Abstract
Adverse childhood experiences (ACEs) have shown strong associations with later-life health such as depression and subjective health. Social participation is also associated with later-life health but it is unclear to what extent this could contribute to alleviating harmful impacts of ACEs, nor is it clear whether ACEs are themselves associated with later-life social participation. Thus, this study aims to understand: (1) the influence of ACEs on social participation in later life and (2) whether social participation can alleviate the harmful influences of ACEs on depression and subjective health among Japanese older adults. Data were from 5,671 Japanese older adults (aged 65+) in surveys in 2013 and 2016 as part of the Japan Gerontological Evaluation Study (JAGES). Logistic regression analyses were conducted to estimate the relations between ACEs and later-life social participation, adjusting for potential confounders and mediators. Inverse probability weighting was used to estimate average effects of ACEs on later-depression and subjective health, adjusting for potential confounders, and these were compared against controlled direct effect (CDE) estimates from marginal structural models based on all respondents experiencing weekly social participation. We found that ACEs were associated with reduced later-life social participation (OR for >1 ACEs = 0.88, 95% CI = 0.79, 0.99). The estimated effect of ACEs on depression ( adjusted total effect estimates: OR = 1.23, 95% CI = 1.05, 1.45) was marginally alleviated in estimates assuming weekly social participation for everyone (CDE = 1.18, 95% CI = 0.98, 1.43). A similar tendency was seen for poor subjective heath. Negative impacts of ACEs on depression may be marginally mitigated through social participation, but mitigating effects were moderate. Further investigation on other potential later-life mitigating factors is needed.
Highlights
This study aims to understand: (1) the influence of Adverse childhood experiences (ACEs) on social participation in later life and (2) whether social participation can alleviate the harmful influences of ACEs on depression and subjective health among Japanese older adults (both known as later-life health outcomes associated with ACEs (Hughes et al, 2017))
The basic sex- and age-adjusted model showed that experience of one or more ACEs was associated with an odds ratio (OR) for participating in community activities more than once a week of 0.88 (95% confidence interval [confidence intervals (CI)] = [0.79, 0.99]), compared with those having not experi enced any ACEs (Model 1, Table 2)
Having any one of the ACEs was associated with reduced social participation in later-life, but this association was not independent of childhood socioeconomic status (SES) or other later-life characteristics
Summary
In 2019, 703 million people were aged 65 years or over, which was 10% of the global pop ulation (UN Population Division, 2019). Countries will continue to face increasingly older populations until 2050 when they are expected to reach 1.5 billion or more. Japan is the leading country worldwide in the speed of population ageing and is projected to maintain the world’s highest ratio of people aged 65 years or over to those of working age until at least 2050 (projected at 81 per 100) (UN Population Division, 2019). The maintenance of physical, mental and social capabilities of older people has become a significant target for public health interventions (World Health Organization, 2002), which are especially relevant to Japan and its ageing population. This study explores social participation as a means of mitigating impacts of adverse early life ex periences on later-life health and depression
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