Associations of intra-familial adverse childhood experiences, depressive symptoms and cardiometabolic multimorbidity among middle-aged and older adults: Evidence from developed and developing countries.

BACKGROUND: Evidence on the associations of intra-familial ACEs and DepS with cardiometabolic multimorbidity (CMM) remains limited. We aimed to evaluate the joint associations of intra-familial ACEs and DepS with CMM and to determine whether DepS mediates the relationship between intra-familial ACEs and CMM.

METHODS: The study sample consisted of adults aged 50 years and older enrolled in the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020) and the Health and Retirement Study (HRS, 2012-2020). CMM was defined as the concurrent presence of at least two cardiometabolic conditions, including diabetes, heart disease, and stroke. The associations of intra-familial ACEs and DepS with CMM were estimated using Cox proportional hazards models. We further explored the mediating role of DepS using mediation analysis.

RESULTS: Among 14829 participants (CHARLS, n = 7210; HRS, n = 7619), 844 (11.7%) incident CMM cases occurred over a median follow-up of 9.0 years in CHARLS and 698 (9.2%) over 7.8 years in HRS. Participants with coexisting 2 or more intra-familial ACEs and DepS showed the highest CMM risk relative to those with 0 or 1 intra-familial ACE and non-DepS (CHARLS: HR, 2.07; 95% CI, 1.72-2.50; HRS: HR, 2.09; 95% CI, 1.60-2.72). DepS mediated 14.58% (95% CI, 7.69-25.78) of the association between intra-familial ACEs and CMM risk in CHARLS and 11.84% (95% CI, 3.61-31.16) in HRS.

CONCLUSION: Intra-familial ACEs and DepS were linked to elevated CMM risk, and the relationship between intra-familial ACEs and CMM was partially mediated by DepS, highlighting the importance of integrated intervention for CMM.