Child Abuse Negl. 2026 Mar 13;175:107987. doi: 10.1016/j.chiabu.2026.107987. Online ahead of print.
ABSTRACT
BACKGROUND: Adverse childhood experiences (ACEs) exhibit subtype-specific pathways to chronic kidney disease (CKD), yet the differential mediation by psychological distress remains unquantified. This study examines how threat-related versus deprivation-related ACEs influence CKD through depressive symptoms (DS) among aging Chinese adults.
METHODS: Among 6308 participants from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018), ACEs were categorized into threat-related and deprivation-related subtypes. CKD was defined based on new self-reported physician diagnosis in 2018 among participants free of CKD at baseline (2011). DS were assessed at baseline using the CESD-10. Formal mediation analysis with bootstrapping (1000 iterations) quantified the mediating role of DS, adjusting for sociodemographic, behavioral, and clinical confounders.
RESULTS: Threat-related and deprivation-related ACEs showed distinct associations with CKD and differential DS mediation. Threat-related ACEs exhibited broad, graded associations with CKD: cumulative exposure (≥3) significantly elevated CKD risk (OR = 2.138, 95% CI: 1.190-3.611) and had a stronger marginal effect on DS, with DS mediating 19.9% of the total CKD risk. Bullying emerged as the most potent threat subtype, increasing CKD (OR = 1.602, 95% CI: 1.145-2.202) and CKD-DS comorbidity most strongly, with a 16.5% DS-mediated pathway. In contrast, deprivation-related ACEs showed selective associations, with only household mental illness exerting significant effects: it elevated CKD (OR = 1.649, 95% CI: 1.246-2.169) and CKD-DS, with DS mediating 24.6% of its CKD risk. Deprivation-related ACEs had a weaker marginal effect on DS and no significant cumulative CKD association.
CONCLUSIONS: Psychological distress mediates the ACEs-CKD pathway more broadly for threat-related exposures (notably bullying), while deprivation-related ACEs operate via selective psychological and socioeconomic pathways (predominantly household mental illness). Precision prevention strategies should prioritize depression management for threat-exposed groups and integrated socioeconomic interventions and psychological support for those affected by deprivation-related ACEs like household mental illness.
PMID:41833142 | DOI:10.1016/j.chiabu.2026.107987