儿童期不良经历与中老年抑郁状态的相关性研究

Association between Depression Prevalence and Adverse Childhood Experiences in Middle-aged and Older People

背景中老年抑郁状态和儿童期不良经历(ACEs)的研究在国际上愈受重视,但以中国人群为样本的研究仍然较少报道,需要进一步探索。目的探索我国当前成年人群的ACEs发生率,研究ACEs对中老年抑郁状态的影响,提供基于我国人群样本的抑郁与ACEs的精准画像。方法2021年7—8月,利用北京大学社会科学调查中心主办的中国健康与养老追踪调查数据库(CHARLS)2015年和2018年的截面数据,选取符合研究要求的7035例≥45岁的中老年人为研究对象。根据抑郁评估量表、ACEs(虐待、忽视、不良家庭)和个体特征,从数据库中筛选出相关问题,生成新的虚拟变量并重新赋值。以零ACEs经历的研究对象为控制组,以有ACEs经历的研究对象为处理组,将所有协变量纳入倾向得分匹配模型,采用稳健标准误形式的多因素Logistic回归模型预估所有协变量的倾向得分,按最近邻1∶1方法匹配控制组和处理组样本,同时进行平衡性检验和共同支持检验,评估处理组ACEs对中老年抑郁状态的平均处理效应。结果7035例调查对象中,6529例(92.81%)经历过ACEs,1802例(25.61%)经历≥4种ACEs,1003例(14.26%)为抑郁状态。多因素Logistic回归模型结果显示,年龄、性别、自评健康与ACEs相关(P<0.05);接下来通过倾向得分匹配模型达到控制组和处理组的个体特征无统计学差异(P>0.05),通过平衡性检验和共同支持检验。倾向得分匹配模型结果显示,有ACEs比零ACEs导致的中老年抑郁状态发生率高出6.9%,差异有统计学意义(P<0.001)。结论当前中老年群体的ACEs发生率居于高位水平,ACEs可明显提升抑郁发生率,亟须建立ACEs筛查干预机制,提升该类人群的健康服务和福祉水平。

Background Depression prevalence and adverse childhood experiences(ACEs)in middle-aged and older people has become an increasingly concerned issue,yet it in Chinese population has been less reported,and needs to be further explored.Objective To investigate the epidemiology of ACEs among middle-aged and elderly Chinese people,and to analyze its association with depression prevalence,providing an accurate delineation of ACEs and depression prevalence in this group of Chinese people.Methods Information of 7035 middle-aged and elderly people≥45 years old who met the research requirements were selected during July to August,2021 from the database of China Health and Retirement Longitudinal Study held by Institute of Social Science Survey,Peking University,in which the questions in the Center for Epidemiologic Studies Depression Scale used in the CHARLS,ACEs(including abuse,neglect,dysfunctional family)and individual characteristics were screened and generated into new dummy variables with the weight reassigned.Covariates of those with ACEs(treatment group)and those without(control group)were included in a propensity score matching model,and propensity scores of them were estimated using robust standard errors in multivariate Logistic regression,then the covariates of two groups were matched using the 1∶1 nearest neighbor matching,and were checked using balance diagnostics and common support assumption.The influence of ACEs on the depression in those with ACEs was quantified by the average treatment effect on the treated.Results Of the 7035 respondents,6529(92.81%)had experienced ACEs,1802(25.61%)had experienced at least four ACEs,and 1003(14.26%)had a depressive state.Multivariate Logistic regression model demonstrated that age,gender,and self-rated health status were significantly associated with ACEs(P<0.05).Individual characteristics of both groups after propensity score matching were comparable(P>0.05),and went through the check of balance diagnostics and common support assumption.Propensity score matching-based analysis revealed that the risk of depression prevalence in those with ACEs was increased by a factor of 6.9% compared with those without(P<0.001).Conclusion The prevalence of ACEs among middle-aged and elderly Chinese people was higher,which may significantly increase the risk of depression prevalence.Therefore,it is urgently needed to establish a system of ACEs screening and intervening to improve the level of healthcare services and well-being for these people.