In this study, We investigated the associations of ACEs exposure with marital status and depressive symptoms and the mediating role of unmarried status in the association between ACEs exposure and depressive symptoms in China over the age of 45 years, based on a national survey of middle-aged and older adults.Studies have shown that people experiencing two or more ACEs have a higher risk of being unmarried and a higher risk of developing depressive symptoms in middle age and older compared to the non-exposed group. There was a significant dose-response relationship between cumulative ACEs counts and both unmarried and depressive symptoms. Unmarried status partially mediated the association between ACEs and depressive symptoms.
Our findings suggest that ACEs are associated with an increased risk of depression in middle-aged and elderly people, consistent with previous studies [21–23].The stress sensitization model suggests that early adversity sensitizes individuals to subsequent proximal stressors (e.g., stressful life events in adulthood), thereby increasing their susceptibility to mental disorders [6]. Thus, adverse childhood experiences as early life adversity may increase the risk of depression in middle-aged and older adults.Furthermore, we found a significant dose-response relationship of cumulative ACEs exposure with depression risk, which is consistent with the conclusions made in previous studies [24].Zhang et al. showed that individuals who experienced four or more ACEs had a higher risk of subsequent depression compared with those who did not have ACEs [3],but in this study we found that two or more ACE exposures were associated with the risk of depression in Chinese middle-aged and older adults, which may be due to the fact that Zhang et al. included a total of 12 indicators of ACEs in their study and used the depressive symptom assessment data from 2015.
As an important aspect of social participation, marital status plays an important role in subjective well-being.In contrast, negative marital status has been identified as a risk factor for mental and somatic impairment[25–26].Previous studies have shown that the ACEs may even affect marital status[27].This study found that middle-aged and older adults experiencing two or more ACEs had a higher risk of being unmarried, with four ACEs (family member incarceration, family mental illness, bullying, and unsafe neighborhoods) associated with an increased risk of unmarried status.Previous studies have shown that individuals who experience adverse childhood experiences are more likely to have deficits in personality functioning [28], in which adults with avoidant and ambivalent styles tend to avoid intimate relationships and reject the need for intimacy [29–30], which supports our findings.However, unlike a Japanese study[8], the effect of ACEs on widowhood among Chinese middle-aged and older adults was not observed in this study, which may be due to the higher degree of aging society in Japan[31].
We found that unmarried status may partially mediate the association between ACEs and depressive symptoms in middle-aged and older adults, with unmarried status significantly mediating the associations of unsafe neighborhood, family member incarceration, family mental illness, and bullying with depressive symptoms.This could be explained by the fact that individuals who have experienced two or more ACEs are more likely to be unmarried than those who have not experienced ACEs, thereby increasing susceptibility to depression in middle-aged and older adults.This finding is often explained in terms of the stress buffering hypothesis[32–33], which states that the presence of a spouse reduces emotional responses to stress, while unmarried, widowed individuals are more susceptible to depression due to emotional reactions to stress.In studies of depression, family function is a protective factor that has been found to reduce the likelihood of developing depression[34].Because according to the family function of Mcmaster model, family as its members of the physical, psychological and social development environment basis[35], good family function can provide family members with a stable and safe psychological development environment, the sense of belonging in intimate relationship can improve the resilience of the negative consequences of childhood trauma.However, due to the lack of family relationship in adulthood, unmarried people cannot possess the positive psychological regulation effect brought by family function. In addition, due to the reduction of social communication among the middle-aged and elderly people, they are easy to suffer from depression in the middle-aged and elderly people.
The above studies and our results support the conclusion that ACEs are associated with a high risk of adverse marital status and depression in middle-aged and elderly people, and that marital status may partially mediate the occurrence of depression.Our findings contribute to the understanding of the mechanisms underlying the long-term adverse effects of adverse childhood experiences across the life course. On the one hand, the long-term effects of ACEs on depressive symptoms indicate the importance of life-course intervention strategies for preventing childhood adversity and mental health-related impairments in middle-aged and older people. On the other hand, the family functioning that comes with marriage can create a favorable environment for psychological development that may help break the stress diffusion process and alleviate psychopathology in victims of ACEs.