, resilience and sleep quality on depressive symptoms among children and adolescents should be highlighted and targeted interventions should be implemented.

Adverse childhood experiences and depressive symptoms among middle-aged or older adults in China and the mediating role of short sleep duration

The objective of the study was to investigate whether adverse and benevolent childhood experiences were associated with trajectories of sleep quality throughout pregnancy. The study was conducted at obstetrics and gynecology clinics in the Rocky Mountain region of the USA. The participants of the study were pregnant individuals (N = 164). Sleep quality was measured with the Pittsburgh Sleep Quality Index at three gestational time points, and adverse childhood experiences (ACEs) and benevolent childhood experiences (BCEs) were assessed once. Multilevel models were conducted to examine the trajectory of sleep quality across gestation in relation to ACEs and BCEs. Sleep quality was similar in early to mid-pregnancy, with a worsening of sleep quality late in pregnancy, following a quadratic trajectory. Higher levels of ACEs predicted poorer prenatal sleep quality (b = 0.36, SE = 0.13, p = .004) throughout pregnancy, while higher levels of BCEs predicted better sleep quality (b = -0.60, SE = 0.17, p < .001) throughout pregnancy. Examination of ACEs subtypes revealed that childhood maltreatment predicted poor sleep quality (b = 0.66, SE = 0.18, p < .001), while childhood household dysfunction was not significantly associated (b = 0.33, SE = 0.21, p = .11). Associations remained after covarying for socioeconomic status and current stressful life events. Both adverse and benevolent childhood experiences predict sleep health during pregnancy. Prevention and intervention strategies targeting resilience and sleep quality during pregnancy should be implemented to promote prenatal health and well-being.

Adverse childhood experiences (ACEs) are associated with persistent mental health risks and brain structural differences across adulthood, yet their long-term neurobiological relevance in aging populations remains unclear. Given that ACEs are common and societies are aging, understanding how early adversity relates to mental and brain health across the lifespan is an important goal. This preregistered study examined whether ACEs are associated with mental health symptoms in mid- to late adulthood, and whether regional brain structure may account for part of this relationship. Cross-sectional data of the Hamburg City Health Study were used, involving participants aged 46-78 years with available magnetic resonance imaging data (Ntotal = 2 624; eligible: nanalysis sample = 1 900). Mental health status was quantified using the Patient Health Questionnaire-9 and the General Anxiety Disorder-7 questionnaire, while ACEs were assessed using the 10-item ACE-questionnaire. Predefined regions of interest (ROI) were the hippocampus, amygdala, and dorsolateral prefrontal cortex. Bayesian statistical analysis provided strong evidence for an association between ACEs and both mental health outcomes but did not confirm the hypothesized mediation by ROI-level brain morphology. Exploratory whole-brain voxel-based morphometry revealed significant regional grey matter volume (rGMV) reductions in individuals with 3 or more ACEs, affecting bilateral limbic and frontal regions-including the nucleus accumbens, gyrus rectus, and insula. These reductions were more pronounced and widespread in individuals with 4 or more ACEs, extending to areas in the dorsolateral and medial prefrontal cortex, anterior cingulate cortex, inferior parietal and temporal gyri, occipital cortex, and cerebellum. Notably, no increases in rGMV were observed for any ACE group. This suggests a dose-dependent effect, with 4 or more ACEs marking a potential threshold for more distributed neuroanatomical alterations. These results derived from a representative general population study extend the understanding of the possible effects of ACEs by providing evidence that structural changes associated with ACEs could last into mid and late adulthood similarly to mental health outcomes.

BackgroundThe relationship between adverse childhood experiences (ACEs) and depression risk has been well documented. However, it remains unclear whether stress-related chronic conditions associated with ACEs, such as asthma, increase the...

Adverse childhood experiences (ACEs) predict problematic health outcomes (eg, substance use, mental health) among young adults; whether specific ACEs are differentially associated with specific substance use and mental health symptoms is understudied. Latent class analysis (LCA) identified classes of ACEs among 2209 US young adults (Mage = 24.69, range: 18-34; 57.4% female; 30.9% sexual minority; 35.8% racial/ethnic minority) in a 2-year study (2018-2020). Multivariable logistic regressions examined ACEs (reported in 2019) in relation to 2020 reports of current (past 30-day) substance use (ie, tobacco use; cannabis use and hazardous use; alcohol use and binge drinking) and mental health (ie, ≥moderate depression and anxiety symptoms), controlling for sociodemographics (ie, age, gender, race, ethnicity, sexual orientation, education). Overall, 65.4% reported ≥1 ACE (M = 2.09, SD = 2.30); 34.8%, 39.1%, and 71.1% current tobacco, cannabis, and alcohol use; 39.1% and 15.3% hazardous cannabis use and binge drinking; and 24.2% and 34.5% ≥moderate depression and anxiety symptoms, respectively. LCA yielded 4 classes: Low ACEs (referent; 55.6%), Poor family health and divorce (16.3%), Parental abuse (16.0%), and High ACEs (12.1%). High ACEs (vs Low ACEs) was associated with each adverse substance use and mental health outcome except alcohol use. Poor family health and divorce was associated with tobacco use, cannabis use, and both mental health outcomes. Parental abuse was associated with tobacco use, cannabis use, hazardous cannabis use, and both mental health outcomes. Health promotion interventions for young adults must assess ACEs, given that certain types of ACEs may be associated with distinct substance use and mental health outcomes.

Adverse childhood experiences (ACEs) are recognized as key risk factors linked to poor mental health throughout life. However, research on the specific associations between ACE dimensions and depressive symptoms (DSs) among the Chinese population during mid to late life is rare. This study aims to investigate the specific effects of different dimensions of ACEs on the new occurrence of DSs and the number of times with DSs among the middle-aged and elderly Chinese populations. The analysis included 3979 adults aged ≥45 years with four repeated measurements of the 10-item Center for Epidemiological Studies Depression Scale from the China Health and Retirement Longitudinal Study 2011-2018. Three types of ACE dimensions (total, deprivation, and threat-related ACEs) were conceptualized in accordance with the 15 types of ACEs that occurred before the age of 18 years recorded using the Life History Survey Questionnaire in 2014. In addition, latent class analysis (LCA) was utilized as an additional method for identifying distinct ACE clusters. The Cox regression and ordered logistic regression were used to estimate the risk of ACEs on DSs. Among the 3979 participants, 1656 developed a new occurrence of DSs during follow-up, with 998, 438, and 220 exhibiting DSs one, two, and three times. For total and deprivation-related ACEs, only the group with ≥3 ACEs was significant with the new occurrence of DSs when compared with the no ACE group, and the adjusted hazard ratios (HRs) (95% confidence interval) were 1.562 (1.296, 1.882) and 1.446 (1.221, 1.712), respectively. With regard to threat-related ACEs, all three groups (1 ACE, 2 ACEs, and ≥3 ACEs) were significantly associated with the new occurrence of DSs. The HRs were 1.260 (1.115, 1.425), 1.407 (1.212, 1.634), and 1.585 (1.366, 1.840), respectively. The findings of total, deprivation-related, and threat-related ACEs and their associations with the number of times with DSs represent a similar phenomenon. The LCA revealed five ACE clusters. Compared to the "low risk" cluster, the "poor parent relationship" cluster and the "physical abuse" cluster were linked to an increased risk of the new occurrence of DSs and the number of times with DSs. The results of the subgroup analysis by sex and age were consistent with the total population. Individuals who have experienced higher ACE scores in early life face a higher risk of developing a new occurrence of DSs and multiple detected DSs in mid to late life, particularly in the case of threat-related ACEs. Parsing ACEs is imperative to explore their distinct effects on DSs and the underlying mechanisms. In addition, Incorporating ACE screening into regular health checks among the middle-aged and elderly populations is recommended. Moreover, targeted mental health interventions should be delivered to those who have experienced early life adversities, particularly threat-related ACEs, to promote healthy aging.