Examining the Contribution of Childhood Maltreatment to the Sex Gap in Depression: Insights from the German National Cohort (NAKO)

INTRODUCTION: Childhood maltreatment is a major risk factor for depression and may contribute to sex differences in depression prevalence. We examined sex-specific associations between childhood maltreatment and depression and estimated the proportion of depression cases attributable to maltreatment subtypes. METHODS: We analyzed baseline data from 159,045 participants (49.4% female; aged 19-72) in the German National Cohort (NAKO). Childhood maltreatment was assessed via the Childhood Trauma Screener; depression was assessed via self-reported physician's diagnosis and MINI classification (lifetime) and the PHQ-9 (current). Associations, including sex interactions, were modeled using binary logistic regressions. Disparity decomposition analyses and sex-stratified population attributable fractions (PAFs) quantified the contribution of childhood maltreatment to depression. RESULTS: Childhood maltreatment was associated with increased odds of lifetime (ORphysician'sdiagnosis = 2.45 [2.38, 2.53]; ORMINI = 2.30 [2.18, 2.43]) and current depression (OR = 2.90 [2.79, 3.02], all padj < 0.001). Sex interactions were observed for physician's diagnosis: physical abuse (padj = 0.024) and neglect (padj < 0.001) had stronger associations in females (ORphysical abuse = 2.74 [2.59, 2.90]; ORphysical neglect = 1.36 [1.28, 1.44]) than males (ORphysical abuse = 2.36 [2.21, 2.52]; ORphysical neglect = 1.08 [1.00, 1.16]), whereas sexual abuse (padj = 0.003) showed stronger associations in males (OR = 3.23 [2.91, 3.57]) than females (OR = 2.61 [2.48, 2.75]). Overall, childhood maltreatment accounted for 21.2-26.2% of lifetime and 33.4% of current depression. Population attributable fractions were higher in females than males for lifetime (24.5-28.5% vs. 16.0-20.9%) and current depression (36.1% vs. 28.4%). Emotional subtypes contributed the highest PAFs (up to 10.2%). Childhood maltreatment contributed 19.2-22.4% to the association between sex and depression. CONCLUSION: Childhood maltreatment accounts for a substantial proportion of depression in both sexes, with stronger overall associations in females. Sex-specific prevention may help reduce depression prevalence.