Spousal concordance in adverse childhood experiences and the association with depressive symptoms in middle-aged and older adults: findings across China, the US, and Europe

Importance Adverse childhood experiences are associated with higher depressive risks in adulthood. Whether respondents’ adverse childhood experiences are associated with their adulthood depressive symptoms and further contribute to spousal depressive symptoms was unexplored. Objective To assess the spousal concordance of adverse childhood experiences, the association of respondents’ adverse childhood experiences with spousal depressive symptoms and the mediating role of respondents’ depressive symptoms in this association. Design This cohort study was conducted based on data from China Health and Retirement Longitudinal Study (CHARLS), the Health and Retirement Study (HRS), and the Survey of Health, Ageing and Retirement in Europe (SHARE). Data were analyzed from June through July 2022. Setting The study was based on three cohorts in China, the US, and Europe. Participants Couples aged 50 years or older with complete data on ACEs and covariates. Exposures Adverse childhood experiences. Main Outcomes and Measures The 10-item Center for Epidemiological Studies Depression Scale, the eight-item Center for Epidemiologic Studies Depression Scale, and the Europe-depression scale were respectively applied in CHARLS, HRS, and SHARE to define depressive symptoms. Results Couples’ adverse childhood experiences were noticeably correlated in the three cohorts. Significant associations between husbands’ adverse childhood experiences and wives’ depressive symptoms in the three cohorts, with ORs and 95% CIs of 2.09 (1.36-3.22) for 4 or more adverse childhood experiences in CHARLS, and 1.25 (1.06-1.48) and 1.38 (1.06-1.79) for 2 or more adverse childhood experiences in HRS and SHARE. However, wives’ adverse childhood experiences were associated with husbands’ depressive symptoms in only CHARLS and SHARE. Findings in intra-familial and extra-familial adverse childhood experiences were consistent with our main results. Additionally, respondents’ depressive symptoms mediated more than 20% of the effect of respondents’ adverse childhood experiences on spousal depressive symptoms. Conclusion and Relevance In the CHARLS, HRS, and SHARE databases, we found that adverse childhood experiences were significantly correlated between couples. Respondents’ adverse childhood experiences were associated with spousal depressive symptoms, with respondents’ depressive symptoms mediating the association. The two-way implications of adverse childhood experiences on depressive symptoms should be considered at couple level and effective interventions are warranted. Key Points Question Whether respondents’ adverse childhood experiences are associated with their adulthood depressive symptoms and further contribute to spousal depressive symptoms? Finding This study found significant associations between husbands’ adverse childhood experiences and wives’ depressive symptoms. Additionally, respondents’ depressive symptoms mediated more than 20% of the effect of respondents’ adverse childhood experiences on spousal depressive symptoms. Meaning The implications of childhood adversity on later-life depressive symptoms at the couple level should be considered and strengthening the effective interventions of adverse childhood experiences and depressive symptoms is needed.