Journal of Affective Disorders · Jan 7, 2026
The long-term impact of adverse childhood experiences on later-life physical and psychological multimorbidity: A prospective cohort study of middle-aged and older adults in China
By He X, Wang M, Du Y et al.
BACKGROUND: Evidence on the link between adverse childhood experiences (ACEs) and psychological-physical multimorbidity (PPM) in older Chinese adults is limited. OBJECTIVES: PPM, defined as the co-occurrence of depressive symptoms and chronic physical illness, is increasingly prevalent among older adults. This study examined the association between ACEs and the risk of PPM in later life, with a focus on the mediating role of depressive symptoms. METHODS: We analyzed prospective data from 4015 participants aged ≥45 years in the China Health and Retirement Longitudinal Study (2011-2018). ACE exposure was retrospectively assessed in 2014. PPM was defined as the presence of clinically significant depressive symptoms alongside at least one chronic physical disease. Poisson regression models were used to estimate associations between ACE exposure and incident PPM. Mediation analysis assessed the indirect effects of baseline depressive symptoms and chronic conditions. RESULTS: During the follow-up period, 42.07% of participants developed PPM. Compared to individuals with no ACE exposure, those with low and high ACE exposure had a 20% (IRR = 1.20, 95% CI: 1.06-1.36) and 56% (IRR = 1.56, 95% CI: 1.36-1.79) higher risk of PPM, respectively. The association was stronger among women. Both depressive symptoms and chronic conditions significantly mediated the ACE-PPM relationship, with depressive symptoms playing a more prominent role among those with high ACE exposure. CONCLUSION: ACEs are strong predictors of PPM in later life. Targeted early-life interventions and mental health support may reduce long-term affective and physical disease burden in aging populations.